Gestational Trophoblastic Disorders

Question 1

What are 3 disorders GTD includes?

Answer 1

complete hydatidiform mole
partial hydatidiform mole
choriocarcinoma

Question 2

What is complete hydatidiform mole?

Answer 2

Benign tumour of trophoblastic material.

Occurs when an empty egg is fertilized by a single sperm that then duplicates its own DNA, hence the all 46 chromosomes are of paternal origin.

Question 3

What are features of a complete hydatidiform mole?

Answer 3

bleeding in first or early second trimester
exaggerated symptoms of pregnancy e.g. hyperemesis
uterus large for dates
very high serum levels of human chorionic gonadotropin (hCG)
hypertension and hyperthyroidism may be seen - hCG can mimic TSH

Question 4

How is a complete hydatidiform mole managed?

Answer 4

urgent referral to specialist centre - evacuation of the uterus is performed

effective contraception is recommended to avoid pregnancy in the next 12 months

Around 2-3% go on to develop choriocarcinoma

Question 5

What is a partial hydatidiform mole?

Answer 5

a normal haploid egg may be fertilized by two sperms, or by one sperm with duplication of the paternal chromosomes. Therefore the DNA is both maternal and paternal in origin. Usually triploid - e.g. 69 XXX or 69 XXY. Fetal parts may be seen