Gestational Trophoblastic Disease

Question 1

What are Gestational Trophoblastic Diseases (GTDs)?

Answer 1

Tumors and tumor-like conditions characterized by the proliferation of placental tissue.

Question 2

List the 5 main types of Gestational Trophoblastic Disease (GTD).

Answer 2

Complete hydatidiform mole (H. Mole), Partial mole, Invasive mole, Choriocarcinoma, Placental-site trophoblastic tumor (PSTT).

Question 3

What is the classic transvaginal sonography (TVS) appearance of a Complete Mole?

Answer 3

“Snow storm” or “bunch of grapes” appearance. Bilateral theca lutein cysts (>6cm) may be seen in 15% of cases.

Question 4

What is the typical transvaginal sonography (TVS) appearance of a Partial Mole?

Answer 4

“Snow storm”/”bunch of grapes” appearance PLUS fetal parts (potentially with cardiac activity, anomalies, or IUGR).

Question 5

What investigation is essential for the definitive diagnosis of GTD?

Answer 5

Histology.

Question 6

What is the method of choice for definitive treatment of Complete & Partial H. Moles?

Answer 6

Suction curettage (irrespective of uterine size). Sharp curettage often follows. Ultrasound guidance can be beneficial.

Question 7

When might medical removal be considered for a Partial Mole instead of suction curettage?

Answer 7

If fetal parts are too large for suction curettage.

Question 8

What is the role and risk of using IV Oxytocin during H. Mole evacuation?

Answer 8

Can stimulate contractions/reduce blood loss. Not routine due to risk of trophoblastic embolization. Ideally used only if risk of massive hemorrhage exists and after evacuation is complete.

Question 9

Why should medical management (e.g., prostaglandins) generally be avoided for H. Moles?

Answer 9

Higher rates of incomplete removal and increased risk of Gestational Trophoblastic Neoplasia (GTN).

Question 10

Does cervical ripening before H. Mole removal increase GTN risk?

Answer 10

No.

Question 11

When might hysterectomy be considered for H. Mole? Does it eliminate GTN risk?

Answer 11

Women >40 years (esp. with other risk factors). Reduces GTN risk but does NOT eliminate it. Post-op serial hCG monitoring is still required.

Question 12

When is Anti-D prophylaxis indicated in suspected molar pregnancy?

Answer 12

Given to Rh-negative mothers irrespective of mole type (complete or partial), as histology results take time.

Question 13

What is the general post-evacuation β-hCG monitoring schedule for H. Mole?

Answer 13

Weekly until levels normalize, then monthly for 6 months.

Question 14

What is the β-hCG follow-up schedule if levels normalize within 56 days post-evacuation?

Answer 14

Monthly follow-up for 6 months from the date of evacuation.

Question 15

What is the β-hCG follow-up schedule if levels do not normalize within 56 days post-evacuation?

Answer 15

Weekly until normalization, then monthly for 6 months from the date of normalization.

Question 16

For how long is contraception required after H. Mole evacuation (post-hCG normalization)? What types are advised initially?

Answer 16

At least 6 months after hCG normalization. Barrier methods are advised if hCG is high; any method can be used once hCG is normal.

Question 17

How long should women avoid conception after completing chemotherapy for GTN?

Answer 17

At least 1 year after treatment completion.

Question 18

What follow-up is required after any future pregnancy for a woman with a history of GTD?

Answer 18

Notify the screening center. Check hCG levels 6-8 weeks post-pregnancy to exclude recurrence.

Question 19

Where are the indications for chemotherapy for GTD detailed (according to the source text)?

Answer 19

Mentioned as being in “Rajeevan sirs book” (details not provided in the text).

Question 20

Define Molar Pregnancy.

Answer 20

Abnormal conception with swollen, edematous villi and trophoblast proliferation.

Question 21

List key risk factors for Molar Pregnancy.

Answer 21

Extremes of maternal age (<20, >35), previous molar pregnancy, history of spontaneous abortions/infertility, maternal smoking, genetic predisposition, deficiency in Vitamin A/animal fats.

Question 22

Describe the pathogenesis and common karyotypes of a Complete Mole.

Answer 22

Fertilization of an anucleated (empty) egg. Genetic material is entirely paternal. 90% are 46,XX (androgenesis), 10% are 46,XX or 46,XY (dispermy).

