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{{Choriocarcinoma}}
__NOTOC__
{{CMG}}
{{Gestational trophoblastic neoplasia}}
{{CMG}}{{AE}}{{Sab}}


==Overview==
==Overview==
==Natural history==
[[Patient|Patients]] with gestational trophoblastic neoplasia (GTN) initially present with abnormal [[Vagina|vaginal]] [[bleeding]]. The [[Vagina|vaginal]] [[bleeding]] can also be associated with elevation of [[Human chorionic gonadotropin|βhCG]]. In rare instances, [[Patient|patients]] can also initially present with [[Symptom|symptoms]] related to distant [[metastasis]] to different [[Organ (anatomy)|organs]]. [[Patient|Patients]] can experience [[nausea and vomiting]] similar to the course of normal [[pregnancy]]. If left untreated, [[Patient|patients]] with gestational trophoblastic neoplasia (GTN) may develop [[Metastasis|metastatic]] [[Lesion|lesions]] in different [[Organ (anatomy)|organs]] and can result in death. [[Complication (medicine)|Complications]] of gestational trophoblastic neoplasia (GTN) include disseminated [[disease|disease,]] [[Exsanguination|hemorrhagic shock]], massive [[hemoptysis]], [[Acute abdomen]], [[Ovarian hyperstimulation syndrome|ovarian hyperstimulation]], [[Kidney|renal]] [[Bleeding|hemorrhage]], severe [[hyperthyroidism]], cardiothyreosis, and death. Poor prognostic factors include age > 35 years, interval since the last [[pregnancy]] of over 2 years, deep [[Myometrium|myometrial]] invasion, advanced stage, maximum [[Human chorionic gonadotropin|βhCG]] level > 1000 mIU/ml, extensive [[coagulative necrosis]], high [[Mitosis|mitotic]] rate, and presence of [[Cell (biology)|cells]] with clear [[cytoplasm]].


==Natural History, Complications, and Prognosis==
===Natural History===
*[[Patient|Patients]] with gestational trophoblastic neoplasia (GTN) initially present with abnormal [[Vagina|vaginal]] [[bleeding]].<ref name="pmid22838240">{{cite journal |vauthors=Killick S, Cook J, Gillett S, Ellis L, Tidy J, Hancock BW |title=Initial presenting features in gestational trophoblastic neoplasia: does a decade make a difference? |journal=J Reprod Med |volume=57 |issue=7-8 |pages=279–82 |date=2012 |pmid=22838240 |doi= |url=}}</ref>
*The [[Vagina|vaginal]] [[bleeding]] can also be associated with elevation of [[Human chorionic gonadotropin|βhCG]].<ref name="pmid12477457">{{cite journal |vauthors=Meydanli MM, Kucukali T, Usubutun A, Ataoglu O, Kafkasli A |title=Epithelioid trophoblastic tumor of the endocervix: a case report |journal=Gynecol. Oncol. |volume=87 |issue=2 |pages=219–24 |date=November 2002 |pmid=12477457 |doi= |url=}}</ref>
*In rare instances, [[Patient|patients]] can also initially present with [[Symptom|symptoms]] related to distant [[metastasis]] to different [[Organ (anatomy)|organs]].<ref name="pmid28411623">{{cite journal |vauthors=Zhang W, Liu B, Wu J, Sun B |title=Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series |journal=J Med Case Rep |volume=11 |issue=1 |pages=110 |date=April 2017 |pmid=28411623 |doi=10.1186/s13256-017-1256-9 |url=}}</ref>
*[[Patient|Patients]] can experience [[nausea and vomiting]] similar to the course of normal [[pregnancy]].
*The increase in the level of [[Human chorionic gonadotropin|βhCG]] is anomalous and can be a major sign in [[diagnosis]] making.
*[[Abdomen|Abdominal]] growth may be at a faster rate than in normal [[pregnancy]].
*If left untreated, [[Patient|patients]] with gestational trophoblastic neoplasia (GTN) may develop [[Metastasis|metastatic]] [[Lesion|lesions]] in different [[Organ (anatomy)|organs]] and can result in death.<ref name="pmid30571055">{{cite journal |vauthors=Bishop BN, Edemekong PF |title= |journal= |volume= |issue= |pages= |date= |pmid=30571055 |doi= |url=}}</ref>


