Gestational Trophoblastic disease

Question 1

Define Gestational Trophoblastic disease

Answer 1

Trophoblastic tissue [part of the blastocyst that normally invades endometrium] proliferates aggressively

Question 2

Outline the classifications of Gestational Trophoblastic disease

Answer 2

Gestational Trophoblastic Disease

1. Hydatidiform mole [local & non-invasive]
   
   1. Complete [entirely paternal in origin (sperm fetilizes empty oocyte) diploid]
   2. Partial [tripoid (two sperms entering one oocyte)]
2. Invasive mole [invasive]
   
   1. Choriocarcinoma [metastasis occurs]

Persistant GTD = Gestational Trophoblastic Neoplasia (GTN) [persistant elevated hCG]

Question 3

Outline the clinical features of Gestational Trophoblastic disease

Answer 3

• Symptoms
  
  • Vaginal bleeding
  • Hyperemesis
• O/E
  
  • Large uterus
  • Early pre-eclampsia
  • Hyperthyroidism

Question 4

Outline the investigations & results for Gestational Trophoblastic disease

Answer 4

• USS
  
  • Snowstorm appearance of swollen villi with = Complete Hydatidiform moles
• hCG HIGH
• Diagnosis confirm histologically

Question 5

Outline the management of Gestational Trophoblastic disease

Answer 5

• **Suction curettage **removes trophoplastic tissue (ERCP)
  
  • • Diagnosis via histology
• Serial blood/ urine hCG
• Referral to Supraregional centre
• Avoid pregnancy & COCP while hCG high

Question 6

Outline potential complicatons of or Gestational Trophoblastic disease

Answer 6

• Recurrence [1/60]
• Gestational Trophoblasti Neoplasia
  
  • As invasive mole or choriocarcinoma
  • 15% of Complete moles & 0.5% of Partial moles
  • 50% of total malignancies [others from miscarriages/ normal pregnancies]
  • Diagnosis: Persistantly high hCG, vaginal bleeding or blood borne mets
  • Treatment:
    
    • Low-risk: Methotrexate + folic acid
    • High-risk: Combination therapy