Gestational trophoblastic disease

Question 1

Incidence of molar pregnancies

Answer 1

1:1200

Question 2

Predisposing factors for moles

Answer 2

Prior mole, extremes of maternal age, ethnicity (Asian is high risk)

Question 3

Beta hcg typical for mole

Answer 3

40% of complete mole have level >100,000

Question 4

Karyotype of complete mole

Answer 4

46XX (most common), 46XY [paternal]

Question 5

Karyotype of partial mole

Answer 5

Triploid, 69XXY (most common) [paternal and maternal]

Question 6

Likelihood of persistent GTD with mole

Answer 6

Complete 30%

Incomplete 3%

Question 7

Beta hcg follow-up for mole

Answer 7

Weekly until 3 consecutive normal, then monthly for 6 months

Question 8

Events preceding choriocarcinoma

Answer 8

50% molar pregnancy
25% normal gestation
25% abortion / ectopic

Question 9

Most common sites of metastatic disease for GTD

Answer 9

Lungs (80%), vagina (30%), brain or liver (10%)

Question 10

FIGO staging for choriocarcinoma by location

Answer 10

I - uterus
II - vagina, adnexa, broad ligament
III - lungs
IV - all other metastatic sites

Question 11

High-risk score on FIGO scoring system

Answer 11

> 7 (used for stage II or III)

Question 12

Treatment of choriocarcinoma

Answer 12

Surgery + single-agent chemo up to stage III

Question 13

Treatment of stage IV choriocarcinoma

Answer 13

Combination chemo, possible whole head RT

Question 14

Elevated human placental lactogen (hPL) associated with…

Answer 14

Placental-site trophoblastic tumor

Question 15

Prognosis for placental site trophoblastic tumor

Answer 15

More likely resistant to chemo and may require surgical resection