Gestational Trophoblastic Disease Flashcards
risk fx of molar preg
- prior hx
- maternal <25 or >40
- prior spontaneous abortion
- diff conceiving
- beta caroten/vitamin A deficiency?
- asian
molar trophoblastic neoplasia
- always gestational
- villi
- paternal DNA OVERABUNDANCE –> preferentially makes extra embryonic tissues
non-molar trophoblastic neoplasia
- no villi
- non-gestational choriocarcinoma
- ovary/testes/chest
complete mole
- single (or 2) sperm + empty egg
- sperm REDUPLICATES (end-duplication) forming “complete” 46 chromosome set
- 46 XX, or 46 XY
- higher CA risk
- uniparental (androgenetic)
partial molar pregnancy
- egg Fert by 2 sperm
- one sperm reduplicates itself (69 XXY, 92 XXXY)
- biparental
paternal DNA preferentially makes
extra-embryonic tissues
maternal DNA preferentially makes
embryonic tissues
NLRP7
inactivates maternal genes
p57
- kinase inhibitor
- apoptosis
- normally express in maternal tissue and villi when maternal DNA present
- molar preg –> NOT expressed
partial hydatiform mole
xs placental tissue, xs paternal DNA
-IUGR, syndactyly
vesicular villi grossly ID, often >1cm
complete hydatidiform mole
which mole has higher recurrence rate?
complete mole
partial mole on US
- placenta w/ cystic spaces
- fetus
- reduced amniotic fluid volume
- theca lutein cysts absent
choriocarcinoma
- malignancy of trophoblast
- gestational
- bleeding
- toxemia (pre-eclampsia)
- hypERthyroidism
- METS
- high chemosensitive
- high hCG
currant juice bleeding
choriocarcinoma
vesicles in discharge
Choriocarcinoma
theca lutein cysts palpable
Choriocarcinoma
monitor ___ after mole evacuation
hCG
Gestational Trophoblastic Disease tx
(chorioCA)
- surgery evacuation
- hysterectomy over 40
- prophylactic chemo (methotrexate, actinomycin D)
choriocarcinoma is highly sensitive to
chemo
When is it safe for woman with past hx of molar preg to become pregnant again?
hCG undetectable for 3 weeks
dx of GTN
hCG plateaus over 3 wk, rises 10% of 2 wk
quiescent GTN
- persistently low (<200)
- measure hCG-H (hyperglycosylated hCG
When is it safe for woman with past hx of molar preg to use OCP?
after hCG falls to zero
