Hydatidiform mole and choriocarcinoma

Question 1

Hydatidiform mole - histology/definition

Answer 1

Abnormal conception –> cystic swelling of chorionic villi and proliferation of epithelium (only trophoblast) (BENIGN)

Question 2

Hydatidiform mole - presentation

Answer 2

1. viginal bleeding
2. uterine enlargement more than expected
3. pelvic pressure/pain
4. hCG-mediated sequelae (a. early preeeclampsia (before 20wk), b. theca-lutein cysts) c. hyperthyroidism, d. hyperemesis gravidarum)
5. Sometimes vaginal passage of grape-like cysts

Question 3

Hydatidiform mole - hCG-mediated sequelae

Answer 3

a. early preeeclampsia (before 20wk)
b. theca-lutein cysts
c. hyperthyroidism
d. hyperemesis gravidarum

Question 4

Hydatidiform mole - management

Answer 4

1. dilation and curettage and methotrexate

2. Monitor β-hCG

Question 5

Hydatidiform mole - types and definition of each type

Answer 5

1. complete mole –> no embryo or normal placental tissue

2. partial mole –> there’s an abnormal embryo and possibly some normal placental tissue

Question 6

Hydatidiform mole - complete vs partial according to mechanism

Answer 6

complete –> Most commonly enucleated egg + single sperm (subsequently duplicates paternal DNA) or 2 sperm + 1 egg (enucleated)
partial –> 2 sperm + 1 egg (nucleated)

Question 7

Hydatidiform mole - complete vs partial according to karyotype

Answer 7

complete –> 46, XX, 46, XY

partial –> 69 XXX, 69 XXY, 69 XYY

Question 8

Hydatidiform mole - complete vs partial according to fetal parts

Answer 8

complete –> no

partial –> yes

Question 9

Hydatidiform mole - complete vs partial according to uterine size

Answer 9

complete –> increased

partial –> normal

Question 10

Hydatidiform mole - complete vs partial according to hCG

Answer 10

complete –> very higly increased

partial –> increased

Question 11

Hydatidiform mole - complete vs partial according to imaging

Answer 11

complete –> “Honeycombed uterus or clustes of grapes, snowstorm on US
partial –> fetal parts

Question 12

Hydatidiform mole - complete vs partial according to risk of malignancy (gestational trophoblastic neoplasia)

Answer 12

complete –> 15-20%

partial –> less than 5%

Question 13

Hydatidiform mole - complete vs partial according to risk of choriocarcinoma

Answer 13

complete –> 2%

partial –> rare

Question 14

Hydatidiform mole - classically present … (when)

Answer 14

in the 2nd trimester as passage of grape like masses through the vaginal canal

Question 15

Choriocarcinoma - frequency/can develop (when)

Answer 15

Rare

can develop during or after pregnancy in mother or baby

Question 16

Choriocarcinoma - definition

Answer 16

RARE malignancy of trophoblast tissue (cytotrophoblast, syncytiotrophoblast), no chorionic villi present

Question 17

Choriocarcinoma - chorionic villi formation

Answer 17

NO - ABSENT

Question 18

Choriocarcinoma presents with (clinical and lab)

Answer 18

1. abnormal increased β-hCG
2. shortness of breath
3. hemoptysis
4. increased frequency of bilateral/multiple theca-lutein cysts

Question 19

Choriocarcinoma - prognosis (why)

Answer 19

poor - hematogenous spread to lungs