gestational trophoblastic disease

Question 1

What are gestational trophoblastic diseases?

Answer 1

variety of conditions from benign to highly malignant.

Question 2

When can GTDs occur in relation to pregnancy?

Answer 2

1. Benign H. mole
2. Persistent trophoblastic disease
3. Choriocarcinoma

Question 3

What are the types of benign H mole?

Answer 3

1. complete
2. partial
3. invasive

Question 4

What are the causes of H mole?

Answer 4

1. Blood group A
2. Vitamin A, beta carotene deficiency
3. Folic acid deficiency

Question 5

Explain the anatomy of H mole.

Answer 5

1. mole= bunch of grape-like vesicles
2. pearly white, translucent
3. contains watery fluid

Question 6

What is partial mole, give its karyotype and mention if fetus is present or not? If present what is the fetus like?

Answer 6

1. resembles placenta
2. 69XXY, triploid
3. maternally lined but few vesicles
4. fetus present
5. malformed fetus or IUGR (IntraUterine Growth Retardation)

Question 7

C/F of partial H mole.

Answer 7

1. beta-HCG low
2. Mild-moderate trophoblastic hyperplasia
3. facial hydropic changes

Question 8

Mention characteristics of complete H mole, its karyotype and give its c/f.

Answer 8

1. Fetus absent
2. 46XX paternally lined
3. very high beta-HCG
4. high grade hyperplasia
5. diffuse hydropic changes
6. can be malignant (15-20%)

Question 9

What happens to the uterine wall in H mole?

Answer 9

1. Becomes hypertrophied like in pregnancy
2. lined by thick decidua

Question 10

What all is included in persistent trophoblastic disease?

Answer 10

1. invasive mole
2. placental-site trophoblastic tumor (PSTT)

Question 11

Explain invasive mole.

Answer 11

When H mole invades/erodes uterine wall, burrow into myometrium/broad lig/peritoneal cavity

Question 12

What is present in invasive mole?

Answer 12

evidence of chorionic villi

Question 13

Dx characteristics of invasive mole?

Answer 13

1. persistent vaginal bleeding
2. pain after evacuation of H mole
3. USG & serial beta-HCG levels persistently increase

Question 14

What is the Tx of invasive H mole?

Answer 14

1. Chemotherapy
2. Hysterectomy

Question 15

Where does PSTT derive from and where does it invade?

Answer 15

derived= placental bed trophoblast
invades= myometrium

Question 16

Dx characteristics of PSTT.

Answer 16

1. low beta-HCG (than choriocarcinoma)
2. high serum HPL

Question 17

Which cells does PSTT contain?

Answer 17

1. mainly cytotrophoblasts
2. few/no synctiotrophoblasts

Question 18

What are the symptoms and signs of H mole? (9)

Answer 18

1. Amenorrhea ,24 weeks gestation (usually 3-4 months in complete mole)
2. Abdominal pain
3. Profuse hemorrhage
4. Spontaneous abortion
5. Hyperemesis
6. Pregnancy induced HTN
7. Pale, ill, febrile
8. Uterus large, doughy (because absence of amniotic fluid)
9. soft cervix

Question 19

How do we diagnose H mole?

Answer 19

1. Doppler= fetal heart beat absent
2. USG= snow-storm uterus
3. beta-HCG= high in complete, low in partial
4. CXR= to rule out lung metastases

Question 19

How to differentiate between complete and partial mole by USG?

Answer 19

complete= absence of fetal shadow
partial= presence of fetal shadow

Question 20

What is Tx of partial & complete H mole?

Answer 20

Partial= MTP & follow up
Complete=
1. Surgical evacuation f/b chemotherapy
2. Cervical softening with mesoprostol f/b surgical evacuation
3. Hysterectomy
4. No pregnancy for 2 yrs & no OCP

Question 21

What are types of choriocarcinoma acc to DNA origin? (2)

Answer 21

1. Non-gestational choriocarcinoma= maternal origin DNA
2. Gestational choriocarcinoma= paternal origin DNA

Question 22

What are the primary causes of secondary choriocarcinoma? and what % of incidence? (3)

Answer 22

1. follow evacuation of H mole= 50%
2. follow abortion= 25%
3. follow full-term pregnancy= 20%

Question 23

What is the anatomy of choriocarcinoma?

Answer 23

1. growth= solid purple friable mass
2. primary growth in body of uterus= ulceration= blood stained discharge= infected & necrotised= purulent & offensive discharge

Question 24

How and where can choriocarcinoma metastize?

Answer 24

1. Hematological= Brain, Liver, Lungs, Vagina, Kidneys, GIT 2. Erosion= Broad lig, Peritoneal cavity, Profuse bleeding

Question 25

What are the signs and symptoms of choriocarcinoma? (5)

Answer 25

1. persistent/ irregular uterine bleeding after abortion/ molar pregnancy/ normal delivery 2. offensive vaginal discharge 3. pyrexia, cachexia 4. amenorrhea d/t increased HCG 5. Vaginal= bluish-red vascular tumor which bleeds on touch

Question 26

What are extra-genital manifestations of choriocarcinoma? (2 organs)

Answer 26

1. Lung= dyspnea, hemoptysis 2. Brain= hemiplegia, epilepsy, headache, visual disturbances

Question 27

Explain staging of choriocarcinoma (4 stages).

Answer 27

I= confined to uterus II= extends outside uterus but limited to genital structures III= lung metastases with or without genital tract involvement IV= other

Question 28

What is Dx of choriocarcinoma based on? (2)

Answer 28

1. C/F 2. Histological evidences

Question 29

What can be used to Dx choriocarcinoma? (6)

Answer 29

1. serum beta-HCG levels increased 2. Lungs X-ray 3. Lungs CT 4. Brain CT 5. Liver & pelvis USG 6. PET

Question 30

What is the Tx of choriocarcinoma? (2)

Answer 30

1. chemotherapy 2. hysterectomy

Question 31

What Tx if lung mets?

Answer 31

Lobectomy

Question 32

What drugs are used in chemotherapy?

Answer 32

1. Methotrexate 2. Actinomycin 3. Cyclophosphamide