Gestational trophoblastic diseaseBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7091.1363 (Published 10 May 1997) Cite this as: BMJ 1997;314:1363
Neoplasia or pregnancy failure?
- Harold Fox, Emeritus professor of reproductive pathologya
- a Department of Pathological Sciences, University of Manchester, Manchester M13 9PT
The term gestational trophoblastic disease includes hydatidiform moles, invasive hydatidiform moles, and choriocarcinoma. However, many gynaecologists and oncologists seem to consider that these conditions represent a neoplastic spectrum, with moles at the benign end, choriocarcinoma at the malignant extreme, and invasive hydatidiform moles being equivalent to a neoplasm of borderline malignancy. I would argue that there is nothing to suggest that a hydatidiform mole of any type is a form of neoplasia. Both partial and complete hydatidiform moles are chromosomally abnormal pregnancies: the complete moles are androgenetic pregnancies, all their nuclear DNA being paternally derived,1 and partial hydatidiform moles are triploid gestations,2 in which the extra chromosomal load is of paternal origin.3
At first sight invasive hydatidiform moles seem better candidates for being classed as neoplasms because they penetrate into or through the myometrium and invade the uterine vasculature, allowing molar tissue to spread through the blood stream to extrauterine sites. However, normal …