Gestational Trophoblastic Diseases MCQs

Hydatidiform mole is a rare mass that rapidly grows within the uterus. It results from hyperplastic proliferation of trophoblast within the uterine wall. It has a high potential to become choriocarcinoma. Reference - Textbook of Langman's, 12th Edition, General Embryology Page number - 43

Choriocarcinoma is a malignant tumor that arises from trophoblastic cells that may occur following normal pregnancy, abortions, or hydatidiform mole. Reference - Textbook of Langman's, 12th Edition, General Embryology Page number - 43

Theca lutein cysts are bilateral cysts seen in ovaries associated with markedly elevated levels of hCG. Conditions of pregnancy where theca lutein cysts are seen: Molar pregnancy Diabetes D alloimmunization Multifetal gestation Chronic renal failure – decreased clearance of hCG Hyperthyroidism (hCG and TSH–anatomically similar) Reference: Williams Obs 24/e, p 50

Staging of Gestational trophoblastic disease: Stage-I Disease confined to the uterus. Stage-II Disease extends outside of the uterus but is limited to the genital structures (adnexa, vagina, broad ligaments). Stage-III Disease extending to the lungs, with or without known genital tract involvement. Stage-IV Disease at other metastatic sites viz brain, liver, kidney or gastrointestinal tract. Reference: COGDT 10/e, p 893

FIGO in 2000 devised a staging system for categorisation of gestational trophoblastic neoplasia into good prognostic (low risk) and bad prognostic (high risk) disease. Also if we have a look at the WHO prognostic scoring system: GTN following a term pregnancy comes under high risk. Reference: COGDT 10/e, p 892, 893; Novak 14/e, p 1593, 1594

Complications of Anemia Preeclampsia Infection Heart failure at 30-32 weeks PPH Shock Subinvolution Pulmonary embolism during puerperium Fetal: Low birthweight Intrauterine death Reference: Dutta Obs. 7/e, p 266

Germ cell Tumors of ovary: Mnemonic: YES PCT Y - Yolk sac Tumor (Endodermal sinus Tm) E - Embryonal carcinoma S Seminoma ≈ Dysgerminoma P - Polyembryoma C - Choriocarcinoma T - Teratoma ≈ Dermoid In contrast to slow growing epithelial ovarian tumors, germ cell malignancies grow rapidly and are characterised by subacute pelvic pain. Most common germ cell Tumor – Mature teratoma or Dermoid cyst (Benign in nature). Most common malignant GCT – Dysgerminoma. Second most common malignant GCT – Endodermal sinus Tumor. (Yolk Sac tumor) Most common benign Tumor of ovary – Dermoid cyst Reference : Novak 14 th /ed pg 1506; 15 th /ed pg 1394; Williams Gynae 1 st /ed pg 741

Histological types of vulval cancers Squamous cell carcinoma-90% Melanoma 5% Adenocarcinoma (Bartholin's gland) Basal cell carcinoma Sarcoma Reference: Dutta Gynae 6 th /ed pg 334