Gestational trophoblastic neoplasia natural history, complications and prognosis: Difference between revisions
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*Age over 35 years (P = 0.025) | *Age over 35 years ([[P-value|P]] = 0.025) | ||
*Interval since the last [[pregnancy]] of over 2 years (P = 0.014) | *Interval since the last [[pregnancy]] of over 2 years ([[P-value|P]] = 0.014) | ||
*Deep [[Myometrium|myometrial]] invasion (P = 0.006) | *Deep [[Myometrium|myometrial]] invasion ([[P-value|P]] = 0.006) | ||
*Stage III or IV (P < 0.0005) | *Stage III or IV ([[P-value|P]] < 0.0005) | ||
*Maximum [[Human chorionic gonadotropin|βhCG]] level > 1000 mIU/ml (P = 0.034) | *Maximum [[Human chorionic gonadotropin|βhCG]] level > 1000 mIU/ml ([[P-value|P]] = 0.034) | ||
*Extensive [[coagulative necrosis]] (P = 0.024) | *Extensive [[coagulative necrosis]] ([[P-value|P]] = 0.024) | ||
*High [[Mitosis|mitotic]] rate (P = 0.005) | *High [[Mitosis|mitotic]] rate ([[P-value|P]] = 0.005) | ||
*Presence of [[Cell (biology)|cells]] with clear [[cytoplasm]] (P < 0.0005) | *Presence of [[Cell (biology)|cells]] with clear [[cytoplasm]] ([[P-value|P]] < 0.0005) | ||
==References== | ==References== |
Revision as of 20:29, 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
- Patients with gestational trophoblastic neoplasia (GTN) initially present with abnormal vaginal bleeding.[2]
- The vaginal bleeding can also be associated with elevation of βhCG.[3]
- In rare instances, patients can also initially present with symptoms related to distant metastasis to different organs.[4]
- 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.
- Abdominal growth may be at a faster rate than in normal pregnancy.
- If left untreated, patients with gestational trophoblastic neoplasia (GTN) may develop metastatic lesions in different organs and can result in death.[5]
Complications
- Disseminated disease[6][7]
- Hemorrhagic shock[7]
- Massive hemoptysis[7][4]
- Acute abdomen[8]
- Ovarian hyperstimulation[9]
- Spontaneous renal hemorrhage[10]
- Severe hyperthyroidism[11][12]
- Cardiothyreosis[11]
- Death[5]
Prognosis
Poor prognosis of gestational trophoblastic neoplasia (GTN) can be determined by the following factors:[13]
- Age over 35 years (P = 0.025)
- Interval since the last pregnancy of over 2 years (P = 0.014)
- Deep myometrial invasion (P = 0.006)
- Stage III or IV (P < 0.0005)
- Maximum βhCG level > 1000 mIU/ml (P = 0.034)
- Extensive coagulative necrosis (P = 0.024)
- High mitotic rate (P = 0.005)
- Presence of cells with clear cytoplasm (P < 0.0005)
References
- ↑ 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
- ↑ 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.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 5.0 5.1 Bishop BN, Edemekong PF. PMID 30571055. Missing or empty
|title=
(help) - ↑ 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.
- ↑ 7.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 11.0 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.
- ↑ 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.
- ↑ 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)