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 Treatment of gestational trophoblastic disease: A 10-year experience

2012 ◽  
Vol 65 (5-6) ◽  
pp. 244-246 ◽  
Author(s):  
Biljana Lazovic ◽  
Vera Milenkovic ◽  
Spomenka Djordjevic
Keyword(s):  
World Health Organization ◽  
Pulmonary Metastases ◽  
Descriptive Study ◽  
Gestational Trophoblastic Disease ◽  
World Health ◽  
Trophoblastic Disease ◽  
Multiple Factors ◽  
Invasive Mole ◽  
Health Organization ◽  
Epidemiological Characteristics

A retrospective descriptive study about the presence of metastases, epidemiological characteristics and treatment of 104 patients suffering from gestational trophoblastic disease was performed in the period from 1st Jan, 2000 to 31st December, 2010. Of eleven patients who were found to have metastases (10.6%), 72.7% had pulmonary metastases, 27.3 had vaginal, and one patient had both pulmonary and brain metastases. The average age was 33.9. Antecedent molar pregnancy was recorded in 63.6% patients. Invasive mole was more frequent than choriocarcinoma (63.6%). According to the World Health Organization criteria, 7 patients (63.6%) had high risk score (the average World Health Organization score was 8.4). All patients were treated by chemotherapy, the average number of courses being 1.8. Complete remission was achieved in all patients. Treatment of metastatic disease depends on multiple factors. However, combined chemotherapy is the universally accepted treatment. If chemotherapy is individualized and applied on time, the prognosis is good, even in cases with cerebral metastases.

scholarly journals Coriocarcinoma gestacional primario de cuello uterino. Presentación de un caso

2021 ◽  
Vol 81 (04) ◽  
pp. 406-410
Author(s):  
Viviana García ◽  
◽  
Franco Calderaro Di Ruggiero ◽  
Jorge Hoegl ◽  
Carlos Quintero ◽  
...  
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
World Health ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Gestational Choriocarcinoma ◽  
Gynecology And Obstetrics ◽  
Gynecological Examination

Choriocarcinoma represents a type of malignant tumor of gestational trophoblastic disease. It can develop after a molar pregnancy, miscarriage, normal or ectopic pregnancy. Generally its seat site is the uterine body; infrequent places such as the cervix have been described. We report the case of a 37-year-old patient is reported, VI gestations IV deliveries I cesarean section I molar pregnancy, with abnormal uterine bleeding, which is referred to the Hospital Oncology Service. On gynecological examination, an exophytic mass is observed in the cervix. A biopsy was taken that reported: Gestational choriocarcinoma and plasma levels of β-hCG were verified: 13805 IU / L. A total abdominal hysterectomy was performed with preservation of the ovaries. It was concluded as stage I of the International Federation of Gynecology and Obstetrics and 8, according to the score of the World Health Organization (ST I: 8), for which adjuvant was indicated. Currently no evidence of disease. Keywords: Choriocarcinoma, gestational trophoblastic disease, cervix.

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.

Gestational Trophoblastic Disease Electronic Consults: What Do Patients and Physicians Want to Know?

2018 ◽  
Vol 28 (4) ◽  
pp. 824-828 ◽  
Author(s):  
Roni Nitecki ◽  
Ross S. Berkowitz ◽  
Kevin M. Elias ◽  
Donald P. Goldstein ◽  
Neil S. Horowitz
Keyword(s):  
United States ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Lung Metastases ◽  
The United States ◽  
Gestational Trophoblastic Disease ◽  
World Health ◽  
Trophoblastic Disease ◽  
Gynecology And Obstetrics ◽  
Medical Oncologists

ObjectivesGiven the rarity of gestational trophoblastic disease (GTD), specialized regional and national centers for GTD have been established. These centers serve at least 3 purposes: to improve care for women with GTD, to enhance research though collaboration, and to educate other clinicians. This study was undertaken to understand the potential GTD knowledge gap by examining both patient and physician inquiries received at a specialized GTD center.MethodsAll electronic consults received by specialists at our center between March 2016 and March 2017 were analyzed. Information collected included source of inquiry, reason for the consult, type of GTD, and the advice provided. Descriptive statistics were used to analyze the major trends.ResultsWe analyzed 102 electronic consults. Physicians sent 49 (48%) and patients sent 53 (52%) consults. Most e-consults were sent by physicians and patients within the United States; however, 11% of the consults were directed from international locations. Among physicians, gynecologic oncologists (65%) were the most common specialty to consult our institution followed by medical oncologists (18%) and obstetrician gynecologists (16%).Most questions from gynecologic (62%) and medical oncologists (77%) concerned treatment regimens. This was contrasted by general obstetrician gynecologists who more commonly asked about human chorionic gonadotropin monitoring (62%). Difficulty with appropriate Federation of Gynecology and Obstetrics staging and World Health Organization risk score assignment were common themes. Most of the confusion centered on the use of chest computed tomography rather than plain chest x-ray for the assessment of lung metastases. Unlike physicians, patient e-consults were most concerned with the duration of human chorionic gonadotropin monitoring (51%) and timing of future conceptions.ConclusionsBoth physicians and patients in the United States and abroad frequently use electronic consults to improve their knowledge about GTD management and follow-up. Although the type of inquires varied, they highlight fundamental gaps in understanding and potential opportunities for formal education.

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.

Placental site trophoblastic tumour: five challenges of patient clinical management

2021 ◽  
Vol 14 (1) ◽  
pp. e238994
Author(s):  
Catarina Peixinho ◽  
Amélia Almeida ◽  
Carla Bartosch ◽  
Mónica Cruz Pires
Keyword(s):  
Gestational Trophoblastic Disease ◽  
Normal Range ◽  
Rare Form ◽  
Gonadotropin Level ◽  
Trophoblastic Disease ◽  
Placental Site ◽  
Abnormal Vaginal Bleeding ◽  
Rare Situation ◽  
Trophoblastic Tumours

Placental site trophoblastic tumour is a rare form of gestational trophoblastic disease accounting for about 1%–2% of all trophoblastic tumours. Diagnosis and management of placental site trophoblastic tumour can be difficult.We report a case of a 30-year-old woman diagnosed with a placental site trophoblastic tumour and identify the challenges in diagnosis and treatment of this rare situation. The presenting sign was abnormal vaginal bleeding that started 3 months after delivery. Image exams revealed an enlarged uterus with a heterogeneous mass, with vesicular pattern, and the increased vascularisation serum human chorionic gonadotropin level was above normal range. The histological diagnosis was achieved through hysteroscopic biopsy. Staging exams revealed pulmonary micronodules. The patient was successfully treated with hysterectomy and chemotherapy. The latest follow-up (37 months after diagnosis) was uneventful, and the patient exhibited no signs of recurrence or metastasis.

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 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. 

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