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{{Gestational trophoblastic neoplasia}} | {{Gestational trophoblastic neoplasia}} | ||
{{CMG}}{{AE}}{{MD}}__NOTOC__ | {{CMG}}{{AE}}{{MD}} | ||
__NOTOC__ | |||
==Overview== | ==Overview== | ||
Gestational trophoblastic disease (GTD) includes several rare tumors that occur in the uterus and start in the cells that form the placenta during pregnancy. Only women develop gestational trophoblastic disease. Most gestational trophoblastic diseases are benign, but some are malignant(gestational trophoblastic neoplasia). It is estimated that the malignant forms of gestational trophoblastic disease account for less than 1% of all women’s reproductive system cancers. Gestational trophoblastic neoplasia may be classified according to [[histology]] into four subtypes: invasive mole, choriocarcinoma, placental-site trophoblastic[[ tumor]], and epithelioid trophoblastic tumor.<ref name=abc> Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref> On gross pathology, dark, shaggy, focally hemorrhagic & friable/necrotic-appearing, and invasive border are characteristic findings of gestational trophoblastic neoplasia.<ref name= abc> Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref><ref name= aaa>{{cite journal |author=Woo J, Hsu C, Fung L, Ma H |title=Partial hydatidiform mole: ultrasonographic features |journal=Aust N Z J Obstet Gynaecol |volume=23 |issue=2 |pages=103-7 |year=1983 |pmid=6578773}}</ref><ref name= ccc> Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015</ref> Symptoms of choriocarcinoma include [[vaginal bleeding]], passing of tissue resembling a “bunch of grapes” from the vagina, and [[abdominal distention]].<ref name= xxx> Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015</ref> Common physical examination findings of choriocarcinoma include [[abdominal distention]], [[pelvic]]/adnexal mass, and blood in vaginal discharge.<ref name= xxx> Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015</ref> Choriocarcinoma must be differentiated from non neoplastic diseases, [[neoplastic]] diseases, and other causes of bleeding during [[pregnancy]]. Elevated serum [[human chorionic gonadotropin]] is diagnostic of choriocarcinoma.<ref name=abc> Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 13, 2015</ref><ref name= aaa> Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015</ref> [[CT scan]], [[MRI]], and [[chest radiography]] may be performed to detect [[metastasis]] of choriocarcinoma to [[lungs]], [[brain]], and [[liver]].<ref name= sss>Choriocarcinoma. Radiopaedia.org. http://radiopaedia.org/articles/choriocarcinoma Accessed on October 11, 2015</ref> The mainstay of therapy for choriocarcinoma is [[chemotherapy]] and [[surgery]].<ref name= abc> Low-Risk Gestational Trophoblastic Neoplasia (FIGO Score 0–6) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_326 Accessed on October 8, 2015</ref><ref name=xxx> High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_328 Accessed on October 8, 2015</ref><ref name= eee> Treatment of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/treatment/?region=ns#type Accessed on October 10, 2015</ref> | Gestational trophoblastic disease (GTD) includes several rare tumors that occur in the uterus and start in the cells that form the placenta during pregnancy. Only women develop gestational trophoblastic disease. Most gestational trophoblastic diseases are benign, but some are malignant(gestational trophoblastic neoplasia). It is estimated that the malignant forms of gestational trophoblastic disease account for less than 1% of all women’s reproductive system cancers. Gestational trophoblastic neoplasia may be classified according to [[histology]] into four subtypes: invasive mole, choriocarcinoma, placental-site trophoblastic[[ tumor]], and epithelioid trophoblastic tumor.<ref name="abc">Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref> On gross pathology, dark, shaggy, focally hemorrhagic & friable/necrotic-appearing, and invasive border are characteristic findings of gestational trophoblastic neoplasia.<ref name="abc">Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref><ref name="aaa">{{cite journal |author=Woo J, Hsu C, Fung L, Ma H |title=Partial hydatidiform mole: ultrasonographic features |journal=Aust N Z J Obstet Gynaecol |volume=23 |issue=2 |pages=103-7 |year=1983 |pmid=6578773}}</ref><ref name="ccc">Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015</ref> Symptoms of choriocarcinoma include [[vaginal bleeding]], passing of tissue resembling a “bunch of grapes” from the vagina, and [[abdominal distention]].<ref name="xxx">Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015</ref> Common physical examination findings of choriocarcinoma include [[abdominal distention]], [[pelvic]]/adnexal mass, and blood in vaginal discharge.<ref name="xxx">Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015</ref> Choriocarcinoma must be differentiated from non neoplastic diseases, [[neoplastic]] diseases, and other causes of bleeding during [[pregnancy]]. Elevated serum [[human chorionic gonadotropin]] is diagnostic of choriocarcinoma.