Gestational trophoblastic neoplasia pathophysiology: Difference between revisions
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====Invasive Mole==== | ====Invasive Mole==== | ||
*Invasive mole is basically a benign tumor which arises from the invasion of the myometrium of a hydatidiform mole.<ref name="Lurain2010">{{cite journal|last1=Lurain|first1=John R.|title=Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole|journal=American Journal of Obstetrics and Gynecology|volume=203|issue=6|year=2010|pages=531–539|issn=00029378|doi=10.1016/j.ajog.2010.06.073}}</ref> | *Invasive mole is basically a benign tumor which arises from the invasion of the myometrium of a hydatidiform mole.<ref name="Lurain2010">{{cite journal|last1=Lurain|first1=John R.|title=Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole|journal=American Journal of Obstetrics and Gynecology|volume=203|issue=6|year=2010|pages=531–539|issn=00029378|doi=10.1016/j.ajog.2010.06.073}}</ref> | ||
*It may be preceded by a complete or partial molar pregnancy and it rarely metastasizes.<ref>https://www.cancer.gov</ref> | *It may be preceded by a complete or partial molar pregnancy and it rarely metastasizes.<ref>https://www.cancer.gov</ref><ref name="pmid20673583">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Berkowitz RS |title=Gestational trophoblastic disease |journal=Lancet |volume=376 |issue=9742 |pages=717–29 |date=August 2010 |pmid=20673583 |doi=10.1016/S0140-6736(10)60280-2 |url=}}</ref><ref name="pmid27743739">{{cite journal |vauthors=Brown J, Naumann RW, Seckl MJ, Schink J |title=15years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage |journal=Gynecol. Oncol. |volume=144 |issue=1 |pages=200–207 |date=January 2017 |pmid=27743739 |doi=10.1016/j.ygyno.2016.08.330 |url=}}</ref> | ||
*Invasive moles are more aggressive than complete or partial hydatidiform moles.<ref>https://www.cancer.gov</ref> | *Invasive moles are more aggressive than complete or partial hydatidiform moles.<ref>https://www.cancer.gov</ref> | ||
*Although rarely metastatic, it can spread through the hematogenous route to the following organs: | |||
:*Lungs (80% of the time)<ref name="pmid20673583">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Berkowitz RS |title=Gestational trophoblastic disease |journal=Lancet |volume=376 |issue=9742 |pages=717–29 |date=August 2010 |pmid=20673583 |doi=10.1016/S0140-6736(10)60280-2 |url=}}</ref><ref name="pmid27743739">{{cite journal |vauthors=Brown J, Naumann RW, Seckl MJ, Schink J |title=15years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage |journal=Gynecol. Oncol. |volume=144 |issue=1 |pages=200–207 |date=January 2017 |pmid=27743739 |doi=10.1016/j.ygyno.2016.08.330 |url=}}</ref><ref name="pmid23999759">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C |title=Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up |journal=Ann. Oncol. |volume=24 Suppl 6 |issue= |pages=vi39–50 |date=October 2013 |pmid=23999759 |doi=10.1093/annonc/mdt345 |url=}}</ref> | |||
:*Vagina (30%)<ref name="pmid20673583">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Berkowitz RS |title=Gestational trophoblastic disease |journal=Lancet |volume=376 |issue=9742 |pages=717–29 |date=August 2010 |pmid=20673583 |doi=10.1016/S0140-6736(10)60280-2 |url=}}</ref><ref name="pmid27743739">{{cite journal |vauthors=Brown J, Naumann RW, Seckl MJ, Schink J |title=15years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage |journal=Gynecol. Oncol. |volume=144 |issue=1 |pages=200–207 |date=January 2017 |pmid=27743739 |doi=10.1016/j.ygyno.2016.08.330 |url=}}</ref><ref name="pmid23999759">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C |title=Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up |journal=Ann. Oncol. |volume=24 Suppl 6 |issue= |pages=vi39–50 |date=October 2013 |pmid=23999759 |doi=10.1093/annonc/mdt345 |url=}}</ref> | |||
:*Pelvis (20%)<ref name="pmid20673583">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Berkowitz RS |title=Gestational trophoblastic disease |journal=Lancet |volume=376 |issue=9742 |pages=717–29 |date=August 2010 |pmid=20673583 |doi=10.1016/S0140-6736(10)60280-2 |url=}}</ref><ref name="pmid27743739">{{cite journal |vauthors=Brown J, Naumann RW, Seckl MJ, Schink J |title=15years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage |journal=Gynecol. Oncol. |volume=144 |issue=1 |pages=200–207 |date=January 2017 |pmid=27743739 |doi=10.1016/j.ygyno.2016.08.330 |url=}}</ref><ref name="pmid23999759">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C |title=Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up |journal=Ann. Oncol. |volume=24 Suppl 6 |issue= |pages=vi39–50 |date=October 2013 |pmid=23999759 |doi=10.1093/annonc/mdt345 |url=}}</ref> | |||
