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Ob/Gyne 2 > Module 17 : Gestational Trophoblastic Neoplasia > Flashcards

Module 17 : Gestational Trophoblastic Neoplasia Flashcards

1
Q

what is the function of the trophoblast

A
  • gain access to maternal circulation
  • infiltrate maternal tissue
  • invade vessles
  • transported to lungs
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2
Q

what is a hydatidiform mole

A
  • refers to cystic degeneration of chorionic villi in molar pregnancy
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3
Q

what 2 things does hydatidiform mole encompass

A
  • complete and partial molar pregnancy
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4
Q

what is a molar pregnancy in general

A
  • abnormal proliferation of pregnancy related to trophoblast with progressive malignant potential
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5
Q

what are the 4 molar pregnancies

A
  • complete
  • partial
  • invasive
  • choriocarcinoma
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6
Q

what increases risk of molar pregnancy

A
  • increase maternal age
  • prior molar pregnancy
  • asian ancestry
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7
Q

what is the most common GTN

A
  • complete molar pregnancy
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8
Q

what is a complete molar pregnancy

A
  • often benign if treated early

-

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9
Q

what is the karyotype for complete molar pregnancy

A
  • 46xx or 46yy
  • chromosomes are exclusively paternal
    + ovum with absent or inactive maternal chromosomes is fertilized by a normal haploid sperm which duplicate to get diploid
  • 46xy
    + exclusively paternal
    + occasionally empty ovum can be fertilized by 2 sperm
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10
Q

US look of complete molar pregnancy

A
  • no fetus
  • no normal placenta
  • placenta replaced by abnormal hydropic chorionic villi with excessive trophoblastic proliferation
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11
Q

what are the signs and symptoms of complete molar pregnancy

A
  • larger for dates
  • bleeding
  • INCREASED HCG > 100,00
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12
Q

sonographic features of complete mole

A
  • 1st trimester look like incomplete abortion
  • 2nd = echogeinc tissue that expands into endo canal with multiple cystic spaces that range in size up to 2 cm GRAPE
  • ovarian theca lutean cysts bilateral occur
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13
Q

what is a partial molar pregnancy

A
  • triploid (69)
  • one set of maternal chromosomes and 2 sets of paternal chromosomes
  • results from fertilization of normal ovum and 2 haploid sperm
  • diandric triploidy
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14
Q

what is the pathology of partial molar pregnancy

A
  • abnormal fetus with triploid karyotype
  • symmetric IUGR
  • large hydropic placental tissue
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15
Q

sonographic appearance of maternal partial mole

A
  • aka triploidy syndrome
  • placenta small
  • asymmetric IUGR
  • mother may develop early pre eclampsia
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16
Q

what are the treatments of complete or partial molar pregnancy

A
  • evacuation of uterine content
  • hCG titer sampling weekly or monthly for a yar
  • avoid pregnancy for 1 year
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17
Q

is it possible to have a complete mole with a twin

A
  • yes

- a normal pregnancy with a normal placenta and a molar placenta seen separately

18
Q

what is persistent trophoblastic neoplasia

A
  • PTN
  • invasive mole and choriocarcinoma are referred to as PTN
  • malignant potential
  • MOST CURABLE GYNE MALIGNANCY
19
Q

is PTN a life threatening condition

A
  • yes

- occurs in setting of molar pregnancy

20
Q

what are some rare cases where PTN can occur

A
  • normal term delivery
  • spontaneous abortion
  • ectopic pregnancy
21
Q

what is an invasive mole

A
  • aka chorioadenoma destruens

- most common form of PTN

22
Q

what is the history of an invasive mole

A
  • presence of chorionic villi and proliferating trophoblast deep in myometrium
23
Q

what are the stages of invasive mole spread

A
  • confined to uterus
  • spread to adjacent organs and vasculature
  • embolism to distant sites
24
Q

what is a choriocarcinoma

A
  • starts as a molar pregnancy

- present as miscarries, abortions, normal pregnancy

25
Q

what is the histology of choriocarcinoma

A
  • abnormal proliferation trophoblast with no formed villi
26
Q

what are the stages of choriocarcinoma

A
  • invades myometrium
  • invasdes vasculature causes hemorrhage
  • necrosis
  • distant mets common
27
Q

what are the signs and symptoms of choriocarcinoma and invasive mole

A
  • vaginal bleeding

- respiratory compromise

28
Q

what is the treatment of PTN

A
  • follow serum hCG after evacuation

- diagnosis can be hard if many systems affected

29
Q

what are the sonographic features of PTN

A
  • NEED EV
  • focal echogenic nodule in myometrium
  • lesions may appear hyperehoi complex or multicystic
  • uterus bulky
  • uterus heterogeneous and lobulated
  • see extension of tumor into other pelvic structures
30
Q

does ultrasound differentiate between forms of PTN

A
  • no pathology does
31
Q

what are the DDX of PTN

A
  • adenomyosis
  • fibroids
  • AV malformation
32
Q

what are the color doppler features of the PTN

A
  • color aliasing does to AV shunting
  • chaotic vascular arrangement
  • size of lesion look larger with color doppler than on gray scale
33
Q

what are the suplex doppler features of PTN

A
  • increase peak systolic velocity
    + > 50
  • low resistive index
    + RI < 0.5
34
Q

does doppler play a greater role in diagnosis of PTN or of diagnosis of primary molar pregnancy

A
  • PTN
35
Q

DDX of doppler diagnosis of PTN

A
  • color and duplex doppler features are typical of trophoblastic flow either normal or abnormal
  • same doppler profiles seen with early pregnancy missed abortion or RPOC, PID, abcesses, ovarian tumors
36
Q

what would help distinguish between PTN and conditions with similar doppler profiles

A
  • serum hCG and sonographic appearance
37
Q

what is sonography mainly used for with PTN

A
  • stage and monitor response to therapy

- proffered over angio because safer

38
Q

what is the therapy for PTN

A
  • non metastatic PTN very good prognosis

- treated with methotrexate

39
Q

what are the 2 categories of PTN

A
  • low risk = chemo

- high risk

40
Q

characteristics of high risk metastatic PTN

A
  • having disease > 4months
  • pretreatments hCG level > 40,000
  • presence of liver or brain mets
  • poor prognosis
41
Q

what is the treatment of high risk PTN

A
  • multiagnet chemo
  • radiotherapy
  • surgery
42
Q

what is a non gestational trophoblastic neoplasia

A
  • choriocarcinoma can occur with dysgerminoma of the ovary
    + ovarian counterpart to seminoma
    + highly malignant germ cell tumor produces hCG

Ob/Gyne 2 (19 decks)

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