Gestational Trophoblastic Disease

(GTD)

Kang Yu

Obstetric & Gynecology Hospital of Fudan Universtity

2013-11-26

Objectives

Section I Brief Summary of GTD

Section II Clinical Probation Case I Case II Case III

Section III Bedside-to-Bench (and Back) Trophoblast and cancer Research design example

GTD is…

A group of disorders in which trophoblastic

tissue proliferates abnormally GTD includes:

Benign• Hydatidiform mole

• (complete or incomplete)

Malignant (Gestational Trophoblastic Neoplasia, GTN)

• Invasive mole • Choriocarcinoma• Placental site trophoblastic tumor (PSTT)

GTN is remarkable because…

One of the few malignant disease which can be cured Has very high rates of response to chemotherapy

Has a tumor marker (β- HCG) that is… highly sensitive and 100% specific (normal pregnancy excluded)

Song Hongzhao (1915 - 2000 )

In 1994 was elected to the Chinese Academy of Engineering (Department of health)

In 1996 was elected an honorary fellow of British (London) the Royal College of obstetricians

Reduced the mortality rate of 从horiocarcinoma from more than 90% to less than 15%

KEY TERMS AND DEFINITIONS

Hydatidiform Mole. A placental abnormality involving swollen placental villi and

trophoblastic hyperplasia with loss of fetal blood vessels. There are two types: complete and partial.

Complete Mole. A molar pregnancy with swelling of all placental villi. Fetal

tissues are absent.

Partial Mole. A molar pregnancy with some normal and some swollen villi

plus fetal, cord, and/or amniotic membrane elements.

KEY TERMS AND DEFINITIONS

Invasive Mole. A variant of hydatidiform mole in which the hydropic villi

invade the myometrium or blood vessels. It may spread to extrauterine sites.

Choriocarcinoma. A morphologic term applied to a highly malignant type of

trophoblastic neoplasia in which both the cytotrophoblast and syncytiotrophoblast grow in a malignant fashion.

PSTT. A rare type of GTD arising in the uterus that secretes

human placental lactogen (hPL) and human chorionic gonadotrophin (HCG).

Complete mole

Partial mole

Section II Clinical Probation

Case I

Case II

Case III

Section III Bedside-to-Bench (and

Back)

Trophoblast and cancer

Research design example

Trophoblast invasion

A successful pregnancy requires

cytotrophoblasts invade the uterus,

inclusive of its blood vessels, to establish

efficient fetomaternal exchange of molecules.

BACKGROUD

The role of trophoblasts

Cancer Metastasis

Cancer metastasis is a multi-step process

BACKGROUD

The similarities of trophoblast and cancer

High cell proliferation rate

Lack of cell-contact inhibition

Invasion

Escape from immune detection

Expression of common growth factors, cell adhesion molecules, matrix-digesting enzymes and proto-oncogene

Express functional tumour-associated genes

BACKGROUD

1 、 Why choriocarcinoma can be cured?

Biological properties of specific cancers (‘ seeds’)

PUZZLES

2

Choriocarcinoma Other cancer

Trophoblast

2 、 Why choriocarcinoma readily metastasizes to lung?

PUZZLES

3

The microenvironments of different organs are biologically unique. (‘soil’) Endothelial cells in the vasculature of different organs express different cell-surface receptors and growth factors

Organ-specific

Trophoblast invasion

Abortion

IUGR

Normal

pregnancy

Placenta implants

ExcessiveInadequate Adequate

3 、 How trophoblast turn into choriocarcinama?

Choriocarcinoma

Invasiveness gradually reduced

ProliferationInvasion matastasis

Trophoblast invasion Trophoblast invasion

Normal

pregnancy

Adequate

Trophoblast invasion Strictly regulatedHighly controlled Trophoblast invasion

Normal

pregnancy

Adequate

Trophoblast invasion Trophoblast invasion Trophoblast invasion

Excessive

Choriocarcinoma

Trophoblast invasion

Normal

pregnancy

Adequate

Trophoblast invasion

Regulatory factorsOut of control

康玉ykang@126.com