GTD: Malignancy

Question 1

Define

Answer 1

A form of gestational trophoblastic disease (GTD) associated with local invasion or metastasis

· 1 in 20,000-30,000 pregnancies

· Rapidly metastasising (lung, vagina, brain, liver, kidney)

· Forms of malignancy (all metastasise widely – especially to lung, pelvic organs and the brain)

• Invasive mole → hydatidiform mole with invasion of myometrium, necrosis and haemorrhage
• Choriocarcinoma → cytotrophoblast and syncytiotrophoblast without formed chorionic villi invade myometrium

Rapidly metastasise
- Placental site trophoblastic tumour à intermediate trophoblasts infiltrate myometrium without causing destruction, contains GPL [very rare – less than 1% of GTD is PSTTs)

Question 2

Risk factors

Answer 2

Extremes of reproductive age

o Ethnicity (Japanese, Asian, native American Indians)

o Previous gestational trophoblastic disease

o Diet – low beta carotene, low saturated fat

Question 3

Aetiology

Answer 3

Abnormal chromosomal material of placental tissue

Invasive moles always follow hydatidiform mole

Choriocarcinoma arises from…
- Molar pregnancy (50%)
- Viable pregnancy (22%)
- Miscarriage (25%)
- Ectopic pregnancy (3%

Question 4

Signs and symptoms

Answer 4

Persistent PV bleeding, hyperemesis gravidarum, lower abdominal pain

o Lung metastasis – haemoptysis, dyspnoea, pleuritic pain

o Bladder/bowel – haematuria, PR bleeding

o O/E → excessive uterine size for gestation

Question 5

Ix/ Mx/ Complications

Answer 5

Investigations:
- Bloods – serum βHCG (persistently raised or rising after ERPC), FBC, LFT (mets)
- Imaging – pelvic USS (snowstorm, vesicles or cysts), CXR, CT CAP, MRI brain

Management:
- Manage in specialist centres – CX, Sheffield, Dundee
- Chemotherapy – methotrexate, hysterectomy for placental site trophoblastic tumour

Complications:
- Metastasis
- Chemotherapy side effects