Gestational Trophoblastic Disease Flashcards
what do hydatidiform moles originate from
the trophoblast
outline the pathology of moles
trophoblastic proliferation
villi become swollen and oedematous
describe the macroscopic appearance of a mole
grape like clusters
what are the risk factors for GTD
extremes of maternal age
history of GTD
OCP
dietary lack of beta carotene
smoking
how does a complete mole arise
there is no maternal tissue in the egg
either one sperm enteres teh egg and duplicates, or 2 sperm enter the egg
compare the chromosomal picture of complete mole to partial mole
partial - 2 sperm join one egg
what does synctoptrophoblast proliferation cause
secretion of lots of bhCG, this is responsible for the exaggerated symptoms of pregnancy
what does the body often confused the large amounts of beta hCG with
TSH or FH/LSH
as a result there may be hyperthyroidism symptoms of formation of lutein cysts
how does a complete mole present
- Typically, presents 1st trimester of pregnancy with missed period
- Heavy vaginal bleeding during early pregnancy (1st/early 2nd trimester)
- Uterus may be larger than expected
- High hCG can cause photophobia, mood changes (agitation and irritability), dizziness, nausea and vomiting - exaggerated symptoms of pregnancy
- May cause hyperemesis gravidarum – severe nausea and emesis
- luteil cysts may be palpable and hyperthyroidism symptoms
what are the average beta hCG levels in complete mole
>100,000 IU/L
what investigation should be performed if susepcted mole
US
what is seen on US of complete mole
absence of foetal parts
large uterus for gestational age
no foetus means absence of heart sounds
snowstorm/bunch of grapes appearance
what are the 2 management options of complete mole
dilation and evacuation - remove tumour and then classify it based on clinical criteria
hysterectomy
which women are more likely to favour a hysterectomy
those who have completed childbearing
what should ne monitored after treatment
hCG, if it doesnt normalise in 10n weeks –> persistent GTD
what is the mangement outline of persistnet disease
CT brain, abdomen, pelvis etc
chemotherapy
what drug is used as chemotherapy
methotrexate
is contraception required after treatment
yes, for 6-12 months
hCG levels need to be monitored and pregnancy would cause them to rise
what is the risk of GTD recurrence
around 1% - is a risk factor
is hCG as elevated in incomplete mole as it is in complete
the cytotrophoblast layer proliferates in incomplete (doesnt produce hCG), so it is only mildly elevated
what is formed in incomplete mole
some foetus, with multiple defects
