Gestational Trophoblastic Disease

What are the three main types of gestational trophoblastic diseases?

• Hydatidiform mole (complete or partial molar pregnancy)

• Invasive mole

• Choriocarcinoma

Hydatidiform mole are _% benign

80%

What percent of invasive moles are malignant?

15%

Choriocarcinoma is _% malignant?

5%

What is Gestational Trophoblastic Disease (GTD)?

A proliferative disease of trophoblasts that occurs after an abnormal conception.

What is another name for a hydatidiform mole?

Molar pregnancy

What tissue is affected in Gestational Trophoblastic Disease?

Trophoblastic tissue

What are the malignant forms GTD can progress into?

A: Invasive mole and choriocarcinoma

What is the most common symptom of GTD?

A: Vaginal bleeding and Severe morning sickness

What hormone level is extremely elevated in GTD?

A: β-hCG (extremely high levels)

What ovarian finding is associated with GTD?

A: Theca lutein cysts

What is the most common type of Gestational Trophoblastic Disease?

A: Hydatidiform mole (molar pregnancy)

What causes the "grape-like" appearance in a molar pregnancy?

A: Placental villi swollen with fluid

What does a hydatidiform mole look like grossly?

A: Clusters of swollen villi resembling bunches of grapes

What is a complete molar pregnancy?

A: Placenta only, no fetal tissue present

What is a partial molar pregnancy?

A: Placental tissue with some fetal tissue present

What is the classic ultrasound appearance of a complete H-mole?

A: "Snowstorm" appearance

How common is a complete hydatidiform mole?

A: ~1 in 1,000 pregnancies

Which age groups are at higher risk for a complete H-mole?

A: Women younger than 20 years or older than 40 years

How does a partial hydatidiform mole develop?

A: Two sperm fertilize one normal egg

What happens to the chromosomes of a fetus in a partial H-Mole

69 chromosomes, fetal tissue present, abnormal fetus (not viable)

Is a viable fetus formed in a partial H-mole?

A: No — fetus is not viable

When do most partial H-mole pregnancies fail?

A: Before or shortly after the 1st trimester

What abnormalities are associated with partial H-moles?

Fetal abnormalities due to triploidy

What key feature distinguishes partial from complete H-moles?

Presence of fetal tissue in partial H-moles

What does PMD stand for?

A: Placental Mesenchymal Dysplasia

What type of condition is placental mesenchymal dysplasia?

A: Rare, benign placental disorder

What is PMD often confused with and why?

A molar pregnancy because they are Similar ultrasound and gross placental appearance

What is the fetal status in placental mesenchymal dysplasia?

Fetus is normal

What does the placenta look like in PMD?

A: Thick, multicystic placenta

What is the main management focus in PMD?

A: Monitor fetus for growth

What is a coexistent mole & twin pregnancy?

A: Dizygotic twin gestation with one normal fetus and one mole

How many placentas are present in a coexistent mole & twin pregnancy?

A: Two separate placentas

How common is a coexistent mole & twin pregnancy?

A: Very rare

What GI symptom is associated with GTD(gestational trophoblastic disease)?

A: Hyperemesis gravidarum (severe morning sickness)

What fetal size abnormality can be seen with GTD?

LGA (large for gestational age)

What hormone level is elevated in GTD?

A: β-hCG

What is the most common presenting symptom of GTD?

Vaginal bleeding

What pregnancy complication can occur early with GTD?

A: Preeclampsia (pregnancy induced high blood pressure)

What ovarian finding is classic for GTD?

A: Theca lutein cysts

What treatment is almost always required for GTD?

Surgical removal of the tumor

What is the most common initial treatment for a molar pregnancy?

A: Suction dilation and curettage (D&C)

When might hysterectomy (TAH) be used in GTD?

A: Selected cases depending on patient and disease severity

When is chemotherapy or radiation used?

A: More aggressive or malignant GTD

: What percentage of hydatidiform moles are treated without chemotherapy?

A: ~85%

Why is follow-up essential after GTD treatment?

To ensure β-hCG levels return to zero

How long should pregnancy be avoided after a molar pregnancy?

A: About 1 year