Gestational trophoblastic neoplasia

2011 ◽  
pp. 1298-1305
Author(s):  
Philip Savage ◽  
Michael J. Seckl
Keyword(s):  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Team Working ◽  
Life Saving ◽  
Placental Site ◽  
Additional Chemotherapy ◽  
Invasive Mole ◽  
Cure Rates ◽  
Prompt Diagnosis ◽  
Hydatidiform Moles

Arising from the cells of conception, gestational trophoblastic disease (GTD) forms a spectrum of disorders from the premalignant complete and partial hydatidiform moles through to the malignant invasive mole, choriocarcinoma and very rare placental site trophoblastic tumours (PSTT). The latter three conditions are also collectively known as gestational trophoblastic neoplasia (GTN) and, although uncommon, are important to recognize as this enables life-saving therapy to be commenced. About 10% of molar pregnancies fail to die out after uterine evacuation and transform into malignant GTN that require additional chemotherapy (1). These cases are usually recognized early and therefore rarely prove difficult to treat, with cure rates approaching 100% reported in most modern series (2). However, GTN can also develop after any type of pregnancy including miscarriages, term deliveries, and medical abortions. Such patients are often not suspected of having GTN and may present late with widespread disease associated with a wide variety of medical, surgical, and gynaecological problems (3). The prompt diagnosis and early effective treatment of these women is aided by an awareness and understanding of these rare, but highly curable malignancies and good team-working between physicians, gynaecologists, pathologists, and oncologists

Results of treatment of gestational trophoblastic neoplasia in the Slovak Republic in the years 1993–2017

2021 ◽  
Vol 86 (2) ◽  
pp. 94-101
Author(s):  
Miroslav Korbeľ ◽  
◽  
Jozef Šufliarsky ◽  
Ľudovít Danihel ◽  
Zuzana Nižňanská
Keyword(s):  
Slovak Republic ◽  
Staging System ◽  
Gestational Trophoblastic Disease ◽  
World Health ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Disease ◽  
Gynecology And Obstetrics ◽  
Placental Site ◽  
Invasive Mole ◽  
Trophoblastic Tumours

Overview Objective: Gestational trophoblastic neoplasia epidemiology and treatment results in the Slovak Republic in the years 1993–2017. Methods: Retrospective analysis results of gestational trophoblastic neoplasia treatment in the Centre for gestational trophoblastic disease in the Slovak Republic in Bratislava in the years 1993–2017 according to prognostic scoring and staging system FIGO/WHO (International Federation of Gynecology and Obstetrics/World Health Organization). Results: The Centre for Gestational Trophoblastic Disease was created in the Slovak Republic in the year 1993, after the split of former Czechoslovakia. A total of 100 patients with gestational trophoblastic neoplasia were treated in this Centre in the years 1993–2017. According to prognostic scoring and staging system FIGO/ WHO, 74% patients were at a low risk and 26% of patients were at a high-risk of gestational trophoblastic neoplasia. There were 56, 2, 32 and 10% patients in stages I, II, III, and IV, respectively. The total curability and mortality rates were 96 and 4%, respectively. The curability rate 100% was achieved in stages I–III and in all placental site trophoblastic tumours, and the curability rate 60% was achieved in stage IV. In the years 1993 –2017, the incidences were 1 in 59,315 pregnancies and 1 in 42,299 deliveries for choriocarcinoma, 1 in 489,348 pregnancies and 1 in 348,965 deliveries for placental site trophoblastic tumours, 1 in 139,814 pregnancies and 1 in 99,704 deliveries for invasive mole, and 1 in 39,947 pregnancies and 1 in 28,487 deliveries for persistent gestational trophoblastic neoplasia. In the Czech Republic in the same period of time, there were treated 281 (301) patients with the curability rate 98.6% (98.7%). Conclusion: The results of the treatment of gestational trophoblastic neoplasia in the Slovak Republic are comparable with those achieved by leading centers specialized for the treatment of this disease in Europe and in the world. Early detection and centralisation of the treatment are crucial points for successful treatment, as the high curability rate of gestational trophoblastic neoplasia is achieved by effective therapy. Keywords: gestational trophoblastic neoplasia – choriocarcinoma – placental site trophoblastic tumour – epithelioid trophoblastic tumour – invasive mole – curability – mortality – reproductive outcomes

scholarly journals A case of methotrexate resistant gestational trophoblastic neoplasia

