Gestational Tumors B&B Flashcards
what is the most common gestational trophoblastic disease (GTD)?
hydatidiform mole, aka molar pregnancy: growth of trophoblast tissue that develops into swollen chorionic villi
“hydatid” = fluid filled cyst, “mola” = false pregnancy
villi form “clusters of grapes” that appear like a “snowstorm” on ultrasound
A women comes into the office for an ultrasound to confirm her pregnancy. However, the ultrasound shows many black circles that give the appearance of a snowstorm. A biopsy is taken from her uterus which shows swollen chorionic villi that appear like a “cluster of grapes.” What is the most likely diagnosis?
hydatidiform mole, aka molar pregnancy: growth of trophoblast tissue that develops into swollen chorionic villi
most common gestational trophoblastic disease (GTD)
[“hydatid” = fluid filled cyst, “mola” = false pregnancy]
how do the 2 subtypes of molar pregnancy differ?
complete mole: sperm fertilizes an “empty” egg, all chromosomes are paternal - p57 negative and NO fetal tissue
partial mole: 2 sperms fertilize a normal egg, causing a triploid (69,XXX or 69,XXY) - p57 positive and some fetal tissue
how can a complete molar pregnancy be detected with immunostaining?
complete mole: sperm fertilizes “empty” egg, so all chromosomes are paternal —> NO fetal tissue
immunostaining shows the tissue is p57 negative because this is a cyclin dependent kinase only expressed by maternal chromosomes (imprinted gene)
What are the clinical features of a complete molar pregnancy? (name a few)
sperm fertilizes an “empty” egg, all chromosomes are paternal - p57 negative and NO fetal tissue
—> uterus is too big for the stage of pregnancy due to swelling of chorionic villi
—> painless uterine bleeding due to separation of molar villi from decidua (do not implant normally)
—> hyperemesis gravidarum: severe N/V with weight loss
—> extremely high hCG levels because this is malignancy of placental tissue, which makes hCG
—> ovarian theca lutein cysts via hCG stimulation
—> hyperthyroidism via very high hCG causing stimulation of TSH receptor
—> preeclampsia in FIRST trimester
A women in her first trimester presents to her OBGYN with painless uterine bleeding. She has had difficulty gaining weight due to severe vomiting. She has also become very heat intolerant. Her BP is taken twice and she is hypertensive. Urinalysis reveals proteinuria. Blood is drawn which shows her hCG is over 100,000. You order an ultrasound. What do you expect to see? What is going on?
complete molar pregnancy: sperm fertilizes an “empty” egg, all chromosomes are paternal - p57 negative and NO fetal tissue
—> uterus is too big for the stage of pregnancy due to swelling of chorionic villi
—> painless uterine bleeding due to separation of molar villi from decidua (do not implant normally)
—> hyperemesis gravidarum: severe N/V with weight loss
—> extremely high hCG levels because this is malignancy of placental tissue, which makes hCG
—> ovarian theca lutein cysts via hCG stimulation
—> hyperthyroidism via hCG stimulation of TSH receptor
—> preeclampsia in FIRST trimester!
ultrasound will show ”snowstorm” appearance (lots of black circles)
hyperemesis gravidarum
severe N/V with weight loss
when a female patient presents with preeclampsia in the first trimester (before 20 weeks), what should you be thinking about?
complete molar pregnancy: sperm fertilizes an “empty” egg, all chromosomes are paternal/ NO fetal tissue —> swelling of chorionic villi
classically presents with first trimester preeclampsia (as well as very high hCG, uterine bleeding, N/V, large uterus)
ultrasound will show “snowstorm” (lots of black circles)
how is molar pregnancy surgically and pharmacologically treated?
molar pregnancy: growth of trophoblast tissue that develops into swollen chorionic villi
usually treated with surgery - uterine suction curettage (scraping device with suction attached)
chemotherapy is used for high risk patients in which features suggest high likelihood of choriocarcinoma - methotrexate or actinomycin D
why is it important to monitor hCG levels after a molar pregnancy?
molar pregnancy: growth of trophoblast tissue that develops into swollen chorionic villi
may be followed by choriocarcinoma (also malignancy of placental tissue)
hCG should fall after treatment of molar pregnancy, but if it falls and plateaus, it suggests choriocarcinoma has developed
A woman recently treated for a molar pregnancy develops a persistent cough with some blood and seeks medical attention. A CXR is taken which shows profuse opacities. How will you confirm the likely diagnosis, and what is her prognosis?
most likely developed choriocarcinoma after molar pregnancy - check to see if hCG levels are still elevated (this is also a malignancy of placental tissue)
made of syncytiotrophoblasts and cytotrophoblasts but NO formation of villi (as forms in molar pregnancy)
has early and extensive metastasis via hematogenous spread, 80% of the time to the lungs
fortunately it is very sensitive to chemotherapy with methotrexate or actinomycin D! most patients are cured!
to where does gestational choriocarcinoma most often metastasize, and what is the prognosis?
made of syncytiotrophoblasts and cytotrophoblasts, often follows molar pregnancy but NO formation of villi (as forms in molar pregnancy) - hCG will be elevated
early and extensive metastasis via hematogenous spread, 80% of the time to the lungs
fortunately it is very sensitive to chemotherapy with methotrexate or actinomycin D! most patients are cured!
