Gestational Trophoblastic Disease Flashcards
types of benign and malignant gestational trophoblastic disease
benign : complete and partial hydatidiform moles
malignant : persistent/invasive moles, choriocarcinoma, PSTTs
in what race ar hydatidiform moles MC
asian
what are risk factors for developing moles
extremities in age
prior GTD
nulliparity
low B carotene/folate/fat diet
complete vs partial moles
etiology
complete: empty egg + sperm
partial : egg + 2 sperm
complete vs partial moles
karyotype
complete: 46, XX (both paternal)
partial : 69, XXY
complete vs partial moles
b-hCG levels, how long does it take to return to normal levels?
complete: very high (>100k); 14 wks to return to nml
partial: normal/slightly elevated; 8 wks to return to nml
complete vs partial moles
pathology
complete: enlarged uterus + grape cluster villi +/- bilateral theca-lutein cysts
partial: normal sized uterus, fetal parts found on autopsy of abortion products
complete vs partial moles
presentation
complete: abnormal vaginal bleeding; severe hyperemesis gravidarum, 1st trimester preeclampsia, hyperthyroid, anemia
partial: missed abortion
complete vs partial moles
malignant potential
complete: 15-20% overall, 2% choriocarcinoma
partial: <5% overall, no risk of choriocarcinoma
complete vs partial moles
findings on pelvic US
complete: “snowstorm” pattern
partial: “swiss cheese” uterus
complete vs partial moles
management
complete: D&C + oxytocin, f/uwith serial b-hCG and relable contraception for next 6 mos
partial: same as complete
low vs high risk malignant GTD
duration
b-hCG levels
low: < 4 mos, 4 mos, > 40k, failed chemo, GTD following pregnancy
persistent/invasive moles vs choriocarcinoma vs PSTTs
etiology
persistent/invasive moles: remnant of benign hydatiform moles
choriocarcinoma: malignant necrotizing tumor
PSTTs : rare tumors that arise from placental invasion site, have no villi
persistent/invasive moles vs choriocarcinoma vs PSTTs
presentation
persistent/invasive moles: presents as plateuign or inc b-hCG s/p molar evacuation
choriocarcinoma: smx of mets (lungs, vagina, liver, brain, kidneys)
PSTTs : abnl vaginal bleeding
persistent/invasive moles vs choriocarcinoma vs PSTTs\
management
persistent/invasive moles: single agent chmo for non-met or low risk and multi-agent chemo for high risk
choriocarcinoma: same as persistent/invasive
PSTTs : low b-hCG (persistently <100); hystorectomy + multi-agent chemo
