Term
| incidence of low postitive hCG |
|
Definition
1% pre-menopausal
7% post-menopausal |
|
|
Term
| definition low positive hCG |
|
Definition
| hCG >4-5 without pregnancy, some say >55 is cut off but >14 is current cut off |
|
|
Term
| cause of low positive hCG |
|
Definition
| cross reaction of elevated FSH/LH and low level benign pituitary hCG production |
|
|
Term
| management of low positive hCG |
|
Definition
| perscribe OCPs to suppress pituitary and reassess in 1wk, if still elevated consider another source |
|
|
Term
| cause of false positive hCG |
|
Definition
| heterophilic Ab cross reacting with test, smallpox vaccine |
|
|
Term
| incidence of false postivie hCG |
|
Definition
| 2% of pre-menopausal women |
|
|
Term
| signs of false postivie hCG |
|
Definition
| low elevation 27-29, occasionally high but never >300 |
|
|
Term
| determining false positive hCG |
|
Definition
will not be affected by dilution
will have variability with different assay techniques
heterophilic antibodies are not excreted in urine so urine hCG will not be positive
most current hCG platforms screen for this |
|
|
Term
| incidence of GTD in theraputic abortions |
|
Definition
|
|
Term
| incidence of GTD in pregnancies |
|
Definition
| 1:1500 - 25% are after molar and 50% are after term pregnancies |
|
|
Term
| incidence of development of malignant disease requiring chemo in GTD |
|
Definition
|
|
Term
|
Definition
complete benign mole 90%
non metastatic invasive moles 15%
partial benign mole 10%
metastatic choriocarcinoma 5%
metastatic PSTT very rare |
|
|
Term
| partial mole - karyotype, fetus, fetal RBC, villous edema, trophoblastic proliferation, theca lutein cysts, malignancy |
|
Definition
69XXX (rare 69XXY)
often fetus
RBC often present
focal villous edema
focal trophoblast proliferation
rare luteun cysts
<5% malignancy |
|
|
Term
| complete mole - karyotype, fetus, fetal RBC, villous edema, trophoblastic proliferation, theca lutein cysts, malignancy |
|
Definition
46XX (rare 46XY)
no fetus
no RBC
diffuse villous edema
diffuse trophoblast proliferation
20% lutean cysts
6-30% malignancy |
|
|
Term
| how does a complete mole happen |
|
Definition
| all chromosomes paternal, enuclate egg fertilized by haploid sperm that duplicates its chromosomes (or 2 sperm) |
|
|
Term
| how does a partial mole happen |
|
Definition
| fertilization of haploid egg and duplication of paternal haploid chromosomes (or 2 sperm) |
|
|
Term
| risks for molar pregnancy |
|
Definition
| low beta carotine, low folic acid, low SES, hx SABs, hx molar pregnancy, saudi arabian, japanese, <20yo, >40yo, caucasian < non-caucasian |
|
|
Term
|
Definition
uteirne enlargement 30%
vaginal bleeding 84%
passage of molar vesicles
hypertension in 1st half of prengnacy
anemia <10%
high output cardiac failure
pre-e
hyperthyroid
hyperemesis <10%
nausea/vomiting 50%
lutein cysts 15% - complete moles
ovaries >6cm
cystic ovarian enlargement
abnormally high hCG
coagulopoathy |
|
|
Term
| histology complete molar pregnancy |
|
Definition
| edematous chorionic villi that invade directly into myometrium |
|
|
Term
| hCG signs molar pregnancy |
|
Definition
hCG plateau 4+ values +/- 10% over 3wk
hCG increased >10% over 3 values over 2wk
persistent hCG >6mo |
|
|
Term
| histology choriocarcinoma |
|
Definition
