gestational trophoblastic disease/molar and GTN

Question 1

Molar pregnancy ?

Answer 1

is an abnormal proliferation of placental tissue

Question 2

Molar pregnancy Classification

Answer 2

*Benign (partial and Complete mole)
*Malignant (choriocarcinoma)

Question 3

Molar pregnancy clinical presentation

Answer 3

Patients present with vaginal bleeding, pelvic pressure or pain, an
enlarged uterus, and hyperemesis gravidarum.

Question 4

Molar pregnancy dx:

Answer 4

*Patients may be diagnosed based on unusually high serum beta-hCG (>20000) or ultrasound findings.

*The ultrasound findings depict a “snowstorm” or “Swiss cheese” pattern

*pattern, classically associated with a complete molar pregnancy (hydatidiform mole

Question 5

malignant GESTATIONAL trophoblastic neoplasm types

Answer 5

*complete hydatidiform mole
*partial hydatidiform mole
*coexistent mole and living fetus
* invasive mole
*choriocarcinoma
*placental site trophoblastic tumor

Question 6

non - metastatic GTN lacation?

Answer 6

localized only to the uterus. Cure rate is 100%.

Question 7

Good prognosis metastatic disease,location?

Answer 7

distant metastasis; the most common location is the pelvis or lung. Cure rate is >95%.

Question 8

Poor prognosis metastatic disease

Answer 8

*distant metastasis (most commonly brain or liver).
*serum β-hCG levels >40,000
* >4 months from the antecedent pregnancy
*following a term pregnancy.50%
*Cure rate is 65%.

Question 9

Benign GTN Tx:

Answer 9

*Urgent suction (to avoid planting)

*Weekly serial β-hCG titers until negative for 3 weeks then monthly titers until negative for 12 months. Follow-up is for 1 year.

*

Question 10

If serial β-hCG titers plateau or rise , patient is diagnosed with

Answer 10

persistent gestational trophoblastic disease

Question 11

persistent gestational trophoblastic disease
next step:

Answer 11

**CT
Proceed with a metastatic workup (CT scan of the brain, thorax, abdomen, and pelvis)

Question 12

Non-metastatic or good prognosis metastatic disease:
tx:

Answer 12

*single agent (methotrexate or actinomycin D) until weekly β-hCG titers become negative for 3 weeks, then monthly titers until negative for 12 months.

*Follow-up is for 1 year.

Question 13

Poor prognosis metastatic disease: tx:

Answer 13

multiple agent chemotherapy (which includes methotrexate, actinomycin-D, and cyclophosphamide until weekly β-hCG titers become negative for 3 weeks, then monthly titers for 2 years, then every 3 months for another 3 years.
** EMACO : Etoposide,Methotrexate,Actinomycin,Oncovin

*Follow-up is for 5 years.

Question 14

typical ultrasound finding in hydatidiform mole

Answer 14

is the presence of multiple hypoechoic areas, known as “snowstorm pattern” which represent hydropic villi.

Question 15

treatment of molar pregnancy

Answer 15

*via evacuation or hysterectomy
*After evacuation, beta HCG is measured serially every week until the values decline to levels undetectable
*woman is placed on oral contraceptive pills during this period.

Question 16

what finding in partial hydatidiform mole from curettage ?

Answer 16

triploid karyotype

Question 17

complete mole

Answer 17

empty egg (always)+sperm or two sperms
* 46,xx/46xy
*no fetus
*no amnion /fetal RBC
*diffuse villous edema and trophoblastic proliferation
* molar gestation presentation
*uterine size 50%larger
*rare complication

• 15% post molar invasion
• 4% malignancy

Question 18

partial mole caused by

Answer 18

normal egg(23,x)+2 sperms or altered sperm (46,xy) = triploid zygote
* 69,xxx/69xxy
*there is fetus
*there is amnion /fetal RBC
*focal villous edema and trophoblastic proliferation
* missed abortion presentation
*uterine size small/appropriate
*rare complication

• 5%post molar invasion
• 5% malignancy