Trophoblastic disease represents an inclusive term for hydatidiform mole,
choriocarcinoma and chorioadenoma destruens, which is relatively uncommon disease in
the United States and Europe, but certain areas of the Asia have greater incidence.
Most of the patients are of the extremely poverty-stricken group where-in an
inadequate diet is standard.
Historically it was Sanger, in 1889, who suggested that there was a special tumor
derived from the decidua of pregnancy which he felt was of a sarcomatous nature. In
1895, Marchand demostrated that these tumors were invariably the sequel to normal
pregnancy, abortion, hydatidiform mole, or ectopic pregnancy, and that they were derived
from chorionic epithelium.
There is still a difference of opinion as to whether hydatidiform mole is to be
considered a degenerative or neoplastic lesion. Hertig and Mansell (1956) believe that
mole is a degenerative process, though capablitity of neoplastic change. The direct
causation of the hydatid process is seemingly deficiency of the circulation to the
placental tissue.
Chorioadenoma destruens should always follow a molar pregnancy, but exception
rarely occurs such as abortion and term delivery. Most pathologists regard
chorioadenoma destruens to be morphologically benign, but it causes uterine perforation
with consequent intraperitoneal hemorrhage and more frequently transition to the
choriocarcinoma than hydatidiform mole, so it can not always be regarded as a benign
neoplasm.
Scott(1962) suggests that the cause of choriocarcinonma be relaxed to a lack of
maternal antibody to retained pregnant tissue, but the cause is still unknown.
It is well known that the most common preceding pregnancy type of choriocarcinoma
is hydatidiform mole and the hydatidiform mole is transformed of the choriocarcinoma
more frequently than normal pregnancy and abortion. The relationship between
hydatidiform mole and chorionic malignant change is still debated.
The prospective study on histological observation of the process from hydatidiform
mole to choricarcinoma by biopsy is impossible and a few reports of retrospecitive study
on choriocarcinoma are reported and which are very important.
There are several reports on trophoblastic disease among Korean Women based on
clinical aspects but there is very little reports on trophoblastic tumors based on
pathological aspects.
The present study is an attempt to investigate mainly the relationship between
histopathological classification, the clinlcal course and prognosis of hydatidiform mole
classified by Eoston and Eagshawe(1972) and choriocarcinoma by Kawashima (1974),
using retrospective study because the prospective study for histologic follow up is
impossible.
Materials and Methods
The materials used in this study consist of 209 cases of trophoblastic disease for 14
years from January, 1960 to December, 1973.
All specimens were fixed in 10% neutral formalin, paraffin embedded blocks were cut
in 5 micron thickness, and sections were stained by hematoxylin-eosin methods and the
classification was done on all cases of hydatidiform mole by Elston and Bagshawe(1972)
and of choriocarcinoma by Kawashima (1974).
For all cases of trophoblastic disease whose clinical records were available, sex, age,
chief complaints, durations, gravidity, previous pregnancy history, metastatic site, H.C.G.
titer and X-ray findings were investigated.
Results and Summary
By histopathological and clinical studies on 209 cases of trophoblastic disease which
were submitted to the Department of Pathology, Yonsei University, College of Medicine,
during the period of 14 years from January 1960 to December, 1973, following results
were obtained.
1. The histological types and respect ice frequencies of the trophoblastic disease were
hydatidiform mole 125 cases, chorioadenoma destruens 25 cases, and choriocarcinoma 59
cases.
2. The histological gradings of hydatidiform mole showed Grade Ⅰ46.2%, Grade Ⅱ
35.9%, Grade Ⅲ 17.9%, and that of choriocarcinoma were Group Ⅰ 29.5%, Group Ⅱ
41.0% and Group Ⅲ 29.5 % Chorioadenoma destruens was frequently associated with
hydatidiform mole, particularly Grade Ⅱ and Ⅲ.
3. The average ages were 32.5 year-old in hydatidiform mole, 39.5 year-old in
chorioadenoma destruens, 36.5 year-old in choriocarcinoma.
4. The relationship between histological types and age distribution was not significant
in hydatidiform mole and choriocarcinoma except the frequency of Group Ⅲ
choriocarcinoma is apparently low in age group of 20-29.
5. Metastases in chriocarcinoma in order of frequency were lung(79.2%), vagina(45.8%),
intestine(20.8%), brain(16.7%), etc. Metastases in choriocarcinoma were frequent in Group
Ⅱ and Ⅲ.
In Summary, these findings suggest that the higher grades of hydatidiform mole may
closely be related to chorioadenoma destruens and the histological type of trophoblastic
disease is correlated with clinical course.
Therefore it can be said that the follow-up study based on the histological grading
and grouping is considered to be significant.
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