Molar preg Flashcards
Gestational Trophoblastic Dz (GTD) is a group of do linked by a common origin in the abnormal prolif of ___
Benign GTD (not cancer)
Partial ___
Complete ___
Malignant GTD (aka \_\_\_) I C Placental site \_\_\_ Epithelioid \_\_\_
placental trophoblasts
hydatidiform mole
hydatidiform mole
GTN Invasive mole choriocarcinoma Trophoblasic Tumor (PSTT) Trophoblastic Tumor (ETT)
Molar preg is abnormal preg characterized by ___ of placental ___
excess ___ (__ allograft)
Paternal genes have more control over ___
Difference in ___ of hetero/homozygous moles
__ origin
normal layers include __ and __ and __
abnormal prolif, trophoblasts
paternal chromos, paternal
placetnal growth
malignant potential
trophoblastic
cyto/synctiotroph, intermediate trophoblast
Normal invastion of __ into maternal __ is a tightly regulated process
GTD is related to __ or __ of maternal genetic material or ___ of paternal genetic material
Complete moles contain only __
Partial moles contain __ maternal genetic material but ___ of paternal genes
Familial moles have mutation in ___ theorized to cause __
troph, endometrium
absence, dysfxn, excess
paternal genes
normal, double dose
maternal gene, imprinting
Complete mole
Karyotype, such as Fetal tissue is Villi are Trophoblastic prolif is \_\_\_ Atypia is \_\_\_ IHC markers Uterine size Theca lutein cysts are \_\_\_ Persistent mole is \_\_ possible \_\_\_
diploid, 46 XX, 46XY (rare) absent diffusely hydropic hyperplastic common hCG, PLAP (rare) greater than date common common CCA
Partial Mole
Karyotype (such as) Fetal tissue Villi are \_\_\_, scallping mixed w \_\_\_ and \_\_\_ Trophoblastic proliferation has \_\_\_ atypia IHC markers Uterine size Theca lutein cysts are Persistent mole is very rare for \_\_\_
triploid, 69XXX, 69XXY, rare 69XYY present focal, normal villi/fetal tissue less hyperplasia infrequent hCG, PLAPP, p57 small for dates rare rare CCA
Benign GTD risk inc w dec intake of ___ and ___
greatest risk in ___ and __
RF for complete mole Extremes of \_\_\_ (esp over \_\_\_) Prior \_\_\_, esp after \_\_ I or N S Type \_\_\_ blood S
Partial mole RF
irregular ___
High dose ___
VA, animal fats
Japan, Taiwan
age, 50 molar preg, 2 moles infertility, nulliparity spontaneous abortion A smoking
menses
estrogen OCP
Familial Repetitive Hydatidiform mole
___ mutation in __ locus on chromo ___
usually present in those w ___ moles
__ imprinting
__ origin
Missense, NLRP7, 19
2
maternal
biparental
CM of Molar preg V Enlarged Pelvic \_\_/\_\_ A Theca \_\_ H H P Passage of
sx are much less __
age of evacuation is ___
vaginal bleeding enlarged uterus pelvic pressure/pain anemia lutein cysts hyperT hyperemesis Preeclampsia hydropic vesicles
common
12 wks
US has ___ (pathognomic) for complete molar preg
early dx of mole does not alter risk of ___
can detect prior to ___
HyperT homology occurs bc ___ of HCG and ___
requires hCG > ___
Can lead to ___
tx w __ and ___ and ___
Snowstorm appearance
malignant GTD
any sx
homology, beta subunit, TSH
200,000
thyroid storm
thionamides, KI, BB
Theca Lutein cysts
Ovarian ___ due to HCG
M
Often ___
Resolve after tx of __
Confirm Dx of benign GTD w __ and __
TX Complete mole requires ___, prepare for
Tx partial mole
non viable needs __
viable needs ___
Can have ___ w viable fetus and __ (partial/complete)
hyperstimulation
multiloculated
bilateral
GTD
path, type of mole
evacuation, hemorrhage
evac
high risk OB/MFM consult
twin gestation, mole
After molar evac, weekly ___ until 3 conseq normal
