Gestational Trophoblastic Disease Flashcards
What proportion of GTD is non invasive or benign?
80%
Benign GTD include
Partial Molar pregnancy, complete molar pregnancy
Complete molar pregnancy has what percent chance of malignancy
15%
Partial molar pregnancy has what percent chance of malignancy
5%
Invasive GTD include
Invasive mole, choriocarcinoma, PSTT, ITT, Epitheliod ITT
Incidence rate for molar pregnancy
1/1500
Risk factors for Molar pregnancy
extremes of maternal age, Asian and Latina race, prior history of GTD, Deficiency in carotene, Vitamin A or animal fat, Smoking, Maternal blood type AB, A, B
What is the risk of recurrence with one prior molar pregnancy?
1%
What is the risk of recurrence with 2 prior molar pregnancies?
30%
Most common symptom of molar pregnancy
First trimester bleeding - 90%
Theca Lutein cysts are associated with which type of molar pregnancy?
complete Mole
Ultrasound findings for complete mole
no fetal parts, no amniotic fluid, thecal lutein cysts, snow storm appearance
Ultrasound findings for partial mole
Fetus with amniotic fluid, focal anechoic spaces, no thecal lutein cysts
True of false: Complete moles have higher HCG than partial mole?
True
Management of Complete and partial molar pregnancy
Suction D&C
Medical complications from Molar pregnancy
Thyroid storm, Embolization of trophoblastic tissue - RDS, Cardiac failure from high output
risk factors associated with medical complications from Molar pregnancy
Uterine size > 14 - 16 wks, High HCG levels
Presentation: Complete Mole
Uterus size > dates, pre-eclampsia, hyperthyroidism, theca lutein cysts
Presentation: Partial Mole
Missed or complete abortion, lower HCG levels
Risk of persistent disease and need for chemo: Complete mole
20%
Risk of persistent disease and need for chemo: Partial Mole
5%
Karyotype of complete mole
Completely dad, 2 sperm empty ovum 46 XX (most common), 46 XY
Karyotype of incomplete mole
2 sperm, complete egg
Triploidy 69 XXX or 69 XXY
Pathology of complete mole
Grape like clusters, Diffuse trophoblastic proliferation
Pathology of incomplete mole
fetal parts, two populations of chorionic villi, focal trophoblastic proliferation
Risk of uterine invasion with complete mole
15%
Follow up for molar pregnancy
weekly bHCG until 0, monthly BHCG for 6 months thereafter
what percent of choriocarcinoma arise from complete molar pregnancies?
50%
What percent of GTD cases are Placental site Trophoblastic tumors PSTT?
< 0.2%
FIGO Criteria for malignant GTD after evacuation of molar pregnancy
- HCG plateau or declined < 10 % on 4 values over a 3 week period
- hcg increases > 10% on 3 values over a 2 week period
- Persistence of detectable HCG after more than 6 months following evacuation
If a patient with GTD has evidence of vaginal involvement or evidence of metastasis on CXR what is the next step?
Brain CT or MRI
What WHO score is considered Low risk
< 4
What WHO score is considered middle risk
4 - 7
What WHO score is considered high risk
> or equal to 8
What percentage of patients with metastatic, poor prognosis disease are cure with chemotherapy
70%
True or false: In patients with previous history of molar pregnancy, obtain a 6 week BHCG following next normal delivery
True
Management of Choriocarcinoma
Multi agent Chemotherapy EMACO
Management of placental site trophoblastic Tumors
Hysterectomy
