31. Gestational Trophoblastic Disease

Question 1

Four major classifications of GTD

(abnormal proliferation of trophoblastic placental tissue… NOT maternal tissue)

Answer 1

Benign GTD (80%)

• Complete mole (classic mole)
• Partial mole (incomplete mole)

Malignant GTD (20%)

• Persistent/invasive mole
• Choriocarcinoma
• Placental site trophoblastic tumors

These tumors share the ability to produce human chorionic gonadotropin (hCG), which serves both as a tumor marker for dx the disease and as a tool for measuring the effect of treatment.

Question 2

Benign GTD consists of molar pregnancies, also known as hydatidiform moles.

90% of molar pregnancies = classic or complete moles… the result of molar degeneration + no associated fetus

10% of molar pregnancies = partial or incomplete moles… the result of molar degeneration + abnormal fetus

Answer 2

Question 3

Risk Factors

Answer 3

Extremes in age

prior hx of GTD

nulliparity

Question 4

Pathogenesis of complete mole

Answer 4

Question 5

The most common presenting symptom of molar pregnancy

Answer 5

Irregular or heavy vaginal bleeding during early pregnancy (97%)

Bleeding is due to separation of the tumor from underlying decidua, resulting in disruption of the maternal vessels

Question 6

Treatment for molar pregnancy

Answer 6

Immediate removal of uterine contents with suction curettage (D&C)

Question 7

Follow-up for removal of complete mole

Answer 7

Prognosis is excellent with 95-100% cure rates after suction curettage

After evacuation of a molar pregnancy, serial hCG titers should be monitored to ensure complete resolution of the disease (measure weekly until negative for 3 consecutive weeks) –> typically takes 14 weeks for a complete mole

Question 8

Partial/incomplete mole:

pathogenesis

Answer 8

when normal egg is fertilized by two sperm simultaneously resulting in a triploid karyotype with 69 xcomes, conssting of two sets which are paternally derived

Question 9

Classification of malignant GTD

Answer 9