===Complications===
*Disseminated [[disease]]<ref name="pmid25118474">{{cite journal |vauthors=Piura E, Piura B |title=Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature |journal=Eur. J. Gynaecol. Oncol. |volume=35 |issue=4 |pages=359–67 |date=2014 |pmid=25118474 |doi= |url=}}</ref><ref name="pmid29969941">{{cite journal |vauthors=Chauhan M, Behera C, Madireddi S, Mandal S, Khanna SK |title=Sudden death due to an invasive mole in a young primigravida: Precipitous presentation masquerading the natural manner |journal=Med Sci Law |volume=58 |issue=3 |pages=189–193 |date=July 2018 |pmid=29969941 |doi=10.1177/0025802418786120 |url=}}</ref>
*[[Exsanguination|Hemorrhagic shock]]<ref name="pmid29969941">{{cite journal |vauthors=Chauhan M, Behera C, Madireddi S, Mandal S, Khanna SK |title=Sudden death due to an invasive mole in a young primigravida: Precipitous presentation masquerading the natural manner |journal=Med Sci Law |volume=58 |issue=3 |pages=189–193 |date=July 2018 |pmid=29969941 |doi=10.1177/0025802418786120 |url=}}</ref>
*Massive [[hemoptysis]]<ref name="pmid29969941">{{cite journal |vauthors=Chauhan M, Behera C, Madireddi S, Mandal S, Khanna SK |title=Sudden death due to an invasive mole in a young primigravida: Precipitous presentation masquerading the natural manner |journal=Med Sci Law |volume=58 |issue=3 |pages=189–193 |date=July 2018 |pmid=29969941 |doi=10.1177/0025802418786120 |url=}}</ref><ref name="pmid28411623">{{cite journal |vauthors=Zhang W, Liu B, Wu J, Sun B |title=Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series |journal=J Med Case Rep |volume=11 |issue=1 |pages=110 |date=April 2017 |pmid=28411623 |doi=10.1186/s13256-017-1256-9 |url=}}</ref>
*[[Acute abdomen]]<ref name="pmid29353908">{{cite journal |vauthors=Yadav RS, Shrestha S, Sharma S, Singh M, Bista KD, Ojha N |title=Partial Invasive Mole with Bilateral Torsion of Theca Lutein Cysts |journal=J Nepal Health Res Counc |volume=15 |issue=3 |pages=298–300 |date=January 2018 |pmid=29353908 |doi= |url=}}</ref>
*[[Ovarian hyperstimulation syndrome|Ovarian hyperstimulation]]<ref name="pmid27399862">{{cite journal |vauthors=Alhalabi K, Lampl BS, Behr G |title=Ovarian hyperstimulation syndrome as a complication of molar pregnancy |journal=Cleve Clin J Med |volume=83 |issue=7 |pages=504–6 |date=July 2016 |pmid=27399862 |doi=10.3949/ccjm.83a.15036 |url=}}</ref>
*Spontaneous [[Kidney|renal]] [[Bleeding|hemorrhage]]<ref name="pmid27352577">{{cite journal |vauthors=Xiao S, Mu Q, Wan Y, Xue M |title=Spontaneous renal hemorrhage caused by invasive mole: a case report |journal=Eur. J. Gynaecol. Oncol. |volume=37 |issue=3 |pages=417–9 |date=2016 |pmid=27352577 |doi= |url=}}</ref>
*Severe [[hyperthyroidism]]<ref name="pmid26559442">{{cite journal |vauthors=Marchand L, Chabert P, Chaudesaygues E, Grasse M, Bretones S, Graeppi-Dulac J, Aupetit JF |title=An unusual cause of cardiothyreosis |journal=Gynecol. Endocrinol. |volume=32 |issue=2 |pages=107–9 |date=2016 |pmid=26559442 |doi=10.3109/09513590.2015.1111328 |url=}}</ref><ref name="pmid30116304">{{cite journal |vauthors=Simes BC, Mbanaso AA, Zapata CA, Okoroji CM |title=Hyperthyroidism in a complete molar pregnancy with a mature cystic ovarian teratoma |journal=Thyroid Res |volume=11 |issue= |pages=12 |date=2018 |pmid=30116304 |pmc=6086074 |doi=10.1186/s13044-018-0056-7 |url=}}</ref>
*Cardiothyreosis<ref name="pmid26559442">{{cite journal |vauthors=Marchand L, Chabert P, Chaudesaygues E, Grasse M, Bretones S, Graeppi-Dulac J, Aupetit JF |title=An unusual cause of cardiothyreosis |journal=Gynecol. Endocrinol. |volume=32 |issue=2 |pages=107–9 |date=2016 |pmid=26559442 |doi=10.3109/09513590.2015.1111328 |url=}}</ref>
*Death<ref name="pmid30571055">{{cite journal |vauthors=Bishop BN, Edemekong PF |title= |journal= |volume= |issue= |pages= |date= |pmid=30571055 |doi= |url=}}</ref>