| neoplastic cytiotriphoblasts and cytotrophoblast elements WITHOUT chorionic villi |
|
|
Term
| how are fetal vessels seen histologically in partial molar pregnancy |
|
Definition
| hematoxylin and eosin stain |
|
|
Term
| what work up should be done for molar pregnancy |
|
Definition
| TVUS, CXR, hCG, BMP, CMP, thyroid, T+S |
|
|
Term
|
Definition
| diffuse mixed echogenic pattern replacing placenta (villi, clot, cluster of grapes), low chance of coexisting fetus (twin pregnancy) |
|
|
Term
| treatment options molar pregnancy |
|
Definition
suction D+C
hyst if no desired fertility |
|
|
Term
| complications of D+C in molar pregnancy |
|
Definition
| trophoblastic embolism -> respiratory distress syndrome |
|
|
Term
| who should get prophylactic chemo therapy after evacuation of molar pregnancy |
|
Definition
>40yo, hCG >100,000, excessive uterine enlargement, theca lutein >6cm
reduces cancer from 50->13% but can cause resistance and need for more chemo if they do get cancer, this is not usually advised, may consider in unreliable patient |
|
|
Term
| what do you do if someone has a molar pregnancy and a co-existing viable twin |
|
Definition
rule out placental abnormalities, fetal karyotype, CXR, hCG
reasonable to continue pregnancy if normal karyotype, no fetal malformations, or evidence of metastasis |
|
|
Term
| what is the follow up after a molar pregnancy |
|
Definition
hCG q1-2wk until normal -> monthly for 6mo
frequent pelvic exams while hCG elevated
contraception - OCPs, IUD not well studied, other methods not reliable enough |
|
|
Term
| what should the monitoring be if someone with a history of molar pregnancy gets pregnant again |
|
Definition
| hCG 6wk postpartum, early ultrasound |
|
|
Term
| what are prognostic factors in molar pregnancy suggesting increased risk of medical complications |
|
Definition
uterus >14-16wk size - 25% risk
twin pregnancy (coexisting viable fetus) |
|
|
Term
| how long does it take for theca lutein cysts to go away after molar evacuation |
|
Definition
| several months, hCG mediated |
|
|
Term
| how long does it take for medical complications of molar pregnancy to go away after evacuation |
|
Definition
| usually almost immediate (esp HTN and hyperthyroid) |
|
|
Term
| what is the risk of a molar pregnancy in someone who had one before |
|
Definition
|
|
Term
| other than being a complete molar pregnancy, what else indicates an increased risk for cancer |
|
Definition
| twin pregnancy coexisting viable fetus 17-50%, complete molar pregnancy with theca lutean cyst 57% cancer risk |
|
|
Term
| post-molar GTN precursor and incidence |
|
Definition
hydatidiform mole 50%
normal pregnancy 25%
ectopic/SAB 25% |
|
|
Term
| diagnosis of post-molar GTN |
|
Definition
hCG plateau over 4wk
hCG rise >10% for 3 values in 2wk
hCG persistant for 6mo |
|
|
Term
| you should get an hCG for ALL patients with AUB >__wk after _____ to exclude GTN |
|
Definition
|
|
Term
| suspect GTN if mets from unknown primary or unexplained ____ in reproductive women |
|
Definition
|
|
Term
|
Definition
| synctiotrophoblasts and cytotrophoblasts |
|
|
Term
| work up after diagnosis of GTN |
|
Definition
| TVUS, CXR, CT A/P and MRI brain if mets |
|
|
Term
|
Definition
1 - confined to uterus
2 - ovary, tube, vagina, broad ligament
3 - lung mets
4 - distant mets |
|
|
Term
| management of GTN - initial |
|
