GTN

Question 1

______ is an abnormal proliferation of placental tissue involving both the cytotrophoblast and/or syncytiotrophoblast

Answer 1

GTN, or molar pregnancy,

Question 2

_______is the most common benign GTN. It results from fertilization of an empty egg with a single X sperm resulting in paternally derived (androgenetic) normal 46,XX karyotype.

Answer 2

Complete mole

Question 3

Complete mole

Progression to malignancy is ______

Answer 3

20%.

Question 4

____is the less common benign GTN. It results from fertilization of a normal egg with two sperm resulting in triploid 69,XXY karyotype

Answer 4

Incomplete mole

Question 5

___is the gestational trophoblastic tumor (GTT) which can develop in 3 categories.

Answer 5

Malignant GTN

Question 6

Good Prognosis metastatic disease has distant metastasis with the most common
location being the _____. Cure rate is >95%.

Answer 6

pelvis or lung

Question 7

Poor Prognosis metastatic disease has distant metastasis with the most common
location being the ______. Cure rate is 65%.

Answer 7

brain or the liver.

Question 8

Poor prognostic factors

Answer 8

Other poor prognosis factors are serum b-hCG levels >40,000, >4 months from the antecedent pregnancy, and following a term
pregnancy

Question 9

SSx of GTN

The most common symptom is_____

Answer 9

bleeding prior to 16 weeks’ gestation and passage of vesicles from the vagina.

Question 10

Sign of GTN

The most common sign is_______, absence of fetal heart tones, bilateral cystic enlargements of the ovary known as theca-lutein cysts

Answer 10

fundus larger than dates

Question 11

Characteristic sonology of GTN

Answer 11

“Snowstorm” ultrasound

Question 12

MX of GTN

Answer 12

• Baseline quantitative b-hCG titer
• Chest X-ray to rule out lung metastasis
• Suction D&C to evacuate the uterine contents

Question 13

Other Mx to give to pt with GTN during ff up

Answer 13

Place the patient on effective contraception (oral contraceptive pills) for the duration of the
follow-up period to ensure no confusion between rising b-hCG titers from recurrent disease and normal pregnancy

Question 14

How frequent to do HCG in benign GTN

Answer 14

Weekly serial b-hCG titers until negative for 3 weeks, then monthly titers until negative for 12 months

Question 15

If serial b-hCG titers plateau or rise and normal intrauterine pregnancy is ruled out by vaginal sonogram,
the patients are diagnosed with ______

Answer 15

persistent gestational trophoblastic disease

Question 16

Non-metastatic or Good Prognosis metastatic disease: ______until weekly b-hCG titers become negative for 3 weeks, then monthly titers until negative for 12 months. Follow-up is for 1 year

Answer 16

Single agent (methotrexate or actinomycin D)

Question 17

Poor Prognosis metastatic disease: __________until weekly b-hCG titers become negative for 3 weeks, then monthly titers for 2 years, then every 3 months for another 3 years. Follow-up is for 5 years.

Answer 17

Multiple agent chemotherapy (which includes

methotrexate, actinomycin-D and cytoxan)