2018 ◽  
Vol 7 (12) ◽  
pp. 5178
Author(s):  
Sanjay Singh ◽  
Akhileshwar Singh ◽  
Shakti Vardhan
Keyword(s):  
High Risk ◽  
Combination Chemotherapy ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Disease ◽  
Peripheral Hospital ◽  
Invasive Mole ◽  
Single Agent Chemotherapy

Gestational trophoblastic neoplasia (GTN) is a subset of gestational trophoblastic disease (GTD) which has a propensity to invade locally and metastasize. Patients with low risk GTN generally respond well to single agent chemotherapy (methotrexate (MTX) or actinomycin-D (ACT-D). However, high risk cases may develop resistance or may not respond to this first-line chemotherapy and are unlikely to be cured with single-agent therapy. Therefore, combination chemotherapy is used for treatment of these cases. Here we present a 25 years old P2 L2 A1 lady, who was initially treated at a peripheral hospital with multiple doses of Injection methotrexate with a working diagnosis of persistent trophoblastic disease. She didn’t respond to this treatment and reported to our centre for further management. On evaluation she was found to be a case of high risk GTN (invasive mole) (I:8) for which she was put on combination chemotherapy in the form of Etoposide-Methotrexate-Actinomycin-Cyclophosphamide-Oncovin (EMA-CO) regime. She responded to this treatment and is presently asymptomatic and is under regular follow up.

scholarly journals Update on the Diagnosis of Gestational Trophoblastic Disease

2019 ◽  
Vol 4 (2) ◽  
pp. 20-30
Author(s):  
Andi Friadi
Keyword(s):  
Polymerase Chain Reaction ◽  
Ct Scan ◽  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Chain Reaction ◽  
Trophoblastic Disease ◽  
Placental Site ◽  
Polymerase Chain

Penyakit trofoblas gestasional (PTG)/Gestational trophoblastic disease (GTD) terdiri dari kelompok mola hidatidosa yang terbagi menjadi komplit dan parsial, hingga kelompok Tumor trofoblas gestasional (TTG)/Gestational trophoblastic neoplasia (GTN) yang terdiri dari mola invasif, koriokarsinoma, dan placental site trophoblastic tumour/epithelioid trophoblastic tumour (PSTT/ETT). TTG dikategorikan menjadi dua yaitu yang tidak bermetastasis (hanya terbatas di uterus) dan yang bermetastasis (telah menyebar ke vagina, paru-paru atau otak). Penegakan diagnosis inisial PTG melalui pendekatan multimodalitas mencakup gejala klinis, kadar hCG dan pemeriksaan USG pelvis. Doppler membantu menilai angiogenesis dan karakterisitik neovaskularisasi PTG. Gambaran yang tampak pada USG akan menjelaskan gambaran pada histopatologinya. Pemeriksaan penunjang lain untuk PTG adalah rontgen thoraks, CT Scan dan MRI. Saat ini pemeriksaan imunohistokimia (IHK) dan polymerase chain reaction (PCR) sudah mulai digunakan untuk menentukan diagnosis PTG. Pemantauan hCG mempunyai peran penting dalam penatalaksanaan PTG. Tetapi karena terdapat beberapa pedoman yang menyatakan protokol berbeda-beda dalam pemantauan hCG, hal ini membuat  para dokter spesialis obgin mempertanyakan mengenai pemantauan hCG pasca evakuasi. Himpunan Onkologi Ginekologi Indonesia mengeluarkan suatu Pedoman Nasional Pelayanan Kedokteran (PNPK) Tumor Trofoblas Gestasional yang didalamnya terkait diagnosis dan penatalaksaan TTG.

Gestational Trophoblastic Disease

2013 ◽  
Vol 3 (2) ◽  
pp. 4-11
Author(s):  
JP Deep ◽  
LB Sedhai ◽  
J Napit ◽  
J Pariyar
Keyword(s):  
Placental Tissue ◽  
Gestational Trophoblastic Disease ◽  
Diagnosis And Treatment ◽  
Gestational Trophoblastic Neoplasia ◽  
Medical College ◽  
Trophoblastic Disease ◽  
Β Hcg ◽  
Invasive Mole

Gestational trophoblastic disease (GTD) is a group of tumors that arise from placental tissue and secrete β-hCG. GTD is a combination of benign or invasive mole and malignant known as Gestational Trophoblastic Neoplasia (GTN). Prevalence, diagnosis and treatment of GTD have drastically changed in recent years. DOI: http://dx.doi.org/10.3126/jcmc.v3i2.8434 Journal of Chitwan Medical College Vol.3(2) 2013 4-11

scholarly journals Fertility and pregnancy outcome in gestational trophoblastic disease

