Gestational Trophoblastic Disease

Question 1

What is gestational trophoblastic disease?

Answer 1

Trophoblastic tissue that normally invades the endometrium, proliferates in a more aggressive way.

Question 2

What are the pre-malignant and malignant forms of gestational trophoblastic disease?

Answer 2

1. Pre-malignant - Hydratiform mole

2. Malignant - Choriocarcinoma

Question 3

What causes a Hydratiform mole?

Answer 3

hCG made in excess = exaggerated pregnancy symptoms

Question 4

What is this a presentation of?
Extremes of reproductive age, Asian woman, failed miscarriage, large uterus for dates, heavy bleeding, severe morning sickness, hyperthyroidism, snowstorm pattern on USS, very high hCG levels.

Answer 4

Hydratiform mole (gestational trophoblastic disease)

Question 5

How is a Hydratiform mole managed?

Answer 5

1. Removed by suction
2. Give anti-D if Rh-ve
3. Serial hCG - if persistent/rising, suggests malignancy
4. Avoid pregnancy until hCG is normal for 6 months

Question 6

What is this a presentation of?
Years after pregnancy, general malaise, persistent PV bleeding and elevated hCG, evidence of blood-borne metastases (lungs commonly).

Answer 6

Choriocarcinoma (gestational trophoblastic disease)

Question 7

How is choriocarcinoma treated?

Answer 7

Combination chemotherapy using methotrexate