International Journal of Community Medicine and Public Health | January 2017 | Vol 4 | Issue 1 Page 269
International Journal of Community Medicine and Public Health
Bachani S et al. Int J Community Med Public Health. 2017 Jan;4(1):269-273
http://www.ijcmph.com
pISSN 2394-6032 | eISSN 2394-6040
Case Report
Varied presentations of gestational trophoblastic disease in
Asian women: one year follow up
Sumitra Bachani, Neha Pruthi, Sana Tiwari*, Pratima Mittal
INTRODUCTION
Gestational trophoblastic disease (GTD) comprises of a
heterogeneous group of tumors arising from abnormal
proliferation of trophoblasts in the placenta. GTD
accounts for less than 1% of female reproductive system
cancers and its incidence varies greatly between different
parts of the world.
1
Incidence of GTD in Asia and South
America is higher than reported in Europe and North
America.
2-4
It can present itself any of the five clinicopathological
forms: hydatidiform mole (complete and partial),
invasive mole, choriocarcinoma, placental site
trophoblastic tumour and epitheloid trophoblastic tumors.
The last four constitute the gestational trophoblastic
neoplasia.
The hydatidiform mole is the most common form,
representing 80 percent of cases of GTD. Complete
hydatidiform moles are diploid and have no fetal tissue
and no maternal DNA while, partial hydatidiform moles
are triploid and have somefetal tissue. The incidence of
partial moles is 3:1000 and complete mole is 1:1000 of
normal pregnancies.
5
Invasive mole is a hydatidiform mole characterized by
the presence of enlarged hydropic villi invading into the
myometrium, vascular spaces or into extrauterine sites. In
10% to 15% of cases, hydatidiform moles may develop
into invasive moles.
6
Choriocarcinoma is characterized by abnormal
trophoblastic hyperplasia and anaplasia, absence of villi,
hemorrhage and necrosis, with direct invasion into
myometrium and vascular invasion resulting in its spread
to distant sites. Relatively it is an uncommon condition.
The incidence varies from 1 in 500 (India) to 1 in 50,000
pregnancies (Western countries).
7
Placental-site trophoblastic tumor (PSTT) is a very rare
form of GTD that develops where the placenta attaches to
ABSTRACT
Gestational trohoblastic tumors are rare tumors which constitute less than 1% cancers of female reproductive system.
They have varied presentations of which hydatidiform mole is most common. The incidence is higher in Asia and
South America as compared to the rest of the world. We present a total of 5 cases of Gestational trophoblastic disease
(GTD) constituting 12.2% of admissions in Gynaecology ward of a tertiary care hospital over one year. There are
various risk factors which predispose to GTD include maternal age less than 20 years or more than 35 years, prior
GTD, prior miscarriages, Asian ethnicity and blood group A. Commonly the woman presents with vaginal bleeding
in first trimester. Sonography and β-hCG are decisive in establishing the diagnosis and further management. Follow
up of the patient is very crucial. Early diagnosis and timely management results in good prognosis.
Keywords: Choriocarcinoma, β-Hcg, Invasive mole, Molar pregnancy
Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
Received: 08 November 2016
Accepted: 03 December 2016
*Correspondence:
Dr. Sana Tiwari,
E-mail: drsanatiwari89@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20164751