Question 23

Describe the pathogenesis and typical karyotype of a Partial Mole.

Answer 23

Fertilization of a normal egg by two sperm (dispermy). Karyotype is typically triploid (e.g., 69,XXY).

Question 24

Which age groups have a higher risk of Molar Pregnancy? Where is incidence higher geographically?

Answer 24

Teens and women 40-50 years old. Higher incidence in Southeast Asia.

Question 25

Typical clinical presentation of Molar Pregnancy?

Answer 25

Often 4th-5th month (though earlier USS diagnosis common) with uterine enlargement, vaginal bleeding, passage of villi.

Question 26

List potential complications of Molar Pregnancy.

Answer 26

Invasive mole (10%), Choriocarcinoma (2.5%), uterine perforation, PIH/Pre-eclampsia, hyperthyroidism, hyperemesis gravidarum, uterine infection post-evacuation, recurrent molar pregnancy (1-2%).

Question 27

What are key investigations for suspected Molar Pregnancy?

Answer 27

Serial serum/urine β-hCG (rapid rise), Thyroid profile (if hyperthyroidism suspected), LFTs/proteinuria (if pre-eclampsia suspected), FBC (anemia/thrombocytopenia), USS ("snow-storm"/"bunch of grapes").

Question 28

Describe the macroscopic morphology of a Complete H. Mole.

Answer 28

Enlarged uterus, grape-like cystic villi (thin-walled, translucent).

Question 29

Describe the microscopic morphology of a Complete H. Mole.

Answer 29

Enlarged, edematous villi with central cavitation (cisterns), avascular villi, extensive circumferential trophoblast proliferation.

Question 30

Describe the macroscopic morphology of a Partial Mole.

Answer 30

Fewer cysts, fetal tissues typically present (may see malformed fetus).

Question 31

Describe the microscopic morphology of a Partial Mole.

Answer 31

Only some villi are swollen/avascular, villi have scalloped shapes, trophoblastic proliferation is focal and less marked, fetal tissues seen.

Question 32

Define Invasive Mole. Is it considered malignant?

Answer 32

Molar pregnancy penetrating or perforating the uterine wall. Not malignant.

Question 33

Describe the morphology of an Invasive Mole.

Answer 33

Hydatidiform mole invading the myometrium, appearing as a hemorrhagic mass.

Question 34

What are the main clinical features of Invasive Mole?

Answer 34

Vaginal bleeding, irregular uterine enlargement.

Question 35

What are potential complications of Invasive Mole regarding embolization? Do these emboli grow like metastases?

Answer 35

Vascular invasion can lead to embolization of hydropic villi (e.g., lungs, brain). These emboli do NOT grow like true metastases and typically regress spontaneously.

Question 36

Define Choriocarcinoma. Is it always gestational?

Answer 36

Malignant neoplasm of trophoblastic cells. Can be gestational (from pregnancy/mole) or non-gestational (germ cell tumor).

Question 37

Describe the macroscopic morphology of Gestational Choriocarcinoma.

Answer 37

Soft, fleshy, irregular, hemorrhagic tumor invading uterine wall, vessels, lymphatics. May have yellow-white necrotic areas.

Question 38

Describe the key microscopic features of Gestational Choriocarcinoma, including the status of chorionic villi.

Answer 38

Mixed proliferation of syncytiotrophoblasts and cytotrophoblasts. Frequent/abnormal mitoses, hemorrhage, necrosis. Crucially, NO chorionic villi are present.

Question 39

How does Choriocarcinoma typically spread?

Answer 39

Direct extension (parametrium, vagina), Lymphohematogenous (lungs, brain, bone marrow, liver, kidney). Primary tumor may necrose completely.

Question 40

How well does Choriocarcinoma respond to treatment?

Answer 40

Responds well to chemotherapy if caught early.

Question 41

What information is provided about Placental Site Trophoblastic Tumor (PSTT) in the source text?

Answer 41

Mentioned as a type of GTD, but no further details provided.

Question 42

What is a key histological difference between Invasive Mole and Choriocarcinoma regarding villi?

Answer 42

Choriocarcinoma lacks chorionic villi, unlike invasive mole which consists of invasive molar villi.