Gestational trophoblastic disease Flashcards
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What forms of GTD are there?
Hydatidiform mole (premalignant); can be partial, complete or invasive (this form is malignant)
Choriocarcinoma (malignant)
Placental site trophoblastic tumour (very rare, also malignant)
What is a partial mole?
Triploid with 2 sets of paternal and 1 set of maternal chromosomes
Embryo often present that dies at 8-9w
0.5% need chemo for invasive disease
What is a complete mole?
No foetal pole, diploid chromosomes paternally derived - androgenetic
No embryo
Chemo rate 8-20%
How many pregnancies are molar?
1 in 1000 live births
Presentation?
Vaginal bleeding (molar tissue may look ‘like frogspawn’)
HG
Uterus large for dates
Possible hyperthyroidism
Diagnosis
USS (‘snowstorm effect’ and increased vascularity)
Histology after surgical evacuation
What are the chances of invasive disease from molar pregnancy?
PM - 0.5%
CM - 8-20%
When is choriocarcinoma likely to present?
Following any subsequent pregnancy - inc miscarriage and TOP, as well as following term birth
Very curable
What are hydatidiform moles derived from?
Chorionic villi (that have swollen and degenerated)
Who is at increased risk of a molar pregnancy?
Extremes of childbearing age
Following previous mole
Asian women
How are moles managed?
Surgical excision and hCG monitoring; recommended the woman avoids pregnancy until hCG normal for 6 months
How does choriocarcinoma present?
May be years after pregnancy with general malaise or uterine pregnancy
Metastatic symptoms
How is choriocarcinoma managed?
Very responsive to combined chemotherapy in high risk groups and methotrexate with folic acid in lower risk groups.
Outlook is good if non-metastatic and fertility typically retained.
Is recurrence common in molar pregnancies?
About 1 in 60; at all future pregnancies further hCG samples required to exclude recurrence
