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Gestational trophoblastic disease

Gestational trophoblastic disease — usually referred to as a mole — is a very rare abnormality of pregnancy in the reproductive female that involves abnormal trophoblast proliferation. It is the result of a (purely chance) genetic error during the fertilization process that in turn causes the growth of abnormal tissue (which is not an embryo) within the uterus. The growth of this material is disproportionately rapid when compared to normal fetal growth. more...

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The two types of hydatidiform molar pregnancy are complete and partial.

Complete moles are the most common type of moles, and are when the mass of tissue is completely made up of abnormal cells that would have become the placenta in a normal pregnancy. There is no fetus and nothing can be found at the time of the first scan. Complete moles often have a diploid karyotype 46,XX due to fertilization of an empty ovum by a single sperm followed by replication of the haploid chromosome. On ultrasound, a complete mole has a "snow storm pattern", and the uterus is large for dates. Microscopically, there is edema of most villi, which gives the appearance of a large and random collection of grape-like cell clusters.

In a partial mole, the mass may contain both these abnormal cells and often a fetus that has severe defects. In this case, the fetus will be consumed by the growing abnormal mass very quickly. Partial moles have a triploid karyotype (69,XXX or 69,XXY) due to the fertilization of a single egg with two sperm. They also have a lower volume of tissue, and smaller hydropic villi (grape-like), as well as normal villi mixed in with the abnormal. Rarely, partial moles can progress to gestational choriocarcinoma.


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Protocol for the examination of specimens from patients with gestational trophoblastic malignancies
From Archives of Pathology & Laboratory Medicine, 1/1/99 by Lage, Janice M

A Basis for Checklists

This protocol is intended to assist pathologists in providing clinically useful and relevant information as a result of the examination of surgical specimens. Use of this protocol is intended to be entirely voluntary. If equally valid protocols or similar documents are applicable, the pathologist is, of course, free to follow these authorities. Indeed, the ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of the individual circumstances presented by a specific patient or specimen.

It should be understood that adherence to this protocol will not guarantee a successful result. Nevertheless, pathologists are urged to familiarize themselves with this document. Should a physician choose to deviate from this protocol owing to the circumstances of a particular patient or specimen, the physician is advised to make a contemporaneous written notation of the reason for the procedure followed.

The College recognizes that this document may be used by hospitals, attorneys, managed care organizations, insurance carriers, and other payers. However, the document was developed solely as a tool to assist pathologists in the diagnostic process by providing information that reflects the state of relevant medical knowledge at the time the protocol was first published. It was not developed for credentialing, litigation, or reimbursement purposes. The College cautions that any uses of the protocol for these purposes involve considerations that are beyond the scope of this document.

Contributors: the College of American Pathologists Cancer Committee; Donald E. Henson, MD; Enrique Hernandez, MD; Maureen Killacky, MD; Beverly B. Kramer, MD; Rachelle Lanciano, MD; Stanley J. Robboy, MD; Steven G. Ruby, MD; Robert E. Scully, MD; Steven G. Silverberg, MD; and Richard Zaino, MD.


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2. Fleming ID, Cooper )S, Henson DE, et al, eds. AJCC Manual for Staging of Cancer. 5th ed. Philadelphia, Pa: Lippincott Raven; 1997.


Bagshawe KD, Lawler SD, Paradinas Fl, Dent J, Brown P, Boxer GM. Gestational trophoblastic tumours following initial diagnosis of partial hydatidiform mole. Lancet. 1990;335:1074-1076.

Collins RJ, Ngan HYS, Wong LC. Placental site trophoblastic tumor: with features between an exaggerated placental site reaction and a placental site trophoblastic tumor. Int ) Gynecol Pathol.1990;9:170-177. Conran RM, Hitchcock El, Popek EJ, et al. Diagnostic considerations in molar gestations. Hum Pathol. 1993;24:41-48.

Fukunaga M, Ushigome S, Fukunaga M, Sugishita M. Application of flow cytom

etrv in diagnosis of hydatidiform moles. Mod Pathol. 1993;6:353-359. Fukunaga M, Ushigome S. Malignant trophoblastic tumors: immunohistochemical and flow cytometric comparison of choriocarcinoma and placental site trophoblastic tumors. Hum Pathol. 1993;24:1098-1106. Howat AJ, Beck S, Fox H, et al. Can histopathologists reliably diagnose molar pregnancy? ) Clin Pathol.1993;46:599-602.

Huettner PC, Gersell DJ. Placental site nodule: a clinicopathologic study of 38

cases. Int J Gynecol Pathol. 1994;13:191-198.

Kurman RI, Young RH, Main CA, et al. Immunohistochemical localization of placental lactogen and chorionic gonadotropin in the normal placenta and trophoblastic tumors with emphasis on intermediate trophoblast and the placental-site trophoblastic tumor. Int J Gynecol Pathol. 1984;3:101-121. Lage JM, Mark SD, Roberts DJ, et al. A flow cytometric study of 137 fresh hydropic placentas: correlation between types of hydatidiform moles and nuclear DNA ploidy. Obstet Gynecol.1992;79:403-410.

Lawler SD, Fisher RA, Dent 1. A prospective genetic study of complete and partial

hydatidiform moles. Am J Obstet Gynecol.1991;164:1270-1277. Miller D, Jackson R, Ehlen T, McMurtie E. Case report: complete hydatidiform mole coexistent with a twin live fetus: clinical course of four cases with complete cytogenetic analysis. Gynecol. Oncol. 1993;50:119-123. Silva E, Tornos C, Lage J, Ordonez M, Kavanagh I. Multiple nodules of interme

diate trophoblast, an unusual complication of hydatidiform motes. Intl Obstet Gynecol.1993;12:324-332.

Silverberg SG, Kurman RJ. Tumors of the Uterine Corpus and Gestational Trophoblastic Disease. Washington, DC: Armed Forces Institute of Pathology; 1992. Atlas of Tumor Pathology, 3rd series, fascicle 3. Soper JT, Hammond CB, Lecois JL Jr. Gestational trophoblastic disease. In: Hoskins WJ, Perez CA, Young RC, eds. Principles and Practice of Gynecologic Oncology Philadelphia, Pa: JB Lippincott; 1992:695-714. Stellar MA, Genest DR, Bernstein MR, Lage JM, Goldstein DP, Berkowitz RS.

Natural history of twin pregnancy with complete hydatidiform mole and coexisting fetus. Obstet Gynecol. 1994;83:3542.

Szulman AE, Surti U. The syndromes of hydatidiform mole, I: cytogenetic and

morphologic correlations. Obstet Gynecol. 1978;131:665-671. Szulman AE, Surti U. The syndromes of hydatidiform mole, ll: morphologic evolution of the complete and partial mole. Am J Obstet Gynecol. 1978;32:2027.

Young RH, Kurman RJ, Scully RE. Placental site nodules and plaques: a clinicopathologic analysis of 20 cases. Am J Surg Pathol. 1990;4:1001-1009.

Accepted for publication August 26, 1998. From the Department of Pathology, Georgetown University Medical Center, Washington, DC.

This protocol was developed by the Cancer Committee of the College of American Pathologists and was submitted for editorial review and publication. It represents the views of the Cancer Committee and is not the official policy of the College of American Pathologists. Reprints: Joe Schramm, College of American Pathologists, 325 Waukegan Rd, Northfield, IL 60093-2750.

Janice M. Lage, MD, for the Members of the Cancer Committee, College of American Pathologists

Copyright College of American Pathologists Jan 1999
Provided by ProQuest Information and Learning Company. All rights Reserved

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