hydatidiform mole

Question 1

what is it

Answer 1

tumours- proliferating chorionic villi which have swollen and degenerated

Question 2

why is there a high HCG

Answer 2

as it is derived from the chorion

Question 3

what does the high HCG lead to

Answer 3

exaggerated pregnancy symptoms and strongly positive pregnancy test

Question 4

when is it more common

Answer 4

at the extremes of reproductive life, increased risk in future pregnancies.

Question 5

signs

Answer 5

early pregnancy failure eg failed miscarriage or signs on ultrasound, heavy bleeding, aborted molar tissue may look like frog spawn. abdominal pain

Question 6

what can the ultrasound show

Answer 6

snowstorm effect, in a large for dates uterus

Question 7

rarer presentation

Answer 7

severe morning sickness, 1st trimester pre eclampsia

Question 8

what cysts are present in the ovaries

Answer 8

theca-lutein cysts. can rupture or tort. take 4 months to resolve after molar evac

Question 9

what does HCG resemble

Answer 9

TSH - may cause hyperthyroidism

Question 10

treatment

Answer 10

molar tissue removed- gentle suction. give anti D.

Question 11

how long will it take for HCG to return to normal

Answer 11

6 months

Question 12

can invasive moles metastasise

Answer 12

yes- to lung, vagina, brain, liver, skin

Question 13

does it respond to chemo

Answer 13

yes

Question 14

if HCG levels dont fall after 6 months what is this due to

Answer 14

invasive (myometrium penetrated) or given rise to choriocarcinoma

Question 15

what is a molar pregnancy

Answer 15

gestational trophoblastic disease

Question 16

what are the moles classified into

Answer 16

complete or partial

Question 17

indications for chemo

Answer 17

rising post evac or plateuing HCG; HCG >20,000 4 weeks post evac, incr HCG 6 months post evac, heavy vaginal bleeding or GI/intraperitoneal bleeding; evidence mets, histology of choriocarcinoma

Question 18

what should you investigate persistent post pregnancy PV bleeding for

Answer 18

to exclude choriocarcinoma

Question 19

presentation choriocarcinoma

Answer 19

can be years after pregnancy, general malaise, uterine bleeding, mets, nodules on CXR

Question 20

treatment choriocarcinoma

Answer 20

combination chemo based on methotrexate