:*Liver (10%)<ref name="pmid20673583">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Berkowitz RS |title=Gestational trophoblastic disease |journal=Lancet |volume=376 |issue=9742 |pages=717–29 |date=August 2010 |pmid=20673583 |doi=10.1016/S0140-6736(10)60280-2 |url=}}</ref><ref name="pmid27743739">{{cite journal |vauthors=Brown J, Naumann RW, Seckl MJ, Schink J |title=15years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage |journal=Gynecol. Oncol. |volume=144 |issue=1 |pages=200–207 |date=January 2017 |pmid=27743739 |doi=10.1016/j.ygyno.2016.08.330 |url=}}</ref><ref name="pmid23999759">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C |title=Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up |journal=Ann. Oncol. |volume=24 Suppl 6 |issue= |pages=vi39–50 |date=October 2013 |pmid=23999759 |doi=10.1093/annonc/mdt345 |url=}}</ref> | |||
:*Brain (10%)<ref name="pmid20673583">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Berkowitz RS |title=Gestational trophoblastic disease |journal=Lancet |volume=376 |issue=9742 |pages=717–29 |date=August 2010 |pmid=20673583 |doi=10.1016/S0140-6736(10)60280-2 |url=}}</ref><ref name="pmid27743739">{{cite journal |vauthors=Brown J, Naumann RW, Seckl MJ, Schink J |title=15years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage |journal=Gynecol. Oncol. |volume=144 |issue=1 |pages=200–207 |date=January 2017 |pmid=27743739 |doi=10.1016/j.ygyno.2016.08.330 |url=}}</ref><ref name="pmid23999759">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C |title=Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up |journal=Ann. Oncol. |volume=24 Suppl 6 |issue= |pages=vi39–50 |date=October 2013 |pmid=23999759 |doi=10.1093/annonc/mdt345 |url=}}</ref> | |||
:*Other sites (< 5%)<ref name="pmid20673583">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Berkowitz RS |title=Gestational trophoblastic disease |journal=Lancet |volume=376 |issue=9742 |pages=717–29 |date=August 2010 |pmid=20673583 |doi=10.1016/S0140-6736(10)60280-2 |url=}}</ref><ref name="pmid27743739">{{cite journal |vauthors=Brown J, Naumann RW, Seckl MJ, Schink J |title=15years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage |journal=Gynecol. Oncol. |volume=144 |issue=1 |pages=200–207 |date=January 2017 |pmid=27743739 |doi=10.1016/j.ygyno.2016.08.330 |url=}}</ref><ref name="pmid23999759">{{cite journal |vauthors=Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C |title=Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up |journal=Ann. Oncol. |volume=24 Suppl 6 |issue= |pages=vi39–50 |date=October 2013 |pmid=23999759 |doi=10.1093/annonc/mdt345 |url=}}</ref> | |||
==Genetics== | ==Genetics== | ||
Revision as of 22:51, 27 February 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]Monalisa Dmello, M.B,B.S., M.D. [3]
Overview
Gestational trophoblastic neoplasia arises from the trophoblastic tissue, which provides nutrients to the embryo and develops into a large part of the placenta. On gross pathology, gestational trophoblastic neoplasia is characterised by a dark, shaggy, focally hemorrhagic & friable/necrotic-appearing mass with invasive borders. The pathophysiology of gestational trophoblastic neoplasia depends on the histological subtype.[1][2][3]
Pathophysiology
Physiology
The normal physiology of pregnancy can be understood as follows:
- Pregnancy occurs when an egg, which is released from the ovary during ovulation, is fertilized by a sperm.
- After ejaculation, the released sperm must spend some time in the female reproductive tract and undergo capacitation, which is basically the acquisition of fertilization capability.[4][5][6]
- The sperm then penetrates the egg after the acrosomal reaction and initiates the process of fertilization in the fallopian tube.[7]
- The sperm breaks through the oocyte's plasma membrane and releases its haploid nucleus into the oocyte.[8]
- Cortical reaction (changes in the oocyte membrane) prevents any further penetration by another sperm.
- Unification of the two haploid nuclei (one each from the sperm and egg) marks the completion of fertilization, resulting in the formation of a diploid zygote.
