Gestational trophoblastic Neoplasia

Question 1

What are diagnostic criteria for GTN?

Answer 1

ddx: plateau or increase hcg after evacuation of mole, diagnosis of choriocarcinoma, invasive mole on ECC.
- hcg plateau of 4 values, persistence of hcg >6 months post-evacuation
- need pelvic US and CXR

Question 2

What is an invasive mole?

Answer 2

molar pregnancy that grows into the uterus. confined to uterus, trophoblasts invade into myometrium

Question 3

What is a choriocarcinoma?

Answer 3

Risk for systemic mets!
50% from term pregnancies, 25% normal gestations, 25% moles
- neoplastic syncytiotrophoblast and cytotrophoblast elements WITHOUT chorionic villi.
- Need chemo bc early systemic mets (lung, vagina, liver, brain)

Question 4

What is a placental site trophoblastic tumor?

Answer 4

rare, absence of villi, arises from placental implantation after NORMAL TERM GESTATION
-, intermediate trophoblastic cells, lower growth rates, chemo-resistant, delayed presentation after pregnancy, vaginal bleeding. HYSTERECTOMY=treatment. Only post-surgery chemo if metastasis. - - assoc w/ nephrotic syndrome
Can’t use WHO scoring system!
malignant transformation of intermediate trophoblasts: can secrete hcg and HPL. polypoid mass in endometrium w/ focal hemorrhage and necrosis.

Question 5

What is an epithelioid trophoblastic tumor (ETT)?

Answer 5

are, resembles squamous cell cervical cancer. Like PSTT, chemoresistant, need hyst w/ LN dissection.

Question 6

What are risk factors for development of post-molar trophoblastic disease?

Answer 6

hcg >100K, excessive uterine size, theca-lutein cysts>6cm. use OCPs for contraception!

Question 7

What is a partial mole?

Answer 7

karyotype 69XXX or 69XXY or 69XYY. - Fetus present, often SAB
- rare postmolar malignant sequelae
- p57 stain
- US findings (focal cystic changes in placenta, ratio of transverse to AP diameter of GS > 1.5)

Question 8

What is a complete mole?

Answer 8

karytype 46 XX (90%), 46 X. Prevalence: 1/1000, 20% persistence after D&E, all paternal origin
no fetal parts
- US: diffuse mixed echogenic pattern (snowstorm), uterus large for dates
theca lutein cysts
- postmolar sequelae.
- B-hcg normalizes after 2 months

Question 9

What happens with metastases in GTN?

Answer 9

The lung is the most common site of metastasis, and other metastatic sites include the vagina, tubes, ovaries, liver, spleen, kidneys, bowel, brain, etc.

• Distant metastases such as liver and brain are more likely to have a poor prognosis