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OB/GYN 303 > Module 16.2 GTN > Flashcards

Module 16.2 GTN Flashcards

1
Q

What is a trophoblast?

A

The tissue that will become the placenta that attaches to the endometrium to gain access to the maternal circulation

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2
Q

Other than gain access to maternal circulation, what can a trophoblast also do?

A
  • Infiltrate maternal tissues
  • Invade vessels
  • Be transported to the lungs as an embolism
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3
Q

What is a hydatidiform mole?

A

A cystic degeneration of chorionic villi in a molar pregnancy (complete and partial molar pregnancies).

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4
Q

What is a molar pregnancy and what are the types?

A

An abnormal proliferation of pregnancy related to a trophoblast with malignant potential.

  1. Complete mole
  2. Partial mole
  3. Invasive mole
  4. Choriocarcinoma
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5
Q

What is GTN and what is the most common type?

A

Gestational Trophoblastic Neoplasia

Most common = Complete molar pregnancy (benign if treated early)

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6
Q

Describe the chromosomes of a complete molar pregnancy and how it occurs?

A
  • 46xx or 46yy (80% of the time)
  • 46xy (20% of the time)
  • Chromosomes are exclusively from father

An ovum with absent/inactive maternal chromosomes is fertilized by a normal haploid sperm that duplicates and produces a diploid 46xx or 46yy

Or:

An empty ovum is fertilized by 2 haploid sperm to get 46xy

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7
Q

How does a molar pregnancy appear?

A

No fetus with an extremely abnormal placenta

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8
Q

What are some signs and symptoms of a molar pregnancy? (7)

A
  • Large for dates
  • Vaginal bleeding (90%)
  • Passage of hydropic villi
  • ++hCG serum >100,000 miu/ml, -
  • Hyperemesis
  • Toxemia or pre-eclampsia before 24 weeks
  • Respiratory failure
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9
Q

What is the sonographic feature of a complete molar in the 1st trimester?

A

Appears like an incomplete abortion

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10
Q

What is the sonographic feature of a complete molar in the 2nd trimester?

A

Echogenic tissue that expands the endometrial canal with multiple cystic spaces that range in size up to 2cm giving a grape-like appearance

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11
Q

What kind of cysts occur bilaterally 25% of the time with a complete molar due to elevated hCG?

A

Ovarian theca lutein cysts

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12
Q

What kind of karyotype does a partial molar pregnancy have?

A

Triploid (69xxx, 69xxy, 69xyy)

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13
Q

What kind of chromosomal makeup does a partial molar pregnancy have?

A

One set of maternal chromosomes and 2 sets of paternal chromosomes

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14
Q

How does a partial molar pregnancy happen?

A

Fertilization of a normal ovum with 2 haploid sperm

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15
Q

Describe the pathology of a partial molar pregnancy: (2)

A
  1. Abnormal fetus with a triploid karyotype

2. Normal and hydropic placental tissue

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16
Q

What is maternal triploidy?

A

When one sperm fertilizes an ovum with double maternal info (not a GTN** and not a risk for cancer)

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17
Q

Describe the sonographic features of the placenta with maternal triploidy:

A

Huge placenta with numerous cystic spaces in a non uniform pattern

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18
Q

How does maternal triploidy appear in the 2nd and 3rd trimester?

A

Severe asymmetric IUGR fetus, may see hydrocephalus

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19
Q

Describe ‘Diploid-Complete Mole’

A

No maternal contribution, single sperm fertilization with duplication

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20
Q

Describe ‘Diploid-Dispermy’

A

No maternal contribution, dual fertilization. Can be XX, YY, or XY

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21
Q

Describe ‘Triploid-Partial Mole’

A

Dispermy paternal contribution with maternal contribution

22
Q

Describe ‘Triploid-Triploidy Syndrome’

A

Diploid maternal contribution

23
Q

What percent of complete molar pregnancies will be benign?

A

80%

24
Q

What percent of partial molar pregnancies will be benign?

A

95%

25
Q

What does PTN stand for?

A

Persistent Trophoblastic Neoplasia

26
Q

Invasive mole and choriocarcinoma are referred to as what?

