Gestational trophoblastic diseases (GTD)

What is the genetic origin and most common karyotype of a Complete Hydatidiform Mole?

It is purely paternal in origin. The most common karyotype is 46, XX (usually from a single sperm fertilizing an "empty" egg and duplicating).

What is the genetic origin and most common karyotype of a Partial Hydatidiform Mole?

It is typically triploid (69, XXY). It results from dispermic fertilization (two sperm) of a normal ovum, creating two sets of paternal genes and one set of maternal.

Which type of molar pregnancy (Complete or Partial) contains identifiable fetal tissue or fetal red blood cells?

Partial mole. (Complete moles have NO maternal chromosomes, and therefore NO fetal tissue).

How does p57 immunostaining help differentiate between a complete and a partial mole?

p57 is a maternal enzyme. It is negative in complete moles (lacks maternal genes) and positive in partial moles.

What is the classic ultrasound appearance suggestive of a Complete Molar Pregnancy?

A "Snowstorm" or "cluster of grapes" appearance.

True or False (Past Paper Trap): The "Snowstorm" ultrasound pattern is definitively diagnostic for a molar pregnancy.

False. While suggestive, the definitive diagnosis strictly requires histological examination of the products of conception.

According to the past papers, what is the most common presenting clinical feature (symptom) of a molar pregnancy?

Irregular vaginal bleeding in the first half of pregnancy.

Why might a patient with a molar pregnancy develop hyperthyroidism or hyperemesis gravidarum?

Due to the extremely high levels of hCG. The alpha-subunit of hCG structurally mimics TSH, which overstimulates the thyroid.

The early development of which maternal hypertensive disorder (specifically before 20 weeks gestation) is a classic sign of a molar pregnancy?

Preeclampsia.

What specific benign ovarian masses frequently develop in response to the massive hCG stimulation of a molar pregnancy?

Theca lutein cysts (they are usually bilateral, large, and regress spontaneously after the mole is evacuated).

What is the standard, mainstay surgical therapy for the evacuation of a molar pregnancy?

Suction curettage.

Why is Anti-D immunoglobulin strictly required after evacuating a Partial mole, but biologically unnecessary for a Complete mole?

Partial moles contain fetal tissue/fetal red blood cells that can sensitize an Rh-negative mother. Complete moles lack fetal tissue entirely.

What is the required duration for strict contraception after documenting the remission of a molar pregnancy?

6 to 12 months (A new pregnancy would raise hCG levels, making it impossible to detect if the GTD was relapsing/becoming malignant).

Which specific contraceptive method is absolutely contraindicated until hCG levels have returned to normal?

Intrauterine Devices (IUDs), due to a significantly increased risk of uterine perforation.

In the FIGO scoring system for Gestational Trophoblastic Neoplasia (GTN), what score determines if a patient receives single-agent vs. multi-agent chemotherapy?

Score ≤6: Low risk (treated with single-agent Methotrexate).Score ≥7: High risk (treated with multi-agent chemotherapy).

According to the past papers, is a Placental Site Trophoblastic Tumor (PSTT) highly sensitive to chemotherapy?

No. PSTT is an exception; it is less chemosensitive and is primarily treated with surgery.

According to the past papers, what is the significance of a "plateau" in serum beta-hCG levels for 3 consecutive weeks following the evacuation of a mole?

It indicates the development of Gestational Trophoblastic Neoplasia (GTN), such as an invasive mole or choriocarcinoma, and mandates chemotherapy.