Gestational trophoblastic neoplasia natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
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>  


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
===Natural History===
===Natural History===
*Patients with gestational trophoblastic neoplasia (GTN) initially present with abnormal 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>
*[[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 vaginal bleeding can also be associated with elevation of 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>
*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, patients can also initially present with symptoms related to distant metastasis to different 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>
*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>
*Patients can experience nausea and vomiting similar to the course of normal pregnancy.
*[[Patient|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.
*The increase in the level of [[Human chorionic gonadotropin|βhCG]] is anomalous and can be a major sign in [[diagnosis]] making.
*Abdominal growth may be at a faster rate than in normal pregnancy.
*[[Abdomen|Abdominal]] growth may be at a faster rate than in normal [[pregnancy]].
*If left untreated, patients with gestational trophoblastic neoplasia may develop metastatic lesions in different 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>  
*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===
===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>
*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>
*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>
*[[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>
*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>
*[[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<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>
*[[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 renal 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>
*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>
*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>
*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>
*Death<ref name="pmid30571055">{{cite journal |vauthors=Bishop BN, Edemekong PF |title= |journal= |volume= |issue= |pages= |date= |pmid=30571055 |doi= |url=}}</ref>
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| style="padding: 5px 5px; background: #DCDCDC; | Age|| style="padding: 5px 5px; background: #F5F5F5;" |<40|| style="padding: 5px 5px; background: #F5F5F5;" |40||style="padding: 5px 5px; background: #F5F5F5;"|-||style="padding: 5px 5px; background: #F5F5F5;"|-  
| style="padding: 5px 5px; background: #DCDCDC; " | Age|| style="padding: 5px 5px; background: #F5F5F5;" |< 40|| style="padding: 5px 5px; background: #F5F5F5;" |40|| style="padding: 5px 5px; background: #F5F5F5;" |-|| style="padding: 5px 5px; background: #F5F5F5;" |-  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; |Antecedent pregnancy|| style="padding: 5px 5px; background: #F5F5F5;" |Mole|| style="padding: 5px 5px; background: #F5F5F5;" |Abortion||style="padding: 5px 5px; background: #F5F5F5;"|Term||style="padding: 5px 5px; background: #F5F5F5;"|-  
| style="padding: 5px 5px; background: #DCDCDC; " |Antecedent [[pregnancy]]|| style="padding: 5px 5px; background: #F5F5F5;" |[[Hydatidiform mole|Mole]]|| style="padding: 5px 5px; background: #F5F5F5;" |Abortion|| style="padding: 5px 5px; background: #F5F5F5;" |Term|| style="padding: 5px 5px; background: #F5F5F5;" |-  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; | Interval months from index pregnancy|| style="padding: 5px 5px; background: #F5F5F5;" |<4|| style="padding: 5px 5px; background: #F5F5F5;" |4 - <7||style="padding: 5px 5px; background: #F5F5F5;"|7 - <13||style="padding: 5px 5px; background: #F5F5F5;"|≥ 13  
| style="padding: 5px 5px; background: #DCDCDC; " | Interval months from index [[pregnancy]]|| style="padding: 5px 5px; background: #F5F5F5;" |< 4|| style="padding: 5px 5px; background: #F5F5F5;" |4 - < 7|| style="padding: 5px 5px; background: #F5F5F5;" |7 - < 13|| style="padding: 5px 5px; background: #F5F5F5;" |≥ 13  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Pretreatment serum hCG (iu/l)|| style="padding: 5px 5px; background: #F5F5F5;" |<10<sup>3</sup> || style="padding: 5px 5px; background: #F5F5F5;" |10<sup>3</sup> - <10<sup>4</sup>||style="padding: 5px 5px; background: #F5F5F5;"|10<sup>4</sup> - <10<sup>5</sup>||style="padding: 5px 5px; background: #F5F5F5;"|≥10<sup>5</sup>  
| style="padding: 5px 5px; background: #DCDCDC;" | Pre-treatment [[serum]] [[Human chorionic gonadotropin|βhCG]]
(iu/l)
| style="padding: 5px 5px; background: #F5F5F5;" |< 10<sup>3</sup> || style="padding: 5px 5px; background: #F5F5F5;" |10<sup>3</sup> - < 10<sup>4</sup>|| style="padding: 5px 5px; background: #F5F5F5;" |10<sup>4</sup> - < 10<sup>5</sup>|| style="padding: 5px 5px; background: #F5F5F5;" |≥ 10<sup>5</sup>  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Largest tumor size (including uterus)|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |3 - <5 cm||style="padding: 5px 5px; background: #F5F5F5;"|≥ 5cm||style="padding: 5px 5px; background: #F5F5F5;"|-  
| style="padding: 5px 5px; background: #DCDCDC;" | Largest [[tumor]] size (including [[uterus]])|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |3 - < 5 cm|| style="padding: 5px 5px; background: #F5F5F5;" |≥ 5cm|| style="padding: 5px 5px; background: #F5F5F5;" |-  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; | Site of metastases|| style="padding: 5px 5px; background: #F5F5F5;" |Lung|| style="padding: 5px 5px; background: #F5F5F5;" |Spleen, Kidney||style="padding: 5px 5px; background: #F5F5F5;"|Gastrointestinal||style="padding: 5px 5px; background: #F5F5F5;"|Liver, Brain  
| style="padding: 5px 5px; background: #DCDCDC; " | Site of [[Metastasis|metastases]]|| style="padding: 5px 5px; background: #F5F5F5;" |[[Lung]]|| style="padding: 5px 5px; background: #F5F5F5;" |[[Spleen]], [[Kidney]]|| style="padding: 5px 5px; background: #F5F5F5;" |[[Gastrointestinal tract|Gastrointestinal]]|| style="padding: 5px 5px; background: #F5F5F5;" |[[Liver]], [[Brain]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Number of metastases|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |1 - 4||style="padding: 5px 5px; background: #F5F5F5;"|5 - 8||style="padding: 5px 5px; background: #F5F5F5;"|>8
| style="padding: 5px 5px; background: #DCDCDC;" | Number of [[Metastasis|metastases]]|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |1 - 4|| style="padding: 5px 5px; background: #F5F5F5;" |5 - 8|| style="padding: 5px 5px; background: #F5F5F5;" |> 8
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Previous failed chemotherapy|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |-||style="padding: 5px 5px; background: #F5F5F5;"|1 drug||style="padding: 5px 5px; background: #F5F5F5;"|2 or more drugs  
| style="padding: 5px 5px; background: #DCDCDC;" |Previous failed [[chemotherapy]]|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |-|| style="padding: 5px 5px; background: #F5F5F5;" |1 drug|| style="padding: 5px 5px; background: #F5F5F5;" |2 or more drugs  
|}
|}


