A Clinicopathological Study of Gestational Trophoblastic Disease

Abstract

Background: Gestational trophoblastic disease (GTD) comprises a heterogeneous spectrum of placental trophoblastic proliferations with substantial diagnostic and prognostic implications in reproductive-aged women. Objective: To delineate the clinicopathological profile of GTD in a tertiary care population and identify demographic, clinical, and histological determinants of disease presentation. Methods: An observational cross-sectional investigation was undertaken in the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital, from September 2013 to February 2014. Thirty consecutive histopathologically confirmed cases of GTD were evaluated. Demographic parameters, clinical presentation, haematological indices, serum β-human chorionic gonadotropin (β-hCG) titres, and histopathological grading were systematically recorded. Statistical analyses were executed using SPSS version 26.0. Results: Histopathology demonstrated hydatidiform mole in 23 cases (76.7%), invasive mole in 1 (3.3%), choriocarcinoma in 2 (6.7%), placental site trophoblastic tumour (PSTT) in 1 (3.3%), and placental site trophoblastic reaction (PSTR) in 3 (10.0%), constituting 23.3% of gynaecological tumours and 0.96% (1:103) of total deliveries. The modal age was 21–30 years (46.7%; mean 27.4 ± 6.8 years; p = 0.003). Blood group A predominated (43.3%). Muslim ethnicity accounted for 73.3% of cases. Bleeding per vagina (100%), amenorrhoea (90%), and abdominal pain (60%) were cardinal symptoms. Mean serum β-hCG was 186,420 ± 72,350 mIU/mL, with choriocarcinoma showing markedly elevated levels (580,200 ± 75,400 mIU/mL; ANOVA p < 0.001). Grade-I moles (n = 17) behaved benignly, whereas Grade-II (n = 5) and Grade-III (n = 1) lesions showed malignant potential. Uterine enlargement exceeded gestational age in 70.0% of complete moles (χ² = 14.82, p = 0.011). Mean haemoglobin was 8.9 ± 1.4 g/dL. Conclusion: GTD represents a clinicopathologically diverse entity with distinct demographic predilections; early histopathological characterisation and β-hCG surveillance are pivotal for reducing malignant progression and mortality.