Gestational Trophoblastic Neoplasia Flashcards
What increases risk of molar pregnancy?
Asian women in US have risk of 1/800; women <20yo or >40yo, areas where people consume less beta-carotene and folic acid, women with 2 or more miscarriages
What does a complete mole look like on ultrasound?
“snowstorm” appearance due to presence of multiple hydropic villi
What is difference between complete and partial mole?
no fetus in cases of complete mole, partial can be a fetus and have placenta/cord which is usually grossly abnormal in partial mole; partial mole are triploid karyotype(69XXY,69XXX, or 69XYY) resulting from fertilization of egg by dispermy; complete moles are diploid resulting from fertilization of “empty egg” by single sperm(46,XX 90%) or by two sperm(46XY); partial moles show marked villi swelling and complete moles show trophoblastic proliferation with hydropic degeneration
What is a classic presentation of molar pregnancy?
vaginal bleeding in 95%, uterine size greater than dates in 25-50%, very high Beta-hCG; tachycardia from hyperthyroidism 10% and hypertension from preeclampsia 12-25% can also be seen
What should be done in case of discrepancy between dates and uterine size?
pelvic ultrasound to confirm dates, exclude multiple gestation, uterine abnormalities and molar pregnancy
what is standard management for molar pregnancy?
suction curettage
What is difference in common presentations of partial and complete?
partial present with lower beta-hCG, affect older patients, have longer gestations, and are often diagnosed as missed or incomplete abortions; complete usually present with larger uteri, preeclampsia and higher likelihood of developing into post molar GTD
What studies should be done prior to suction curettage of complete mole?
standard to rule out related problems such as chest xray to rule out pulmonary metastases, and liver and thyroid function; pelvic CT and brain MRI may be indicated if persistent GTD suspected following evacuation
How can persistent GTD be cured?
chemotherapy
At what point postpartum should beta-hCG return to normal?
3 months
What is CA-125 a tumor marker for?
epithelial ovarian cancers
Why should lesions suspicious for choriocarcinoma never be biopsied?
highly vascular
What is necessary to establish diagnosis of GTD(choriocarcinoma)?
positive beta-hCG in reproductive aged woman who has history of recent pregnancy(term, miscarriage,termination,mole)
Where does GTD commonly metastasize to?
lung(most common), brain, liver
What is the risk that molar pregnancy progress to malignant GTD?
20%