Avg time to normalization is __ (complete) and __ (partial) days
monthly __ for 6m
__ important
some complete moles can become ___
few __ become GTN
hCG
99, 59
hCG
contraception
GTN
partial moles
Invasive mole
Hyropic villi invade into __, ___ and ___
__ proliferation
CCA
most ___
no __
sheets of ___ cyto/synctiotroph
biphasic pattern of malignant ___ and __ pathognomonic
Necrosis, __ and ___
Hisologic distinction bw __ and ___ not necessary for management
obtaining tissue for definitive dx risks
myometrium, vasc spaces, extrauterine sites
troph
undiff
villi
anaplastic
mono/multinuclear cells
hemorrhage, vasc invasion
invasive mole, CCA
hemorrhage
Post molar evac RF for GTN
\_\_\_ greater than 6cm (high risk for GTN) Excessively enlarged \_\_ Age greater than \_\_\_ Previous \_\_\_ Initial hCG > \_\_ H or A H (46 XY)
Theca lutein cyst uterus 35-40 GTD 100,000 Hyperplasia, atypia Heterozygosity
Dx criteria for GTN
Serum HCG ___ (decline of less than ___ for __ values over __ wks)
serum hCG ___ (inc of __ of __ values over __ wks)
Persistant _ for > 6m
majority of cases are ___
metastasis implies ___
Path is not needed in ___
Tx same for __ and ___
Path often needed if GTN suspected after __ preg
plateaus, 10%, 4, 3 wks
rises, 10%, 3, 2
serum hCG
invasive mole
CCA
postmolar period
CCA, invasive mole
nonmolar
GTN Workup
Eval for \_\_ look for \_\_ sx such as C, H \_\_ and \_\_ and \_\_ bleeding Liver mets present w \_\_ CCA can present w \_\_
Prognosis determined by A Interval since \_\_ \_\_ dz H
Dx made by ___ parameters
Mets can occur __ and can present w/out primary __
metastasis resp, cough/hemoptysis GI/GU/intracranial RUQ vaginal mets
age
gestational event
persistent
HCG
clinical/biochem markers
early, pelvic dz
Stage 1: elevated __ and tumor confined to __
Satge 2: tumor outside __ but limited to ___
Stage 3: __ mets
Stage 4: ___ mets
WHO score helps determine __vs ___ chemotherapy
Stage 1 is all __
Stage 4 is mostly __
Most important for stage __ to determine __ vs __risk
Metastatic GTN w good prognosis Who score <
poor prognosis w who score >
hCG, uterus
uterus, pelvis
pulm
other
single/multi agent
low risk
high risk
2-3
7
Treat Low risk GTN
Exquisitely ___
__ agent chemo w M/A
Very high rate of __ in stage 1-3
Treat high risk GTN
5 drug regimen EMA-CO
every __ until remission w ___ and then __ addtl cycles
relatively high ___
monitor hCG __ for minimum __
Use ___
chemo-sensitive
Single- methotrexate/Actinomycin D
remission
Etoposide, methotrexate, actinomycin D, cyclophosphamide, Vincristine (oncovin)
2wks, 3
remission
monthly, 1yr
contraception
Future fertility
Delay at least __
Majority of pt on ___ can have live birth
woman receiving more than ___ drugs are __ to have live birth
__ not an indication for chemo
1yr
MTX
3, less likely
repeat mole
PSTT and ETT
Derived from __/intermediate trophs
infiltration of ___ and ___ into myometrium
abundant __ material
ETT more __, proliferation of __ more __ cells
extravillous
monomorphic/nuclear trophs
fibrinoid
nodular, smaller, monomorphic
Nonmolar preg has persistent low __
rule out ___
H
reacts w __ used in assays
does not pass into ___ (UPT should be __)
consider __
PSTT features very \_\_\_ often present \_\_ to \_\_ antecendent to \_\_ hCG is weakly \_\_\_ marker is \_\_\_ common sx include may have \_\_ at dx
hCG
HAMA
mouse Ab
urine, negative
PSTT
rare mnths/yrs, preg positive hPL vaginal bleeding, enlarged uterus mets
Treat PSTT
H
Stage 1: __ alone
Stage 2> __ and or ___
less __ than other GTN
hysterectomy
surgery
surgery, EMA CO
chemoresponsive