2021 ◽  
Vol 31 (3) ◽  
pp. 399-411
Author(s):  
Ulrika Joneborg ◽  
Leonoor Coopmans ◽  
Nienke van Trommel ◽  
Michael Seckl ◽  
Christianne A R Lok
Keyword(s):  
Pregnancy Outcome ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Tumor ◽  
Epithelioid Trophoblastic Tumor ◽  
Placental Site ◽  
Multi Agent

The aim of this review is to provide an overview of existing literature and current knowledge on fertility rates and reproductive outcomes after gestational trophoblastic disease. A systematic literature search was performed to retrieve all available studies on fertility rates and reproductive outcomes after hydatidiform mole pregnancy, low-risk gestational trophoblastic neoplasia, high- and ultra-high-risk gestational trophoblastic neoplasia, and the rare placental site trophoblastic tumor and epithelioid trophoblastic tumor forms of gestational trophoblastic neoplasia. The effects of single-agent chemotherapy, multi-agent including high-dose chemotherapy, and immunotherapy on fertility, pregnancy wish, and pregnancy outcomes were evaluated and summarized. After treatment for gestational trophoblastic neoplasia, most, but not all, women want to achieve another pregnancy. Age and extent of therapy determine if there is a risk of loss of fertility. Single-agent treatment does not affect fertility and subsequent pregnancy outcome. Miscarriage occurs more often in women who conceive within 6 months of follow-up after chemotherapy. Multi-agent chemotherapy hastens the natural menopause by three years and commonly induces a temporary amenorrhea, but in young women rarely causes permanent ovarian failure or infertility. Subsequent pregnancies have a high chance of ending with live healthy babies. In contrast, high-dose chemotherapy typically induces permanent amenorrhea, and no pregnancies have been reported after high-dose chemotherapy for gestational trophoblastic neoplasia. Immunotherapy is promising and may give better outcomes than multiple schedules of chemotherapy or even high-dose chemotherapy. The first pregnancy after immunotherapy has recently been described. Data on fertility-sparing treatment in placental site trophoblastic tumor and epithelioid trophoblastic tumor are still scarce, and this option should be offered with caution. In general, patients with gestational trophoblastic neoplasia may be reassured about their future fertility and pregnancy outcome. Detailed registration of high-risk gestational trophoblastic neoplasia is still indispensable to obtain more complete data to better inform patients in the future.

scholarly journals Case Report: Acute abdomen presentation revealing a metastatic invasive mole with uterine rupture

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1115
Author(s):  
Fatma Dhieb ◽  
Miriam Boumediene ◽  
Armi Saoussem ◽  
Garci Mariem ◽  
Mathlouthi Nabil ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Uterine Rupture ◽  
Pulmonary Nodules ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Tumor ◽  
Clinical Presentations ◽  
History Of ◽  
Invasive Mole

Gestational trophoblastic neoplasia refers to the aggressive subset of gestational trophoblastic disease, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors may have atypical clinical presentations that can mislead the diagnosis. The reported case is a 48-year-old woman in perimenopause, without any history of vaginal bleedings nor molar pregnancy, who presented to the Emergency Department with acute abdominal pain. Serum beta human chorionic gonadotropin (β-HCG) was highly elevated at 261 675.23 mIU/ml. A complicated invasive mole was suspected, and an abdominal computed tomography was performed, showing a moderate hemoperitoneum associated to complex cystic and solid uterine mass, with a common left iliac adenomegaly and multiple pulmonary nodules. MRI showed a multiloculated cystic uterine mass with zones of hemorrhage recalling an invasive mole with perforation of the posterior uterus wall, associated to a high abundance hemoperitoneum. The diagnosis of a metastatic invasive mole complicated of uterine rupture and hemoperitoneum was retained. A surgical intervention was decided immediately and a subtotal hysterectomy with bilateral annexectomy was done. Pathologic examination of the specimen was positive for an invasive mole. The patient was proposed for chemotherapy. This case study will increase awareness of unusual clinical presentations of gestational trophoblastic neoplasia We believe that our case will contribute to the literature not only because of the rarity of this entity in perimenopausal period, but also due the atypical clinical presentation as acute abdomen without vaginal bleeding nor history of molar pregnancy evacuation

scholarly journals Prospective and Retrospective Analysis of Gestational Trophoblastic Disease over a Period of 5 Years