<ref name="abc">Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 13, 2015</ref><ref name="aaa">Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015</ref> [[CT scan]], [[MRI]], and [[chest radiography]] may be performed to detect [[metastasis]] of choriocarcinoma to [[lungs]], [[brain]], and [[liver]].<ref name="sss">Choriocarcinoma. Radiopaedia.org. http://radiopaedia.org/articles/choriocarcinoma Accessed on October 11, 2015</ref> The mainstay of therapy for choriocarcinoma is [[chemotherapy]] and [[surgery]].<ref name="abc">Low-Risk Gestational Trophoblastic Neoplasia (FIGO Score 0–6) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_326 Accessed on October 8, 2015</ref><ref name="xxx">High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_328 Accessed on October 8, 2015</ref><ref name="eee">Treatment of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/treatment/?region=ns#type Accessed on October 10, 2015</ref> | ||
== Historical Perspective == | |||
In 6th century, Aetius of Amida, a [[physician]] at Justinian's court came up with the term 'hydatid'. Next mention of 'mole' is from 1276 when Margaret, Countess of Henneberg, delivered approximately 300 babies on Good Friday (the Friday before Easter Sunday). In 1827, Marie Anne Victoire Boivin, a Parisian [[Midwifery|midwife]], proposed her findings of this condition in 'Nouvelles Recherches de la Mole Visiculaire' (News Searches of the Vesicular Mole). In 1840, William Wilton reported a case of invasive mole that was complicated by [[Uterine rupture|uterine]] [[perforation]] and fatal internal [[Bleeding|hemorrhage]]. In 1867, Richard von Volkmann, a German [[surgeon]], also described a [[lesion]] resembling an invasive mole. In 1877, Hans Chiari, an Austrian [[Pathology|pathologist]], reported three cases of choriocarcinoma. He recognized the [[Tumor|tumors]] as [[Epithelium|epithelial]]. In 1888, Max Sanger, a German [[Obstetrics|obstetrician]], proposed his [[theory]] that these [[Tumor|tumors]] were actually [[Sarcoma|sarcomas]]('deciduoma malignum'). In 1890, Pfeiffer, a student of Hans Chiari, re-examined Chiari's cases and added a fourth case. He named them all 'deciduoma malignum'. In 1891, Pestalozza from Italy, reported three cases of a [[malignant]][[Uterus|uterine]] [[tumor]] associated with [[pregnancy]]. He described these cases as 'sarcoma hemorrhagicum sen infectiosum'. | |||
==Classification== | ==Classification== | ||
Gestational trophoblastic neoplasia may be classified according to [[histology]] into four subtypes: invasive mole, choriocarcinoma, placental-site trophoblastic[[ tumor]], and epithelioid trophoblastic tumor.<ref name=abc> Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref> | Gestational trophoblastic neoplasia may be classified according to [[histology]] into four subtypes: invasive mole, choriocarcinoma, placental-site trophoblastic[[ tumor]], and epithelioid trophoblastic tumor.<ref name="abc">Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
Gestational trophoblastic neoplasia arises from the [[trophoblast]]ic tissue, which provide nutrients to the [[embryo]] and develop into a large part of the [[placenta]]. On gross pathology, dark, shaggy, focally hemorrhagic & friable/necrotic-appearing, and invasive border are characteristic findings of gestational trophoblastic neoplasia. The pathophysiology of gestational trophoblastic neoplasia depends on the [[histological]] subtype.<ref name= abc> Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref><ref name= aaa>{{cite journal |author=Woo J, Hsu C, Fung L, Ma H |title=Partial hydatidiform mole: ultrasonographic features |journal=Aust N Z J Obstet Gynaecol |volume=23 |issue=2 |pages=103-7 |year=1983 |pmid=6578773}}</ref><ref name= ccc> Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015</ref> | Gestational trophoblastic neoplasia arises from the [[trophoblast]]ic tissue, which provide nutrients to the [[embryo]] and develop into a large part of the [[placenta]]. On gross pathology, dark, shaggy, focally hemorrhagic & friable/necrotic-appearing, and invasive border are characteristic findings of gestational trophoblastic neoplasia. The pathophysiology of gestational trophoblastic neoplasia depends on the [[histological]] subtype.<ref name="abc">Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref><ref name="aaa">{{cite journal |author=Woo J, Hsu C, Fung L, Ma H |title=Partial hydatidiform mole: ultrasonographic features |journal=Aust N Z J Obstet Gynaecol |volume=23 |issue=2 |pages=103-7 |year=1983 |pmid=6578773}}</ref><ref name="ccc">Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015</ref> | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Choriocarcinoma must be differentiated from non neoplastic diseases, [[neoplastic]] diseases, and other causes of bleeding during [[pregnancy]]. | Choriocarcinoma must be differentiated from non neoplastic diseases, [[neoplastic]] diseases, and other causes of bleeding during [[pregnancy]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The [[incidence]] of choriocarcinoma is approximately 110-120 per 100,000 pregnancies.<ref name= abc> General Information About Gestational Trophoblastic Disease | The [[incidence]] of choriocarcinoma is approximately 110-120 per 100,000 pregnancies.<ref name="abc">General Information About Gestational Trophoblastic Disease | ||
