scholarly journals Gestational Trophoblastic Disease Spectrum: Case Report and Anaesthetic Implications

2020 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Hydatidiform Mole ◽  
Asian Population ◽  
Anaesthetic Management ◽  
Gestational Trophoblastic Disease ◽  
Definitive Treatment ◽  
Surgical Removal ◽  
Molar Pregnancy ◽  
Rare Type ◽  
Trophoblastic Disease ◽  
Disease Spectrum

Gestational Trophoblastic Disease (GTD) is a spectrum of tumours with abnormal placental trophoblastic proliferation. They can be benign or malignant lesions. When they invade locally or metastasise, they are called Gestational Trophoblastic Neoplasia (GTN). Clinically, women present with history of amenorrhoea, abdominal pain, mild to severe vaginal bleed with or without symptoms due to metastases. Based on the organ of metastasis, symptoms may vary from breathlessness and cough with chest involvement to lethargy, loss of memory or seizures with brain metastasis. This entity ranges from pre-malignant conditions like hydatidiform mole and partial hydatidiform mole to neoplastic invasive mole, choriocarcinoma or rare type of epitheloid trophoblastic tumour. [1,2] Undetected hyperthyroidism can complicate GTD and present with potential significant complications like cardiac failure and arrhythmias. Manifestations of the disease are attributed to excess secretion of human chorionic gonadotropin (HCG) that has thyrotrophic activity due to its structural similarity. [3,4] The incidence reported in Asian population is as high as 1:400, three times higher. In majority of cases, early diagnosis and treatment provide complete cure in GTD. In 20%, even locally invasive disease, with or without metastasis can be life threatening. [5] Surgical removal is the definitive treatment. Peri-operative anaesthetic management of patients with multiple system involvement as a result of extensive disease can be challenging, hence from anaesthetic perspective it is essential to understand the pathophysiology, clinical presentations and potential complications of molar pregnancy. We hereby report successful management of two cases presenting at different areas of the disease spectrum. Keywords: Molar pregnancy; Choriocarcinoma; Tropoblastic disease.

The clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation

2004 ◽  
Vol 14 (2) ◽  
pp. 366-369 ◽  
Author(s):  
A. M. Gillespie ◽  
E. A. Lidbury ◽  
J. A. Tidy ◽  
B. W. Hancock
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Gestational Trophoblastic Disease ◽  
Surgical Removal ◽  
Molar Pregnancy ◽  
Initial Management ◽  
Trophoblastic Disease ◽  
Treatment Centre ◽  
History Of ◽  
Park Hospital

The objective of this study was to determine the clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation registered with the Trophoblastic Disease Screening and Treatment Centre, Weston Park Hospital, Sheffield between 1986 and 2000. From the 5581 women registered, those with a diagnosis of ectopic molar pregnancy were identified from a computer database. Information regarding the relevant history of each patient and the clinical presentation, treatment, and outcomes of gestational trophoblastic disease (GTD) was determined by reviewing referral forms, case notes, and pro formas completed by the referring gynecologist. Histological review of the cases was undertaken where possible. Suspected ectopic molar gestations comprised 31/5581 (0.55%) of registrations. Known risk factors for ectopic pregnancy were identified in 79% of cases. Central histological review confirmed only six cases of GTD: three choriocarcinoma and three early complete moles. Four patients subsequently required chemotherapy. All patients are now in complete remission. We conclude that ectopic GTD is uncommon, with a UK incidence of approximately 1.5 per 1,000,000 births. Initial management is usually surgical removal of the conceptus, pathological suspicion of the diagnosis and registration with a screening center. Chemotherapy may be required and the prognosis is excellent.

scholarly journals SUN-513 Severe Hyperthyroidism in a Complete Molar Pregnancy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nikoletta Proudan ◽  
Kersthine Andre
Keyword(s):  
Perioperative Complications ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Storm ◽  
Molar Pregnancy ◽  
Free T4 ◽  
Trophoblastic Disease ◽  
Increased Risk ◽  
History Of

