*Gestational Trophoblastic Disease

Question 1

Signs of GTD

Answer 1

• Rapidly enlarging uterus in early pregnancy
• Elevated beta-HCG levels (HG) / severe nausea and vomiting
• Vaginal bleeding
• Pain or pressure in pelvis
• Early PET
• Fatigue, shortness of breath, diziness, fast/irregular heartbeat caused by anaemia

Question 2

What is gestation trophoblastic disease (GTD)?

and categories of GTD

Answer 2

Benign or malignant tumour growths arising from products of conception in the uterus.
* Results from abnormal proliferation of trophoblasts.
* Most are benign but some types become malignant and spread.

Hydatidiform moles (HM, aka molar pregnancy)
* comlete HM
* partial HM
Gestational Trophoblastic Neoplasia (GTN) - requiring chemo and/or excision surgery
* Invasive moles
* Choriocarcimonas
* Placenta-site trophoblastic tumours (PSTT) - very rare
* Epitheloid throphoblastic tumours (ETT) - even more rare)

Question 3

What is a molar pregnancy?

Answer 3

An issue occurs during fertilisation leading to the growth of abnormal cells (tumour) or water-filled sacs grow in the womb. (Snow storm appearance on USS)

Until there are signs and symptoms of tumour, the pregnancy will seem like a normal pregnancy.

Unknown cause.

Can be partial or complete.

(Noncancerous (benign) growth of tissue in the uterus that forms as a result of a fertilized egg that doesn’t develop properly. It occurs when the cells that would normally become the placenta (trophoblasts) grow in an abnormal way.)

Hydatidiform mole

Question 4

How does a complete hydatidiform mole occur?

Answer 4

Sperm fertilises an egg that doesn’t contain mother’s DNA.
Genetic material - PATERNAL DNA only.

Cells that were meant to become the placenta are abnormal

Question 5

How does a partial hydatidiform mole occur?

Answer 5

2 sets of DNA from father; 1 from mother

Only part of the fetus forms and cells that were meant to become the placenta are abnormal
May have a FHR on USS

Question 6

What is GTN?

Answer 6

Gestational trophoblastic neoplasia
* Invasive moles
* Choriocarcinomas
* Placental-site trophoblastic tumours (PSTT)
* Epitheloid trophoblastic tumours (ETT, even more rare)

Requires further surgery or chemo

~20% of complete HM and 2% of partial HM … become persistent GTD or GTN

Question 7

What are the stages of GTN?

Answer 7

I: uterus
II: ovary, fallopian tube, vagina
III: lung
IV: distant parts of the body

Question 8

*What is the difference between complete and partial GTD?

Answer 8

Complete vs. Partial
* Genetic material contains paternal DNA only in fertilised egg vs. 2x sets paternal DNA and 1x set maternal DNA in fertilised egg
* No fetus forms (no identifable embyonic fetal tissue) vs. only part of fetus forms (fetal or embyronic tissue on histology)
* Common - cells that were meant to become the placenta are abnormal in both

Question 9

*What is the difference between HM and GTN?

Answer 9

Definition
* GTN includes invasive moles, choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor
* Both involve abnormal growth of placental cells.

Genetic makeup
* HM - complete (sperm fertilises empty egg, paternal DNA only), partial (2 sperm or sperm with extra chromosomes, 1 egg)
* GTN - more genetically varied and have higher likelihood of becoming malignant compared to HM

Malignancy
* HM - usually benign
* GTN - can be malignant and spread

Treatment
* HM - D&C
* GTN - chemo, sugery or combination

Question 10

What investigations occur for GTD?

Answer 10

Full clinical assessment including relevant history
Blood tests:
* serum beta HCG levels
* blood group and antibody screen
* FBC
* Coags
* Us&Es
* LFT
* TFT