Gestational trophoblastic disease (GTD) Flashcards
what is GTD
tumor originating from the trophoblast, which surrounds the blastocyst and develops into the chorion and amnion
can occur during or after an intrauterine or ectopic pregnancy
which diseases characterize GTD
include hydatidiform moles (both complete and partial), invasive moles, and choriocarcinoma.
typically arise from the abnormal fertilization of the ovum or overproliferation of the trophoblast
what is a Hydatidiform mole
growth of an abnormal fertilized egg (molar pregnancy) or an overgrowth of trophoblast from the placenta.
classificcation of hytadid mole
COMPLETE -no fetal parts -caused by fertilization of an empty egg w/o chromosomes -46xx d/2 sperm splitting 90% 46xy: dispermy 46yy is non viable so is not seen -diffuse choronic villi enlargement and inflammatin -increased risk of choriocarcinoma
partial -parts of fetus present -caused by fertilization of egg containing a haploid set of chromosomes with two sperms (each of them containing a haploid set of chromosomes) tal karyotype 69XXX, 69XXY, 69XYY -reduced risk of choriocarcinoma
invasive
Trophoblasts infiltrate the myometrium and gain access to the vascular system.
Hematogenic dissemination leads to metastatic growth in different organs (brain, lungs, liver).
RF for hytadid mole
Prior molar pregnancy
History of miscarriage
Patients ≤ 15 and ≥ 35 years
clinical features of complete mole
first trimester
vaginal bleeding
Uterus size greater than normal for gestational age
pathognomic ‘bunch of grapes’ which are vesicles(inflammed fluid filled blisters) that pass through vagina
endocrine symptoms
-preeclampsia before 20th wk gestation
-Hyperemesis gravidarum(severe nausea and vom in preg)
hyperthyroidism(Very high amounts of β-hCG may lead to hyperthyroidism because β-hCG structurally resembles TSH.)
Ovarian theca lutein cysts: bilateral, large, cystic, adnexal masses that are tender to the touch
what is a theca lutein cyst
functional ovarian cyst that is thought to originate from excessive amounts of circulating gonadotropins such as β-hCG. Typically multiple and seen bilaterally, with a high association with gestational trophoblastic disease and multiple gestations. USG shows bilateral enlarged, multilocular, cystic masses of the ovaries. Usually resolve spontaneously once the source of beta-hCG is removed
clinical features of partial mole
Less severe symptoms due to β-HCG levels that are lower than in complete moles
Vaginal bleeding
Pelvic tenderness
dg if hytadiform mole
β-HCG level measurement: reveal β-HCG that is way higher than expected for the gestational age
d/2 overproduction by proliferating trophoblast cells (> 100,000 mIU/mL)
Transvaginal ultrasound
complete:
- bunch of grapes,” or “snowstorm”) d/2 cystic spaces formed by hydropic(inflamed) villi
- No amniotic fluid
- Lack of fetal heart tones
partial:
-fetal parts may be visualized.
-Fetal heart tones may be detectable.
-Amniotic fluid is present.
-Increased placental thickness
-Swiss cheese US appearance
uterine evacuation: histopathological examination of evacuated uterine specimen
what dg method provides definite diagnosis
Uterine evacuation
rx of hytadid mole
Uterine evacuation by dilation and suction curettage to prevent invasive moles and choriocarinoma
Chemotherapy (usually methotrexate) if unresolved e.g.
1) β-HCG values do not decrease.
2) Histological features of malignant GTD are present.
3) If metastases are present on chest x-ray.
prognosis of hytadiform mole
Most patients achieve normal reproductive function after recovery.
define choriocarcinoma
Highly aggressive, malignant tumor consisting of trophoblastic tissue(synciotrophoblast and cytotrophoblast)
with a tendency to metastasize early vie hematogenous route
Staging 1 low risk
Stage 2-4 high risk
etiology of choriocarcinoma
50% hydatidiform mole
25% miscarriages or ectopic pregnancy
25% normal pregnancy
how does a choriocarcinoma develop (pathophys)
Destructive growth into myometrium without chorionic villi → risk of hemorrhage and early metastasis
Stage
