Gestational trophoblastic disease Flashcards
What is gestational trophoblastic disease??
Hydatidiform mole
Choriocarcinoma
Trophoblastic tumour
What are complete moles?
Diploid and androgenic
Single sperm after ferilization of empty ovum
Disperm fertilisation of empty ovum so no maternal nuclear DNA altho mitochondrial DNA is maternal
What are partial moles
Dispermic fertilisation of an ovum and are triploid
Evidence of fetal parts or red cells
What are hydatidimform moles?
Tumours consist of proliferating chorionic villi which have swollen and degenerated
Makes lots of hCG giving rise to exaggerated pregnancy symptoms and strongly positive pregnancy tests
What are risk factors for hydatidiform mole?
Extremes of child-bearing age
Past mole
Asian women
What are signs of hydatidiform moles?
Early pregnancy failrue - failed miscarriage or signs on US Vaginal bleeding Molar tissue may look like frogspawn passed PV Large abdomen - uterus large for dates Severe nausea and vomiting First trimester pre-eclampsia
Abdo pain due to huge theca-lutein cysts in both ovaries
Take 4 months to resolve after molar evaluation
hCG resembles TSH and may cause hyperthyroidism
What is seen on US in hydatidiform moles?
Snowstorm effect
What is management for hydatidiform moles?
Molar tissue is removed from the soft, easily perforated uterus by gentle suction ( with dilation and curettage)
Send to histology for confirmation of diagnosis
Give Anti-D if Rh negative mother
Pregnancy avoided for 6 months until hCG normal
What is choriocarcinoma?
Highly malignant tumour
Following benign mole
Following miscarriage
Following a normal pregnancy
How does choriocarcinoma present?
May be years after pregnancy General malaise Uterine bleeding Signs and symptoms form metastases Nodules on CXR Pulmonary artery obstruction via tumour emboli may cause pulmonary artery hypertension (haemoptysis, dyspnoea)
what is management for choriocarcinoma?
Combination chemotherapy based on methotrexate
What are placental site trophoblastic tumours?
Grow slower, present later, rarer, produce less hCG
Post chemotherapy residual disease is excised (womb and nodes)
What are indications for chemotherapy?
hCG > 20000 units/L 4 weeks post evaculation
Static or rising hCG after evacuation in absence of new pregnancy
Raised hCG 6m post evacuation even if falling
Heavy vaginal bleeding or GI or intraperitoneal bleeding
Evidence of brain, liver, GI or lung mets
Histology of choriocarcinoma
What tests following removal of mole?
CXR to check for spread to lungs
hCG level:
Level returns to normal, usually within 10 weeks, and remains normal, and no further treatment is needed
Then, computed tomography (CT) of the brain, chest, abdomen, and pelvis is done to determine whether choriocarcinoma has developed and spread
If mole persists - chemotherapy - methotrexate, cyclophosphamide
What advice following molar pregnancy
No pregnancy for 6 months
This is make sure treatment is successful
Use contraceptive
If they do become pregnant, do USS early
