Gestational trophoblastic neoplasia natural history, complications and prognosis
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Patients with gestational trophoblastic neoplasia (GTN) initially present with abnormal vaginal bleeding. The vaginal bleeding can also be associated with elevation of βhCG. In rare instances, patients can also initially present with symptoms related to distant metastasis to different organs. Patients can experience nausea and vomiting similar to the course of normal pregnancy. If left untreated, patients with gestational trophoblastic neoplasia (GTN) may develop metastatic lesions in different organs and can result in death. Complications of gestational trophoblastic neoplasia (GTN) include disseminated disease, hemorrhagic shock, massive hemoptysis, Acute abdomen, ovarian hyperstimulation, renal hemorrhage, severe hyperthyroidism, cardiothyreosis, and death. Poor prognostic factors include age > 35 years, interval since the last pregnancy of over 2 years, deep myometrial invasion, advanced stage, maximum βhCG level > 1000 mIU/ml, extensive coagulative necrosis, high mitotic rate, and presence of cells with clear cytoplasm.
Natural History, Complications, and Prognosis
- Patients with gestational trophoblastic neoplasia (GTN) initially present with abnormal vaginal bleeding.
- The vaginal bleeding can also be associated with elevation of βhCG.
- In rare instances, patients can also initially present with symptoms related to distant metastasis to different organs.
- Patients can experience nausea and vomiting similar to the course of normal pregnancy.
- The increase in the level of βhCG is anomalous and can be a major sign in diagnosis making.
- Abdominal growth may be at a faster rate than in normal pregnancy.
- If left untreated, patients with gestational trophoblastic neoplasia (GTN) may develop metastatic lesions in different organs and can result in death.
- Disseminated disease
- Hemorrhagic shock
- Massive hemoptysis
- Acute abdomen
- Ovarian hyperstimulation
- Spontaneous renal hemorrhage
- Severe hyperthyroidism
- Age over 35 years (P = 0.025)
- Interval since the last pregnancy of over 2 years (P = 0.014)
- Deep myometrial invasion (P = 0.006)
- Stage III or IV (P < 0.0005)
- Maximum βhCG level > 1000 mIU/ml (P = 0.034)
- Extensive coagulative necrosis (P = 0.024)
- High mitotic rate (P = 0.005)
- Presence of cells with clear cytoplasm (P < 0.0005)
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