Molar Pregnancy: A Case Study
Gestational Trophoblastic Disease (GTD)
Hydatidiform Moles
Pathophysiology of Hydatidiform Mole
Typical Presentation of Complete Moles
Presentation of Partial Moles
Choriocarcinoma (cont’d)
Placental Site Trophoblastic Tumor
Classic Ultrasound Images
Human Chorionic Gonadotropin
Phantom hCG Levels/False Positive Results
Pathologic Diagnosis
Patient HistoryOB Hx: G2P0010; SAB 3/2011
Objective Info
The exam was WNL, with the exception of an 8‐9 week uterus
Initial Ultrasound
Work Up for Suspected Mole
Pathology ResultsFinal pathology showed Complete Mole:
Classic Ultrasound Images
Next Step for this Patient
Repeat HCG Levels
Testing with Dx of GTN
Results of Pt’s Testing
Scoring System for GTNRisk Factor 0 1 2 4
Age (years) <= 39 >39 ‐ ‐
Antecedent pregnancy
Mole Abortion Term ‐
Pregnancy event to treatment interval (months)
<4 4‐6 7‐12 >12
Pretreatment hCG,mIU/mL
<10,000 10,000‐100,000
100,000‐1,000,000
>1,000,000
Largest tumor mass,including uterus (cm)
<3 3‐4 >=5 ‐
Site of metastasis ‐ Spleen,kidney
GI tract Brain, liver
No. of metastasis ‐ 1‐4 5‐8 >8
Previous failed chomotherapy
‐ ‐ Single drug >=2 drugs
Total score is obtained by adding individual scores for each prognostic factor. Low risk <7, High risk >=7.
Case Patient’s Treatment
Treatment for Low Risk GTN
Treatment for High Risk GTN
Follow Up after Chemotherapy
Future Pregnancies?