Gestational Trophoblastic Disease Flashcards
What are the GTDs?(6)
- complete hydatidiform mole
- partial mole
- invasive mole
- choriocarcinoma
- placental site trophobkastic tumor
- epitheliod trophoblastic tumor
Incidence of GTD
1:714
Most common karyotype of CHM
Diploid 46XX
-75-80%
-Paternal origin
- empty ovum with duplicated sperm
Other karyotype of CHM
46 XX or 46 XY
- dispermic fertilization
- 20- 25%
What is the genetic predisposition to CHM
NLRP7 - Chromosome 19q
- autosomal recessive
- associated with recurrent mole
- maternal and paternal DNA (dipload)
Karyotype of partial mole
- triploid 69 xxy/xyy/xxx (90%)
- tetrapoid/mosaic (10%)
- dispermic fertilization of ovum with genetic material
What is the risk of recurrence of HM?
- 2% following 1 mole
- 20% following 2 moles
Histopathology of CHM (3)
- diffuse villus hydrops
- diffuse trophoblast hyperplasia
- cluster of grapes macroscopically
Histology partial mole (4)
- focal villas hydrops
- focal trophoblast hyperplasia
- trophoblacyix pseudoinclusions
- identifiable fetal tissue
Which mole is p57 detected in on immunohistochemistry?
Partial mole
Risk of requiring chemotherapy in CHM
13-16%
Risk of requiring chemotherapy in PM
.5- 1%
Common presentation of CHM (2)
- irregular vaginal bleeding in early pregnancy
- ultrasound findings polypoid mass with multiple echoes (snowstorm pattern)
Less frequent features (4)
- hypermesis gravidarum
- early onset pre eclampsia
- LGA
- abdominal dissension to the theca lutein cyst
Ultrasound features PM(3)
- enlarged placental tissue
- cystic changes within the decidual reaction with an empty gestational sac
- increased transverse diameter of GS (ratio >1.5)
Accuracy of ultrasound In detecting GTD
40-60%
Follow up regime in CHM
- if HCG normalized within 56 days then follow up 6mnths after uterine evacuation
- if not normalized within 56days then followup 6mnths post normalization
Incidence of choriocarcinoma
1:50000 pregnancies
1:40 moles
Risk factors for persistent GTD or GTN (7)
- pre evacuation HCD >100,000
- Uterine size >20weeks and theca lutein cyst > 6cm
- age >40
- recurrent mole
- aneuploid mole
- medical complications eg pre eclampsia/hyperthyroidism
- any evidence of distant embolisation
Signs if post-molar GTN (3)
- enlarged irregular uterus
- persistent ovarian enlargement
- elevated hcg
GTN score for high risk disease requiring chemotherapy
> 7
Cure rate for FIGo <6
100%
Cure rate FIGO >7
94%
Risk associated with FIGO >13 (2)
- death within 4 weeks due to organ hemorrhage
- late death due to multidrug resistance
What is the risk of gtd in a female <15yrs compared to age 20-40
20 times higher
What is the risk of gtd in women >45 compared to age 20-40
Several hundred times higher