A

PTN (persistent trophoblastic neoplasia)

27
Q

What potential do PTN’s have?

A

Malignancy (considered to be the most curable gynecological malignancy)

28
Q

What percent of molar pregnancies develop into a persistent disease?

A

20%

In rare cases years after normal term delivery

29
Q

What is an invasive mole and what is it also known as?

A

The presence of chorionic villi and proliferating trophoblast deep in the myometrium

AKA: Chorioadenoma Destruens

30
Q

What is the most common form of PTN?

A

Invasive mole (80-95%)

31
Q

What are the stages of an invasive mole?

A
  1. Confined to the uterus
  2. Spread to adjacent organs/vessels
  3. Embolize to distant sites (lung/brain)
32
Q

What does choriocarcinoma start as most of the time?

A

Molar pregnancy and can present after miscarriages, abortions or normal pregnancies occasionally.

33
Q

What is the histology of invasive mole?

A

Presence of chorionic villi and proliferating trophoblast deep in the myometrium

34
Q

What is the histology of choriocarcinoma?

A

Abnormal proliferating trophoblast with no formed villi

35
Q

Why is choriocarcinoma able to easily travel from the uterus to other structures?

A

Because chorionic villi is purely cellular

36
Q

What are the stages of choriocarcinoma?

A
  1. Invades the myometrium
  2. Invades vessels causing hemorrhage
  3. Necrosis
  4. Distant mets
37
Q

What are the frequent metastasis sites of choriocarcinoma in order of spread?

A

Lungs, followed by the liver and brain

38
Q

What are some differentials for PTN? (3)

A
  • Adenomyosis
  • Fibroids
  • AV malformations
39
Q

Describe the features of PTN on colour (4) and spectral (2)?

A

Colour:

  • Aliasing due to AV shunt
  • Chaotic vasc arrangement
  • Lesion looks larger with colour than 2D
  • Trophoblastic flow

Spectral:
- Increased PSV >50cm/s (normal = <50)

  • Low resistive index (RI) <0.5 (normal = 0.7)
40
Q

What are other conditions that would have the same high velocity/low impedance type flow like PTN?

A
  • PID
  • Pelvic abscess
  • Benign and malignant ovarian neoplasia
41
Q

What helps distinguish between PID, abscess, and ovarian neoplasms from PTN? (3)

A
  • Clinical findings
  • Serum hCG **
  • U/S appearance
42
Q

What is non metastatic PTN treated with?

A

Methotrexate (good prognosis)

43
Q

High risk metastatic PTN has a pretreatment hCG level of what?

A

> 40,000 miu/ml

44
Q

What are the risk factors for a molar pregnancy? (3)

A
  1. Advanced maternal age
  2. Prior molar pregnancy
  3. Asian ancestry
45
Q

What is another name for partial molar pregnancy?

A

Diandric triploidy

46
Q

What is the treatment for complete and partial mole? (4)

A
  • Induced labor
  • D & C
  • hCG titer sampling weekly or monthly for a year
  • Avoid pregnancy for 1 year
47
Q

What are the US features of PTN and what scan is used to assess? (5)

A

EV scan

  • Focal echogenic nodule in myometrium
  • Grape like cysts
  • Hyperechoic/complex lesions
  • Bulky, heterogenous uterus
  • Tumour may extend to other organs or side walls
48
Q

What differentiates between diff forms of PTN?

A

The pathology, not U/S

49
Q

What are the 2 catagories of metastatic PTN?

A
  1. Low risk - cured with chemo

2. High risk

50
Q

What are the factors of high risk metastatic PTN? (4)

A
  • Having the disease more than 4 months
  • Having a pretreatment hCG level > 40,000 miu/ml
  • Brain/liver mets
  • Poor prognosis
51
Q

What is the treatment for high risk metastatic PTN? (3)

A
  • Multi-agent chemo
  • Radiotherapy
  • Surgery
52
Q

What is Non-Gestational Trophoblastic Neoplasia?

A

A tumour that produces hCG and can infiltrate into the uterus causing choriocarcinoma

OB/GYN 303 (21 decks)

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