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Flashcards in Gestational trophoblastic neoplasia Deck (22):
1

Gestational trophoblastic neoplasia

very rare
invasive mole - hydatidiform mole/molar pregnancy
choriocarcinoma

2

Etiology of gestational trophoblastic neoplasia

can occur after any pregnancy
usually after non-malignant GTN

3

Natural Hx of gestational trophoblastic neoplasia

hemorrahge
metastasis
preeclampsia, etc

4

Spread of gestational trophoblastic neoplasia

via blood
lungs 80%
pelvis 30%
vagina 20%
brain/liver 10%
bowel, kidney, spleen

5

SSx of gestational trophoblastic neoplasia

large for date pregnancy
bleeding
nausea
no fetal HR
Preeclampsia: 27% historically, now 1-2%
Theca lutein cysts
Hyperthyroidism: chorionic gonadotropin bears structural homology to pit thyrotropin 1

6

Dx of gestational trophoblastic neoplasia

US
very high betahCG
metastatic signs: blood test for kidney, liver, bone, anemia, etc
Imaging: lungs, head, abdomen, pelvis

7

Staging of gestational trophoblastic neoplasia

beta hCG
imaging

8

Tx of gestational trophoblastic neoplasia

D&C
possible chemotherapy for rising betahCG, invasive disease

9

Followup of gestational trophoblastic neoplasia

monthly betahCG
contraception 1 year
early ultrasound and betahCG in next pregnancy

10

Prognosis of gestational trophoblastic neoplasia (malignant)

very good: 95% 5 year
fertility unchanged

High risk prognosis: 5 Fs
antecedent Full term pregnancy
Far away mets
bhCG> 40,000
Failed low risk chemo
>4 mo since pregnancy

11

Hydatidiform mole

Empty ovum fertilized by a haploid sperm then 2x
--> ovum nucleus deactivated/absent
--> entirely paternal origin in complete mole
- trophoblast proliferates only

Pregnancy with no embryo but cystic degeneration of chorionic villi

12

Incidence of GTD

Hydatidiform mole 1:1000
Invasive 1:10000
Placental site trophoblastic tumour: 1:20000
Choriocarcinoma: 1:40000

13

Normal placenta biochemical markers

Syncytiotrophoblast - hCG, hPL
Intermediate trophoblast --> hPL
Cytotrophoblast - none

14

Risk factors for GTD/molar pregnancy

Extremes of maternal age (40)
Previous molar pregnancy - 1-2%
?Dietary ?geographical factors

15

Complete mole

diffuse hydatidiform swelling
difuse trophoblastic hyperplasia
No fetal tissue
Karyotype: 2 paternal haploid - 46XX, XY

16

Partial mole

Focal hydatidiform swelling
focal trophoblastic hyperplasia
fetal tissue present
Karyotype: 2 paternal + 1 maternal haploid, 69 XXY, XYY

17

Investigations of GTD

Diagnostic imaging: US classic snowstorm pattern
Lab:
CBC
bhCG - high
thyroid
liver function tests (mets)
renal function (prior to chemo)

18

Management of GTD

CXR - metastatic workup; spreads to lungs first
Dilatation/suction - risk for massive hemorrhage so need to evacuate ASAP
betahCG weekly until normal x3 and then monthly for a year
6-12 mo
Average time to normalcy 9-11 wks
Contraception 6-12 mo
- Need to follow up betahCG; CANNOT get pregnant!!

19

Danger of GTD

Invasive mole: 15-20% of complete moles; 2-4% of partial moles
Choriocarcinoma: extremely malignant form
Placental site trophoblastic tumour: rare

20

Symptoms/signs of malignant GTD

elevated betahCG but not pregnant
vaginal bleeding
metastatic disease - cerebral, abdominal, pulmonary bleeding
consider GTD in differential in reproductive age woman with systemic disease

21

Management of low risk malignant GTD

Single Agent Chemo - methotrexate, actinomycin D
Combination Chemo: methotrexate + actinomycin D
90% remission

22

Management of high risk GTD

Combination chemo
- MAC
-VPB
-EMA-CO