I went to Oman a couple of months ago, I was talking to Rouba Ali-Fehmi, in fact she got in touch with me before Oman and she said that this conference is being held here in Cairo, would I be interested in speaking. I said yes I would, whatever she wants me to speak on. And why on trophoblast when I don't work at Charing Cross, as I told you, because the big centre, the referral centre for trophoblastic neoplasia is at Charing Cross. The reason is that in East London we get a lot of products of conception and because of the population that we serve, often the Bangladeshi population, they get married very young and we do see moles, hydatidiform moles and partial moles, quite a lot. The whole diagnosis of moles has changed in the recent years. Contrary to what was written in textbooks about fifteen years ago, now we know how to diagnose moles in early pregnancy. Because I look at so many products of conception I found it very useful and then realised that a lot of pathologists, products of conception, it's not a complete mole, throw it in the bin. But there is a significance and it makes my life interesting; it's basically because it makes my life interesting, that's why I do it.
But the partial mole, for instance, a complete mole usually is not that difficult to diagnose; for partial moles it is not that easy to diagnose it and is there a consequence for missing a partial mole? Persistent gestational neoplasia following a partial mole is less than 1% so I don't think that people should immediately commit hara-kiri if they think they've missed a partial mole but as is to pathologists it's interesting and it's good to make the diagnosis if we can. And sometimes it is very relevant and I do remember a few years ago, I refer all my cases to Charing Cross, as I'm supposed to do as soon as a mole is diagnosed or any kind of gestational neoplasia. I did refer it and it was a difficult case and I felt it probably wasn't a partial mole although it looked like it, it had a very strange immunohistochemical profile. As it happened this woman had some very rare… I've forgotten to follow it up, Baljeet Kaur is usually my point of contact in Charing Cross Hospital. And later on we found that the woman did have persistent gestational neoplasia and it had spread so she got the chance to be treated.

So that's why I felt to share that experience with general pathologists might be useful for them. I felt that there was a lot of interest because afterwards they feel a bit shy to ask questions when everyone is around but when the talk had finished several of the audience came and they asked me questions and they said that we've never seen what a placental site looks like, at least we've never noticed it. We didn't know anything about non-molar aneuploidy, which was one of the things I'd dealt with. There was a lot of interest, in fact several people came so I spent some time talking to them, drew some diagrams for them.

Education and training are of high importance

Absolutely because I'm also the training programme director for the region. I drag my trainees shouting and screaming, saying, 'No, you are going to learn this, even if I have to beat it into your heads! Because if you go to a district general hospital you are going to be seeing a lot of products of conception and you're going to get really bored. So if there's exciting things to see in it then you will see it.' So I try, well I try and make sure that anyone who passes through my department has a look at them carefully.

What would you say to clinicians who can't make it to London and are interested in this research and training?

There are three enormous centres, one in Charing Cross Hospital which takes all the referrals for that part of England. The other one is in Sheffield and there's one in Dundee. It's a very, very good idea to have these big trophoblastic centres because, moles aside, all the other types of trophoblastic neoplasia are very rare and people will hardly get a chance to see it. In the British Association of Gynae Pathologists, I used to be the Honorary Secretary until last year, completed my term of office, we try and do updates. We try and include trophoblastic neoplasia, I don't think there's one next year. The BAGP itself runs updates and, in fact, I can always suggest to them to do a trophoblastic neoplasia update. I do remember that two years ago in the Gynae Pathology EQA there was a separate educational session on trophoblastic neoplasia, those slides were provided by Baljeet from Charing Cross Hospital. So there are opportunities and if there are any pathologists out there who have an interest in it, they're very welcome to contact me and I will try and arrange for an update course which will be open to anyone who wishes to attend it, not necessarily in London but it could be somewhere where people find it easy to get to.