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Ob/gyn > chp 45- gestational trophoblastic neoplasia > Flashcards

chp 45- gestational trophoblastic neoplasia Flashcards

1
Q

Persistent or malignant disease will develop in ___% of pt with molar pregnancy

A

20

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2
Q

Epidemiology of molar pregnancy

A

1/200 asian pregnancies > 1/1500 USA. Higher in women >35 or <20.

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3
Q

What is the recurrence rate of molar pregnancy?

A

1-2%

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4
Q

Risk factors for molar pregnancy

A

low dietary carotene consumption, vit A deficiency, history of infertility/sab

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5
Q

A mole includes abnormal proliferation of _____ and replacement of normal placental tissue by ____.

A

syncytiotrophoblast/ hydropic placental vili

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6
Q

Genetic constituents of complete moles

A

entirely paternal origin. Reduplicated haploid sperm or 2 sprem. Usually 46 XX and has no fetal parts.

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7
Q

Genetic constituents of partial moles.

A

triploid with one haploid maternal set and 2 haploid paternal sets.

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8
Q

T or F. Complete moles are MC than partial and are less likely to undergo malignant transformation.

A

F. They are mc but are more likely to undergo transformation.

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9
Q

Presentation of complete molar pregnancy

A

abnormal gestation, 50% will have large uterus, >25% will have bilateral theca lutein cysts,. Other s/s- exaggerated symptoms of pregnancy (N/V), painless 2nd trimester bleeding, lack of FHT, gestational htn, proteinuria (hyperrflexia), hyperthyroid (due to high hcg)

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10
Q

Presentation of partial molar pregnancy

A

missed abortion, small or appropriate sized uterus, Other s/s- exaggerated symptoms of pregnancy (N/V), painless 2nd trimester bleeding (less common), lack of FHT, gestational htn, proteinuria (hyperrflexia), hyperthyroid (due to high hcg)

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11
Q

Diagnosis of molar pregnancy

A

snowstorm USG,very high hcg

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12
Q

classification of malignant GTN

A

persistent nonmetastatic GTN, metastatic GTN (good prognosis, bad prognosis), placental site tumors (malignant, usually nonmetastatic)

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13
Q

In a woman with severe HTN before week 20, what should you suspect?

A

molar pregnancy

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14
Q

Definitive tx of molar pregnancy

A

uterine evacuation (dilation,suction, then gentle sharp curretage)

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15
Q

The _____ the uterus, the greater the risk of pulm complications associated with trophoblastic emboli, fluid overload, anemia.

A

larger

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16
Q

Despite removal of molar pregnancy, the risk of persistent GTN is ___

A

3-5%

17
Q

What causes theca lutein cysts

A

follicular stimulation by high levels of hCG. spontaneously regress

18
Q

Preop evaluation of molar pregnancy

A

baseline hcg, CXR, CBC, blood type an screen, blotting function studies, other tests if clinical evidence of hyperthyroidism and/or gestational HTN

19
Q

What is postevac management for these pt?

A

monitor closely for 6-12 mo, give Rh- pt Rh Ig, check hCG 48 hrs after, every 1-2 weeks while elevated, and at 1-2 mo

20
Q

The risk of recurrence after 1 year remission is __. The risk with future pregnancies is ___.

A

<1%, 1-2%

21
Q

When is persistent GTN diagnosed?

A

when hcg levels dont fall after molar or normal pregnancy

22
Q

An invasive mole is histologically identical to ____

A

complete mole

23
Q

Appearance of choriocarcinomas

A

red, granular appearance with intermingled syncytiotrophoblast and cytotrophoblast elements

24
Q

Describe path of choriocarcinomas

A

rapid myometrial and urterine vessel invasion and systemic mets from hematogenous emoblization. Lung, vagina, CNS, kidny, liver MCly.

25
Q

How common are choriocarcinomas

A

1/150,000 pregs, 1/15000 abortions, 1/5000 ectopics, 1/40 molars

26
Q

How is choriocarcinoma treated?

A

test hcg (esp w bleeding >6 wks after pregnancy). Single agent chemo (mtx or actinomycin D) for nonmetastatic disease, FIGO>7 requires multiagent chemo with EMACO.

27
Q

Choriocharcinoma prognosis

A

5 year for nonmets and goodprog is 100%. For poor prog is 80%

28
Q

What cells make up placental site tumors

A

monomorphic populations of intermediated cytotrophoblastic cells that are locally invasive

29
Q

What do placental site tumors make?

A

small amounts of hcg. Better managed by hpl

30
Q

How are placental tumors treated

A

hysterectomy

31
Q

good prognosis GTN criteria

A

No risk factors, <40,000, no brain or liver mets, no antecedent term pregnancy, no prior chemo

32
Q

Poor prognosis GTN criteria

A

more than 4 mo after pregnancy, pretherapy hCG >40,000, brain or liver mets, antecedent term pregnancy, prior chemo

Ob/gyn (7 decks)

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