1. Vesicular Mole Dr. MOHAMMED ABDALLA EGYPT, DOMIAT G. HOSPITAL

2. It is a benign neoplasm of the chorionic villi

3. Incidence: 1:2000 pregnancies in United States and Europe 1:200 in Asia 10 times more in women over 45 years old. The increasing use of ultrasound in early pregnancy has probably led to the earlier diagnosis of molar pregnancy

4. 1 -Maternal age : Young mothers (under age 20 years) have a slightly higher prevalence of GTD, although not nearly so great as those mothers over age 35 years. 2- Women who have had a previous molar gestation 3- The risk increases with the number of spontaneous abortions . 4- Women with blood type A may be more likely to develop choriocarcinoma (but not hydatidiform mole); RISK FACTORS:

6. Differentiation Between Complete And Partial Mole Rare 5-10% Malignant Changes Paternal and maternal 69 XXY or 69 XYY Paternal 46 XX (96%) or 46 XY (4%) Karyotype Focal Diffuse Trophoblastic hyperplasia Focal Diffuse Swelling of the villi Present Absent Embryonic or foetal tissue Partial Mole Complete Mole Feature

7. Three components make up the trophoblast: cytotrophoblast, syncytiotrophoblast intermediate trophoblast The cytotrophoblast is a stem cell with high mitotic activity but without hormonal synthesis. The syncytiotrophoblast, which constitutes the villous trophoblast, has low mitotic activity. The syncytiotrophoblast is responsible for the synthesis of the (beta-hCG) and can be identified with immunohistochemical stains. The intermediate trophoblast has features of the other two components and is responsible for endometrial invasion and implantation

17. Complete Hydatidiform Mole Theca lutein cysts multiloculated, often bilateral resolve after treatment of the intrauterine process Occasionally seen in twin gestations, fetal hydrops, pharmacologic stimulation (especially with human maternal gonadotropin) U/S evaluation .

28. Therapy: dilatation and suction curettage ( at which time the diagnosis is confirmed ). 15% of women with complete hydatidiform mole will develop recurrent disease in the form of invasive mole or choriocarcinoma . all patients are followed up with successive serum beta - hCG measurements to allow early detection of persistent gestational trophoblastic neoplasia SO IF serial testing shows progressive decrease in the serum beta - hCG level The clinical diagnosis of complete hydatidiform mole is reached. Avoid pregnancy

29. At the Eleventh World Congress on Gestational Trophoblastic Disease 2001, over 70 cases of persistent low level hCG elevation were reported from four Trophoblast Centres. The majority view of an expert panel was to refrain from immediate chemotherapy and/or surgery but to monitor such patients carefully and repeatedly (even over many years) looking for evidence of tumour or for a definite rise in hCG values. Hancock BW, Everard JE, Drew D. Quiescent gestational trophoblastic disease (FTD): how common is it and what is its outcome? XIth World Congress on Gestational Trophoblastic Diseases, Santa Fe, 2001, abstract. Kohorn EI. Persistent low level hCG: a clinical enigma. XIth World Congress on Gestational Trophoblastic Disease, Santa Fe, 2001, abstract. Newlands ES, Seckl MJ, Foskett M, Short D, Fuller S and Mitchell H. Problems of interpretation of persistent low levels of hCG in patients suspected of having gestational trophoblastic disease (GTD). XIth World Congress on Gestational Trophoblastic Diseases, Santa Fe, 2001, abstract. Clinical management of persistent low level hCG elevation

32. THANK YOU