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4: Y4 - Gynaecology [8] > [15] Gestational Trophoblastic Disease > Flashcards

[15] Gestational Trophoblastic Disease Flashcards

1
Q

What is gestational trophoblastic disease?

A

A term used to describe a group of pregnancy related tumours

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2
Q

What can gestational trophoblastic disease be divided into?

A
  • Pre-malignant conditions

- Malignant conditions

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3
Q

What form of gestational trophoblastic disease is more common?

A

Pre-malignant conditions

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4
Q

What are the types of pre-malignant gestational trophoblastic disease?

A
  • Partial molar pregnancy

- Complete molar pregnancy

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5
Q

What are the types of malignant gestational trophoblastic disease?

A
  • Invasive mole
  • Choriocarcinoma
  • Placental trophoblastic site tumour
  • Epithelioid trophoblastic tumour
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6
Q

What is the fetus formed from in normal conception, in terms of chromosomes?

A

23 maternal chromosomes and 23 paternal chromosomes

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7
Q

When does a molar pregnancy arise?

A

When there is an abnormality in chromosomal number during fertilisation

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8
Q

What is a partial molar pregnancy?

A

When one ovum with 23 chromosomes is fertilized by 2 sperm, each with 23 chromosomes, producing cells with 69 chromosomes

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9
Q

Can a partial molar pregnancy exist with a viable fetus?

A

Yes

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10
Q

What happens chromosomally in a viable partial molar pregnancy?

A

Mosaicism where the fetus has normal karyotype and triploidy is confined to the placenta
(Normally the fetus and placenta are triploidy, which isn’t viable)

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11
Q

What is a complete molar pregnancy?

A

Where one ovum without any chromosomes is fertilised by one sperm which duplicates, or less commonly by two different sperm, leading to 46 chromosomes of paternal origin alone

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12
Q

Are molar pregnancies benign or malignant?

A

Usually benign, but can become malignant

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13
Q

What happens when molar pregnancies become malignant?

A

They invade into the myometrium and disseminate throughout the body

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14
Q

What are malignant molar pregnancies known as?

A

Invasive moles

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15
Q

What is a choriocarcinoma?

A

A malignancy of trophoblastic cells of the placenta

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16
Q

What does choriocarcinoma commonly co-exist with?

A

Molar pregnancy

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17
Q

Where does choriocarcinoma characterically metastasise to?

A

Lungs

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18
Q

What is a placental site trophoblastic tumour?

A

A malignancy of the intermediate trophoblasts

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19
Q

What are the intermediate trophoblasts normally responsible for?

A

Anchoring the placenta to the uterus

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20
Q

What can placental site trophoblastic tumours occur after?

A
  • Normal pregnancy (more common)
  • Molar pregnancy
  • Miscarriage
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21
Q

What is an epithelioid trophoblastic tumour?

A

A malignancy of the trophoblastic placental cells

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22
Q

What can an epithelioid trophoblastic tumour be difficult to determine from?

A

Choriocarcinoma

23
Q

What does an epithelioid trophoblastic tumour mimic the cytological features of?

A

A squamous cell carcinoma

24
Q

What are the risk factors for gestational trophoblastic disease?

A
  • Maternal age <20 or >35
  • Previous gestational trophoblastic disease
  • Previous miscarriage
  • Use of OCP
25
Q

How do molar pregnancies most commonly present?

A

Vaginal bleeding and abdominal pain early in pregnancy

26
Q

What is found on examination in molar pregnancy?

A

Uterus can be larger than expected for gestation, and of soft, boggy consistency

27
Q

What finding can occasionally be present in molar pregnancy?

A

Molar vesicles shed per vagina

28
Q

How is the diagnosis of molar pregnancy usually made?

A

Ultrasound

29
Q

What are the later symptoms may be present if molar pregnancy is missed?

A
  • Hyperemesis
  • Hyperthyroidism
  • Anaemia
30
Q

What are the most common investigations in the assessment of suspected GTD?

A
  • ß-hCG
  • Ultrasound scan
  • Histological examination of products of conception
31
Q

What ß-hCG measurements are made in suspected GTD?

A
  • Urine

- Blood

32
Q

When should a urine pregnancy test be performed?

A

In all cases of persistent or irregular vaginal bleeding after a pregnancy event

33
Q

What happens after delivery in GTD, with regards to urinary pregnancy test?

A

It will remain positive for a number of weeks following delivery, as ß-hCG is cleared gradually

34
Q

What will be found on blood ß-hCG at diagnosis of GTD?

A

Markedly raised

35
Q

What can blood ß-hCG be used for in GTD?

A

Monitoring

36
Q

How does a complete mole appear on ultrasound?

A

Granular or snowstorm appearance, with central heterogeneous mass and surrounding multiple cystic areas/vesicles

37
Q

Can ultrasound scan be diagnostic for other forms of GTD?

A

No

38
Q

Why is ultrasound scan not diagnostic for partial moles?

A

May not have distinctive ultrasound appearance

39
Q

When is histological examination of the products of conception performed in GTD?

A

Post-treatment on molar pregnancies, and all non-viable pregnancies

40
Q

What is the purpose of histological examination of the products of conception in GTD?

A

To confirm diagnosis and plan follow up

41
Q

What should be done where a diagnosis of partial molar pregnancy is suspected and the fetus is viable?

A

The woman should be given the option to continue the pregnancy, and if she does placental histology should be performed after delivery

42
Q

What investigation is required in cases where metastatic spread is suspected?

A

Staging investigations

43
Q

What staging investigations may be done in metastatic GTD?

A
  • MRI
  • CT chest-abdo-pelvis
  • Pelvic ultrasound
44
Q

Where should all women in the UK with GTD be registered?

A

GTD centre

45
Q

Why should all women with GTD in the UK be registered with a GTD centre?

A

For follow-up and monitoring in future pregnancies

46
Q

What does the specific management of GTD depend on?

A

The exact type of tumour

47
Q

What is the most effective treatment for complete moles and non-viable partial moles?

A

Suction curettage

48
Q

When might medical evacuation be appropriate in molar pregnancy?

A

If the partial mole is of a greater gestation with fetal development, and is not conducive to surgical evacuation

49
Q

What investigation should be performed with medical evacuation of molar pregnancy?

A

Urinary ß-hCG 3 weeks post-treatment

50
Q

What is recommended post evacuation of molar pregnancy for rhesus negative mothers?

A

Anti-D prophylaxis

51
Q

What may be required if ß-bCG levels does not fall after treatment of molar pregnancy?

A

Chemotherapy

52
Q

What should be done in cases of malignant gestational trophoblastic disease, or a partial/complete mole that has not resolved?

A

The woman should be referred to a specialist GTD treatment centre

53
Q

What is the mainstay of treatment for malignant GTD?

A

Chemotherapy +/- surgery

4: Y4 - Gynaecology [8] (52 decks)

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