Gestational trophoblastic disease

Question 1

What are the two types of Gestational trophoblastic disease? Aetiology

Answer 1

two forms of tumour of trophoblastic tissues- benign form -hydatidiform Mole
and cancerous -Gestational trophoblastic disease (malignant)

Aetiology - abnormal fertilisation that can lead to a “mole” (hydatidiform) which can either be - empty egg fertilised by 2 sperms 46XY or 46XX
or normal egg fertilised by 2 sperm - 69xxx 69xxy

Invasive mole ALWAYS follow hydatidiform mole
Malignant form metstases FAST to lung/vagina/brain/liver/kidney

Question 2

What are the 3 types of malignant Gestational trophoblastic disease

Answer 2

3 types -
Invasive mole - hydatidiform mole with invasion of myometrium, necrosis, heammorhage
Choriocarcinoma- cytotrophoblast and synctiotrophoblast without formed chorionic villi-invade mymetrium
Placental site trophoblastic tumour- intermediate trophoblasts infltrate myometrium with destruction (v v rare)

usually from abnormal choromosomal material of placental tissue

choriocarcinoma arise from-
molar pregnancies (50%), viable preg (0%), misscariages (25%), ectopic

Question 3

Risk factors of Gestational trophoblastic disease

Answer 3

Extreme of reproductive ages,
Ethinicity (japanese, asian, native american), previous GTD, diet (low B caroten, low fat)

Pmh of recent -
Choriocarcinoma arises from…

§ Molar pregnancy (50%)

§ Viable pregnancy (22%)

§ Miscarriage (25%)

§ Ectopic pregnancy (3%)

Question 4

Sx and Ix of hydatiform mole

Answer 4

Painless PV bleeding (misscariage)
Sx oof hyperthyroidism (from bHCG mimicking TSH)
Uterus larger than expected
Hyperemesis (From bHCG)
Often seen ion USS before Sx

Ix -
Urine preg test +ve
bloods bHCG high, + mimick TSH - low TSH, high T4

Imaging-
complete mole - SNOWSTORM/cluster of grapes -but no foetal parts
Incomplete mole - same but with foetal parts

Question 5

Sx and Ix of Malignant Gestational Trophoblastic Disease

Answer 5

PErsistant PV bleeding, hyperemesis, Lower adbominal pain
Lung meta - heampotoys, dynpnea, pleuritic
Bladder/bowel - blood
OE - excessiove uterine size

Ix -
urine test +ve
Bloods = bHCG peristantly raised, or rising after ERPC. LFT (mets)

USS- smowstorm, vesicle, cysts, CXR, CTCAP
MRI brain

Question 6

Mx and complications of Hydatidiform Mole

Answer 6

Urgent referal to specialist centres -
1st -surgrical - ERPC (evacuation of retained products of contraception)- no contractions

then monitor- serial bHCG, with methotrexate if rising/stagnant levels
avoid pregnancy until 6m after normal levels

if still rise - choiocarcinoma

complications
complete -invasive mole 10%, choriocarcinoma 2.5%
partial - choriocarcinoma (rare)
reccurence 1%

Question 7

Mx and complications of Malignant Gestational Trophoblastic Disease

Answer 7

Mx - specialist centres, CX, Sherffield, dundee
chemo- methotrexate and hyserectomy

complications =
metastases
chemo SE