Gestational Trophoblastic Disease GTD

Question 1

Define gestational trophoblastic disease

Answer 1

Spectrum of pregnancy related neoplastic conditions that may be benign (molar pregnancy/ hydatiform mole ) or malignant (choriocarcinoma)
Due to abnormal proliferation of placental trophoblasts

Question 2

Define complete molar pregnancy

Answer 2

AKA complete hydatiform mole

Abnormally fertilised egg: ovum containing no maternal genetic material fertilised by one or two sperm so all genetics from paternal. Chromosomes from mother lost /inactivated and paternal chromosomes duplicated

Question 3

Define incomplete hydatiform mole

Answer 3

AKA incomplete molar

Maternal chromosomes remain but 2 sets of paternal chromosomes. Embryo has 69 chromosomes instead of 46. Usually when 2 sperm fertilise egg

Question 4

Name 3 types malignant gestational trophoblastic disease

Answer 4

• Choriocarcinoma!
• Placental site trophoblastic tumour PSTT
• epitheloid trophoblastic tumours ETT

Question 5

Name 3 common sites metastasis choriocarcinoma

Answer 5

• Lungs
• brain
• liver
• vaginal

Question 6

What do placental site tumours and epitheloid trophoblastic tumours produce

Answer 6

Human placental lactogen

Question 7

Define post molar gonadotropic neoplasm/how diagnose (4)

Answer 7

Now cancerous. diagnose if:

• plateau BHCG lasts for 4 measurements over 3 or more weeks
• rise of BHCG of a 3 week consecutive measurement or longer, over at least 2 weeks or more
• BHCG remains elevated for 6 months or more
• confirm with histology choriocarcinoma

Question 8

FIGO anatomic staging for gonatrophic tumour?

Answer 8

Stage 1: confined to uterus
Stage 2: outside uterus but confined to genital organs
Stage 3: lungs
Stage 4: distant site mets eg brain, liver, GIT