Recent advances in diagnostics of trophoblastic disease

Mihaela Mocko-Kacanski
Mihaela Mocko-Kacanski

Published: 01.12.2011.

Biochemistry

Volume 28, Issue 2 (2012)

pp. 540-547;

https://doi.org/10.5937/matmed1202540m

Abstract

Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours, overwhelmingly affecting women of childbearing age. These tumours are rare, and they appear when trophoblastic cells start to grow out of control. In these conditions production of beta subunit of human chorionic gonadotropin (hCG) is evident. Hydatidiform moles, partial or complete, are in most cases benign featured by villous hydrps, scalloping effect, hyperplastic trophoblastic pseudoinclusions and syncytiotrophoblastic sprouts. Invasive mole is an aggressive trophoblastic lesion with myometrial and/or vascular invasion. Choriocarcinoma, placental site trophoblastic tumor and epitheloid trophoblastic tumor are clearly malignant tumors with proliferation of intermediate trophoblast, with metastatic potential. Tumor-like trophoblastic conditions are placental site nodul and exaggerated placental site wich are proliferative lesions and reactive processes and are not considered as true tumor lesions.In all of these conditions vaginal bleeding is the most common symptom followed by elevation of serum beta hCG. GTD has to be confirmed histologically with extensive sampling of the material. Follow up is necessary in all women with GTD and it is rutinley done by measurment of serum levels of hCG. Since GTDs are proliferative conditions of diferent trophoblastic tisues, pathologists should be well histologicly educated about normal pregnancy stages and its abnormalities in order of adeqate diagnosing these rare conditions.

