Female Genital Tract
A 25 yr woman is found to have a uterus that is much larger than estimated by her gestational dates. Her uterus is found to be filled with cystic, avascular, grapelike structures that do not penetrate that uterine wall. No fetal parts are found. Which of the following is the most likely diagnosis? (AIIMS Nov 2013)
|A||Partial hydatidiform mole|
|B||Complete hydatidiform mole|
|D|| Placental site trophoblastic tumor|
a. Gestational trophoblastic diseases include benign hydatidiform mole (partial and complete), invasive mole (chorioadenoma destruens), placental site trophoblastic tumor, and choriocarcinoma.
b. In partial moles, only some of the villi are abnormal and fetal parts may be seen.
c. About 2% of complete moles may develop into choriocarcinoma, but partial moles are rarely followed by malignancy. Invasive moles penetrate the myometrium and may even embolize to distant sites.
d. A similar lesion is the placental site trophoblastic tumor, which is characterized by invasion of the myometrium by intermediate trophoblasts.
e. Gestational choriocarcinomas, composed of malignant proliferations of both cytotrophoblast and syncytiotrophoblasts without the formation of villi, can arise from either normal or abnormal pregnancies: 50% arise in hydatidiform moles, 25% in cases of previous abortion, 22% in normal pregnancies, and the rest in ectopic pregnancies or teratomas.
f. Both hydatidiform moles and choriocarcinomas have high levels of human chorionic gonadotropin (hCG); the levels are extremely high in choriocarcinoma unless considerable tumor necrosis is present.