1. Disease of the trophoblast and Breast
Dr. Amitabha Basu MD

2. Our lecture topic
Hydatidiform mole [ Gestational trophoblastic disease]
Choriocarcinoma
Breast

3. Hydatidiform mole Definition Types Pathogenesis
Complete Vs partial Mole
Morphology
Clinical features

4. But these grapes are sour !!!!!!
Definition
A voluminous, cystically dilated chorionic Villi appearing grossly as grape like structure.
But these grapes are sour !!!!!!

5. Types Complete Mole Partial Mole
INCIDENCE : PER 2000 PREGNENCY IN USA.

6. Etiopathogenesis
Asian countries.
Mother over 40 or under age 20.

7. Pathogenesis : complete mole
This mole has only paternal chromosome : thus this mole DOES NOT contain Fetal parts [ Androgenetic mole].

8. Pathogenesis : complete mole
This mole has BOTH paternal and maternal chromosome : thus this mole contain Fetal parts ( Tissue).

9. Complete Vs Partial Mole
Features
Complete
Partial Mole
Villous edema
All Villi
Some Villi
Karyotype
46, XX(46XY)
Triploid
( 69XXY)
Trophoblastic proliferation
Diffuse
Focal ,slight

10. Features Complete Mole Partial Mole
Atypia
Often Present
Absent
Serum hCG
Elevated
Less elevated
hCG
++++ +
Behabiour
2% choriocarcinoma
Rare

11. Features Complete Mole Partial Mole
Morphology
Micro
All Villi are
a-vascular and show stromal edema.
Some normal Villi are present.
Fetal parts
Absent
Present

12. FREQUENT SIGNS AND SYMPTOMS
Uterus too “large for dates”
Vaginal bleeding.
Morning sickness that is frequently excessive.
Passage of vesicle (small sac).
Discovered By 12 to 14 week.

13. Morphology : Complete mole Gross

14. The villi are avascular and show extensive stromal edema.

15. Partial Villi : scattered hydropic swollen villi are present.

16. Diagnosis Ultrasound examination
Physical examination : Uterus size larger for “Dates”.
Increased beta HCG.

17. Snow Storm appearance : No fetus.

18. Choriocarcinoma Very aggressive malignant tumor. Cell of origin:
Trophoblastic cells of placenta (gestational).
Totipotent cells (ovary , testis).

19. Age : Before 20, after 40. Incidence High Risk:
50% = Follow complete mole
25% = After abortion
Remainder = after pregnancy.

20. Choriocarcinoma: General Features
Site of Metastasis :
LUNG ,VAGINA, BRAIN, LIVER, KIDNEY.
Route of metastasis : Hematgenous

21. Gross : Large , hemorrhagic , infiltrative mass in uterus

22. Micro: a hemorrhagic tumor composed of anaplastic cuboidal cytotrophoblast and syntiotrophoblast.

23. Micro: a hemorrhagic tumor composed of anaplastic cuboidal cytotrophoblast and syntiotrophoblast.

24. Diagnosis and Management
RAISING TITRE OF betahcG
Gestational choriocarcinoma respond very well in chemotherapy. !
but not that arise in ovary /testis.

25. Preeclamsia / eclamsia of pregnancy
Hypertension, edema and protenuria ( in the third term of pregnancy).
Eclamsia
Hypertension, edema and protenuria + convulsive seizures.
Complication: DIC

26. Placental pathology in Preeclamsia / eclamsia
Infarction
Fibrinoid necrosis of the placental vessel wall.

27. Thank you !
Best of luck

28. Thank you
Next topic in Breast carcinoma file.