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Placenta

Gestational trophoblastic disease

Invasive mole

Reviewers: Mandolin Ziadie, M.D. (see Reviewers page)
Revised: 10 December 2011, last major update December 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Also known as chorioadenoma destruens
● Patients present with uterine bleeding and elevated hCG after evacuation of a mole
● Occurs in 16% of all complete moles, due to an increased capacity of the trophoblast for invasion
● Tumor may invade parametrial tissue, broad ligament and blood vessels, but serosa is usually intact
● Rarely perforates uterus, causing life-threatening hemorrhage
● Villi may embolize to distant sites (lung, vagina, brain and spinal cord) with hemorrhagic complications
● Do NOT grow (i.e. not true metastases), and eventually regress

Treatment
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● Chemotherapy (often cannot differentiate tumor from choriocarcinoma)

Gross description
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● Hemorrhagic lesion with irregular borders invading myometrium

Micro description
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● Villi with features of mole (complete) invade the myometrium, its vessels or broad ligament
● Villi may be obscured by trophoblastic proliferation and require careful scrutiny to identify

Differential diagnosis
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● Choriocarcinoma: high hCG, but no villi in metastatic foci; both treated similarly
● Placenta increta or percreta: present during delivery/parturition; no hydropic villi, no abnormal trophoblastic proliferation
● Trophoblastic emboli in lungs after normal pregnancy

End of Placenta > Gestational trophoblastic disease > Invasive mole

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