Gestational trophoblastic disease

Question 1

Complete mole

Answer 1

Majority of hydatiform moles
Fertilization of empty egg by haploid sperm
46 XX with both X’s paternally derived
Multiple vesicles aka “Bunch of grapes”
Abdomen is larger than expected
Snow storm pattern on US
FU includes B-hCGs every 2-3 days until negative

Question 2

Partial mole

Answer 2

Two sperm fertilizing one egg
Triploid karyotype - 69 XXY
Often present with coexisting fetus
Most pts are small for dates

Question 3

Invasive mole

Answer 3

Locally invasive tumor
Rarely metastasizes
Persistent B-hCG elevations after molar evacuation

Question 4

Choriocarcinoma

Answer 4

1/2 of these pts have had preceding molar pregnancy
Disseminates hematogenously
Vaginal bleeding, occasionally amenorrhea
Hemoptysis
HA, dizzy spells, blacking out
Rectal bleeding

Question 5

Two types of cancers that cross the placenta

Answer 5

Choriocarcinoma

Melanoma

Question 6

Etiology

Answer 6

Exact cause unknown
Related to defective fertilization
More prevalent < 20 and > 40

Question 7

High risk factors of developing persistence after complete molar pregnancy

Answer 7

Age > 40
Prior molar pregnancy
Uterine size greater than dates
Prominent theca-lutein cysts
Serum hCG > 100,000
Pre-eclampsia
Hyperthyroidism
Trophoblastic embolization

Question 8

Tx of Choriocarcinoma

Answer 8

Methotrexate in pts with good prognosis
Combo chemo in pts with poor prognosis
Mets to brain or liver - chemo + rads

Question 9

Dx of Choriocarcinoma

Answer 9

Persistent elevated B-hCG

CT scan of abdomen, pelvis, head, lumbar puncture