Gestational Trophoblastic Disease — MCQs
Possible conversion to choriocarcinoma after hydatidiform mole is denoted by all of the following, except:
Snow storm appearance on an ultrasound is seen in:
Which of the following statements is true regarding placental site trophoblastic disease?
Chromosome number of partial hydatidiform mole is-
Tumor marker of epithelial ovarian carcinoma is:
A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?
Surgical staging is done for all the genital malignancies EXCEPT:
A 32-year-old woman with a history of molar pregnancy presents with heavy vaginal bleeding. Which of the following is a serious malignant complication of molar pregnancy?
What are the potential complications in subsequent pregnancies for a woman with a history of gestational trophoblastic disease?
Which is the most common complication of molar pregnancy?
Gestational Trophoblastic Disease Indian Medical PG Practice Questions and MCQs
Question 1: Possible conversion to choriocarcinoma after hydatidiform mole is denoted by all of the following, except:
- A. More Theca lutein cysts
- B. Sub urethral nodule (Correct Answer)
- C. Increase uterus size
- D. Rising hCG
Explanation: ***Sub urethral nodule*** - A **suburethral nodule** is a sign of **metastatic choriocarcinoma**, indicating the disease has already converted and spread. - The question asks for signs indicating a *possible conversion* to choriocarcinoma, not an established metastatic disease. *More Theca lutein cysts* - **Theca lutein cysts** result from overstimulation of the ovaries by high levels of **hCG**, which is elevated in both hydatidiform mole and choriocarcinoma. - An increase in these cysts suggests persistent trophoblastic activity, raising suspicion for transition to choriocarcinoma. *Increase uterus size* - An **enlarging uterus** post-evacuation of a hydatidiform mole can indicate persistent trophoblastic tissue or the development of choriocarcinoma. - This suggests continued growth and abnormal proliferation of trophoblastic cells. *Rising hCG* - **Persistently rising or plateauing hCG levels** after evacuation of a hydatidiform mole are the most critical indicator of persistent gestational trophoblastic disease (GTD), including potential conversion to choriocarcinoma. - Serial hCG monitoring is essential for surveillance following a molar pregnancy to detect malignant transformation.
Question 2: Snow storm appearance on an ultrasound is seen in:
- A. Vesicular mole (Correct Answer)
- B. Chronic ectopic pregnancy
- C. Hydatid cyst
- D. Dermoid cyst
Explanation: ***Vesicular mole*** - The classic ultrasound finding in a **complete hydatidiform mole** is a **"snowstorm" appearance**, characterized by a uterine cavity filled with echogenic, vesicular tissue and no fetal parts. - This appearance is due to the **swollen chorionic villi** and **trophoblastic proliferation**. *Chronic ectopic pregnancy* - While an ectopic pregnancy involves an implantation outside the uterus, it typically presents with an **adnexal mass**, sometimes with a **"ring of fire" sign** on Doppler, but not a snowstorm pattern within the uterine cavity. - Chronic ectopic pregnancies may show a more complex adnexal mass with varying echogenicity due to hemorrhage and organization, but this is distinct from the diffuse uterine changes in a hydatidiform mole. *Hydatid cyst* - A **hydatid cyst**, caused by *Echinococcus granulosus*, is typically found in the liver or lungs and appears as a **well-defined, anechoic lesion** with possible internal septations or daughter cysts (often called a "water lily" sign if ruptured) but not a diffuse snowstorm pattern within the uterus. - This condition is a parasitic infection, entirely unrelated to pregnancy. *Dermoid cyst* - A **dermoid cyst** (mature cystic teratoma) is an ovarian tumor that typically appears as a **complex adnexal mass** with characteristic features like a **"Rokitansky nodule"**, fat-fluid levels, and highly echogenic components (e.g., hair, teeth). - Its appearance is localized to the ovary and does not mimic the widespread uterine findings of a vesicular mole.
Question 3: Which of the following statements is true regarding placental site trophoblastic disease?
- A. Has a highly malignant potential
- B. It secretes human placental lactogen (Correct Answer)
- C. Mainly contains syncytiotrophoblasts
- D. The treatment of choice is hysterectomy followed by chemotherapy
Explanation: ***It secretes human placental lactogen*** - Placental site trophoblastic tumor (PSTT) characteristically consists of intermediate trophoblasts which secrete **human placental lactogen (hPL)**. - Unlike choriocarcinoma, PSTT secretes relatively low levels of **human chorionic gonadotropin (hCG)**. *Has a highly malignant potential* - PSTT generally has a **good prognosis** if the disease is confined to the uterus, with a survival rate of over 95%. - It has a low metastatic potential compared to choriocarcinoma, with metastases occurring in only about 15% of cases. *Mainly contains syncytiotrophoblasts* - PSTT is composed predominantly of **intermediate trophoblasts** that infiltrate the myometrium, rather than syncytiotrophoblasts or cytotrophoblasts. - The distinctive feature is the proliferation of these intermediate trophoblasts at the implantation site. *The treatment of choice is hysterectomy followed by chemotherapy* - **Hysterectomy** is generally the primary treatment for PSTT confined to the uterus, and it often cures the disease. - **Chemotherapy** is usually reserved for metastatic or recurrent disease, or in cases of extensive local invasion, and is not a routine follow-up after an uncomplicated hysterectomy.
