Gestational trophoblastic neoplasia pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Pregnancy occurs when an egg, which is released from the ovary during ovulation, is fertilized by a sperm. Human pregnancy takes approximately 40 weeks. Gestational trophoblastic neoplasia arises from the trophoblastic tissue, which provides nutrients to the embryo and develops into a large part of the placenta. Invasive mole is basically a benign tumor which arises from the invasion of the myometrium of a hydatidiform mole. Choriocarcinoma is a malignant tumor of the trophoblastic epithelium. Placental-site trophoblastic tumor (PSTT), a rare tumor, arises from the implantation site of placenta. Epithelioid trophoblastic tumor (ETT) is basically a rare variant of placental-site trophoblastic tumor (PSTT) which arises from the malignant transformation of chorionic-type intermediate trophoblastic cells. Invasive mole is usually diploid but can also be aneuploid in karyotype. Choriocarcinoma has an aneuploid karyotype and majority of the cases have a Y chromosome.

Pathophysiology

Physiology

The normal physiology of pregnancy can be understood as follows:

Placental Trophoblast and Pregnancy

For more information on fertilization, click here.
For more information on pregnancy, click here.

Pathogenesis

Pathogenesis of each sub-type of gestational trophoblastic neoplasia is explained as follows:

Invasive Mole

Choriocarcinoma

Placental-site Trophoblastic Tumor (PSTT)

Epithelioid Trophoblastic Tumor (ETT)

  • Epithelioid trophoblastic tumor (ETT) is basically a rare variant of placental-site trophoblastic tumor (PSTT).
  • It arises from the malignant transformation of chorionic-type intermediate trophoblastic cells.[27]
  • Epithelioid trophoblastic tumor (ETT) can clinically present as benign or malignant.[28]
  • Majority of the cases of epithelioid trophoblastic tumors (ETT) present years after full-term gestations.[27][29]

Genetics

Associated Conditions

Conditions associated with gestational trophoblastic neoplasia include:

Gross Pathology

Gross pathological findings of the sub-types of gestational trophoblastic neoplasia are as follows:

Invasive mole

Choriocarcinoma

Epithelioid Trophoblastic Tumor (ETT)

Placental-site Trophoblastic Tumor (PSTT)

Microscopic Pathology

On microscopic histopathological analysis, the characteristic features of each sub-type of gestational trophoblastic neoplasia are explained in the table below:[44][45][46]

Types of Gestational Trophoblastic Neoplasia Histopathological features

Invasive mole

Choriocarcinoma

Placental-site trophoblastic tumor

Epithelioid trophoblastic tumor

Courtesy Wikipedia

References

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