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Radiology
Gestational Trophoblastic Disease
Built from Obstetric Imaging
What’s inside
8 sections · 82 slides
Overview
- What this topic covers
- Start with the trophoblast
- Three kinds of trophoblast cell
- One spectrum, two halves
- The malignant group
- Why it matters
How common, and in whom
Incidence around the world, and the risks that raise it
- 0.57–1.1
- Incidence varies with where you look
- Differences by race and ethnicity
- The two main risk factors
- Risk after a first molar pregnancy
- Other things that raise the risk
- 50%
- A mole alongside a living fetus
- How rare the placental site tumour is
How it happens
The abnormal fertilisation behind each type
- How a complete mole is made
- The complete mole
- How a partial mole is made
- The partial mole
- Complete versus partial at a glance
- Uterus opened to show molar vesicles
- Grape-like vesicles close up
- Swollen villus under the microscope
- When it turns malignant
- The locally invasive mole
- The placental site trophoblastic tumour
- What the placental site tumour looks like
- The epithelioid trophoblastic tumour
How patients present
From a positive test and heavy bleeding to a tumour years later
- The classic picture of a mole
- Why it is now caught earlier
- The later features
- The partial mole hides as a miscarriage
- A mole with a fetus: how it shows up
- Why a mole with a fetus is dangerous
- How the placental site tumours present
- Where these tumours spread
- over 90%
- What predicts the outcome
What imaging shows
Ultrasound first, then Doppler, CT and MRI
- Ultrasound of a complete mole
- Distended cavity of a complete mole
- Uterus filled with a cystic mass on ultrasound
- Theca lutein cysts on the scan
- How reliable is ultrasound
- Blood flow inside a complete mole
- Ultrasound of a partial mole
- Focal cystic change with an embryo
- Normal placenta beside molar tissue
- What to notice in that scan
- The placental site tumour on ultrasound
- When CT and when MRI
- What MRI shows
Telling it apart
What the microscope settles that the scan cannot
- The diagnosis is ultimately histological
- Hydropic abortion versus a mole
- Staining tells the tumours apart
- Sheets of abnormal trophoblast cells
- The hormone helps sort them too
- The placental site nodule
Treatment and follow-up
Empty the uterus, then track the hormone for a year
- What to check before treating
- Emptying the uterus
- The follow-up path after evacuation
- Tracking the hormone
- Persistent neoplasia after a mole
- Who is likely to have persistent disease
- 40%
- Once the hormone reaches zero
- Contraception and future pregnancies
- A mole with a fetus: no clear rules
- Counselling if the pregnancy continues
- Surgery for the placental site tumours
- Chemotherapy for trophoblastic neoplasia
- Chemotherapy and radiation for PSTT and ETT
Pulling it together
The points worth carrying out of this topic
- Take-home points: the disease
- Take-home points: imaging and care
- Suggested readings
- Suggested readings (continued)
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition