Gestational Trophoblastic Disease Flashcards

1
Q

What is a complete mole?

A

Fertilization of an “empty” oocyte by a haploid sperm. 46XX karyotype, all paternal.

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2
Q

What is a partial or incomplete mole?

A

Two sperm fertilize one egg, triploid phenotype usually 69XXY

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3
Q

What is an invasive mole?

A

A hydatiform mole that invades local tissue and can metastasize to the vagina, lungs or brain.

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4
Q

When should you suspect a metastatic invasive mole?

A

When there are persistent elevated beta-hCG levels even after the mole is removed.

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5
Q

What lab value often indicates a hydatiform mole of some kind?

A

Incredibly high levels of beta-hCG

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6
Q

How do complete moles appear on examination?

A

Many vesicles, “bunch of grapes”

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7
Q

How do complete moles appear on ultrasound?

A

Snowstorm pattern

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8
Q

How do most complete moles present?

A

Painless heavy vaginal bleeding. Similar to placenta previa, however, the moles occur in the 1st trimester or early second and have very high hCG levels.

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9
Q

What is the treatment for a complete mole?

A

Suction evacuation and curettage. IV Pitocin to induce uterine contraction and close off placental blood vessels.

Monitor beta-hCG every 2 weeks until it declines.

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10
Q

What should the physician do if the b-hCG levels do not decline after removing a complete mole?

A

Chest X-ray, liver tests to look for metastasis of complete mole.

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11
Q

Type of growth that occurs in the ovaries that is a strong risk factor for choriocarcinoma.

A

Theca-lutein cyst

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12
Q

Two drugs used to treat choriocarcinoma

A

Methotrexate
Actinomycin-D

(For poor prognosis, use a combo of methotrexate, actinomycin-D, and cyclophosphamide)

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13
Q

What is the follow up for choriocarcinoma after the original treatment?

A

b-hCG titers every month for 2 years, then every 3 months for 5 years.

Advise to avoid pregnancy

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