Keywords

References

1.
Tavassoli F, Peter. World Health Organization: tumours of the breast and female genital organs. 2004;
2.
Tham K. The classifi cation of gestational trophoblastic disease: a critical review. Int j Gynaecol Obstet. 1998;(1):39–49.
3.
Hancock B. staging and classifi cation of gestational trophoblastic disease. Best Pract res Clin Obstet Gynaecol. 2003;(6):869–83.
4.
The cell biology of human implantation. Placenta. 1996;(5–6):269–75.
5.
Carson Dd, Bagchi I, Enders Ac, Fazleabas At L, Ba. Embryo implantation dev Biol. 2000;(2):217–37.
6.
Yoshinaga K. research on blastocyst implantation essential factors (BIEFs). am j reprod Immunol. 2010;(6):413–24.
7.
Shih I, Rj K. The pathology of intermediate trophoblastic tumors and tumor-like lesions. Int j Gynecol Pathol. 2001;(1):31–47.
8.
Cheah P, Looi L. Hydatidiform molar pregnancy in malaysian women: a histopathological study from the University Hospital, Kuala Lumpur. Malays j Pathol. 1993;(1):59–63.
9.
Di Cintio E, Parazzini F, Rosa C, Chatenoud L, Benzi G. The epidemiology of gestational trophoblastic disease. Gen diagn Pathol. 1997;(2–3):103–8.
10.
Palmer L, Berkowitz Rs, Lurain Jr. Oral contraceptive use and risk of gestational trophoblastic tumors. Natl Cancer Inst. 1999;(7):635–40.
11.
Sebire Nj, Foskett M, Fisher M, Newlands E. risk of partial and complete hydatidiform molar pregnancy in relation to maternal age. BjOG. 2002;(1):99–102.
12.
Baasanjav B, Usui H, Kihara M, Kaku H, Nakada E, Tate. The risk of post-molar gestational trophoblastic neoplasia is higher in heterozygous than in homozygous complete hydatidiform moles. Hum reprod. 2010;(5):1183–91.
13.
Berkowitz Rs G, Dp. Clinical practice. Molar pregnancy. N Engl j Med. 2009;(16):1639–45.
14.
Keep, Zaragoza M, Hassold T. Very early complete hydatidiform mole. Hum Pathol. 1996;(7):708–13.
15.
Mosher R, Goldstein Dp, Berkowitz R, Bernstein M, Dr G. Complete hydatidiform mole. Comparison of clinicopathologic features, current and past. j reprod Med. 1998;(1):21–7.
16.
Qiao S, Nagasaka T, Nakashima N. Numerous vessels detected by Cd34 in the villous stroma of complete hydatidiform moles. Int j Gynecol Pathol. 1997;(3):233–8.
17.
Mcconnell T, Murphy K, Hafez M, Vang. diagnosis and subclassifi cation of hydatidiform moles using p57 immunohistochemistry and molecular genotyping: validation and prospective analysis in routine and consultation practice settings with development of an algorithmic approach. am j surg Pathol. 2009;(6):805–17.
18.
Bifulco C, Johnson C, Hao L, Kermalli H, Bell, Hui P. Genotypic analysis of hydatidiform mole: an accurate and practical method of diagnosis. am j surg Pathol. 2008;(3):445–51.
19.
Doshi N. Morphologic anomalies in triploid liveborn fetuses. Hum Pathol. 1983;(8):716–23.
20.
Sebire Nj, Fisher. Histopathological diagnosis of partial and complete hydatidiform mole in the fi rst trimester of pregnancy. Pediatr dev Pathol. 2003;(1):69–77.
21.
Scully Re Y, Rh. Trophoblastic pseudotumor: a reappraisal. am j surg Pathol. 1981;(1):75–6.
22.
Baergen, Young Rh, Osann K, Scully R. Placental site trophoblastic tumor: a study of 55 cases and review of the literature emphasizing factors of prognostic signifi cance. Gynecol Oncol. 2006;(3):511–20.
23.
Baergen Y, Rh. Extrauterine lesions of intermediate trophoblast. Int j Gynecol Pathol. 2003;(4):362–7.
24.
Lee Y, Kr K, Mckeon F, Boyd Y, Crum T, C. a unifying concept of trophoblastic differentiation and malignancy defi ned by biomarker expression. Hum Pathol. 2007;(7):1003–13.
25.
Shih Ie M, Trophogram. an immunohistochemistrybased algorithmic approach, in the differential diagnosis of trophoblastic tumors and tumorlike lesions. ann diagn Pathol. 2007;(3):228–34.
26.
Shih I, Rj K. Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma. am j surg Pathol. 1998;(11):1393–403.
27.
Li Y, Wan X, Qian H, Zhou C, Chen X. Epithelioid trophoblastic tumor: a clinicopathological and imunohistochemical study of seven cases. Med Oncol. 2011;(1):294–9.
28.
Nj, Lindsay I. Current issues in the histopathology of gestational trophoblastic tumors. Fetal Pediatr Pathol. 2010;(1):30–44.
29.
Ho, Kohorn E, La C. Choriocarcinoma and gestational trophoblastic disease. Obstet Gynecol Clin North am. 2005;(4):661–84.
30.
Seckl Mj, Fisher G, Rees H, Fj P, Foskett M. Choriocarcinoma and partial hydatidiform moles. Lancet. 2000;(9223):36–9.
31.
Fukunaga M, Ishikawa U, E. Choriocarcinoma in situ: a case at an early gestational stage. Histopathology. 1995;(5):473–6.
32.
Baker P, Oliva E. Immunohistochemistry as a tool in the differential diagnosis of ovarian tumors: an update. Int j Gynecol Pathol. 2005;(1):39–55.
33.
Kohorn E. The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. Int j Gynecol Cancer. 2001;(1):73–7.
34.
Mandal D, Nandi N, Dey R. Biswas rr, Bhattacharya aK, Biswas sC. Partial invasive molar pregnancy -2 case reports. al ameen j Med sci. 2010;(1):91–3.
35.
Rj K. Placental site nodule and characterization of distinctive types of intermediate trophoblast. Hum Pathol. 1999;(6):687–94.
36.
Chen X, Shi Y, Xie X. The clinical and pathological characteristics of exaggerated placental site. Zhonghua Fu Chan Ke Za Zhi. 1998;(6):352–4.
37.
Buza N, Hui P. Gestational trophoblastic disease: histopathological diagnosis in the molecular era. diagn Histopathol. 2010;(11):526–37.

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