Definition
confined to uterus - repeat D+C or hysterectomy
beyond uterus - determine prognostic score, treat as cancer |
|
|
Term
| treatment of GTN - low risk prognosis <7 |
|
Definition
| single agent chemo - MTX or dactinomycin until 2C past normal hCG, consider hysterectomy |
|
|
Term
| treatment of GTN - high risk prognosis >7 |
|
Definition
EMACO
if brain mets - whole brain radiotherapy or MTX intrathecial
early hysterectomy does not improve outcomes |
|
|
Term
|
Definition
>40yo
longer duration of pregnancy
showed up longer after pregnancy >6-12mo
hCG higher >10^5
tumor >5cm
brain or liver mets
>8 met sites
failed previous chemo |
|
|
Term
|
Definition
|
|
Term
| what is hyperglycosylated hCG |
|
Definition
| made by cytotrophoblasts, associated with trophoblastic invasion, associated with GTN chemoresistance |
|
|
Term
| what do you do if a patient with GTN has a plateau in hyperglycosylated hCG |
|
Definition
|
|
Term
| where does GTN metastasize to and incidence |
|
Definition
vagina 30%
lung 60%
liver 10%
brain 10% |
|
|
Term
| remission rate for GTN treated with MTX |
|
Definition
|
|
Term
| recurrence rate if normal hCG is achieved in GTN |
|
Definition
| 5% low risk, 13% high risk disease |
|
|
Term
| recurrence rate GTN after 1y remission |
|
Definition
|
|
Term
| % patients that fail initial MTX in GTN |
|
Definition
|
|
Term
| survival rate GTN high risk disease |
|
Definition
|
|
Term
| cure rates of brain mets with systemic chemo and radiation in GTN |
|
Definition
|
|
Term
| cure rate for GTN without mets |
|
Definition
|
|
Term
| types of intermediate trophoblastic tumors |
|
Definition
placental site trophoblastic tumor
epitheloid trophoblastic diseases |
|
|
Term
| histology intermediate trophoblastic tumors |
|
Definition
no villi
proliferation of trophoblasts in sheets
moderate mitotic activity
pleomorphism
surrounded by fibrinoud materal replacing vessel walls
decreased synctytiotrophoblast cells |
|
|
Term
| what does intermediate trophoblastic tumor look like |
|
Definition
| polypoid or endophytic mass in endomyometrium with fleshy yellow tan surface, focal hemorrhage, necrosis |
|
|
Term
| invasion rates intermediate trophoblastic tumor |
|
Definition
| 10% cervix, 50% outer 1/3 myometrium |
|
|
Term
| typical hCG levels and tumor marker intermediate trophoblastic tumor |
|
Definition
|
|
Term
| symptoms of intermediate trophoblastic tumor |
|
Definition
|
|
Term
| management of intermediate trophoblastic tumor |
|
Definition
no mets - hysterectomy, SLN, if poor prognostic factors consider chemo
mets - hysterectomy, met excision, chemo |
|
|
Term
| survellieance after intermediate trophoblastic tumor |
|
Definition
| PET q6-12mo for 2-3y, hCG 6wk post subsequent pregnancies |
|
|
Term
| poor prognostic factors in intermediate trophoblastic tumors |
|
Definition
high mitotic rate (>5-10 per 10 HPF)
deep myometrial invasion
extensive coagulative necrosis
interval since last pregnancy >1y
LVSI |
|
|
Term
| worst prognostic factor in intermediate trophoblastic tumors |
|
Definition
| interval since last pregnancy >1y |
|
|
Term
| survival intermediate trophoblastic tumor if confined to the uterus and if outside uterus |
|
Definition
confined - 90%
outside - 50% |
|
|
Term
| overall mortality intermediate trophoblastic tumors |
|
Definition
|
|
Term
|
Definition
