Gestational trophoblastic neoplasia overview
Template:Choriocarcinoma 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 tumours 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 the abdomen may grow at a much faster rate than with a normal pregnancy.[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 may be performed to detect metastases of choriocarcinoma to lung, brain, and liver.[5] The mainstay of therapy for choriocarcinoma is chemotherapy.[1][4] Surgery is the mainstay of treatment for choriocarcinoma.[6]
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 the abdomen may grow at a much faster rate than with a normal pregnancy.[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 metastases of choriocarcinoma. The characteristic findings of pulmonary metastases are peripheral, rounded nodules of variable size scattered throughout both lungs.
CT
CT scan may be performed to detect metastases of choriocarcinoma to lung, brain, and liver.[5]
MRI
MRI may be performed to detect metastases of choriocarcinoma to brain and spinal cord.[7]
Ultrasound
Ultrasound may be performed to detect metastases 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