Abstract Hydatidiform mole (HM), a type of gestational trophoblastic disease (GTD), is a rare cause of clinical hyperthyroidism. The development of hyperthyroidism requires an elevation of HCG >100,000 mlU/mL for several weeks. Complete mole has a marked HCG elevation compared to partial mole thus presents with a higher incidence of thyrotoxicosis. Surgical uterine evacuation is the treatment of choice for HM. However, untreated hyperthyroidism can pose a risk for the development of thyroid storm and high-output cardiac failure in the perioperative period. To our knowledge, there are no specific guidelines for management at this time. We present a case of hyperthyroidism secondary to complete molar pregnancy successfully treated with propylthiouracil (PTU), potassium iodide (SSKI), and atenolol in the preoperative period. A 42-year-old female with history of migraines presented to her gynecologist with a 3-week history of lower abdominal cramping, vomiting, loss of appetite, and abnormal vaginal bleeding. She also endorsed a 6-pound weight loss, intermittent tachycardia, exertional dyspnea, and increased anxiety. Pregnancy test was positive, and ultrasound was concerning for GTD. Laboratory work up was significant for HCG 797,747 mIU/mL (< 5mlU/mL), TSH <0.005 mIU/mL (0.4-4.0 mlU/mL), Free T4 3.09 ng/dL (0.9-1.9 ng/dL), and Free T3 11.48 pg/dL (1.76-3.78 pg/dL). The patient was admitted to the hospital and started on PTU 100 mg Q6H, SSKI 200 mg TID following the first dose of PTU, and atenolol 25 mg daily. She underwent an uncomplicated D & C the next day. On post-op day 1, HCG decreased to 195,338 mIU/mL and Free T4 to 2.39 ng/dL. The patient was discharged on the aforementioned doses of PTU and atenolol. One-week follow-up labs showed HCG 8,917 mIU/mL and Free T4 1.22 ng/dL. Surgical pathology confirmed a complete hydatidiform mole. PTU was decreased to 50 mg TID. On post-op day 14, HCG had risen to 15,395 mIU/mL with onset of nausea and vomiting. Repeat Free T4 remained within reference range. Patient was taken back to surgery for a laparoscopic total hysterectomy with bilateral salpingectomy. Pathology confirmed an invasive hydatidiform mole. Two-week follow-up lab work showed HCG 155 mIU/mL, TSH 1.5 mIU/mL, and Free T4 1.19 ng/dL. PTU and atenolol were then discontinued. The development of hyperthyroidism in molar pregnancy is largely influenced by the level of HCG and usually resolves with treatment of GTD (1). However, it’s crucial to control thyrotoxicosis to avoid perioperative complications. This case also highlights the importance of monitoring HCG levels following a complete molar pregnancy due to an increased risk for invasive neoplasm. 1. Walkington, L et al. “Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.” British journal of cancer vol. 104,11 (2011): 1665-9. doi:10.1038/bjc.2011.139

scholarly journals A PROSPECTIVE STUDY ON CLINICOEPIDEMIOLOGICAL PROFILE OF MOLAR PREGNANCY IN A TERTIARY CARE HOSPITAL

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Ajit Kumar Nayak ◽  
Dr. Sumitra Hota ◽  
Dr. Maya Padhi ◽  
, Dr. Manju Kumari Jain
Keyword(s):  
Low Socioeconomic Status ◽  
Hydatidiform Mole ◽  
Tertiary Care ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Care Hospital ◽  
Molar Pregnancy ◽  
Medical College ◽  
Trophoblastic Disease ◽  
Common Time

Introduction: Gestational trophoblastic diseases (GTD) refers to a spectrum of pregnancy related trophoblastic abnormalities. The objective of this study was to determine the incidence of molar pregnancies in SCB Medical College & Hospital along with the demographics and risk factors associated and to evaluate its management and outcome.  Methods: The study was a prospective epidemiological study which includes fifty eight patients with gestational trophobastic diseases treated at the gynecological ward, S.C.B. Medical College & Hospital, Cuttack, Odisha during July 2015 to July 2017. Results: The incidence was 2.85 in 1000 deliveries in the institution. Most of the patients belonged to low socioeconomic status and in the age group of 21 to 30 years. Primigravida were more prone to the disease and no patients had history of molar in prior pregnancies. Most commonly encountered symptom was vaginal bleeding following a period of amenorrhea. Second trimester was the most common time of presentation with mean gestational age around 12 weeks. Out of 57 patients treated with suction and evacuation, 23 patients developed persistent trophoblastic disease who were further managed by methotrexate and folinic acid. Failure rate of single agent chemotherapy was 21.7% which were successfully managed by triple agent chemotherapy [EMA-CO regimen]. Conclusion: Incidence of molar pregnancies in this study was much higher as this hospital is the referral centre for South Eastern Odisha. However, proper reporting and follow up can prevent mortality associated with malignant transformation. Keywords: Beta hCG, Chemotherapy, Gestational trophoblastic disease, Hydatidiform mole, molar pregnancy

scholarly journals Clinicopathological study of Gestational Trophoblastic Disease