| etoposide, MTX, dactinomycin / cyclophosphamide, vincristine |
|
|
Term
|
Definition
| bleomycin, etoposide, cisplatin |
|
|
Term
|
Definition
| etoposide, MTX, dactinomycin / etoposide, cisplatin |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| risk of quiescent GTN developing chemosensitive disease |
|
Definition
|
|
Term
| how do you identify quiescent GTN |
|
Definition
| positive hCG in blood, negative in urine, level 50-100 |
|
|
Term
| GTN prognostic score 0 - 8 parts |
|
Definition
| <40yo, molar precursor, <4mo from pregnancy, hCG <100,000, tumor <3cm, lung mets only, #mets 0, no failed treatment |
|
|
Term
| GTN prognostic score 1 - 8 parts |
|
Definition
| >40yo, SAB precursor, 4-6mo from pregnancy, hCG 100,000 to 1,000,000, tumor 3-5cm, mets in spleen/kidney, 1-4 mets, no failed treatment |
|
|
Term
| GTN prognostic score 2 - 8 parts |
|
Definition
| no age, SVD precursor, 7-12mo from pregnancy, hCG 1,000,000 to 10,000,000, >5cm tumor, GI mets, 5-8 mets, failed 1 drug |
|
|
Term
| GTN prognostic score 4 - 8 parts |
|
Definition
| no age, no precursor, >12mo from pregnancy, hCG >10,000,000, no tumor size, brain/liver mets, >8 mets, 2+ drug failure |
|
|
Term
| management of PSTT/ETD with mets |
|
Definition
| hyst/BS then EMA/EP vs EP/EMA + G-CSF |
|
|
Term
| after MTX or dactinomycin what do you do if hCG plateaus |
|
Definition
|
|
Term
| after MTX or dactinomycin what do you do if hCG rises |
|
Definition
|
|
Term
| after EMACO what do you do if hCG plateaus |
|
Definition
|
|
Term
| after EMACO what do you do if hCG rises |
|
Definition
| platinum and etoposide and resection |
|
|
Term
| cells involved in complete mole |
|
Definition
| diffuse trophoblastic hyperproliferation |
|
|
Term
| cells involved in partial mole |
|
Definition
| focal hyperproliferation of trophoblasts |
|
|
Term
| cells involved in invasive mole |
|
Definition
| diffuse trophoblastic hyperproliferation |
|
|
Term
| cells involved in choriocarcinoma |
|
Definition
| hyperproliferative trophoblasts, synchitotrophoblasts, cytotrophoblasts |
|
|
Term
|
Definition
| intermediate trophoblasts in sheets |
|
|
Term
| cells involved in epitheloid trophoblastic disease |
|
Definition
| extravillous trophoblasts, mononucleate intermediate trophoblasts |
|
|
Term
| which type of GTD has hemorrhage and necrosis |
|
Definition
|
|
Term
| prognostic score 0, 1, 2, 4 points - age |
|
Definition
| 0 - <40yo, 1 - >40yo, no 2/4 |
|
|
Term
| prognostic score 0, 1, 2, 4 points - pregnancy timing |
|
Definition
| 0 - <4mo, 1 - 4-6mo, 2 - 7-12mo, 4 >12mo |
|
|
Term
| prognostic score 0, 1, 2, 4 points - type of pregnancy |
|
Definition
| 1 mole, 2 SAB, 4 SVD, 4 none |
|
|
Term
| prognostic score 0, 1, 2, 4 points - tumor size |
|
Definition
| 0 <3cm, 1 3-5cm, 2 >5cm, 4 non |
|
|
Term
| prognostic score 0, 1, 2, 4 points - hCG |
|
Definition
| 0 - <100,000, 1 - 100,000 to 1,000,000, 2 - 1,000,000 to 10,000,000, 4 - >10,000,000 |
|
|
Term
| prognostic score 0, 1, 2, 4 points - number of mets |
|
Definition
| 0 - 0, 1 - 1 to 4, 2 - 5 to 8, 4 - >8 |
|
|
Term
| prognostic score 0, 1, 2, 4 points - mets location |
|
Definition
| 0 - lung, 1 - spleen/kidney, 2 - GI, 4 - brain/liver |
|
|
Term
| prognostic score 0, 1, 2, 4 points - failed treatments |
|
Definition
| 0 - none, 1 - n/a, 2 - 1 failed, 4 - 2+ failed |
|
|
