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.

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

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

scholarly journals Study of gestational trophoblastic diseases at a tertiary care hospital in India

2018 ◽  
Vol 7 (4) ◽  
pp. 1622
Author(s):  
Ramalingappa C. Antaratani ◽  
Shruthi M.
Keyword(s):  
Hydatidiform Mole ◽  
Local Population ◽  
Tertiary Care ◽  
Spontaneous Remission ◽  
Standard Of Care ◽  
Gestational Trophoblastic Disease ◽  
Care Hospital ◽  
Case Record ◽  
Trophoblastic Diseases ◽  
Gestational Trophoblastic Diseases

Background: Gestational trophoblastic disease refers to the heterogeneous group of interrelated lesions that arises from abnormal proliferation of placental trophoblasts. GTNs are among the rare human tumours that can be cured even in the presence of widespread dissemination. Although GTNs commonly follow a molar pregnancy, they can occur after any gestational event, including induced or spontaneous abortion, ectopic pregnancy, or term pregnancy. The study was conducted to know the incidence of different types of gestational trophoblastic diseases in the local population and the percentage of people ultimately requiring chemotherapy.Methods: The retrospective analysis of case record of 124 women with a diagnosis of GTD admitted to Karnataka Institute of Medical Sciences Hubli between November 2008 to November 2017.Results: A total of 124 cases of GTD were reviewed. Hydatidiform mole was diagnosed in 91 patients; of those experienced spontaneous remission after evacuation. 04 patients had persistent gestational trophoblastic Neoplasia and 13 cases of invasive mole (GTN) 1 case of epitheloid trophoblastic tumors and 15 cases of choriocarcinoma 99 (80%) had low-risk GTN, 25 (20%) had high-risk GTN.Conclusions: Hydatidiform mole was found to be the most common form of gestational trophoblastic diseases. Majority of the cases got cured by simple surgical evacuation. During the course of our study some rare cases of gestational trophoblastic diseases were noted. Patients’ compliance for serial follow up is a highly challenging task in developing countries. Registration of women with GTD represents a minimum standard of care.

scholarly journals Morbidity and mortality of patients suffering from gestational trophoblastic diseases at the Clinic of gynecology and obstetrics, Clinical center of Serbia in the period from 2000 to 2007

2011 ◽  
Vol 64 (11-12) ◽  
pp. 579-582 ◽  
Author(s):  
Biljana Lazovic ◽  
Vera Milenkovic ◽  
Ljiljana Mirkovic
Keyword(s):  
Risk Factors ◽  
Gestational Trophoblastic Disease ◽  
Morbidity And Mortality ◽  
Trophoblastic Disease ◽  
Gynecology And Obstetrics ◽  
Heterogenous Group ◽  
Clinical Center ◽  
Trophoblastic Diseases ◽  
Potential Risk Factors ◽  
Gestational Trophoblastic Diseases

Introduction. Gestational trophoblastic disease is a heterogenous group of diseases with malignant potential. The aim of this retrospective study was to evaluate potential risk factors in pathogenesis of gestational trophoblastic disease, its morbidity and mortality as well as treatment results. Method. We investigated 82 patients who were treated at the University Clinic of Gynecology and Obstetrics Clinical Center of Serbia from Jan 1st 2000 to Dec 31st 2007. The data were collected from their hospital charts and referred to gynecological anamnesis, diagnosis, protocols of operated patients, diagnosis, histopathological findings, decisions of expert team for trophoblastic disease and hospital discharge. Results. The incidence was 1.5 per 1000 deliveries. The most frequent finding was hydatiform mole (59.8%). The patients were treated by chemotherapy and surgery. All patients survived. Conclusion. The maternal age and a larger number deliveries and abortions are risk factors for gestational trophoblastic disease. The incidence in our clinic is approximately equal to the incidence in western countries in this period.

scholarly journals Clinical study of gestational trophoblastic disease in a tertiary care hospital

2020 ◽  
Vol 9 (7) ◽  
pp. 2964
Author(s):  
Jayashree Mulik ◽  
Archana Choudhary
Keyword(s):  
Histopathological Examination ◽  
Hydatidiform Mole ◽  
Tertiary Care ◽  
Gestational Trophoblastic Disease ◽  
Care Hospital ◽  
Complete Mole ◽  
Trophoblastic Diseases ◽  
Study Centre ◽  
Gestational Trophoblastic Diseases ◽  
Chest X Ray