Question 4: Chromosome number of partial hydatidiform mole is-
- A. 46 XX
- B. 45 XO
- C. 69 chromosomes (Correct Answer)
- D. 47 chromosomes (XXY)
Explanation: ***69 chromosomes*** - A **partial hydatidiform mole** typically results from **dispermy** (fertilization of one ovum by two sperm), leading to a **triploid karyotype** (69 chromosomes). - This triploidy usually consists of **69, XXY** or **69, XXX**, with the paternal contribution being twice the maternal. *46 XX* - This is a normal diploid female karyotype and is the typical chromosome number for a **complete hydatidiform mole** if the maternal chromosomes are lost and the paternal chromosomes duplicate. - In a complete mole, there is **no fetal tissue**, unlike in a partial mole. *45 XO* - This karyotype, known as **Turner syndrome**, is characterized by the absence of one sex chromosome. - It does not represent a hydatidiform mole but is a chromosomal abnormality associated with developmental disorders. *47 chromosomes (XXY)* - This karyotype is characteristic of **Klinefelter syndrome**, a sex chromosome aneuploidy in males (47,XXY). - While it involves an extra sex chromosome, it is not associated with partial hydatidiform moles, which are triploid with 69 chromosomes.
Question 5: Tumor marker of epithelial ovarian carcinoma is:
- A. Alpha feto protein
- B. CA-125 (Correct Answer)
- C. Beta HCG
- D. LDH
Explanation: ***CA-125*** - **CA-125 (Cancer Antigen 125)** is the most widely used and validated tumor marker for detecting and monitoring **epithelial ovarian carcinoma**. - Elevated levels are found in approximately 80% of women with epithelial ovarian cancer, making it useful in guiding treatment decisions and assessing recurrence. *Alpha feto protein* - **Alpha-fetoprotein (AFP)** is primarily elevated in **germ cell tumors** of the ovary (e.g., endodermal sinus tumor) or in hepatocellular carcinoma and some testicular cancers, not epithelial ovarian carcinoma. - Its presence usually indicates a different histological subtype of ovarian malignancy. *Beta HCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a tumor marker utilized for detecting **germ cell tumors**, particularly **choriocarcinoma** and some embryonal carcinomas, as well as pregnancy. - It is not typically elevated in epithelial ovarian carcinoma. *LDH* - **Lactate dehydrogenase (LDH)** is a general marker of **tissue damage or high cell turnover**, elevated in many cancers, including dysgerminoma (an ovarian germ cell tumor), but it is not specific for epithelial ovarian carcinoma. - Due to its lack of specificity, LDH alone is not considered the primary tumor marker for epithelial ovarian cancer.
Question 6: A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?
- A. Chlamydia infection
- B. Gonococcal vaginitis
- C. Candidiasis
- D. Trichomoniasis (Correct Answer)
Explanation: ***Trichomoniasis*** - The classic presentation of **greenish, frothy vaginal discharge** coupled with **strawberry cervix (multiple punctate spots)** is highly characteristic of trichomoniasis, caused by the parasite *Trichomonas vaginalis*. - This infection often causes **vaginal itching, irritation**, and dyspareunia. *Chlamydia infection* - Chlamydia often presents with **mucopurulent cervical discharge** and can be **asymptomatic**, but typically does not cause frothy, green discharge or strawberry cervix. - It is more commonly associated with symptoms like **dysuria** or **post-coital bleeding** when symptomatic. *Gonococcal vaginitis* - Gonorrhea typically causes **purulent discharge** that may be yellowish or greenish, but it is not typically frothy. - It is also associated with **dysuria** and pelvic pain, but the strawberry cervix is not a common finding. *Candidiasis* - Candidiasis (yeast infection) typically presents with a **thick, white, curd-like vaginal discharge**, often described as cottage cheese-like. - It is associated with **intense vulvovaginal itching and burning**, but not a frothy discharge or strawberry cervix.
Question 7: Surgical staging is done for all the genital malignancies EXCEPT:
- A. Gestational trophoblastic neoplasia (Correct Answer)
- B. Fallopian tube malignancy
- C. Endometrial carcinoma
- D. Ovarian malignancy
Explanation: ***Gestational trophoblastic neoplasia*** - Gestational trophoblastic neoplasia (GTN) is primarily staged **clinically** and **biochemically** using beta-human chorionic gonadotropin (β-hCG) levels. - **Surgical staging is not typically performed** for GTN due to its high sensitivity to chemotherapy and its hematogenous spread pattern. *Fallopian tube malignancy* - **Surgical staging is essential** for fallopian tube malignancy to determine disease extent and guide treatment. - Staging often involves **laparotomy**, histological examination, and evaluation of surrounding tissues. *Endometrial carcinoma* - **Surgical staging is the cornerstone of management** for endometrial carcinoma, as it provides crucial prognostic information. - This typically includes **hysterectomy**, bilateral salpingo-oophorectomy, and lymph node dissection. *Ovarian malignancy* - **Comprehensive surgical staging** is standard for ovarian malignancy to assess the spread of the disease within the peritoneal cavity. - This involves **laparotomy**, biopsies, and often extensive debulking procedures.
