45 Questions
What is the term for the GTD forms that have the potential for tissue invasion and metastasis?
Gestational trophoblastic neoplasia (GTN)
Which clinical markers help in the identification of GTDs?
Beta subunit of human chorionic gonadotropin (β-hCG)
What is the characteristic feature of complete hydatidiform mole (CHM)?
Placental overgrowth with severely abnormal or absent embryonic development
What is the precursor lesion of some gestational trophoblastic neoplasia?
Complete moles
What is believed to give rise to all GTDs?
Neoplastic transformation of trophoblastic stem cells
Which trophoblastic tumor is the most primitive?
Choriocarcinoma
What is the potential of CHMs to transform into trophoblastic tumors?
Transform into choriocarcinoma and placental-site trophoblastic tumor
How does parity affect the risk of developing CHM?
Parity does not affect the risk
What differentiates placental-site trophoblastic tumor from choriocarcinoma?
The neoplastic cytotrophoblast differentiates into extravillous (intermediate) trophoblastic cells in an implantation site
What is the cause of complete hydatidiform mole (CHM)?
Fertilization of an empty ovum by one sperm, which then duplicates its DNA
What is the genetic composition of the conceptus in 20% of CHM cases?
46,XX or 46,XY, all paternally derived
What is the main reason for the lack of embryo/fetus formation in complete hydatidiform mole (CHM)?
Lack of maternal nuclear DNA
What is the preferred method of evacuation for patients with complete hydatidiform mole (CHM) who desire to preserve fertility?
Suction curettage
What is a characteristic feature of complete hydatidiform mole (CHM) based on sonographic features?
Absence of an embryo or fetus
Which laboratory study is indicative of exuberant trophoblastic growth and raises suspicion for a molar pregnancy?
Very high levels of β-hCG
What is the DNA ploidy pattern typically observed in complete hydatidiform moles (CHMs) as determined by DNA flow cytometry?
Diploid or tetraploid
What is a common clinical manifestation in women with complete hydatidiform mole (CHM) due to the rapid growth of the mole?
Severe nausea and vomiting
What is the natural history of most complete hydatidiform moles (CHMs)?
Benign course with excellent outcome after treatment
What is a histological characteristic of hydropic villi in complete hydatidiform mole (CHM)?
Large central cavitation (cistern)
What is the potential transformation of complete hydatidiform moles (CHMs) into trophoblastic tumors?
15-20% develop into invasive moles and 2-3% into choriocarcinoma
What is the characteristic DNA ploidy pattern observed in partial hydatidiform moles (PHMs) as determined by DNA flow cytometry?
Triploid (69 chromosomes, including 23 of maternal origin and 46 of paternal origin)
What is a characteristic sonographic feature favoring the diagnosis of a partial mole over a complete mole?
Demonstration of fetal parts
What is the natural history of partial hydatidiform moles (PHMs) compared to complete hydatidiform moles (CHMs)?
Much more benign with only 1-5% of women developing into invasive mole
What is a distinguishing feature of partial moles on imaging studies compared to complete moles?
Enlarged and thickened placenta relative to the size of the uterus
What is the main difference in the gross findings between complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM)?
CHM consists of grape-like clusters of villi, while PHM consists of normal appearing placental tissue admixed with hydropic villi and identifiable embryo/fetus or gestational sac
What are the microscopic findings in partial hydatidiform mole (PHM)?
Microscopic examination of PHM demonstrates two populations of villi: (i) small, normal-appearing villi, and (ii) large hydropic villi with central cavitation
How do patients with partial mole typically present?
Patients with partial mole usually present with signs and symptoms consistent with an incomplete or missed abortion, including cramps of the lower abdomen, vaginal bleeding during pregnancy, and absence of fetal heart tones
What is the main precursor lesion of gestational trophoblastic neoplasms (GTNs)?
Complete hydatidiform mole
What is the subtype of gestational trophoblastic neoplasms that usually develops from the malignant transformation of trophoblastic tissue after evacuation of a complete or partial hydatidiform mole?
Invasive mole
What is the characteristic immunohistochemical staining for placental-site trophoblastic tumor (PSTT)?
Positive staining for hPL
What is the most common clinical presentation of placental-site trophoblastic tumor (PSTT)?
Abnormal vaginal bleeding and/or amenorrhea
What is the difference in β-hCG levels between placental-site trophoblastic tumor (PSTT) and choriocarcinoma?
PSTT patients have lower β-hCG levels than those seen in choriocarcinoma
Which cellular component is not found in placental site trophoblastic tumor (PSTT)?
Syncytiotrophoblast cells
What is the DNA content of the intermediate trophoblast cells in placental site trophoblastic tumor (PSTT)?
Diploid
What is the characteristic gross morphology of placental site trophoblastic tumor (PSTT)?
Invasion of myometrium
What is the most common precursor of choriocarcinoma?
Complete hydatidiform mole
Where does choriocarcinoma most commonly arise in the female body?
Interface between endometrium and myometrium
What is the characteristic cellular composition of choriocarcinoma?
Admixed proliferating cytotrophoblast, intermediate trophoblast, and syncytiotrophoblast
Which type of trophoblast is recognized by its abundant, darkly stained cytoplasm and small-to-intermediate sized nuclei with eosinophilic nucleoli?
Syncytiotrophoblast
What is the most common presenting maternal sign of choriocarcinoma?
Vaginal bleeding
What is the homeobox gene believed to be involved in the development of choriocarcinoma?
NECC1
Which distant organs are most often affected by choriocarcinoma metastases?
Brain, liver, gastrointestinal tract, kidneys
What is the characteristic feature of the syncytiotrophoblast nuclei compared to cytotrophoblast nuclei?
Small-to-intermediate sized with eosinophilic nucleoli
What is the characteristic feature of vascular invasion in choriocarcinoma?
Occurs early in tumor development and is usually extensive
What is the characteristic feature of choriocarcinoma spread?
Hematogenous dissemination
Study Notes
Gestational Trophoblastic Disease Overview
- Gestational trophoblastic disease (GTD) encompasses hydatidiform mole, invasive mole, choriocarcinoma, and placental-site trophoblastic tumor
- GTD is characterized by abnormal proliferation of placental tissue and can have tissue invasion and metastasis
- Incidence of complete hydatidiform mole is 1-3 cases per 1,000 pregnancies, and choriocarcinoma is 1 in 30,000 pregnancies in the US
- Complete hydatidiform mole arises from abnormal fertilization and is more common in extremes of reproductive age
- Pathogenesis of GTD involves neoplastic transformation of trophoblastic stem cells, leading to various trophoblastic tumors
- Complete moles result from fertilization of an empty ovum by one or two sperm, leading to trophoblastic hyperplasia
- Gross and microscopic findings of complete hydatidiform mole include edematous trophoblastic villi and extensive trophoblast proliferation
- Clinical presentation of complete mole includes rapid uterine enlargement and high levels of β-hCG
- DNA flow cytometry can differentiate between complete and partial hydatidiform moles
- Imaging studies, such as ultrasound, show characteristic features like the "snowstorm" appearance in complete moles
- Most complete hydatidiform moles have a benign course but should be closely monitored due to the potential for malignant transformation
- Treatment options for complete hydatidiform mole include suction curettage for fertility preservation or total abdominal hysterectomy
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
