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24 Cards in this Set
- Front
- Back
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Define: Gestational Trophoblastic Disease
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BENIGN
1) Molar Pregnancies --> complete (classic) and incomplete (partial) moles MALIGNANT 2) Persistent moles 3) choriocarcinoma 4) placental site trophoblastic tumors |
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Which group of people have the highest rate of molar pregnancy?
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Asian women, especially from Japan
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Name some of the risk factors associated with molar pregnany
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1) extremes of age
2) history of GTD 3) nulliparity |
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Define: complete mole
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fertilization of an 'enucleate ovum' or *empty egg* by a sperm that then replicates with itself, making it *entirely paternally derived*
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Will fetal tissue be present in complete moles or incomplete moles?
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fetal tissue will be present in *incomplete moles.* Remember that incomplete moles are the ones with an extra paternal set, and so have both maternal and paternal genes.
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Trophoblastic proliferatoin is characteristic of a partial or complete mole?
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Complete! trophoblastic proliferation is characteristic of complete moles and associated w/ diffuse swelling of chorionic villi called "hydropic degeneration."
-Mole appears grape-like -Absence of fetus villi |
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high hCG levels: complete or incomplete?
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high hCG levels --> complete!
hCG>100,000 mIU/mL |
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Discuss the biochemistry of hCG, and what other central systems it can affect
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hCG has an alpha subunit that is also found in LH, FSH, and TSH
-FSH/TSH stimulation --> theca lutein cysts -TSH stimulation --> hyperthyroidism |
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Describe what the villi look like in a complete mole vs. normal vs. partial mole
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A) normal chorionic villi
B) partial mole w/ normal villi mixed w/ swollen ones C) complete mole, swollen vesicular villi |
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Most common symptom of molar pregnancy?
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irregular, heavy vaginal bleeding during early pregnancy
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Grape-like molar clusters in the vagina or cervical os are most representative of?
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Complete mole
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absence of feta heart sounds and uterine size greater than gestational age with grape like molar clusters and theca lutein cysts is indicative of?
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complete mole
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Tx: complete molar pregnancy
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Immediately remove the mole w/ a D and C. Give the mom Rhogam if she is Rh negative.
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A woman is s/p D and C for a complete mole. How should she be monitored to ensure that she has had a complete resolution of the disease?
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Serial beta-hCG titers
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Pathogenesis: Partial/incomplete mole
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Fromed when a normal ovum is fertilized by 2 sperm simultaneously, resulting in a *triploid karyotype* w/ 69 chromosomes (69XXY)
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Discuss the hCG levels in a partial or incomplete mole
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They are normal or only mildly elevated because there is more cytotrophoblast
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Will there be a fetus with an incomplete mole?
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Yes! amniotic fluid, fetal heart rate, and fetus can all be present. Often there is an overwhleming number of abnormalities and they spontaneously abort in a few weeks.
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Compare the diagnosis times of partial to complete mole
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Partial: diagnosis comes w/ vaginal bleeding from miscariage/incomplete abortion in late first trimester
Complete: more severe sx, earlier in pregnancy |
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Tx: partial mole
Followup: partial mole |
D and C
serial hCG levels |
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What are the three types of malignant GTD?
-how can we further classify these types? |
-invasive or persistent mole
-choriocarcinoma -PSTT (placental site trophoblastic tumors) 1) metastatic vs. nonmetastatic 2) IF METASTATIC: good prognosis vs. bad prognosis |
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How is malignant GTD treated?
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chemotherapy -- it is *extremely sensitive to it!*
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What is a persistent mole?
-how to identify? |
A mole that occurs after the evacuation of a molar pregnancy.
-identified as a plateau'd hCG after molar tx |
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Define: Choriocarcinoma
-sx |
rare form of GTD, necrotizing tumor that occurs weeks-years after any gestation type
-pts present with mets to lungs, vagina, liver, brain, kidney |
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Define: PSTT
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extremely rare tumor that arise at placental implantation site characterized by
-absence of villi -proliferation of cytoptrophoblasts -chronic low hCG levels |
