Gestational trophoblastic disease Flashcards

1
Q

Define gestational trophoblastic disease.

A

Group of disorders spanning complete + partial molar pregnancies through to malignant conditions

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2
Q

What are the 2 pre-malignant manifestations of GTD?

A

Complete hydatidiform mole
Partial hydatidiform

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3
Q

Give 4 malignant manifestations of GTD

A

Invasive mole
Choriocarcinoma
Placental site trophoblastic tumour (PSTT)
Epithelioid trophoblastic tumour

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4
Q

What are complete molar pregnancies?

A

Empty egg fertilized by a single sperm that then duplicates its own DNA, hence all 46 chromosomes are of paternal origin

No evidence of fetal tissue

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5
Q

What is a partial molar pregnancy?

A

Normal haploid egg fertilized by 2 sperms, or by 1 sperm with duplication of the paternal chromosomes.

DNA is both maternal + paternal in origin.

Usually triploid e.g. 69 XXX or 69 XXY.

Fetal parts may be seen

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6
Q

Explain the aetiology of gestational trophoblastic disease.

A

Abnormal chromosomal material of placental tissue.

Invasive moles always form from hyatidiform nuclei.

Choriocarcinoma often after molar pregnancy, viable, miscarriage or ectopic.

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7
Q

What are the risk factors for gestational trophoblastic disease?

A

Extreme of age
Previous GTD
Ethnicity (Asian)

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8
Q

What is an invasive mole?

A

develops from a complete mole + invades the myometrium.

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9
Q

List 4 symptoms of a molar pregnancy

A

Persistent/ irregular PV bleed
+ve pregnancy test
Hyperemisis
Lower abdo pain.

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10
Q

List 3 signs molar pregnancy

A

Uterine large for dates
Signs of hyperthyroidism
HTN

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11
Q

Why do signs of hyperthyroidism occur in molar pregnancy?

A

bHCG can act on Thyroid stimulating hormone receptors at high concentrations

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12
Q

What is seen on bloods in molar pregnancy?

A

Very high serum bHCG

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13
Q

What is seen on USS in molar pregnancy?

A

Complete: “SNOWSTORM” or “Bunch of GRAPES”

Partial: enlarged placenta + cystic changes

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14
Q

What is the investigation for definitive diagnosis of molar pregnancy?

A

Histological exam

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15
Q

What is the management plan for molar pregnancies?

A

urgent referral to specialist centre: evacuation via Suction curettage

effective contraception is recommended to avoid pregnancy in the next 12 months

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16
Q

What follow up is required for molar pregnancies?

A

2-weekly serum + urine samples until hCG concentrations are normal.
Partial: surveillance ends 4w later if normal
Complete: once normal, monthly urine hCG for 6m

17
Q

What are the complications of a complete molar pregnancy?

A

~10% develop into invasive moles- can cause significant damage to surrounding structures
~2.5% transform into choriocarcinoma: rapidly invasive, widely metastasising malignancy