Gestational Trophoblastic Disease Flashcards
What is a complete mole?
Fertilization of an “empty” oocyte by a haploid sperm. 46XX karyotype, all paternal.
What is a partial or incomplete mole?
Two sperm fertilize one egg, triploid phenotype usually 69XXY
What is an invasive mole?
A hydatiform mole that invades local tissue and can metastasize to the vagina, lungs or brain.
When should you suspect a metastatic invasive mole?
When there are persistent elevated beta-hCG levels even after the mole is removed.
What lab value often indicates a hydatiform mole of some kind?
Incredibly high levels of beta-hCG
How do complete moles appear on examination?
Many vesicles, “bunch of grapes”
How do complete moles appear on ultrasound?
Snowstorm pattern
How do most complete moles present?
Painless heavy vaginal bleeding. Similar to placenta previa, however, the moles occur in the 1st trimester or early second and have very high hCG levels.
What is the treatment for a complete mole?
Suction evacuation and curettage. IV Pitocin to induce uterine contraction and close off placental blood vessels.
Monitor beta-hCG every 2 weeks until it declines.
What should the physician do if the b-hCG levels do not decline after removing a complete mole?
Chest X-ray, liver tests to look for metastasis of complete mole.
Type of growth that occurs in the ovaries that is a strong risk factor for choriocarcinoma.
Theca-lutein cyst
Two drugs used to treat choriocarcinoma
Methotrexate
Actinomycin-D
(For poor prognosis, use a combo of methotrexate, actinomycin-D, and cyclophosphamide)
What is the follow up for choriocarcinoma after the original treatment?
b-hCG titers every month for 2 years, then every 3 months for 5 years.
Advise to avoid pregnancy
