Classification and etiologies of gestational trophoblastic disease

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.

Spectrum of Gestational Trophoblastic Disease Secondary to Dilation and Evacuation - Our Experience at a Tertiary Care Centre in Mullana, Ambala

BACKGROUND Gestational trophoblastic diseases have varying clinical presentations with certain diagnostic signs and symptoms. A strong correlation between gestational trophoblastic diseases (GTD) and a previous history of dilation & evacuation (D & E) has been documented in the limited available literature. We wanted to study the spectrum of gestational trophoblastic disease secondary to dilation & evacuation. METHODS A two-year study including all the females who were admitted to MMIMSR Hospital in view of suspicion of gestational trophoblastic disease was conducted with all having a common history of dilatation and evacuation in the recent past. RESULTS Through the analysis we saw the spectrum of GTD including partial mole, complete mole, invasive mole and choriocarcinoma, as well as its complications in the form of arterio-venous malformation (AVM). CONCLUSIONS The two-year experience suggests that dilatation and curettage may predispose a female of reproductive age group to develop gestational trophoblastic disease in the future. Hence, a high index of suspicion is necessary for timely diagnosis and intervention. The study further helped us understand the wide spectrum of the disease and its associated complications. KEY WORDS Abortion, AVM, Dilatation and Evacuation, GTD, GTN

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

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.

An invasive mole with pulmonary metastases in a 55-year-old postmenopausal Syrian woman: a case report and review of the literature

Background Invasive mole is a subtype of gestational trophoblastic neoplasms (GTNs) that usually develops from the malignant transformation of trophoblastic tissue after molar evacuation. Invasive moles mostly occur in women of reproductive age, while they are extremely rare in postmenopausal women. Case presentation We present the case of a 55-year-old postmenopausal Syrian woman who was admitted to the emergency department at our hospital due to massive vaginal bleeding for 10 days accompanied by constant abdominal pain with diarrhea and vomiting. Following clinical, laboratory and radiological examination, total hysterectomy with bilateral salpingo-oophorectomy was performed. Histologic examination of the resected specimens revealed the diagnosis of an invasive mole with pulmonary metastases that were diagnosed by chest computed tomography (CT). Following surgical resection, the patient was scheduled for combination chemotherapy. However, 2 weeks later the patient was readmitted to the emergency department due to severe hemoptysis and dyspnea, and later that day the patient died in spite of resuscitation efforts. Conclusion Although invasive moles in postmenopausal women have been reported previously, we believe our case is the first reported from Syria. Our case highlights the difficulties in diagnosing invasive moles in the absence of significant history of gestational trophoblastic diseases. The present study further reviews the diagnostic methods, histological characteristics and treatment recommendations.