Background: Gestational trophoblastic diseases (GTDs) had been associated with significant morbidity and mortality till recently. Wide variation in incidences have been reported worldwide. The present study was planned with the objective of determination of incidence, assessment of risk factors, clinical presentation, management protocols and outcomes in GTD cases in Indian population at a tertiary care centre.Methods: All the diagnosed cases of GTD reporting to study centre during study period of 1.5 years were included. Detailed history taking, examination and relevant investigations (Hb%, blood grouping, thyroid functions, serum ß-hCG, USG and chest X-ray) were undertaken. Suction and evacuation were done for all patients as primary mode of management and samples were sent for histopathological examination. Comprehensive follow ups were done, including weekly ß-hCG until normal for 3 consecutive weeks followed by monthly determination until the levels were normal for 6 consecutive months.Results: Total 22 cases out of 19500 deliveries were diagnosed as GTD (incidence rate-1.13/1000 deliveries). Mean age was 23.64±3.89 years with 50% participants being primigravida. The commonest symptom after amenorrhea 22 (100%) was bleeding per-vaginum 15 (68.2%). Maximum cases were of complete hydatidiform mole histopathology 16 (72.73%), USG 19 (86.4%). Clinical characteristics were statistically comparable between patients of complete mole and partial mole. Out of 22 cases, 1 (4.5%) was diagnosed as GTN.Conclusions: Early diagnosis and treatment along with regular follow up is the key in GTD. There is need to establish a centralized disease specific registry in future.

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.

scholarly journals GESTATIONAL TROPHOBLASTIC DISEASES;

2012 ◽  
Vol 19 (02) ◽  
pp. 159-161
Author(s):  
SYED MEHMOOD HASSAN ◽  
SHOAIB NAYYER I HASHM ◽  
BUSHRA AYAZ ◽  
Faisal Rashid Lodhi ◽  
Kanwal Sohail
Keyword(s):  
Hydatidiform Mole ◽  
Age Groups ◽  
Gestational Trophoblastic Disease ◽  
Trophoblastic Disease ◽  
Complete Mole ◽  
Trophoblastic Diseases ◽  
Partial Mole ◽  
Gestational Trophoblastic Diseases ◽  
Data Source ◽  
Naval Hospital

Objective: The study was carried out to evaluate the frequency and types of gestational. Trophoblastic diseases (GTD) inendometrial curettings received for histopathology examination. Data Source: Pathology Department, Shifa Naval Hospital Karachi. Design ofStudy: It was a Retrospective Descriptive Observational study. Setting: Department of Pathology, Pakistan Naval Ship; Shifa Naval HospitalKarachi. Period: From 2009 till 2010. Material & Methods: A total of 170 cases of endometrial curettage were examined. All specimensreceived with a diagnosis of product of conceptions (POC) or with the clinical suspicion of a gestational trophoblastic disease were included.Results: It was observed that partial mole identified in 57.1 % cases followed by complete mole 21.4%, choriocarcinoma 14.2% and placentalsite Trophoblastic disease 7.1% cases. Nearly half of the cases were diagnosed as having a gestational trophoblastic disease; these were fromthe age groups of 26-30 years followed by 21-25 years. Conclusions: Hydatidiform mole is the commonest gestational trophoblastic disease.Most complete moles are detected clinically but partial moles are misdiagnosed as abortions therefore all cases of abortions should be sent forhistopathological examinations.

INCIDENCE OF TROPHOBLASTIC TUMORS: A RETROSPECTIVE CASE STUDY AT RIMS RANCHI

2021 ◽  
pp. 26-27
Author(s):  
Sona Pathak ◽  
Suraj Sinha ◽  
Md Raihan Md Raihan ◽  
M. A. Ansari
Keyword(s):  
Clinical Presentation ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Retrospective Case ◽  
Trophoblastic Diseases ◽  
Wide Range ◽  
Gestational Trophoblastic Diseases ◽  
Common Clinical Presentation ◽  
Abnormal Vaginal Bleeding ◽  
Retrospective Case Study