==Prognosis==
===Prognosis===
The prognosis for cure of patients with GTDs is good even when the disease has spread to distant organs, especially when only the lungs are involved.<ref name= abc> General Information About Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq Accessed on October 14, 2015</ref>  
Poor [[prognosis]] of gestational trophoblastic neoplasia (GTN) can be determined by the following factors:<ref>{{Cite journal
The probability of cure depends on the following:
| author = [[Rebecca N. Baergen]], [[Joanne L. Rutgers]], [[Robert H. Young]], [[Kathryn Osann]] & [[Robert E. Scully]]
* Histologic type (invasive mole or choriocarcinoma)
| title = Placental site trophoblastic tumor: A study of 55 cases and review of the literature emphasizing factors of prognostic significance
* Extent of spread of the disease/largest tumor size
| journal = [[Gynecologic oncology]]
* Level of serum beta-hCG
| volume = 100
* Duration of disease from the initial pregnancy event to start of treatment
| issue = 3
* Number and specific sites of metastases
| pages = 511–520
* Nature of antecedent pregnancy
| year = 2006
* Extent of prior treatment
| month = March
 
| doi = 10.1016/j.ygyno.2005.08.058
==Complications==
| pmid = 16246400
 
}}</ref>
* Recurrance
*Age over 35 years ([[P-value|P]] = 0.025)
* Anemia
*Interval since the last [[pregnancy]] of over 2 years ([[P-value|P]] = 0.014)
*Deep [[Myometrium|myometrial]] invasion ([[P-value|P]] = 0.006)
*Stage III or IV ([[P-value|P]] < 0.0005)
*Maximum [[Human chorionic gonadotropin|βhCG]] level > 1000 mIU/ml ([[P-value|P]] = 0.034)
*Extensive [[coagulative necrosis]] ([[P-value|P]] = 0.024)
*High [[Mitosis|mitotic]] rate ([[P-value|P]] = 0.005)
*Presence of [[Cell (biology)|cells]] with clear [[cytoplasm]] ([[P-value|P]] < 0.0005)


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Disease]]
[[Category:Disease]]
[[Category:Gynecology]]
[[Category:Gynecology]]

Latest revision as of 20:38, 11 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

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

Natural History

Complications

Prognosis

Poor prognosis of gestational trophoblastic neoplasia (GTN) can be determined by the following factors:[12]

References

  1. ↑ Killick S, Cook J, Gillett S, Ellis L, Tidy J, Hancock BW (2012). "Initial presenting features in gestational trophoblastic neoplasia: does a decade make a difference?". J Reprod Med. 57 (7–8): 279–82. PMID 22838240.
  2. ↑ Meydanli MM, Kucukali T, Usubutun A, Ataoglu O, Kafkasli A (November 2002). "Epithelioid trophoblastic tumor of the endocervix: a case report". Gynecol. Oncol. 87 (2): 219–24. PMID 12477457.
  3. ↑ 3.0 3.1 Zhang W, Liu B, Wu J, Sun B (April 2017). "Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series". J Med Case Rep. 11 (1): 110. doi:10.1186/s13256-017-1256-9. PMID 28411623.
  4. ↑ 4.0 4.1 Bishop BN, Edemekong PF. PMID 30571055. Missing or empty |title= (help)
  5. ↑ Piura E, Piura B (2014). "Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature". Eur. J. Gynaecol. Oncol. 35 (4): 359–67. PMID 25118474.
  6. ↑ 6.0 6.1 6.2 Chauhan M, Behera C, Madireddi S, Mandal S, Khanna SK (July 2018). "Sudden death due to an invasive mole in a young primigravida: Precipitous presentation masquerading the natural manner". Med Sci Law. 58 (3): 189–193. doi:10.1177/0025802418786120. PMID 29969941.
  7. ↑ Yadav RS, Shrestha S, Sharma S, Singh M, Bista KD, Ojha N (January 2018). "Partial Invasive Mole with Bilateral Torsion of Theca Lutein Cysts". J Nepal Health Res Counc. 15 (3): 298–300. PMID 29353908.
  8. ↑ Alhalabi K, Lampl BS, Behr G (July 2016). "Ovarian hyperstimulation syndrome as a complication of molar pregnancy". Cleve Clin J Med. 83 (7): 504–6. doi:10.3949/ccjm.83a.15036. PMID 27399862.
  9. ↑ Xiao S, Mu Q, Wan Y, Xue M (2016). "Spontaneous renal hemorrhage caused by invasive mole: a case report". Eur. J. Gynaecol. Oncol. 37 (3): 417–9. PMID 27352577.
  10. ↑ 10.0 10.1 Marchand L, Chabert P, Chaudesaygues E, Grasse M, Bretones S, Graeppi-Dulac J, Aupetit JF (2016). "An unusual cause of cardiothyreosis". Gynecol. Endocrinol. 32 (2): 107–9. doi:10.3109/09513590.2015.1111328. PMID 26559442.
  11. ↑ Simes BC, Mbanaso AA, Zapata CA, Okoroji CM (2018). "Hyperthyroidism in a complete molar pregnancy with a mature cystic ovarian teratoma". Thyroid Res. 11: 12. doi:10.1186/s13044-018-0056-7. PMC 6086074. PMID 30116304.
  12. ↑ Rebecca N. Baergen, Joanne L. Rutgers, Robert H. Young, Kathryn Osann & Robert E. Scully (2006). "Placental site trophoblastic tumor: A study of 55 cases and review of the literature emphasizing factors of prognostic significance". Gynecologic oncology. 100 (3): 511–520. doi:10.1016/j.ygyno.2005.08.058. PMID 16246400. Unknown parameter |month= ignored (help)

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