1. Dr. Madhavi Karki

2. DEFINITION : GTD refers to the spectrum of proliferative
abnormalities of the trophoblast associated with pregnancy.
CLASSIFICATION

3. Hydatiform Mole (Syn : Vesicular Mole)

4. ETILOGY

5. Partial Mole
Complete Mole
Feature
Triploid
46 XY
Karyotype
Present
Absent
Embryo
Scalloped, less swollen, focal villi involved with fibrosis
Round, swollen, all villi involved
Villi
Focal, minimal
Circumferential, marked
Trophoblastic proliferation
None
Often present
Trophoblastic atypia
PLAP, rare hCG
hCG, rare PLAP*
Immunocytochemistry
Often small for dates
Often large for dates
Uterine size
Rare
Present in 25 percent
Theca lutein cysts
Occur in less than 5 percent
Occur in up to one-third
Malignant sequelae

6. Pathology

7. Fig : H. Mole showing clusters of vesicles of varying sizes

8. Symptoms :

9. SIGNS :

10. INVESTIGATIONS

11. Fig: H. Mole

12. Complications

13. To give adequate supportive therapy to restore blood loss
To evacuate the uterus as soon as the diagnosis is made
Risk of hemorrhage
Perforation of the uterine wall by the mole
To take appropriate steps to minimize infection.
The patients are divided into two groups:
Group A: mole is in the process of expulsion
Group B: The uterus is still inert

14. Supportive therapy:
Group A
Morphine 15mg IM is given
5% dextrose drip started
Arrangement is made for blood transfusion
Group B
Blood should be kept prior to elective termination
Definitive Therapy :
Group A and Group B:
Suction and evacuation

15. Indications of Chemotherapy :

16. Follow – up Protocols :