Background: The gestational trophoblastic diseases encompass a wide range of conditions that vary in their clinical presentation, their propensity for spontaneous resolution, local invasion and metastasis and their overall prognosis. Advanced or adolescent maternal age has consistently correlated with higher rates of complete Hydatidiform mole. Material and Methods: It is a retrospective record based study, performed in Department of pathology RIMS, Ranchi. Study population included all cases which were clinically suspected of gestational trophoblastic disease, with common clinical presentation of abnormal vaginal bleeding, amenorrhea, pain abdomen, from January 2017- December 2020. Results: Hydatidiform mole was found to be the most common form of gestational trophoblastic diseases. Our study shows maximum cases of GTD falls in the age group of 20-29 years followed by 30-39 years.

scholarly journals Uterine Rescue in High-Risk Gestational Trophoblastic Neoplasia Treated with EMA-CO by Uterine Arteries Embolization due to Arteriovenous Malformations

2021 ◽  
Vol 43 (04) ◽  
pp. 323-328
Author(s):  
Arlley Cleverson Belo da Silva ◽  
Jurandir Piassi Passos ◽  
Roney Cesar Signorini Filho ◽  
Antonio Braga ◽  
Rosiane Mattar ◽  
...  
Keyword(s):  
High Risk ◽  
Vaginal Bleeding ◽  
Hydatidiform Mole ◽  
World Health ◽  
Complete Regression ◽  
Gestational Trophoblastic Neoplasia ◽  
Sonographic Examination ◽  
Complete Control ◽  
Uterine Arteries ◽  
Gynecology And Obstetrics

AbstractComplete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation. We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral artery puncture, which was crucial to avoid the hysterectomy and allow GTN cure and maintenance of reproductive life.

Gestational Trophoblastic Neoplasia and Human Immunodeficiency Virus Infection: A 10-Year Review

2011 ◽  
Vol 21 (9) ◽  
pp. 1684-1691 ◽  
Author(s):  
Shahila Tayib ◽  
Leon van Wijk ◽  
Lynette Denny
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hydatidiform Mole ◽  
Survival Rates ◽  
Figo Stage ◽  
Poor Compliance ◽  
World Health ◽  
Hiv Positive ◽  
Gestational Trophoblastic Neoplasia ◽  
Gynecology And Obstetrics ◽  
Immunodeficiency Virus

ObjectivesThe objective of the study was to describe the management of gestational trophoblastic neoplasia (GTN), with particular reference to concurrent human immunodeficiency virus (HIV) infection.MethodsThis retrospective descriptive study comprised all cases of GTN managed at Groote Schuur Hospital over a 10-year period (1999–2008).ResultsSeventy-six patients, with a median age of 30 years at presentation, were included in the study. Only 36 patients (47.4%) had known HIV status. Fourteen (18.4%) were HIV positive, and of these, 4 (28.6%) were on antiretroviral treatment (ARV). The mean CD4 count was 142 cells/μL for those on ARV and 543 cells/μL for those not on ARV (P= 0.001). Histologically, 44 patients (58%) had hydatidiform mole, and 21 (28%) had choriocarcinoma. In the remaining 10 cases, a clinical diagnosis was made. Based on the revised International Federation of Gynecology and Obstetrics (FIGO)/modified World Health Organization scoring, 43 patients (56.6%) were low risk, and 33 (43.4%) were high risk. Thirty-eight patients (50%) were staged as FIGO stage I. Of 73 patients who received chemotherapy, 56 (76.7%) achieved complete remission, 9 (12.3%) did not achieve any remission, 7 (9.6%) had a relapse, and 1 (1.4%) was lost to follow-up. Patients who never went into remission had frequent treatment delays due to poor compliance or inadequate blood counts. The overall survival at 60 months was 81.9%. Of the 13 patients (17.1%) who have died, 5 (38.5%) were HIV positive. The overall 5-year survival rates for FIGO stages I, II, III, and IV were 97.4%, 66.7%, 77.8%, and 46.2%, respectively. The overall 5-year survival for HIV-positive patients was 64.3% versus more than 85% for both the HIV-negative and HIV-unknown groups.ConclusionsApart from more advanced stage, HIV seropositivity and poor compliance with treatment also portend poorer outcome in GTN patients. In HIV-positive patients with poor CD4, little clarity is available whether ARV should be commenced speedily, and the administration of chemotherapy delayed until immune reconstitution occurs.

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