National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_1. Accessed on October7, 2015</ref> | National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_1. Accessed on October7, 2015</ref> | ||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of choriocarcinoma are child-bearing age, previous [[hydatidiform mole]], and family history of gestational trophoblastic disease.<ref name=abc> Risk factors for gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/risks/?region=ns. Accessed on October 7, 2015</ref> | Common risk factors in the development of choriocarcinoma are child-bearing age, previous [[hydatidiform mole]], and family history of gestational trophoblastic disease.<ref name="abc">Risk factors for gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/risks/?region=ns. Accessed on October 7, 2015</ref> | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
Depending on the extent of the [[tumor]] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.<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> | Depending on the extent of the [[tumor]] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.<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> | ||
==Diagnosis== | ==Diagnosis== | ||
===Staging=== | ===Staging=== | ||
According to the Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) [[cancer staging]] system, there are 4 stages of choriocarcinoma.<ref name= eee>Stage Information for Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq#section/_11 URL Accessed on October 7, 2015</ref> | According to the Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) [[cancer staging]] system, there are 4 stages of choriocarcinoma.<ref name="eee">Stage Information for Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq#section/_11 URL Accessed on October 7, 2015</ref> | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
Symptoms of choriocarcinoma include [[vaginal bleeding]], passing of tissue resembling a “bunch of grapes” from the vagina, and abdominal distention.<ref name= xxx> Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015</ref> | Symptoms of choriocarcinoma include [[vaginal bleeding]], passing of tissue resembling a “bunch of grapes” from the vagina, and abdominal distention.<ref name="xxx">Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015</ref> | ||
===Physical Examination=== | ===Physical Examination=== | ||
Common physical examination findings of choriocarcinoma include [[abdominal distention]], [[pelvic]]/adnexal mass, and blood in vaginal discharge.<ref name= xxx> Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015</ref> | Common physical examination findings of choriocarcinoma include [[abdominal distention]], [[pelvic]]/adnexal mass, and blood in vaginal discharge.<ref name="xxx">Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015</ref> | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Elevated serum [[human chorionic gonadotropin]] is diagnostic of choriocarcinoma.<ref name=abc> Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 13, 2015</ref><ref name= aaa> Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015</ref> | Elevated serum [[human chorionic gonadotropin]] is diagnostic of choriocarcinoma.<ref name="abc">Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 13, 2015</ref><ref name="aaa">Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015</ref> | ||
===Chest Xray=== | ===Chest Xray=== | ||
[[Chest radiography]] (CXR) may be helpful in the diagnosis of [[pulmonary]] [[metastasis]] of choriocarcinoma. The characteristic findings of [[pulmonary]] [[metastasis]] are peripheral, rounded nodules of variable size scattered throughout both [[lungs]]. | [[Chest radiography]] (CXR) may be helpful in the diagnosis of [[pulmonary]] [[metastasis]] of choriocarcinoma. The characteristic findings of [[pulmonary]] [[metastasis]] are peripheral, rounded nodules of variable size scattered throughout both [[lungs]]. | ||
===CT=== | ===CT=== | ||
[[CT scan]] may be performed to detect [[metastasis]] of choriocarcinoma to [[lung]], [[brain]], and [[liver]].<ref name= sss>Choriocarcinoma. Radiopaedia.org. http://radiopaedia.org/articles/choriocarcinoma Accessed on October 11, 2015</ref> | [[CT scan]] may be performed to detect [[metastasis]] of choriocarcinoma to [[lung]], [[brain]], and [[liver]].<ref name="sss">Choriocarcinoma. Radiopaedia.org. http://radiopaedia.org/articles/choriocarcinoma Accessed on October 11, 2015</ref> | ||
===MRI=== | ===MRI=== | ||
