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OBGYN > Gestational Trophoblastic Disease > Flashcards

Gestational Trophoblastic Disease Flashcards

1
Q

What is Gestational trophoblastic disease (GTD)?

A

Abnormal proliferation of trophoblastic (placental) tissue

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2
Q

What are the categories of GTD?

A

Molar pregnancies (80%)
Persistent/invasive moles
Choriocarcinoma
Placental site trophoblastic tumors (arises from fetal tissue)

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3
Q

What do GTD tumors produce?

A

hCG

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4
Q

What is the treatment for GTD?

A

Chemotherapy (extremely sensitive)

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5
Q

What are the risk factors for GTD?

A

Extremes in age and prior history of GTD
Nulliparity
diet low in beta-carotene, folic acid, animal fat
OCP use

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6
Q

How do complete moles arise?

A

Fertilization of an enucleate ovum (empty egg) by one normal sperm which replicates itself
Chromosomal pattern of 46XX (all sperm derived)

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7
Q

What are the signs of complete mole?

A

Syncytiotrophoblastic proliferation leading to hydropic degeneration = grape-like vesicles in uterus without fetus
Very high hCG levels (>100,000) which has the same alpha subunit as FSH, LH, and TSH = large theca lutein cysts, hyperthyroidism, hyperemesis gravidarum, early preeclampsia (photophobia)

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8
Q

What is the most common presenting sign of molar pregnancy?

A

Irregular or heavy vaginal bleeding during early pregnancy

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9
Q

How is molar pregnancy diagnosed?

A

hCG > 100,000
pelvic ultrasound showing snowstorm pattern
pathologic exam of intrauterine tissue

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10
Q

What is the treatment for molar pregnancy?

A

Immediate removal of uterine contents (D&C)
baseline hCG
RhoGAM for all RH- patients
beta blockers and anti-hypertensives
type/screen for blood in case of heavy uterine bleeding

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11
Q

What is the average time to normalization of hCG levels post-evacuation?

A

14 weeks for complete

8 weeks for partial

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12
Q

What are you concerned with if hCG levels plateau or rise?

A

Persistent/invasive disease

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13
Q

What is a partial molar pregnancy?

A

Normal ovum fertilized by 2 sperm simultaneously = 69XXY

Presence of fetus

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14
Q

Why are hCG levels in partial molar pregnancy not elevated?

A

Proliferation of cytotrophoblastic tissue which does not produce hCG

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15
Q

What pattern can be seen on pelvic ultrasound with partial molar pregnancy?

A

Swiss-cheese appearance

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16
Q

What is important for patients to be on during follow-up of molar pregnancy?

A

Contraception because resolution is based on serial hCG monitoring

17
Q

What is the staging for malignant GTD?

A

Stage I: confined to uterus
II: mets to pelvis or vagina
III: mets to lung
IV: distant mets

18
Q

How is malignant GTD treated?

A

Extremely sensitive to chemotherapy

no surgery

19
Q

What can be seen on pelvic ultrasound with persistent/invasive mole?

A

High vascular flow on doppler

20
Q

What is choriocarcinoma?

A

Malignant necrotizing tumor, typically with preceding complete molar pregnancy (50%)
Pure epithelial tumor

21
Q

What is the histologic pattern of choriocarcinoma?

A

Sheets of anaplastic cytotrophoblasts and syncytiotrophoblasts in the absence of chorionic villi

22
Q

How does choriocarcinoma spread?

A

Hematogenously to lungs, vagina, pelvis, brain, liver, intestines, kidneys

23
Q

What are the signs and symptoms of choriocarcinoma?

A

Late post-partum bleeding (>6-8 weeks), or irregular uterine bleeding years afterwards
Often presents with metastatic disease = resp distress, cough, dyspnea, hemoptysis, CNS symptoms, vaginal bleeding, etc

24
Q

What is the nickname for choriocarcinoma?

A

The great imitator (because of mets)

25
Q

What is the treatment for choriocarcinoma?

A

Single-agent chemotherapy

multi-agent chemo for poor-prognosis

26
Q

What is PSTT?

A

Placental site trophoblastic tumors
Absence of villi
production of human placental lactogen (hPL)

27
Q

What is treatment for PSTT?

A

Hysterectomy and multiagent chemo to prevent recurrence

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