2013 ◽  
Vol 5 (1) ◽  
pp. 11-14
Author(s):  
Uma Singh ◽  
Nisha Singh ◽  
Sanghmitra Srivastava
Keyword(s):  
Retrospective Analysis ◽  
Scoring System ◽  
Gynecological Cancer ◽  
Survival Rates ◽  
Gestational Trophoblastic Disease ◽  
Trophoblastic Disease ◽  
Lower Drug ◽  
Invasive Mole ◽  
Cure Rates

ABSTRACT Objective To study incidence and outcome of gestational trophoblastic disease and its variants and changes in gestational trophoblastic neoplasia (GTN) outcome since the use of FIGO 2002 scoring system. Materials and method A prospective and retrospective cohort study was conducted on all cases of GTD. Those admitted from Jan 2005 to Dec 2007 were retrospectively analyzed from hospital records. Cases admitted from Jan 2008 to Dec 2009 were followed prospectively. Data was analyzed in terms of methods of diagnosis, FIGO score, treatment methods, success and follow- up feasibility. Statistical analysis was done on SPSS 11 of Windows 2003. Results Forty-four patients of GTD were analyzed, 21 retrospectively and 23 prospectively. The incidence of GTD was 1.1 per 1,000 admissions and 1.5 per 1,000 deliveries. GTN constituted 1.44% of all the gynecological cancer cases admitted in 5 years. Invasive mole constituted 68% of GTN. Seventyone percent of the GTN belonged to stage 1 and 60% had low risk score. Prospective cases managed according to new FIGO (2002) scoring system showed a faster decline in βhCG, lower drug toxicity and higher complete cure rates. Conclusion Management of GTN according to new scoring system results in high cure rates. Centralized registry can achieve 100% follow-up and higher survival rates. How to cite this article Singh N, Singh U, Srivastava S. Prospective and Retrospective Analysis of Gestational Trophoblastic Disease over a Period of 5 Years. J South Asian Feder Obst Gynae 2013;5(1):11-14.

scholarly journals Recurrent hydatidiform mole transformed into invasive mole with co-morbid depression- a rare case report

2017 ◽  
Vol 6 (7) ◽  
pp. 3197
Author(s):  
Nisha Bhagat ◽  
Rajnish Raj
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Placental Site Trophoblastic Tumor ◽  
Trophoblastic Disease ◽  
Placental Site ◽  
Rare Case Report ◽  
Invasive Mole ◽  
Methotrexate Chemotherapy

The gestational trophoblastic disease is a group of interrelated lesions that arise from abnormal proliferation of placental trophoblast. It comprises of hydatidiform mole (partial or complete), invasive mole, placental site trophoblastic tumor and choriocarcinoma. The occurrence of hydatidiform mole in more than two conceptions is known as recurrent hydatidiform mole. Although, its incidence is less than 2% but it may progress to invasive mole or choriocarcinoma. The case of 26-year old female is reported; she had five consecutive molar pregnancies and the sixth one developed into invasive mole with co-morbid depression that was managed by methotrexate chemotherapy, antidepressant and psychotherapy. 

scholarly journals Classification and etiologies of gestational trophoblastic disease

2021 ◽  
Vol 8 (9) ◽  
pp. 4592
Author(s):  
Nadia D. Younis ◽  
Fatimah H. Juwayd ◽  
Mohammed A. Aljawi ◽  
Fai T. Althoini ◽  
Fatema H. Alsaffaf ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Classification Systems ◽  
Gestational Trophoblastic Neoplasia ◽  
Adequate Treatment ◽  
Gynecology And Obstetrics ◽  
Trophoblastic Diseases ◽  
Placental Site ◽  
Attending Physicians

Various forms of trophoblastic diseases were reported in the literature, including complete and partial of hydatidiform moles, gestational choriocarcinomas, placental-site and epitheloid trophoblastic tumors. Among patients who suffer from hydatidiform mole, gestational trophoblastic neoplasia can be easily diagnosed by using the levels of the human chorionic gonadotropin (hCG). Therefore, complex investigations are not usually necessary in measuring the levels of hCG, physical examination and assessments. In addition, patients’ medical history can help the attending physicians to draw an adequate treatment plan for patients with gestational trophoblastic neoplasia. However, Pelvic Doppler ultrasonography might also be used for additional assessments, including the presence or absence of pregnancy, measurement of the uterine volume and size. Additionally, it determines the vasculature and spread of the neoplasm within the pelvic region. Furthermore, genetic analysis can be used to differentiate between the types of the disease. Moreover, among the reported staging and classification systems, the international federation of gynecology and obstetrics (FIGO) seems to be the best efficacious modality for the determination of the prognosis of the various types of the disease to properly choose the best treatment modality.

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