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HIGH-YIELD FACTS IN - Gestational Trophoblastic Neoplasias

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Gestational trophoblastic neoplasias are neoplasms arising from placental syncytiotrophoblasts and cytotrophoblasts. The four tumors are: Hydatidiform mole (complete or partial) Invasive mole Choriocarcinoma Placental site trophoblastic tumor | high Gestational Trophoblastic Neoplasias GTN DEFINITION OF GTN Gestational trophoblastic neoplasias are neoplasms arising from placental syn-cytiotrophoblasts and cytotrophoblasts. The four tumors are Hydatidiform mole complete or partial Invasive mole Choriocarcinoma Placental site trophoblastic tumor HYDATIDIFORM MOLE Complete Mole A placental trophoblastic tumor forms when a maternal ova devoid of DNA is fertilized by the paternal sperm Karyotype Most have karyotype 46XX resulting from sperm penetration and subsequent DNA replication. Some have 46XY believed to be due to two paternal sperms simultaneously penetrating the ova. Epidemiology Incidence is 1 in 1 500 pregnancies in the United States 1 in 200 in Mexico 1 in 125 in Taiwan Partial Mole A mole with a fetus or fetal parts. Women with partial incomplete molar pregnancies tend to present later than those with complete moles Karyotype Usually 69XXY and contains both maternal and paternal DNA Epidemiology 1 in 50 000 pregnancies in the United States rO DNA of complete mole is always paternal. r -DNA of a partial mole is both maternal and paternal. 213 A young woman who passes grape-like vesicles from her vagina should be diagnosed with hydatidiform mole. HIGH-YIELD FACTS All early 20 weeks preeclampsia is molar pregnancy until proven otherwise. GTN secrete human chorionic gonadotropin hCG lactogen and thyrotropin. Ten to 15 of complete moles will be malignant. Two percent of partial moles will be malignant. Any of the following on exam indicates molar pregnancy Passage of grape-like vesicles Preeclampsia early in pregnancy Snow storm pattern on ultrasound Nonmetastatic malignancy has almost a 100 remission rate following chemotherapy. Invasive Mole A hydatidiform mole that invades the myometrium It is by definition malignant and thus treatment involves complete metastatic workup and appropriate malignant metastatic therapy see below . Histology of Hydatidiform Mole Trophoblastic proliferation Hydropic .