Clinical 5 Gline Gestational Trophoblast Flashcards
Complete Mole
Majority of Hydatiform Moles.
“empty” egg fert by a haploid sperm
Usually 46XX Karyotype with both X’s paternally derived. Rarely 46XY.
Rarely associated with a fetus.
Partial Mole
“Incomplete Mole”
Results from two sperm fertilizing one egg.
10% of Moles
Triploid Karyotype usually 69 XXY (80%), can be 69 XXX or 69 XYY. Occasionally have a mosaic pattern.
Often present with a coexisting fetus.
Invasive Mole
Locally Invasive Tumor
5% to 10% of all GTD.
Rarely metastasizes (usually to vagina or lungs, brain).
Represents Majority of Pts w/persistent B-HCG elevations after molar evacuation.
Choriocarcinoma
Frankly Malignant Form of GTD.
1/2 of these patients have had a preceding molar pregnancy.
The rest have had a spontaneous or induced abortion, ectopic pregnancy or normal pregnancy.
Disseminates Hematogenously.
FOR THE BOARDS…
Name the two types of cancer that cross the placenta.
Placental site trophoblastic tumor
Uncommon
Consists of Intermediate trophoblast and a few syncytial elements.
Produce small amounts of hCG and human placental lactogen.
Remain confined to the uterus.
Metastasize late in their course.
Insensitive to Chemotherapy.
Two cancers that cross the placenta
choriocarinoma & melanoma
Two types of hydatidform mole
complete mole
Incomplete/partial mole
Complete Mole
Appears as multiple vesicles “bunch of grapes”. Pathologically associated with o hydropic villi o absence of fetal vessels o hyperplasia of trophoblastic tissue.
Complete Mole symptoms
Irregular Heavy Vaginal bleeding in the first or early second trimester.
Usually Painless
Sometimes nausea or “hyperemesis”.
May expel vesicles.
May experience nervousness, anorexia and tremors associated with hyperthyroidism.
May experience irritability, dizziness and photophobia associated with pre-eclampsia.
Complete Mole signs
Vitals- Tachycardia, tachypnea, hypertension
Chest- wheezing, rhonchi
Abdomen- absent fetal heart sounds, larger than expected uterus.
Vagina- grapelike vesicles.
Ovaries - one third will have theca-lutein cysts.
Complete Mole diagnosis
High B-hCG titers.
Ultrasound- “snow storm” pattern.
Pathological- hydropic villi, absence of fetal blood vessels and hyperplasia of trophoblastic tissue
Complete Mole Treatment
suction evacuation with sharp curettage
IV pitocin
Follow up includes B-hCGs every 2-3 days until negative then weekly for three weeks then monthly times one year.
Should decline in 12-16 weeks.
90% have spontaneous remissions.
Chest x-ray
Liver Enzymes
If B-hCG levels plateau or rise at any time, chemotherapy should be instituted.
Usually methotrexate or Actinomycin-D.
Hysterectomy in appropriate patients ie age >40 etc.
Partial Mole
Usually associated with a developing fetus.
These patients will display similar pathologic and clinical features as patients with complete moles, only less severe.
Diagnosed later than complete moles and generally present as a spontaneous or missed abortion.
Most patients are small for dates.
U.S. may indicate molar degeneration with developing fetus.
If pre-eclampsia occurs it usually occurs one month later than a complete mole.
Less likely than a complete mole to metastasize.
Choriocarcinoma signs/symptoms
vaginal bleeding but occasionally amenorrhea
respiratory: hemoptysis
CNS: headaches, dizzy spells and blackin gout
GI: Rectal bleeding
Uterine enlargement
firm discolored mass in vagina
actue abdomen from ruptured uterus, theca-lutein cyst or liver
Neurologic signs
Choriocarcinoma diagnosis
persistent elevated B-hCG
Same workup as Molar pregnancy