- The zygote undergoes multiple divisions called cleavage before its migration to the uterus.[9]
- Human pregnancy takes approximately 40 weeks.
Placental Trophoblast and Pregnancy
- Trophoblast (outer layer of the blasotcyst) is composed of cytotrophoblast, syncytiotrophoblast, and intermediate trophoblast.[10]
- Syncytiotrophoblast invades the endometrial stroma and produces human chorionic gonadotropin (hCG).[11]
- Cytotrophoblast supplies the syncitium with cells and also forms the outpouchings that later become the chorionic villi.[12]
- Intermediate trophoblast is situated in the villi, the implantation site, and the chorionic sac.[13]
For more information on fertilization, click here.
For more information on pregnancy, click here.
Pathogenesis
Pathogenesis of the sub-types of gestational trophoblastic neoplasia is explained as follows:
Invasive Mole
- Invasive mole is basically a benign tumor which arises from the invasion of the myometrium of a hydatidiform mole.[14]
- It may be preceded by a complete or partial molar pregnancy and it rarely metastasizes.[15][16][17]
- Invasive moles are more aggressive than complete or partial hydatidiform moles.[18]
- Although rarely metastatic, it can spread through the hematogenous route to the following organs:
Genetics
Gross Pathology
- Dark, shaggy, focally hemorrhagic & friable/necrotic-appearing[3]
- Invasive border
Microscopic Pathology
Gestational trophoblastic neoplasia classification[1]
| Types of Gestational Trophoblastic Neoplasia | Histopathological features |
|---|---|
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Invasive mole |
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Choriocarcinoma |
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Placental-site trophoblastic tumor |
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Epithelioid trophoblastic tumor |
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References
- ↑ 1.0 1.1 1.2 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
- ↑ 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
- ↑ CHANG MC (October 1951). "Fertilizing capacity of spermatozoa deposited into the fallopian tubes". Nature. 168 (4277): 697–8. PMID 14882325.
- ↑ AUSTIN CR (November 1951). "Observations on the penetration of the sperm in the mammalian egg". Aust J Sci Res B. 4 (4): 581–96. PMID 14895481.
- ↑ AUSTIN CR (August 1952). "The capacitation of the mammalian sperm". Nature. 170 (4321): 326. PMID 12993150.
- ↑ Moore, Keith (1988). Essentials of human embryology. Toronto Philadelphia Saint Louis, Mo: B.C. Decker C.V. Mosby Co. distributor. ISBN 9780941158978.
- ↑ Moore, Keith (1988). Essentials of human embryology. Toronto Philadelphia Saint Louis, Mo: B.C. Decker C.V. Mosby Co. distributor. ISBN 9780941158978.
- ↑ Miklavcic JJ, Flaman P (May 2017). "Personhood status of the human zygote, embryo, fetus". Linacre Q. 84 (2): 130–144. doi:10.1080/00243639.2017.1299896. PMC 5499222. PMID 28698706.
- ↑ Moore, Keith (2016). The developing human : clinically oriented embryology. Philadelphia, PA: Elsevier. ISBN 9780323313384.
- ↑ Moore, Keith (2016). The developing human : clinically oriented embryology. Philadelphia, PA: Elsevier. ISBN 9780323313384.
- ↑ Moore, Keith (2016). The developing human : clinically oriented embryology. Philadelphia, PA: Elsevier. ISBN 9780323313384.
- ↑ Moore, Keith (2016). The developing human : clinically oriented embryology. Philadelphia, PA: Elsevier. ISBN 9780323313384.
- ↑ Lurain, John R. (2010). "Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole". American Journal of Obstetrics and Gynecology. 203 (6): 531–539. doi:10.1016/j.ajog.2010.06.073. ISSN 0002-9378.
- ↑ https://www.cancer.gov
- ↑ 16.0 16.1 16.2 16.3 16.4 16.5 16.6 Seckl MJ, Sebire NJ, Berkowitz RS (August 2010). "Gestational trophoblastic disease". Lancet. 376 (9742): 717–29. doi:10.1016/S0140-6736(10)60280-2. PMID 20673583.
- ↑ 17.0 17.1 17.2 17.3 17.4 17.5 17.6 Brown J, Naumann RW, Seckl MJ, Schink J (January 2017). "15years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage". Gynecol. Oncol. 144 (1): 200–207. doi:10.1016/j.ygyno.2016.08.330. PMID 27743739.
- ↑ https://www.cancer.gov
- ↑ 19.0 19.1 19.2 19.3 19.4 19.5 Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C (October 2013). "Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Ann. Oncol. 24 Suppl 6: vi39–50. doi:10.1093/annonc/mdt345. PMID 23999759.