Gestational Trophoblastic Disease 3 Flashcards

Diagnose and develop a management plan for a hydatidiform mole.

1
Q

What are the defining characteristics of an invasive mole?

A
  • Benign tumor arising from H. Mole (10-17%)
  • Hydropic chorionic villi with trophoblastic hyperplasia in sites outside the uterine cavity•Invades the myometrium; may metastasize to the lungs and vagina
  • Rising or plateauing hCG levels, uterine bleeding, persistently enlarged uterus, theca lutein cysts after molar evacuation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the pathologic characteristics of choriocarcinoma?

A
  • Abnormal trophoblastic hyperplasia and anaplasia
  • Absence of chorionic villi
  • Hemorrhage and necrosis
  • Direct invasion of adjacent tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a placental-site trophoblastic tumor? What is the treatment?

A
  • Intermediate trophoblast
  • Necrosis and hemorrhage less evident than in choriocarcinoma
  • Propensity for lymphatic metastasis
  • Immunoperoxidase staining for hPL positive
  • Serum hCG levels relatively low
  • Resistance to chemotherapy
  • Treatment:
    • hysterectomy & LNBXs +/- EMA-EP
    • adverse prognostic variables: metastasis, antecedent pregnancy > 2 years, mitoses >6/10HPFs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the clinical signs of molar pregnancies?

A
  • Vaginal bleeding
  • Uterine enlargement
  • Toxemia
  • Hyperemesis
  • Hyperthyroidism
  • Trophoblastic emboli
  • Bilaterally enlarged ovaries
  • Absence of fetal heart sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the management options for hydatidiform moles?

A
  • Preoperative: CBC, platelets, chemistries, coagulation profile, thyroid panel, blood type and crossmatch, U/A, hCG, CXR, EKG, pelvic U/S
  • Operative
    • D & E
    • Hysterectomy
  • Do not use medical induction of labor or hysterotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the important points of follow-up for hydatidiform moles?

A
  • hCG levels (serum quantitative hCGs) every 1 – 2 weeks until negative for 3 consecutive determinations, then every 3 months for 6-12 months
  • Postoperative physical exam in one month
  • Contraception during follow-up period for 6 months after spontaneous return of hCG to normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly