F. Trophoblastic Disease - Gestational Trophoblastic Diseases

Front 1

What are Gestational Trophoblastic Diseases?

Back 1

Diseases with PROLIFERATION of trophoblastic tissue

Front 2

What is the most common GTD? What is its incidence in the US? Far east?

Back 2

Hydatidiform mole
US: 1/1000
Far east: 10/1000

Front 3

What is Hydatid. mole the most common precursor to?

Back 3

Choriocarcinoma

Front 4

What is Choriocarcinoma responsive to?

Back 4

Chemotherapy

Front 5

What is the rarest GTD?

Back 5

Invasive mole

Front 6

What is a good serum marker for the development of a Hydatidiform mole?

Back 6

beta-hCG in levels that are much higher than they should be for the corresponding gestational age.

Front 7

What could be another cause of unusually high levels of bhCG?

Back 7

Twins

Front 8

What IS hydatidiform mole?

Back 8

Cystic swelling of the chorionic villi with variable proliferation of the trophoblast

Front 9

What are the 3 layers of trophoblast?

Back 9

-Cytotrophoblast
-Intermediate trophoblast
-Syncytiotrophoblast

Front 10

How does Hydat. mole commonly manifest itself? When?

Back 10

As vaginal bleeding, around the 4th-5th month

Front 11

What 2 age groups are at higher risk of developing hydatidiform mole?

Back 11

-Teens
-Women in 5th decade

Front 12

What are the 2 variations of Hydat. mole?

Back 12

-Complete (classic)
-Partial

Front 13

What are the 2 findings in Complete Mole?

Back 13

-Most of villi are edematous
-Diffuse trophoblastic proliferation

Front 14

What is a Partial Mole?

Back 14

-Only some villi edematous
-Focal trophoblastic proliferation

Front 15

What is the karyotype seen in >90% of complete moles?

Back 15

46XX - diploid

Front 16

What cytogenetic pattern is seen in most partial moles?

Back 16

Triploid 69 XXY

Front 17

What is the process that causes COMPLETE moles, with 46XX patterns, to develop called?

Back 17

Androgenesis

Front 18

What is Androgenesis?

Back 18

Fertilization of an egg that lost its chromosome, by a single spermatozoon

Front 19

So if it's a hydatidiform mole with 46 XX or 46XY, what do you know?

Back 19

BOTH CHROMOSOMES came from the dad.

Front 20

Since there is no maternal DNA in a complete mole, what results?

Back 20

No embryo or fetal structures.

Front 21

What % of complete classic moles progress to choriocarcinomas?

Back 21

2.5%

Front 22

What is seen in Partial mole again?

Back 22

-Only SOME edematous villi
-FOCAL trophoblastic proliferation

Front 23

What is the karyotype seen in partial mole?

Back 23

Triploid 69XXY

Front 24

How does the Triploid karyotype develop?

Back 24

By fertilization of ONE egg that does have its DNA, with one or 2 sperms.

Front 25

So what results from this type of mole?

Back 25

There IS viable embryo, but it only lasts for a few weeks.

Front 26

Which is more likely to cause choriocarcinoma; complete or partial hydatidiform mole?

Back 26

Complete; it is a RARE complication of partial.

Front 27

Which type of mole causes higher serum hCG levels?

Back 27

Complete causes much higher hCG levels

Front 28

What would the OB-gyn see in the uterine cavity with a hydatid. mole?

Back 28

Grape-like structures extruding out of the cervical os. - in either complete or partial.

Front 29

What makes an invasive mole different from just a hydatidiform mole?

Back 29

Penetration into the myometrial wall.

Front 30

How is hydat. mole treated?

Back 30

By evacuation with D/C

Front 31

What % of hydat. moles develop into
-Invasive moles
-Choriocarcinoma

Back 31

10% - invasive
2.5% - choriocarcinoma

Front 32

What do you have to do AFTER the evacuation of the hydatidiform mole?

Back 32

Monitor hCG levels for several months to make sure there was no invasion.

Front 33

What is Invasive mole?

Back 33

Invasion of the myometrium with villi and trophoblast

Front 34

What do Hydropic villi have the potential to do?

Back 34

Embolize to distant sites like the lungs/brain.

Front 35

What symptoms will invasive moles cause?

Back 35

-Vaginal bleeding
-Irregular uterine enlargmt

Front 36

How can you tell Invasive moles from just hydat. moles?

Back 36

Persistence of elevated hCG even after the D/C extraction.

Front 37

What is a treatment for Invasive mole?

Back 37

Chemotherapy

Front 38

What complication may result if Invasive mole is not detected and it completely perforates the myometrium?

Back 38

Uterine rupture

Front 39

What is an epithelial malignancy of trophoblastic cells derived from any form of previous NORMAL or ABNORMAL pregnancy called?

Back 39

Gestational choriocarcinoma

Front 40

What WON'T form in gestational choriocarcinoma?

Back 40

NO villous structures

Front 41

What WILL form in gestational choriocarcinoma? Why?

Back 41

-Cytotrophoblast
-Syncytiotrophoblast
Bc it is only EPITHELIUM

Front 42

What is the general NATURE of gestational choriocarcinoma?

Back 42

-Rapidly metastasizing
-Invasive
-Malignant

Front 43

What is the treatment for gestational choriocarcinoma?

Back 43

Chemotherapy

Front 44

What is the incidence of gestational choriocarcinoma and where is it more common?

Back 44

-Uncommon in US 1/20-30,000
-More in Asian/African cntries

Front 45

From what do gestational choriocarcinomas rise?
-50%
-25%
-22%

Back 45

50% from hydat. moles
25% from previous abortion
22% from normal pregnancy

Front 46

Is it possible to continue a normal pregnancy through gestational choriocarcinoma?

Back 46

No, but she can have a normal SUBSEQUENT pregnancy.

Front 47

So what is the incidence of gestational choriocarcinoma in hydat. moles?

Back 47

1/40

Front 48

What is the incidence of gestational choriocarcinoma in normal pregnancies?

Back 48

1/150,000

Front 49

What does gestational choriocarcinoma look like grossly?

Back 49

Soft, fleshy, yellow-white tumor with LARGE areas of ischemic necrosis

Front 50

Why is choriocarcinoma so destructive?

Back 50

Because it penetrates deep into the uterine wall

Front 51

Where do 50% of gestational choriocarcinoma metastesize?

Back 51

LUNGS

Front 52

What does choriocarcinoma NOT form?

Back 52

Chorionic villi - just the trophoblast.

Front 53

What symptoms does choriocarcinoma cause?

Back 53

Irregular spotting

Front 54

What does it NOT produce?

Back 54

Large bulky mass

Front 55

How will the hCG levels in choriocarcinoma compare to normal gestation and Hydat. mole?

Back 55

MUCH HIGHER

Front 56

What is the hallmark characteristic of unmonitored, undetected choriocarcinoma?

Back 56

WIDESPREAD METASTASIS

Front 57

What is the prognosis for gestational choriocarcinoma like?

Back 57

Pretty good - there is a high rate of remission/cure with chemotherapy.

Front 58

What type of choriocarcinoma has a much worse prognosis? Why?

Back 58

NONGESTATIONAL - resistant to chemotherapy.

Front 59

What trophoblast tissues form gestational choriocarcinoma?

Back 59

-Cytotrophoblast
-Syncytiotrophoblast

Front 60

What can develop from INTERMEDIATE trophoblast?

Back 60

Placental site trophoblastic tumor

Front 61

How does placental site trophoblastic tumor develop?

Back 61

By invasion of the proliferating intermed trophoblast into the myometrium.

Front 62

What is the marker that detects this rare neoplasm of placental site trophoblast?

Back 62

HPL - human placental LACTOGEN

Front 63

What cells will NOT be found in placental site trophoblastic tumor?

Back 63

Cytotrophoblast

Front 64

What level of hCG will be produced by it?

Back 64

low

Front 65

How does the malignancy of placental site trophoblastic tumor compare to choriocarcinoma?

Back 65

Much less invasive; self limited.

Front 66

What is the treatment for placental site trophoblastic tumor?

Back 66

Curettage