[[MRI]] may be performed to detect [[metastasis]] of choriocarcinoma to [[brain]] and [[spinal cord]].<ref name=xyz>. Diagnosing gestational trophoblastic disease | [[MRI]] may be performed to detect [[metastasis]] of choriocarcinoma to [[brain]] and [[spinal cord]].<ref name="xyz">. Diagnosing gestational trophoblastic disease | ||
Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on october 13, 2015</ref> | Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on october 13, 2015</ref> | ||
===Ultrasound=== | ===Ultrasound=== | ||
[[Ultrasound]] may be performed to detect [[metastasis]] of choriocarcinoma to [[pelvis]] and [[abdomen]].<ref name= qqq> Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 12, 2015</ref> | [[Ultrasound]] may be performed to detect [[metastasis]] of choriocarcinoma to [[pelvis]] and [[abdomen]].<ref name="qqq">Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 12, 2015</ref> | ||
==Treatment== | ==Treatment== | ||
===Medical therapy=== | ===Medical therapy=== | ||
The mainstay of therapy for choriocarcinoma is [[chemotherapy]].<ref name= abc> Low-Risk Gestational Trophoblastic Neoplasia (FIGO Score 0–6) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_326 Accessed on October 8, 2015</ref><ref name=xxx> High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_328 Accessed on October 8, 2015</ref> | The mainstay of therapy for choriocarcinoma is [[chemotherapy]].<ref name="abc">Low-Risk Gestational Trophoblastic Neoplasia (FIGO Score 0–6) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_326 Accessed on October 8, 2015</ref><ref name="xxx">High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_328 Accessed on October 8, 2015</ref> | ||
===Surgery=== | ===Surgery=== | ||
[[Surgery]] is the mainstay of treatment for choriocarcinoma.<ref name= eee> Treatment of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/treatment/?region=ns#type Accessed on October 10, 2015</ref> | [[Surgery]] is the mainstay of treatment for choriocarcinoma.<ref name="eee">Treatment of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/treatment/?region=ns#type Accessed on October 10, 2015</ref> | ||
==References== | ==References== | ||
Revision as of 19:37, 12 March 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]
Overview
Gestational trophoblastic disease (GTD) includes several rare tumors that occur in the uterus and start in the cells that form the placenta during pregnancy. Only women develop gestational trophoblastic disease. Most gestational trophoblastic diseases are benign, but some are malignant(gestational trophoblastic neoplasia). It is estimated that the malignant forms of gestational trophoblastic disease account for less than 1% of all women’s reproductive system cancers. Gestational trophoblastic neoplasia may be classified according to histology into four subtypes: invasive mole, choriocarcinoma, placental-site trophoblastictumor, and epithelioid trophoblastic tumor.[1] On gross pathology, dark, shaggy, focally hemorrhagic & friable/necrotic-appearing, and invasive border are characteristic findings of gestational trophoblastic neoplasia.[1][2][3] Symptoms of choriocarcinoma include vaginal bleeding, passing of tissue resembling a “bunch of grapes” from the vagina, and abdominal distention.[4] Common physical examination findings of choriocarcinoma include abdominal distention, pelvic/adnexal mass, and blood in vaginal discharge.[4] Choriocarcinoma must be differentiated from non neoplastic diseases, neoplastic diseases, and other causes of bleeding during pregnancy. Elevated serum human chorionic gonadotropin is diagnostic of choriocarcinoma.[1][2] CT scan, MRI, and chest radiography may be performed to detect metastasis of choriocarcinoma to lungs, brain, and liver.[5] The mainstay of therapy for choriocarcinoma is chemotherapy and surgery.[1][4][6]
Historical Perspective
In 6th century, Aetius of Amida, a physician at Justinian's court came up with the term 'hydatid'. Next mention of 'mole' is from 1276 when Margaret, Countess of Henneberg, delivered approximately 300 babies on Good Friday (the Friday before Easter Sunday). In 1827, Marie Anne Victoire Boivin, a Parisian midwife, proposed her findings of this condition in 'Nouvelles Recherches de la Mole Visiculaire' (News Searches of the Vesicular Mole). In 1840, William Wilton reported a case of invasive mole that was complicated by uterine perforation and fatal internal hemorrhage. In 1867, Richard von Volkmann, a German surgeon, also described a lesion resembling an invasive mole. In 1877, Hans Chiari, an Austrian pathologist, reported three cases of choriocarcinoma. He recognized the tumors as epithelial. In 1888, Max Sanger, a German obstetrician, proposed his theory that these tumors were actually sarcomas('deciduoma malignum'). In 1890, Pfeiffer, a student of Hans Chiari, re-examined Chiari's cases and added a fourth case. He named them all 'deciduoma malignum'. In 1891, Pestalozza from Italy, reported three cases of a malignantuterine tumor associated with pregnancy. He described these cases as 'sarcoma hemorrhagicum sen infectiosum'.
