Gestational Trophoblastic Disease 3 Flashcards
Diagnose and develop a management plan for a hydatidiform mole.
1
Q
What are the defining characteristics of an invasive mole?
A
- Benign tumor arising from H. Mole (10-17%)
- Hydropic chorionic villi with trophoblastic hyperplasia in sites outside the uterine cavity•Invades the myometrium; may metastasize to the lungs and vagina
- Rising or plateauing hCG levels, uterine bleeding, persistently enlarged uterus, theca lutein cysts after molar evacuation
2
Q
What are the pathologic characteristics of choriocarcinoma?
A
- Abnormal trophoblastic hyperplasia and anaplasia
- Absence of chorionic villi
- Hemorrhage and necrosis
- Direct invasion of adjacent tissues
3
Q
What is a placental-site trophoblastic tumor? What is the treatment?
A
- Intermediate trophoblast
- Necrosis and hemorrhage less evident than in choriocarcinoma
- Propensity for lymphatic metastasis
- Immunoperoxidase staining for hPL positive
- Serum hCG levels relatively low
- Resistance to chemotherapy
-
Treatment:
- hysterectomy & LNBXs +/- EMA-EP
- adverse prognostic variables: metastasis, antecedent pregnancy > 2 years, mitoses >6/10HPFs
4
Q
What are the clinical signs of molar pregnancies?
A
- Vaginal bleeding
- Uterine enlargement
- Toxemia
- Hyperemesis
- Hyperthyroidism
- Trophoblastic emboli
- Bilaterally enlarged ovaries
- Absence of fetal heart sounds
5
Q
What are the management options for hydatidiform moles?
A
- Preoperative: CBC, platelets, chemistries, coagulation profile, thyroid panel, blood type and crossmatch, U/A, hCG, CXR, EKG, pelvic U/S
-
Operative
- D & E
- Hysterectomy
- Do not use medical induction of labor or hysterotomy
6
Q
What are the important points of follow-up for hydatidiform moles?
A
- hCG levels (serum quantitative hCGs) every 1 – 2 weeks until negative for 3 consecutive determinations, then every 3 months for 6-12 months
- Postoperative physical exam in one month
- Contraception during follow-up period for 6 months after spontaneous return of hCG to normal
