Molar Pregnancy

Question 1

Molar pregnancy definition

Answer 1

Increased proliferation of gestational trophoblastic tissue and B-HCG levels are elevated

Question 2

Types of GTD

Answer 2

Non invasive (Hydatidiform mole)
GTN (Choriocarcinoma, invasive, PST)

Question 3

Hydatidiform mole

Answer 3

Complete
Incomplete

Question 4

Complete mole def

Answer 4

Empty ovum fertilized by a haploid sperm that duplicates later or Empty ovum fertilized by two sperms

Question 5

Incomplete mole def

Answer 5

Ovum fertilized by two sperms

Question 6

Complete mole karyotyping

Answer 6

46 XX
46 XY

Question 7

Incomplete mole karyotyping

Answer 7

69 XXX
69 XXY
69 XYY

Question 8

Features of Complete mole

Answer 8

B-HCG elevated too much
No fetal parts present
Trophoblastic tissue diffusely involved
Villi are edematous
Vessels are present
2% chance of choriocarcinoma

Question 9

Features of Incomplete mole

Answer 9

B-HCG elevated slightly
Fetal parts present
Trophoblastic tissue focally involved
Villi are not edematous
Vessels are not present
Rare chance of choriocarcinoma

Question 10

Risk factors of Molar Pregnancy

Answer 10

Previous history
Extremes of age
Blood group A
Diet

Question 11

Presentation of Molar Pregnancy

Answer 11

Bleeding
Enlarged uterus
Pain
N/V
Early preeclampsia
Hyperthyroidism

Question 12

Investigation

Answer 12

B HCG
TVUSS - Snow storm appearance

Question 13

Tx of Molar Pregnancy

Answer 13

Suction D & C
Hysteroscopy
Don’t conceive till B-HCG levels are normal

Question 14

Invasive mole features?

Answer 14

Proliferation of trophoblastic tissue that invades the myometrium
Locally destructive and may embolize to different areas in the body

Question 15

What is choriocarcinoma?

Answer 15

Malignant epithelial neoplastic tissue of trophoblasts
Most aggressive and early metastasis
Responds well to chemotherapy

Question 16

Risk factors of developing choriocarcinoma

Answer 16

Hydatidiform mole
Previous abortion
Normal pregnancy
Ectopic pregnancy

Question 17

Karyotype of choriocarcinoma

Answer 17

46XY

Question 18

Histopathology of Choriocarcinoma

Answer 18

Atypia
Necrosis
No villi, vesicles, or embryo
Vessels are present and abnormal

Question 19

What is placental site trophoblastic tumor?

Answer 19

Malignancy of intermediate/extra-villous trophoblasts arising from implantation site or placental membranes

Question 20

What does Placental site trophoblastic tumor makes?

Answer 20

HPL
HCG

Question 21

What biomarkers used to differentiate between pstt from normal exaggerated placental implantation trophoblast

Answer 21

Ki-67
Mel-Cam

Question 22

Risk fctrs for PSTT

Answer 22

Normal preg
Spontaneus abortion
Hydatidiform molw

Question 23

Dx of GTN

Answer 23

US
HCG
CXR
CT

Question 24

Low risk GTN

Answer 24

Age less than 40
Tumor size less than 5cm
Serum HCG less than 40,000 IU/L
Time interval from antecedent preg to chemo less than 4 months
Good response to chemo

Question 25

High risk GTN

Answer 25

Age more than 40
Tumor size more than 5cm
Serum HCG more than 40,000 IU/L
Time interval from antecedent preg to chemo more than 4 months
Poor response to chemo

Question 26

Low risk/ Good prognostic GTN tx

Answer 26

MTX
Actinomycin-D

Question 27

High risk/Poor prognostic GTN tx

Answer 27

Etoposide
MTX
Actinomycin-D
Cyclophosphamide

Question 28

Follow up of GTN

Answer 28

3 cons. weekly b-HCG titers within normal range
b-HCG titer normal till 12 months
Follow up is for 1 year