gestational trophoblastic disease Flashcards
hydatiform mole, choriocarcinoma, c/f, Dx, Tx
What are gestational trophoblastic diseases?
variety of conditions from benign to highly malignant.
When can GTDs occur in relation to pregnancy?
- Benign H. mole
- Persistent trophoblastic disease
- Choriocarcinoma
What are the types of benign H mole?
- complete
- partial
- invasive
What are the causes of H mole?
- Blood group A
- Vitamin A, beta carotene deficiency
- Folic acid deficiency
Explain the anatomy of H mole.
- mole= bunch of grape-like vesicles
- pearly white, translucent
- contains watery fluid
What is partial mole, give its karyotype and mention if fetus is present or not? If present what is the fetus like?
- resembles placenta
- 69XXY, triploid
- maternally lined but few vesicles
- fetus present
- malformed fetus or IUGR (IntraUterine Growth Retardation)
C/F of partial H mole.
- beta-HCG low
- Mild-moderate trophoblastic hyperplasia
- facial hydropic changes
Mention characteristics of complete H mole, its karyotype and give its c/f.
- Fetus absent
- 46XX paternally lined
- very high beta-HCG
- high grade hyperplasia
- diffuse hydropic changes
- can be malignant (15-20%)
What happens to the uterine wall in H mole?
- Becomes hypertrophied like in pregnancy
- lined by thick decidua
What all is included in persistent trophoblastic disease?
- invasive mole
- placental-site trophoblastic tumor (PSTT)
Explain invasive mole.
When H mole invades/erodes uterine wall, burrow into myometrium/broad lig/peritoneal cavity
What is present in invasive mole?
evidence of chorionic villi
Dx characteristics of invasive mole?
- persistent vaginal bleeding
- pain after evacuation of H mole
- USG & serial beta-HCG levels persistently increase
What is the Tx of invasive H mole?
- Chemotherapy
- Hysterectomy
Where does PSTT derive from and where does it invade?
derived= placental bed trophoblast
invades= myometrium
Dx characteristics of PSTT.
- low beta-HCG (than choriocarcinoma)
- high serum HPL
Which cells does PSTT contain?
- mainly cytotrophoblasts
- few/no synctiotrophoblasts
What are the symptoms and signs of H mole? (9)
- Amenorrhea ,24 weeks gestation (usually 3-4 months in complete mole)
- Abdominal pain
- Profuse hemorrhage
- Spontaneous abortion
- Hyperemesis
- Pregnancy induced HTN
- Pale, ill, febrile
- Uterus large, doughy (because absence of amniotic fluid)
- soft cervix
How do we diagnose H mole?
- Doppler= fetal heart beat absent
- USG= snow-storm uterus
- beta-HCG= high in complete, low in partial
- CXR= to rule out lung metastases
How to differentiate between complete and partial mole by USG?
complete= absence of fetal shadow
partial= presence of fetal shadow
What is Tx of partial & complete H mole?
Partial= MTP & follow up
Complete=
1. Surgical evacuation f/b chemotherapy
2. Cervical softening with mesoprostol f/b surgical evacuation
3. Hysterectomy
4. No pregnancy for 2 yrs & no OCP
What are types of choriocarcinoma acc to DNA origin? (2)
- Non-gestational choriocarcinoma= maternal origin DNA
- Gestational choriocarcinoma= paternal origin DNA
What are the primary causes of secondary choriocarcinoma? and what % of incidence? (3)
- follow evacuation of H mole= 50%
- follow abortion= 25%
- follow full-term pregnancy= 20%
What is the anatomy of choriocarcinoma?
- growth= solid purple friable mass
- primary growth in body of uterus= ulceration= blood stained discharge= infected & necrotised= purulent & offensive discharge
How and where can choriocarcinoma metastize?
- Hematological= Brain, Liver, Lungs, Vagina, Kidneys, GIT
- Erosion= Broad lig, Peritoneal cavity, Profuse bleeding
What are the signs and symptoms of choriocarcinoma? (5)
- persistent/ irregular uterine bleeding after abortion/ molar pregnancy/ normal delivery
- offensive vaginal discharge
- pyrexia, cachexia
- amenorrhea d/t increased HCG
- Vaginal= bluish-red vascular tumor which bleeds on touch
What are extra-genital manifestations of choriocarcinoma? (2 organs)
- Lung= dyspnea, hemoptysis
- Brain= hemiplegia, epilepsy, headache, visual disturbances
Explain staging of choriocarcinoma (4 stages).
I= confined to uterus
II= extends outside uterus but limited to genital structures
III= lung metastases with or without genital tract involvement
IV= other
What is Dx of choriocarcinoma based on? (2)
- C/F
- Histological evidences
What can be used to Dx choriocarcinoma? (6)
- serum beta-HCG levels increased
- Lungs X-ray
- Lungs CT
- Brain CT
- Liver & pelvis USG
- PET
What is the Tx of choriocarcinoma? (2)
- chemotherapy
- hysterectomy
What Tx if lung mets?
Lobectomy
What drugs are used in chemotherapy?
- Methotrexate
- Actinomycin
- Cyclophosphamide