Classification
Gestational trophoblastic neoplasia may be classified according to histology into four subtypes: invasive mole, choriocarcinoma, placental-site trophoblastictumor, and epithelioid trophoblastic tumor.[1]
Pathophysiology
Gestational trophoblastic neoplasia arises from the trophoblastic tissue, which provide nutrients to the embryo and develop into a large part of the placenta. On gross pathology, dark, shaggy, focally hemorrhagic & friable/necrotic-appearing, and invasive border are characteristic findings of gestational trophoblastic neoplasia. The pathophysiology of gestational trophoblastic neoplasia depends on the histological subtype.[1][2][3]
Differential Diagnosis
Choriocarcinoma must be differentiated from non neoplastic diseases, neoplastic diseases, and other causes of bleeding during pregnancy.
Epidemiology and Demographics
The incidence of choriocarcinoma is approximately 110-120 per 100,000 pregnancies.[1]
Risk Factors
Common risk factors in the development of choriocarcinoma are child-bearing age, previous hydatidiform mole, and family history of gestational trophoblastic disease.[1]
Natural History, Complications and Prognosis
Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.[1]
Diagnosis
Staging
According to the Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) cancer staging system, there are 4 stages of choriocarcinoma.[6]
History and Symptoms
Symptoms of choriocarcinoma include vaginal bleeding, passing of tissue resembling a “bunch of grapes” from the vagina, and abdominal distention.[4]
Physical Examination
Common physical examination findings of choriocarcinoma include abdominal distention, pelvic/adnexal mass, and blood in vaginal discharge.[4]
Laboratory Findings
Elevated serum human chorionic gonadotropin is diagnostic of choriocarcinoma.[1][2]
Chest Xray
Chest radiography (CXR) may be helpful in the diagnosis of pulmonary metastasis of choriocarcinoma. The characteristic findings of pulmonary metastasis are peripheral, rounded nodules of variable size scattered throughout both lungs.
CT
CT scan may be performed to detect metastasis of choriocarcinoma to lung, brain, and liver.[5]
MRI
MRI may be performed to detect metastasis of choriocarcinoma to brain and spinal cord.[7]
Ultrasound
Ultrasound may be performed to detect metastasis of choriocarcinoma to pelvis and abdomen.[8]
Treatment
Medical therapy
The mainstay of therapy for choriocarcinoma is chemotherapy.[1][4]
Surgery
Surgery is the mainstay of treatment for choriocarcinoma.[6]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015
- ↑ 2.0 2.1 2.2 2.3 Woo J, Hsu C, Fung L, Ma H (1983). "Partial hydatidiform mole: ultrasonographic features". Aust N Z J Obstet Gynaecol. 23 (2): 103–7. PMID 6578773.
- ↑ 3.0 3.1 Choriocarcinoma. librepathology.org. http://librepathology.org/wiki/index.php/Choriocarcinoma Accessed on October 8, 2015
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Signs and symptoms of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/signs-and-symptoms/?region=ns Accessed on October 10, 2015
- ↑ 5.0 5.1 Choriocarcinoma. Radiopaedia.org. http://radiopaedia.org/articles/choriocarcinoma Accessed on October 11, 2015
- ↑ 6.0 6.1 6.2 Treatment of gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/treatment/?region=ns#type Accessed on October 10, 2015
- ↑ . Diagnosing gestational trophoblastic disease Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on october 13, 2015
- ↑ Diagnosing gestational trophoblastic disease. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/gestational-trophoblastic-disease/diagnosis/?region=ns Accessed on October 12, 2015