GTN Flashcards
a predominant maternal risk factor for molar pregnancy includes which of the following?
a. Advanced maternalage
b. Prior cesarean delivery
c. Type 2 diabetes mellitus
d. African American ethnicity
a. Advanced maternalage
also very young and prior h.mole
hydatidiform moles are characterized by the lack of/presence of villi and nonmolar trophoblastic malignant neoplasm are characterized by the lack of/presence of villi.
hydatidiform moles are characterized by the presence of villi and nonmolar trophoblastic malignant neoplasm are characterized by the lack of villi.
Partial Mole
Karyotype
Preliminary diagnosis
uterine size
Karyotype - 69XXX or 69XXY
Preliminary diagnosis - missed abortion
uterine size - small for dates
Partial Mole
Karyotype
Preliminary diagnosis
uterine size
theca-lutein cysts - rare
initial hCG level - <100,000
rate of subsequent GTN - 1-5%
Complete Mole
Karyotype
Preliminary diagnosis
uterine size
Karyotype - 46XX
Preliminary diagnosis - molar gestation
uterine size - large for dates
Complete Mole
theca-lutein cysts
initial hCG level
rate of subsequent GTN
theca-lutein cysts - 25-30%
initial hCG level - >100,000
rate of subsequent GTN
Partial Mole
embryo-fetus
amnion, fetal erythrocytes
villous edema
embryo-fetus - often present
amnion, fetal erythrocytes - often present
villous edema - focal
Partial Mole
throphoblastic proliferation
trophoblast atypia
p57 immunostaining
throphoblastic proliferation - focal, slight to moderate
trophoblast atypia - mild
p57 immunostaining - positive
Complete Mole
embryo-fetus
amnion, fetal erythrocytes
villous edema
embryo-fetus - absent
amnion, fetal erythrocytes - absent
villous edema - widespread
Complete Mole
throphoblastic proliferation
trophoblast atypia
p57 immunostaining
throphoblastic proliferation - slight to severe
trophoblast atypia - marked
p57 immunostaining - negative
With regard to molar pregnancies, what does the
term “androgenesis” refer to?
a. Increased placental androgen production
that promotes villous edema
b. Development of a zygote that contains
only maternal chromosomes
c. Increased placental androgen production
the leads to maternal virilization
d. Development of a zygote that contains only paternal chromosomes
d. Development of a zygote that contains only paternal chromosomes
Increased serum free thyroxine levels in women with hydatidiform moles stem from increases in which of the following:
A. Maternal estrogen levels
B. Fetal thyroxine production
C. Maternal progesterone levels
D. Maternal B-HCG levels
D. Maternal B-HCG levels
thyrotropin-like effects of hCG frequently cause serum free thyroxine (fT4) level to be levated and TSH levels to be decreased
(-) p57 immunostaining
a. incomplete mole
b. complete mole
b. complete mole
Triploid diandric monogenome
A. Partial mole
B. Complete mole
C. Invasive mole
D. Choriocarcinoma
A. Partial mole
Marked trophoblast atypia
A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma
B. Complete Mole
As gestation advances, symptoms tend to be more/less pronounced with complete complete mole compared to partial mole
As gestation advances, symptoms tend to be MORE pronounced with complete complete mole compared to partial mole
What is the phenomenon called when high serum hCG levels cause a false negative? Why?
Hook effect; excessive hCG level oversaturate the assay’s targeting antibody and create a falsely low reading
sonography yields a “snowstorm” appearance
A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma
B. Complete Mole
sonography yields a thickened, multicystic placenta along with a fetus or at least fetal tissue
A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma
A. Partial Mole
Sonography yields multi-cystic findings
A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma
A. Partial Mole
p57 is a nuclear protein whose gene is maternally/paternally imprinted and maternally/paternally expressed
p57 is a nuclear protein whose gene is paternally imprinted and maternally expressed
In addition to partial moles, what are the two conditions in which p57 is strongly expressed?
normal placentas
spontaneous pregnancy losses with hydropic degerneration
what is the preferred method of molar evacuation?
suction curetage
Criteria for diagnosis of gestational trophoblastic neoplasia, which of the ff is included?
A. Rising B-hcg levels
B. Plateued B-hcg levels
C. Persistent high B-hcg levels
D. Aota
C. Persistent high B-hcg levels
What is the most common finding in GTN?
irregular bleeding associated with uterine subinvolution
How are placental tumors clinically classified?
aggressive invation into the myometrium and propensity to metastasize
the diagnosis of gestational trophoblastic neoplasia
typically is determined by which of the following?
a. Histologic tissue evaluation
b. Serum b-hCG levels
c. Physical examination findings
d. CT imaging
b. Serum b-hCG levels
true evidence-based risks for future pregnancy following treatment of gestational trophoblastic disease include which of the following?
a. Decreased fertility
b. Increased risk of preterm labor
c. Increased risk of placenta accreta
d. Increased risk of a second molar pregnancy
d. Increased risk of a second molar pregnancy
35-year-old, G2P1 (0010), pregnancy uterine 10 weeks AOG, sought consult at a local hospital. Transvaginal ultrasound showed slightly enlarged uterus with thickened multi-cystic placenta with fetus, endometrial strip 4 cm. serum beta hCG was 10,000. Her previous pregnancy was last april 2018, missed abortion terminated with D & C.
how will you manage this case?
a. Hysterectomy
b. Suction curettage
c. Hysterotomy
d. expectant
b. Suction curettage
35-year-old, G2P1 (0010), pregnancy uterine 10 weeks AOG, sought consult at a local hospital. Transvaginal ultrasound showed slightly enlarged uterus with thickened multi-cystic placenta with fetus, endometrial strip 4 cm. serum beta hCG was 10,000. Her previous pregnancy was last april 2018, missed abortion terminated with D & C.
according to the WHO modified prognostic scoring
system that was adapted by the international federation of Gynecology and Obstetrics
(FIGO), what is the score of this patient?
a. 3
b. 4
c. 5
d. 6
a. 3
1 - missed abortion
1 - b-hCG 100,000
1 - largest tumor size 4cm
What are the parameters for WHO prognostic scoring?
age antedecent pregnancy interval after index pregnancy pretreatment serum b-hCG largest tumor size site of metastases number of metastases previous failed chemotherapy drugs
How do prognostially score age
0 - <40
1 - >40
How do prognostially score antecedent pregnancy
0 - mole
1 - abortion
2 - term
How do prognostially score interval after index pregnancy
0 - <4 mo
1 - 4-6 mo
2 - 7-12 mo
4 - >12
How do prognostially score pretreatment serum b-hCG
0 - < 10.3
1 - 10.3 - 10.4
2 - 10.4 - 10.5
4 - > 10.5
How do prognostially score largest tumor size
0 - <3 cm
1- 3-4 cm
2 - >5cm
How do prognostially score site of metasases
1 - spleen, kidney
2 - GI
4 - liver, brain
How do prognostially score number of metasases
1 - 1-4
2 - 5-8
4 - >8
How do prognostially score previous failed chemotherapy drugs
2 - 1
4 - >2
chemotherapeutic agents in the EMA-CO regimen include all EXCEPT which of the following?
a. Methotrexate
b. Etoposide
c. Cisplatin
d. Actinomycin-D
c. Cisplatin
EMA-CO Etoposide MTX actinomycin D Cyclophasphamide oncovin
