36 Gestational Trophoblastic Disease

These flashcards focus on key vocabulary and definitions related to Gestational Trophoblastic Disease as covered in the lecture.

Gestational Trophoblastic Disease (GTD)

A group of rare neoplastic conditions derived from the placenta, characterized by proliferation of placental tissue.

Complete Hydatidiform Mole (CHM)

An abnormal pregnancy characterized by placental overgrowth, but abnormal or absent embryo development.

Partial Hydatidiform Mole (PHM)

An independent condition with normal placental tissue mixed with hydropic villi and some fetal fragments.

Choriocarcinoma

A malignant trophoblastic neoplasm primarily arising from the placenta.

Beta-HCG (β-hCG)

A hormone used as a clinical marker to help identify gestational trophoblastic disease.

Placental Site Trophoblastic Tumor (PSTT)

A rare form of gestational trophoblastic neoplasia that differentiates into extravillous trophoblastic cells.

Epidemiology of CHM

Estimated incidence is 1 per 1200 pregnancies, more common in women at extremes of reproductive age.

Pathogenesis of CHM

Arises when an empty ovum is fertilized by a sperm, resulting in a 46, XX androgenic karyotype.

Clinical Features of CHM

Rapidly enlarging uterus, elevated β-hCG levels, and signs of pregnancy complications.

DNA Flow Cytometry

A method used to measure the DNA content of cells to aid in diagnosing gestational trophoblastic disease.

Snowstorm Appearance

Ultrasound feature indicative of a complete hydatidiform mole, showing multiple cystic areas.

Natural History of CHM

Typically benign with a good prognosis after treatment, but close monitoring is essential.

Grape-like Clusters

Characteristic gross finding in hydatidiform moles, indicating trophoblastic hyperplasia.

Invasive Mole

A type of GTN characterized by the invasion of the myometrium by hydropic chorionic villi.

Chemotherapy for Invasive Moles

Treatment often includes methotrexate, achieving high rates of complete remission.

Histopathologic Examination

Microscopic examination revealing abnormal proliferation of trophoblastic cells in various GTDs.

Cystic Mass in Choriocarcinoma

Characteristic pathological finding, indicating advanced disease with metastasis.

Signs of PSTT

Abnormal vaginal bleeding and amenorrhea, often developing after term gestation.

Vascular Invasion in Choriocarcinoma

A prominent feature indicating aggressive growth and spread of the tumor.

Molecular Genetics of Choriocarcinoma

NECC1 gene loss is associated with malignant conversion of placental trophoblasts.

Incidence of Choriocarcinoma

Occurs in approximately 1 in 50,000 pregnancies, with higher rates following hydatidiform moles.

Management of PSTT

Primarily involves total abdominal hysterectomy, as chemotherapy is less effective.

Symptoms of PHM

Typically presents with signs consistent with incomplete abortion, including vaginal bleeding.

Characterization of Hydropic Villi

Histologically, these villi are edematous, distended, and often show central cavitations.

Incidence of GTD

Estimated at 1-3 cases per 1,000 pregnancies for complete mole and higher for partial moles.

Laboratory Finding in Moles

Elevated β-hCG levels are a primary indicator of gestational trophoblastic disease.

Treatment Principle for Molar Pregnancy

Suction curettage is often preferred to evacuate the uterus and preserve fertility.

Pathological Confirmation

Often pursued after a hysterectomy since invasion can be difficult to diagnose pre-operatively.

Clinical Features of Invasive Mole

Includes vaginal bleeding, enlarged uterus, and elevated β-hCG levels after a molar pregnancy.

Hydropic Villi Appearance

Characteristic of moles, appearing fluid-filled and balloon-like on gross examination.

Diagnosis of Gestational Trophoblastic Disease

Often confirmed through clinical history, laboratory studies, and imaging findings.

Significance of Syncytiotrophoblast

Highly proliferative cell type in choriocarcinoma that lacks chorionic villi.

Clinical Monitoring for GTD

Essential for detecting potential malignant transformation post-molar evacuation.

Effects of Maternal Age

Women older than 40 years have a significantly increased risk for CHM.

Histology of Placental Site Tumor

Characterized by distinct polyhedral cells with irregular nuclei infiltrating the myometrium.

Cystic Spaces in Ultrasound

Indicative of hydropic villi in complete moles, often referred to as 'Swiss cheese pattern'.

Management of Choriocarcinoma

Involves chemotherapy, often effective even in advanced stages, with high cure rates.

Metastatic Potential of Choriocarcinoma

Can spread to distant organs, including lungs, liver, and brain.

Trophoblastic Hyperplasia

Exaggerated proliferation of placental tissue, seen in moles and indicative of GTD.

Symptoms of Choriocarcinoma

Vaginal bleeding and signs of metastasis such as hemoptysis and abdominal pain.