Gestational Trophoblastic Disease

Question 1

What proportion of GTD is non invasive or benign?

Answer 1

80%

Question 2

Benign GTD include

Answer 2

Partial Molar pregnancy, complete molar pregnancy

Question 3

Complete molar pregnancy has what percent chance of malignancy

Answer 3

15%

Question 4

Partial molar pregnancy has what percent chance of malignancy

Answer 4

5%

Question 5

Invasive GTD include

Answer 5

Invasive mole, choriocarcinoma, PSTT, ITT, Epitheliod ITT

Question 6

Incidence rate for molar pregnancy

Answer 6

1/1500

Question 7

Risk factors for Molar pregnancy

Answer 7

extremes of maternal age, Asian and Latina race, prior history of GTD, Deficiency in carotene, Vitamin A or animal fat, Smoking, Maternal blood type AB, A, B

Question 8

What is the risk of recurrence with one prior molar pregnancy?

Answer 8

1%

Question 9

What is the risk of recurrence with 2 prior molar pregnancies?

Answer 9

30%

Question 10

Most common symptom of molar pregnancy

Answer 10

First trimester bleeding - 90%

Question 11

Theca Lutein cysts are associated with which type of molar pregnancy?

Answer 11

complete Mole

Question 12

Ultrasound findings for complete mole

Answer 12

no fetal parts, no amniotic fluid, thecal lutein cysts, snow storm appearance

Question 13

Ultrasound findings for partial mole

Answer 13

Fetus with amniotic fluid, focal anechoic spaces, no thecal lutein cysts

Question 14

True of false: Complete moles have higher HCG than partial mole?

Answer 14

True

Question 15

Management of Complete and partial molar pregnancy

Answer 15

Suction D&C

Question 16

Medical complications from Molar pregnancy

Answer 16

Thyroid storm, Embolization of trophoblastic tissue - RDS, Cardiac failure from high output

Question 17

risk factors associated with medical complications from Molar pregnancy

Answer 17

Uterine size > 14 - 16 wks, High HCG levels

Question 18

Presentation: Complete Mole

Answer 18

Uterus size > dates, pre-eclampsia, hyperthyroidism, theca lutein cysts

Question 19

Presentation: Partial Mole

Answer 19

Missed or complete abortion, lower HCG levels

Question 20

Risk of persistent disease and need for chemo: Complete mole

Answer 20

20%

Question 21

Risk of persistent disease and need for chemo: Partial Mole

Answer 21

5%

Question 22

Karyotype of complete mole

Answer 22

Completely dad, 2 sperm empty ovum
46 XX (most common), 46 XY

Question 23

Karyotype of incomplete mole

Answer 23

2 sperm, complete egg

Triploidy 69 XXX or 69 XXY

Question 24

Pathology of complete mole

Answer 24

Grape like clusters, Diffuse trophoblastic proliferation

Question 25

Pathology of incomplete mole

Answer 25

fetal parts, two populations of chorionic villi, focal trophoblastic proliferation

Question 26

Risk of uterine invasion with complete mole

Answer 26

15%

Question 27

Follow up for molar pregnancy

Answer 27

weekly bHCG until 0, monthly BHCG for 6 months thereafter

Question 28

what percent of choriocarcinoma arise from complete molar pregnancies?

Answer 28

50%

Question 29

What percent of GTD cases are Placental site Trophoblastic tumors PSTT?

Answer 29

< 0.2%

Question 30

FIGO Criteria for malignant GTD after evacuation of molar pregnancy

Answer 30

1. HCG plateau or declined < 10 % on 4 values over a 3 week period 2. hcg increases > 10% on 3 values over a 2 week period 3. Persistence of detectable HCG after more than 6 months following evacuation

Question 31

If a patient with GTD has evidence of vaginal involvement or evidence of metastasis on CXR what is the next step?

Answer 31

Brain CT or MRI

Question 32

What WHO score is considered Low risk

Answer 32

< 4

Question 33

What WHO score is considered middle risk

Answer 33

4 - 7

Question 34

What WHO score is considered high risk

Answer 34

> or equal to 8

Question 35

What percentage of patients with metastatic, poor prognosis disease are cure with chemotherapy

Answer 35

70%

Question 36

True or false: In patients with previous history of molar pregnancy, obtain a 6 week BHCG following next normal delivery

Answer 36

True

Question 37

Management of Choriocarcinoma

Answer 37

Multi agent Chemotherapy EMACO

Question 38

Management of placental site trophoblastic Tumors

Answer 38

Hysterectomy