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Endo Repro 2 > Molar preg > Flashcards

Molar preg Flashcards

1
Q

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 \_\_\_
A

placental trophoblasts

hydatidiform mole
hydatidiform mole

GTN
Invasive mole
choriocarcinoma
Trophoblasic Tumor (PSTT)
Trophoblastic Tumor (ETT)
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2
Q

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 __

A

abnormal prolif, trophoblasts

paternal chromos, paternal

placetnal growth

malignant potential

trophoblastic
cyto/synctiotroph, intermediate trophoblast

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3
Q

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 __

A

troph, endometrium

absence, dysfxn, excess

paternal genes

normal, double dose

maternal gene, imprinting

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4
Q

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 \_\_\_
A 
diploid, 46 XX, 46XY (rare)
absent
diffusely hydropic
hyperplastic
common
hCG, PLAP (rare)
greater than date
common
common
CCA
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5
Q

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 \_\_\_
A 
triploid, 69XXX, 69XXY, rare 69XYY
present
focal, normal villi/fetal tissue
less hyperplasia
infrequent
hCG, PLAPP, p57
small for dates
rare
rare
CCA
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6
Q

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 ___

A

VA, animal fats

Japan, Taiwan

age, 50
molar preg, 2 moles
infertility, nulliparity
spontaneous abortion
A
smoking

menses
estrogen OCP

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7
Q

Familial Repetitive Hydatidiform mole

___ mutation in __ locus on chromo ___
usually present in those w ___ moles

__ imprinting
__ origin

A

Missense, NLRP7, 19
2

maternal
biparental

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8
Q 
CM of Molar preg
V
Enlarged
Pelvic \_\_/\_\_
A
Theca \_\_
H
H
P
Passage of

sx are much less __
age of evacuation is ___

A 
vaginal bleeding
enlarged uterus
pelvic pressure/pain
anemia
lutein cysts
hyperT
hyperemesis
Preeclampsia
hydropic vesicles

common
12 wks

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9
Q

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 ___

A

Snowstorm appearance

malignant GTD
any sx

homology, beta subunit, TSH

200,000

thyroid storm
thionamides, KI, BB

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10
Q

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)

A

hyperstimulation
multiloculated
bilateral
GTD

path, type of mole

evacuation, hemorrhage

evac
high risk OB/MFM consult

twin gestation, mole

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11
Q

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

A

hCG

99, 59

hCG

contraception

GTN

partial moles

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12
Q

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

A

myometrium, vasc spaces, extrauterine sites

troph

undiff
villi
anaplastic

mono/multinuclear cells

hemorrhage, vasc invasion

invasive mole, CCA

hemorrhage

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13
Q

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)
A 
Theca lutein cyst
uterus
35-40
GTD
100,000
Hyperplasia, atypia
Heterozygosity
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14
Q

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

A

plateaus, 10%, 4, 3 wks

rises, 10%, 3, 2

serum hCG

invasive mole

CCA

postmolar period
CCA, invasive mole

nonmolar

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15
Q

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 __

A 
metastasis
resp, cough/hemoptysis
GI/GU/intracranial
RUQ
vaginal mets

age
gestational event
persistent
HCG

clinical/biochem markers

early, pelvic dz

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16
Q

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 >

A

hCG, uterus

uterus, pelvis

pulm
other

single/multi agent

low risk
high risk

2-3

7

17
Q

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 ___

A

chemo-sensitive
Single- methotrexate/Actinomycin D

remission

Etoposide, methotrexate, actinomycin D, cyclophosphamide, Vincristine (oncovin)

2wks, 3

remission

monthly, 1yr
contraception

18
Q

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

A

1yr

MTX
3, less likely

repeat mole

19
Q

PSTT and ETT
Derived from __/intermediate trophs

infiltration of ___ and ___ into myometrium

abundant __ material

ETT more __, proliferation of __ more __ cells

A

extravillous

monomorphic/nuclear trophs

fibrinoid

nodular, smaller, monomorphic

20
Q

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
A

hCG

HAMA
mouse Ab

urine, negative

PSTT

rare
mnths/yrs, preg
positive
hPL
vaginal bleeding, enlarged uterus
mets
21
Q

Treat PSTT
H
Stage 1: __ alone
Stage 2> __ and or ___

less __ than other GTN

A

hysterectomy
surgery
surgery, EMA CO

chemoresponsive

Endo Repro 2 (24 decks)

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