Revision as of 19:20, 11 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

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]

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Modified WHO prognostic scoring system as adapted by Fédération Internationale de Gynécologie et d'Obstétrique (FIGO)[13]

Score 0 1 3 4
Age < 40 40 - -
Antecedent pregnancy Mole Abortion Term -
Interval months from index pregnancy < 4 4 - < 7 7 - < 13 ≥ 13
Pre-treatment serum βhCG

(iu/l)

< 103 103 - < 104 104 - < 105 ≥ 105
Largest tumor size (including uterus) - 3 - < 5 cm ≥ 5cm -
Site of metastases Lung Spleen, Kidney Gastrointestinal Liver, Brain
Number of metastases - 1 - 4 5 - 8 > 8
Previous failed chemotherapy - - 1 drug 2 or more drugs

References

  1. ↑ 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
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 4.0 4.1 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.
  5. ↑ 5.0 5.1 Bishop BN, Edemekong PF. PMID 30571055. Missing or empty |title= (help)
  6. ↑ 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.
  7. ↑ 7.0 7.1 7.2 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 11.0 11.1 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.
  12. ↑ 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.
  13. ↑ Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S (October 2003). "Gestational trophoblastic neoplasia, FIGO 2000 staging and classification". Int J Gynaecol Obstet. 83 Suppl 1: 175–7. PMID 14763174.

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