In gestational trophoblastic disease, metastases most commonly occur to:
Ans-C Lungs Shaw 15th/259 Hydatidiform moles are abnormal pregnancies characterized histologically by aberrant changes within the placenta. Specifically, the chorionic villi in these placentas show varying degrees of trophoblastic proliferation and edema of the villous stroma. They are of two types: partial and complete. Complete Mole Partial mole * A molar pregnancy with some normal and some swollen villi plus fetal, cord, and/or amniotic membrane elements. * Fetal tissue present. * Karyotype: 46, XX or 46, XY * Villous edema: diffuse * Typical clinical presentation: Molar gestation * Post molar malignant sequelae-15-20% * A molar pregnancy with swelling of all placental villi. * Fetal tissues are absent. * Karyotype: 69, XXX or 69, XXY * Villous edema: focal * Typical clinical presentation: Missed abortion * Post molar malignant sequelae- 2-4% Investigation * Diagnosing in first-trimester is now common because of the routine use of serum (3-hCG measurements (as they produce excess (3-hCG due to trophoblastic proliferation) and transvaginal sonography. * Although (3-hCG levels are helpful, the diagnosis of molar pregnancy more frequently is found sonographically because of the identifiable diffuse swelling and enlargement of the chorionic villi. * Appearance on USG: Snowstorm appearance Treatment * Suction curettage is the preferred method of evacuation regardless of uterine size in patients who wish to remain fertile. POST MOLAR SURVEILLANCE * Gestational trophoblastic neoplasia (GTN) develops after approximately 15-20 % of complete moles and 2-4% in partial moles. * Post molar surveillance with serial quantitative serum b-hCG levels is the standard. Also, Know * GTD INCLUDES: H.Mole, Invasive mole, ChorioCA, PSTT (Placental Site Trophoblastic Tumor) * MC site of metastasis of GTD: Lungs
Brain
Liver
Lungs
Bone