Gestational Trophoblastic Disease

Question 1

What is GTD

Answer 1

disorder of early pregnancy, term for a group of pregnancy related tumours

Question 2

How does GTD differ from normal pregnancy?

Answer 2

the trophoblastic tissue proliferates more aggressively and the pregnancy is non-viable

Question 3

In what ethnicity is GTD more common?

Answer 3

asian

Question 4

What are the different types of GTD?

Answer 4

hydatidiform mole - localised and non-invasive proliferation (complete or partial)
invasive mole - malignant prolif w invasion local to the uterus
choriocarcinoma - invasive but w metastasis
GT neoplasia - persistence of GTD w persistently high hCG

Question 5

What are the types of hydatidiform mole

Answer 5

complete - entirely paternal in origin, sperm fertilises empty oocyte and does mitosis, resulting in XX tissue, no fetal tissue
partial - triploid, two sperm enter one oocyte leading to variable evidence of a fetus

Question 6

What is found on examination in GTD?

Answer 6

large uterus
early pre-eclampsia
hyperthyroidism

Question 7

What sx can the woman experience in GTD?

Answer 7

heavy menorrhagia

hyperemesis

Question 8

What are the ix for GTD

Answer 8

US - snowstorm appearance of stollen villi w complete moles
Histological diagnosis
Increased hCG

Question 9

What is the management of GTD

Answer 9

1. Suction curettage (ERPC) to remove tissue

2. Take serial hCG + if rinse or persistent -> malignancy

Question 10

What is the recurrence rate in subsequent pregnancies and how can this be excluded?

Answer 10

1 in 60, exclude w hCG measurements