Molar Pregnancy Flashcards
Molar pregnancy definition
Increased proliferation of gestational trophoblastic tissue and B-HCG levels are elevated
Types of GTD
Non invasive (Hydatidiform mole)
GTN (Choriocarcinoma, invasive, PST)
Hydatidiform mole
Complete
Incomplete
Complete mole def
Empty ovum fertilized by a haploid sperm that duplicates later or Empty ovum fertilized by two sperms
Incomplete mole def
Ovum fertilized by two sperms
Complete mole karyotyping
46 XX
46 XY
Incomplete mole karyotyping
69 XXX
69 XXY
69 XYY
Features of Complete mole
B-HCG elevated too much
No fetal parts present
Trophoblastic tissue diffusely involved
Villi are edematous
Vessels are present
2% chance of choriocarcinoma
Features of Incomplete mole
B-HCG elevated slightly
Fetal parts present
Trophoblastic tissue focally involved
Villi are not edematous
Vessels are not present
Rare chance of choriocarcinoma
Risk factors of Molar Pregnancy
Previous history
Extremes of age
Blood group A
Diet
Presentation of Molar Pregnancy
Bleeding
Enlarged uterus
Pain
N/V
Early preeclampsia
Hyperthyroidism
Investigation
B HCG
TVUSS - Snow storm appearance
Tx of Molar Pregnancy
Suction D & C
Hysteroscopy
Don’t conceive till B-HCG levels are normal
Invasive mole features?
Proliferation of trophoblastic tissue that invades the myometrium
Locally destructive and may embolize to different areas in the body
What is choriocarcinoma?
Malignant epithelial neoplastic tissue of trophoblasts
Most aggressive and early metastasis
Responds well to chemotherapy
Risk factors of developing choriocarcinoma
Hydatidiform mole
Previous abortion
Normal pregnancy
Ectopic pregnancy
Karyotype of choriocarcinoma
46XY
Histopathology of Choriocarcinoma
Atypia
Necrosis
No villi, vesicles, or embryo
Vessels are present and abnormal
What is placental site trophoblastic tumor?
Malignancy of intermediate/extra-villous trophoblasts arising from implantation site or placental membranes
What does Placental site trophoblastic tumor makes?
HPL
HCG
What biomarkers used to differentiate between pstt from normal exaggerated placental implantation trophoblast
Ki-67
Mel-Cam
Risk fctrs for PSTT
Normal preg
Spontaneus abortion
Hydatidiform molw
Dx of GTN
US
HCG
CXR
CT
Low risk GTN
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
High risk GTN
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
Low risk/ Good prognostic GTN tx
MTX
Actinomycin-D
High risk/Poor prognostic GTN tx
Etoposide
MTX
Actinomycin-D
Cyclophosphamide
Follow up of GTN
3 cons. weekly b-HCG titers within normal range
b-HCG titer normal till 12 months
Follow up is for 1 year
