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2.1
Gestational Trophoblastic Disease

Images

WIKIDATA, CC BY-SA 3.0

Presentation

The clinical records of all molar patients were reviewed regarding presentation, treatment, and follow-up. [ncbi.nlm.nih.gov]

Urogenital

  • Vaginal Bleeding

    Pulmonary, vulval, or vaginal metastases unless hCG concentrations are falling. Heavy vaginal bleeding or evidence of GI or intraperitoneal haemorrhage. [patient.co.uk]

    Patients with GTD frequently present with vaginal bleeding and pelvic tenderness. Complete hydatidiform moles are associated with several additional clinical features (e.g., enlarged uterus, hyperemesis gravidarum, preeclampsia ). [amboss.com]

    bleeding in the absence of other symptoms is most common presentation CHM Most frequently diagnosed in first half of pregnancy Most common symptom is abnormal vaginal bleeding – usually 6-16 weeks gestation Other symptoms include the following Uterine [arupconsult.com]

    Patient with complete hydatidiform mole who was admitted to the operating room with severe vaginal bleeding after a tomographic exam with iodinated contrast. [ncbi.nlm.nih.gov]

  • Uterine Hemorrhage

    Its use may help avoid invasive interventions, such as hysterectomy and embolization, currently used to control hemorrhage after uterine evacuation. [ncbi.nlm.nih.gov]

    Hydatidiform Mole Many patients with complete mole present with or develop anemia from uterine hemorrhage and may require transfusion support. [clinicaladvisor.com]

  • Sexual Dysfunction

    Psychological morbidity rates exceeded community norms, but sexual dysfunction rates, although high, are likely consistent with local norms. [ncbi.nlm.nih.gov]

Workup

Recently, PCR-based short tandem repeat DNA genotyping has emerged as a powerful diagnostic measure in the workup of gestational trophoblastic disorders, particularly hydatidiform moles. [ncbi.nlm.nih.gov]

If malignancy is suspected, workup must include an x-ray of the chest to screen for lung metastases. Hydatidiform moles are normally treated via dilation and curettage, whereas choriocarcinoma typically requires chemotherapy. [amboss.com]

Metastatic workup:• Includes:• Xray chest and CT scan• USG and CT scan abdomen and pelvis• CT or MRI scan of head• hCG levels can be measured in CSF to exclude cerebral involvement if CT brain is normal.• Ratio of plasma to CSF hCG has to be lower than [slideshare.net]

See Workup for more detail. Management Patients with GTN are subdivided into 2 groups: those with a WHO score of less than 7 (low-risk) and those with a score of 7 or higher and who are at high risk of therapy failure. [emedicine.com]

Treatment

When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Clinical trials are taking place in many parts of the country. [cancer.gov]

However, it is associated with significant neutropenia often requiring dose reductions and treatment delays. We describe the use of granulocyte colony-stimulating factor (G-CSF) in three patients in order to maintain the treatment schedule. [ncbi.nlm.nih.gov]

Prognosis

Prior evidence shows that FIGO score ≥7 is associated with poorer prognosis. [2minutemedicine.com]

A patient with metastatic, poor prognosis disease and a large metastatic lesion on her left fifth digit is presented. The clinical course and complete response to EMACO chemotherapy are outlined. [ncbi.nlm.nih.gov]

The prognosis can sway from good to poor, depending on its stage. [thebabycorner.com]

Only a few women with GTD have a poor prognosis, e.g. some forms of stage IV GTN. The FIGO staging system is used. [en.wikipedia.org]

Etiology

[…] an invasive mole Etiology Risk factors Prior molar pregnancy History of miscarriage Patients ≤ 15 and ≥ 35 years Complete mole Does not contain any fetal or embryonic parts Caused by fertilization of an empty egg that does not carry any chromosomes → [amboss.com]

Etiology The etiology of gestational trophoblastic tumors is not known. [rarediseases.info.nih.gov]

This article seeks to address recent advances in the genetics of GTN in relation to diagnosis, etiology, prognosis and treatment. [ncbi.nlm.nih.gov]

Epidemiology

The epidemiology, pathology, clinical presentation, and diagnosis of each of these trophoblastic disease variants are discussed. [ncbi.nlm.nih.gov]

Numero Pagine: 205 Rilegatura: Rilegato Formato: 25x31 Prezzo Copertina: € 150.55 Sconto 15% Descrizione Comprehensive presentation of histological diagnosis and differential diagnoses of GTD In-depth reviews of the molecular genetic background of GTD, epidemiology [libreriascientifica.com]

Pathophysiology

Pathophysiology Hydropic degeneration of chorionic villi with concomitant proliferation of cytotrophoblasts and syncytiotrophoblasts → death of the embryo Clinical features Complete mole Vaginal bleeding during the first trimester Uterus size greater [amboss.com]

Pathophysiology Fertilization occurs as the sperm enters the ovum. In instances of a partial mole, two sperms might fertilize a single ovum. Reduction division or meiosis was not able to occur in a partial mole. [nurseslabs.com]

Some comments about diabetes mellitus are made regarding: history, pathophysiology, value of glucose tolerance tests, dietary management and preferred methods of delivery. [link.springer.com]

[…] hydatidiform molar pregnancy Asian or American Indian ancestry, or (for GTN only) African ancestry Older maternal age – women >40 years Familial disease – rare, more common in recurrent CHM NLRP7 and (rarely) KHDC3L gene mutations implicated (Wang, 2009) Pathophysiology [arupconsult.com]

Prevention

Triploid partial moles which arise mainly from dispermic fertilization may also be prevented by ICSI. [ncbi.nlm.nih.gov]

Causes & Prevention NCI does not have PDQ evidence-based information about prevention of gestational trophoblastic disease. Screening NCI does not have PDQ evidence-based information about screening for gestational trophoblastic disease. [cancer.gov]

While GTD cannot be prevented, you should get HCG tests and regular prenatal tests if you are at risk. Most cases of GTD are completely treatable, even if they are not found in the earliest stages. [loyolamedicine.org]

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