Question 8: A 32-year-old woman with a history of molar pregnancy presents with heavy vaginal bleeding. Which of the following is a serious malignant complication of molar pregnancy?
- A. Choriocarcinoma (Correct Answer)
- B. Endometrial carcinoma
- C. Cervical cancer
- D. Benign ovarian cysts
Explanation: **Choriocarcinoma** - **Choriocarcinoma** is a highly malignant form of trophoblastic neoplasia that can arise after a **molar pregnancy**, especially a complete hydatidiform mole. - The persistent elevation of **human chorionic gonadotropin (hCG)** following a molar pregnancy is a key indicator for the development of choriocarcinoma. *Endometrial carcinoma* - **Endometrial carcinoma** is a cancer of the lining of the uterus and is typically associated with hormonal imbalances or genetic predispositions, not directly with molar pregnancy. - While both affect the uterus, they originate from different cell types: molar pregnancy complications arise from **trophoblasts**, whereas endometrial cancer arises from **endometrial glandular cells**. *Benign ovarian cysts* - **Benign ovarian cysts**, particularly **theca-lutein cysts**, can be associated with molar pregnancies due to excessive hCG stimulation of the ovaries. - However, these cysts are typically **benign** and resolve spontaneously after the molar pregnancy is treated, and are not a malignant complication like choriocarcinoma. *Cervical cancer* - **Cervical cancer** is caused primarily by persistent infection with **human papillomavirus (HPV)** and is not a direct complication of molar pregnancy. - The pathology and risk factors for **cervical cancer** are distinct from those associated with gestational trophoblastic disease.
Question 9: What are the potential complications in subsequent pregnancies for a woman with a history of gestational trophoblastic disease?
- A. Neural tube defects
- B. Skeletal defects
- C. Cardiac defects
- D. Increased risk of recurrent GTD and pregnancy complications (Correct Answer)
Explanation: ***Increased risk of recurrent GTD and pregnancy complications*** - A history of **gestational trophoblastic disease (GTD)** significantly increases the risk of recurrence in subsequent pregnancies, emphasizing the need for close monitoring. - There is also an elevated risk of other **adverse pregnancy outcomes**, including **preterm birth** and **preeclampsia**, following a GTD history. *Neural tube defects* - **Neural tube defects** are congenital anomalies primarily associated with **folate deficiency** and genetic factors, not a prior history of GTD. - They involve incomplete closure of the neural tube during embryonic development, unrelated to trophoblastic tissue. *Cardiac defects* - **Congenital cardiac defects** are multifactorial, linked to genetic predisposition, maternal conditions like **diabetes**, and certain exposures, but not a history of GTD. - They result from abnormal heart development in the early stages of pregnancy. *Skeletal defects* - **Skeletal defects** can be hereditary or related to maternal infections (e.g., rubella), drug exposure (e.g., thalidomide), or specific genetic syndromes, not GTD. - These malformations occur during fetal bone and limb development.
Question 10: Which is the most common complication of molar pregnancy?
- A. Placenta previa
- B. Ovarian torsion
- C. Choriocarcinoma
- D. Invasive mole (Correct Answer)
Explanation: **Invasive mole** - An **invasive mole** is the most common complication of molar pregnancy, occurring in about 10-15% of complete hydatidiform moles and 1-5% of partial moles. - It involves the trophoblastic tissue invading the myometrium, which can lead to continued **human chorionic gonadotropin (hCG) elevation** and persistent vaginal bleeding. *Placenta previa* - **Placenta previa** is a condition where the placenta partially or totally covers the cervix, which is unrelated to the abnormal trophoblastic proliferation seen in molar pregnancies. - Its primary risk factors differ from those for molar pregnancy complications and include prior C-sections or uterine surgery. *Ovarian torsion* - **Ovarian torsion** is the twisting of the ovary and/or fallopian tube, cutting off blood supply, and although it can occur in pregnancy, it is not a direct complication of molar pregnancy. - It is often associated with ovarian cysts or masses, and while **theca lutein cysts** can be seen with molar pregnancy, torsion of these cysts is less common than invasive mole. *Choriocarcinoma* - While a serious neoplastic complication of molar pregnancy, **choriocarcinoma** is much rarer than an invasive mole, occurring in only 2-3% of complete hydatidiform moles. - It represents a **malignant transformation** of trophoblastic tissue with metastatic potential, distinguishing it from the localized invasion of an invasive mole.
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