Gestational Trophoblastic Disease

Question 1

DEFINITIONS:

1. Hydatidiform mole
2. Complete hydatidiform mole
3. Partial hydatidiform mole
4. Invasive mole
5. Choriocarcinoma
6. Gestational trophoblastic neoplasiaf

Answer 1

1. Localized, non-invasive proliferation.
2. one sperm fertilizes empty oocyte, no fetal tissue. 2 sets of paternal chromosomes, no fetus.
3. two sperms enter one oocyte, variable evidence of fetus. 3 sets, 2 paternal + 1 maternal, non-viable foetus
4. Proliferation characteristic of malignancy but locally within uterus.
5. If metastasis occurs.
6. Persistent GTD

Question 2

EPIDEMIOLOGY

Answer 2

1. 1 in 500-1000 pregnancies.
2. Asian
3. Extremes of reproductive age.

Question 3

CLINICAL FEATURES

Answer 3

1. Large uterus
2. Early pre-eclampsia
3. Hyperthyroidism(rare)
4. Heavy vaginal bleeding
5. Hyperemesis
6. Hypert.

Question 4

INVESTIGATIONS

Answer 4

1. US: snowstorm appearance w multiple swollen villi w complete moles.
2. Dx. confirmed histologically
3. Serum hCG: v high.

Question 5

MANAGEMENT

Answer 5

1. ERPC, confirm Dx. histologically.
2. Serial blood and urine hCG.
   - follow up every 2w ntil 6 months
   - beta-hCG usually normal within 2-3 months.
3. Register w supraregional centre.
4. Avoid pregnancy and COCP until hCG levels normal. usually for 12 months.
   - Inform supraregional centre at the end of future pregnancy. hCG levels will be measured at end of pregnancy to exclude the disease recurrence.

Question 6

COMPLICATIONS

1. Recurrence:
   - 1 in 60 subsequent pregnancies.
2. GTN
   - follows 15% complete moles, 0.5% partial moles
   - molar pregnancy precedes 50% malignancies

*scoring based on FIGO 2000.

Answer 6

1. further hCG samples after every future pregnancy.
2. Persistently elevated hCG, persistent vaginal bleeding, evidence of blood-borne mets(commonly lungs)
   Tx: low-risk pts(≤6): IM methotrexate + folic acid. high-risk pts(>6): combination chemotx. Advised not to conceive for 1y after completing tx.
   5y Prognosis near 100%