Molar Pregnancy: A Case Study

Molar Pregnancy: A Case Study
Objectives
Gestational Trophoblastic Disease (GTD)
Hydatidiform Moles
Pathophysiology of Hydatidiform Mole
Typical Presentation of Complete Moles
Presentation of Partial Moles
Invasive Moles
Choriocarcinoma
Choriocarcinoma (cont’d)
Placental Site Trophoblastic Tumor Diagnosis
Ultrasound
Classic Ultrasound Images
Human Chorionic Gonadotropin
Phantom hCG Levels/False Positive Results
Pathologic Diagnosis
Case Study
Patient History
OB Hx: G2P0010; SAB 3/2011
Objective Info
The exam was WNL, with the exception of an 8‐9 week uterus
Initial Ultrasound
Work Up for Suspected Mole
Twin Pregnancy
Plan D&C Pathology Results
Final pathology showed Complete Mole: Classic Ultrasound Images
Next Step for this Patient
Repeat HCG Levels
What is next?
Testing with Dx of GTN
Results of Pt’s Testing
Staging for GTN
Scoring System for GTN
Risk Factor
0
1
2
4
Age (years)
<= 39
>39
‐
‐
Antecedent pregnancy
Mole
Abortion
Term
‐
Pregnancy event to treatment interval (months)
<4
4‐6
7‐12
>12
Pretreatment hCG,
mIU/mL
<10,000
10,000‐
100,000
100,000‐
1,000,000
>1,000,000
Largest tumor mass,
including uterus (cm)
<3
3‐4
>=5
‐
Site of metastasis
‐
Spleen,
kidney
GI tract
Brain, liver
No. of metastasis
‐
1‐4
5‐8
>8
Previous failed chomotherapy
‐
‐
Single drug
>=2 drugs
Total score is obtained by adding individual scores for each prognostic factor. Low risk <7, High risk >=7. Case Patient’s Treatment
Treatment for Low Risk GTN
Treatment for High Risk GTN
Follow Up after Chemotherapy
Future Pregnancies?
Summary
References
Questions???