GYN TRIAD
Molar PregnancyGestational trophoblastic neoplasia (GTN), or molar pregnancy, is an abnormal
proliferation of placental tissue involving both the cytotrophoblast and/or
syncytiotrophoblast. Classification of GTN is done as follows:
Pregnancy <20 weeks
HTN and proteinuria
Vaginal passage of vesiclesBenign GTN is the classic hydatidiform mole (H-mole). Incidence is 1:1200
in the U.S., but 1:120 in the Far East.
Complete mole (most common benign GTN) results from fertilization
of an empty egg with a single X sperm resulting in paternally derived
(androgenetic) normal 46,XX karyotype. No fetus, umbilical cord, or
amniotic fluid is seen. The uterus is filled with grape-like vesicles
composed of edematous avascular villi. Progression to malignancy is 20%.
Incomplete mole (less common) results from fertilization of a normal
egg with 2 sperm resulting in triploid 69,XXY karyotype. A fetus,
umbilical cord, and amniotic fluid is seen, which results ultimately in fetal
demise. Progression to malignancy is 10%.
Malignant GTN is the gestational trophoblastic tumor (GTT ) which can
develop in 3 categories.
Non-metastatic disease is localized only to the uterus.
Good prognosis metastatic disease has distant metastasis; the most
common location is the pelvis or lung. Cure rate is >95%.
Poor prognosis metastatic disease has distant metastasis (most