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2344-2349
Author(s):  
Ramesh M. Oswal ◽  
Mahendra A. Patil ◽  
Sujata M. Kumbhar ◽  
Jyoti S. Tele ◽  
Atul B. Hulwan
Keyword(s):  
Risk Factors ◽  
Maternal Age ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Histopathological Study ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
Complete Mole ◽  
Clinicopathological Study

Several potential etiologic risk factors have been evaluated for the development of complete hydatidiform mole. The two established risk factors that have emerged are extremes of maternal age and prior molar pregnancy. Advanced or very young maternal age has consistently correlated with higher rates of complete hydatidiform mole. Compared to women aged 21- 35 years, the risk of a complete mole is 1.9 times higher for women both more than 35 years and less than 21 years as well as 7.5 times higher for women more than 40 years. (49, 50) The risk of repeat molar pregnancy after 1 mole is about 1% or about 10-20 times the risk for the general population. The present study on the gestational trophoblastic disease (GTD) was carried out as it is one of the fascinating gynaecological tumours. Hence a clinicopathological study of gestational trophoblastic disease was undertaken with relevance to the histopathological study of GTD and clinical correlation.

scholarly journals Gestational Trophoblastic Disease: Review of Cases Managed at B P Koirala Memorial Cancer Hospital

2013 ◽  
Vol 8 (1) ◽  
pp. 18-21
Author(s):  
Jitendra Pariyar ◽  
B Shrestha ◽  
J Shrestha ◽  
J Shrestha ◽  
BP Rauniyar ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Hydatidiform Mole ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Brain Irradiation ◽  
Trophoblastic Disease ◽  
Cancer Hospital ◽  
Invasive Mole ◽  
Multiagent Chemotherapy

Aims: This study was done to analyze the clinical presentation and management outcomes of gestational trophoblastic disease managed at B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal. Methods: Descriptive study was conducted at B.P. Koirala Memorial Cancer Hospital. Case records of all gestational trophoblastic cases from January 2001 to December 2007 were analyzed regarding clinical details, investigations and treatment outcomes. Results: Forty-five cases of 16 to 50 years (mean 29.1 years) had gestational trophoblastic disease, among which 19 (43%) were of Tibeto- Burmese and 15 (33%) Indo-Aryan ethnic group. Hydatidiform mole, invasive mole and choriocarcinoma were observed in 17 (37.8%), six (13.3%) and 22 (48.8%) cases respectively. In seven cases (15.5%) molar pregnancy had occurred in primigravida, seven cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. Vaginal bleeding was the commonest presentation and 26 (57.8%) cases had anaemia. Eleven (24.5%) cases had theca luteal cyst, 17 (37.8%) had lung metastasis and 4 (8.9%) had brain metastasis. Chemotherapy was administered in 34 (75.5%) cases, among which 15 (33.3%) received single agent and 18 (40%) received multiagent chemotherapy. Hysterectomy was done in nine (20%) cases. Brain irradiation was done in a case with brain metastasis. Five (11.2%) cases with high WHO risk score left the hospital against medical advice. There were three (6.6%) mortalities. Thirty-seven (72.1%) cases were in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 18-21 DOI: http://dx.doi.org/10.3126/njog.v8i1.8855

scholarly journals Preterm Gestation Along with Partial Hydatidiform Mole and Alive Foetus

2012 ◽  
Vol 9 (3) ◽  
pp. 222-224 ◽  
Author(s):  
S R Tamrakar ◽  
C D Chawla
Keyword(s):  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Diverse Group ◽  
Partial Hydatidiform Mole ◽  
Second Stage ◽  
Trophoblastic Disease

Gestational trophoblastic disease encompasses a diverse group of lesion. If molar changes in the placenta are known along with an alive fetus then the situation is difficult to manage. We present successfully managed case of partial degeneration of placenta in molar pregnancy with an alive fetus at second stage of preterm labour.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6310 Kathmandu Univ Med J 2011;9(3):222-4 

Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women

2016 ◽  
Vol 26 (5) ◽  
pp. 984-990 ◽  
Author(s):  
Antonio Braga ◽  
Valéria Moraes ◽  
Izildinha Maestá ◽  
Joffre Amim Júnior ◽  
Jorge de Rezende-Filho ◽  
...  
Keyword(s):  
Natural History ◽  
Early Diagnosis ◽  
Clinical Symptoms ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
History Of

ObjectiveThe aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil.MethodsA retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models.ResultsA downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat molar pregnancy. Although the duration of postmolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia.ConclusionsEarly diagnosis of complete hydatidiform mole has altered the natural history of molar pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.

scholarly journals Delivery of Euthyroid Baby following Hyperthyroidism in Twin Gestation with Coexisting Complete Hydatidiform Mole

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Rishi Raj ◽  
Edilfavia Mae Uy ◽  
Matthew Hager ◽  
Kamyar Asadipooya
Keyword(s):  
Twin Pregnancy ◽  
Molecular Mimicry ◽  
Rare Complication ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Stimulating Hormone ◽  
Dose Titration ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Normal Fetus

Context. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Twin pregnancies with GTD and coexisting normal fetus are extremely rare with an estimated incidence of 1 case per 22,000–100,000 pregnancies. Molecular mimicry between human chorionic gonadotrophin (hCG) and thyroid-stimulating hormone (TSH) leads to gestational trophoblastic hyperthyroidism (GTH) which is further associated with increased maternal and fetal complications. This is the first reported case in literature describing the delivery of a baby with biochemical euthyroid status following a twin pregnancy with hydatidiform mole (HM) associated with gestational trophoblastic hyperthyroidism (GTH). Case Description. A 24-year-old G4 P3 Caucasian female with twin gestation was admitted to hospital for gestation trophoblastic hyperthyroidism. She was later diagnosed to have twin pregnancy with complete mole and coexisting normal fetus complicated by gestational trophoblastic hyperthyroidism (GTH). Despite the risk associated with the continuation of molar pregnancy, per patient request, pregnancy was continued till viability of the fetus. The patient underwent cesarean section due to worsening preeclampsia and delivered a euthyroid baby at the 24th week of gestation. Conclusions. Twin pregnancy with gestational trophoblastic disease and coexisting normal fetus is associated with high risk of hyperthyroidism, and careful monitoring of the thyroid function test along with dose titration of thionamides is of utmost importance throughout the gestation. If normal thyroid hormone levels are maintained during the pregnancy, euthyroidism could be successfully achieved in the baby.

Malignant disease in pregnancy

2010 ◽  
pp. 2181-2185
Author(s):  
Robin A.F. Crawford
Keyword(s):  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Live Births ◽  
Trophoblastic Disease ◽  
Gestational Choriocarcinoma ◽  
Placental Site ◽  
Cancer In Pregnancy ◽  
Malignant Trophoblast ◽  
In Pregnancy

Cancer in pregnancy is rare, affecting less than 1 in 1000 live births. It may be specific to pregnancy (gestational trophoblastic disease) or incidental to it, the less infrequent conditions being melanoma, lymphoma, and cervical malignancy. Gestational trophoblastic disease—a group of conditions that arise in the fetal chorion during various types of pregnancy: histologically they are categorized as (1) partial or complete hydatidiform mole, (2) gestational choriocarcinoma, or (3) placental site trophoblastic tumour. The most common of these conditions is molar pregnancy, when villi are present in association with malignant trophoblast in gestational choriocarcinoma....

scholarly journals TUBAL HYDATIDIFORM MOLE: A CASE REPORT

2021 ◽  
Vol 9 (01) ◽  
pp. 646-649
Author(s):  
B. Mouhamed Mahmoud ◽  
◽  
N. Abdelkader ◽  
M. Mohamed Lemine ◽  
K. Saoud N. Mamouni ◽  
...  
Keyword(s):  
Case Report ◽  
Hemorrhagic Shock ◽  
Histological Examination ◽  
Hydatidiform Mole ◽  
Metastatic Potential ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Surgical Specimen ◽  
Trophoblastic Disease

Gestational trophoblastic disease (MTG) groups together conditions that are very variable from a clinical, biological and metastatic potential point of view.We report a case of ruptured molar pregnancy, diagnosed by a picture of hemorrhagic shock, and confirmed by histological examination of the surgical specimen. Monitoring was by assaying plasma BhCG levels.

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