We reported two cases of metastatic gestational trophoblastic neoplasms with bizarre pulmonary symptoms, one patient with small bowel metastasis, and two patients with brain metastasis presenting with unusual manifestations. [ncbi.nlm.nih.gov]

Other presentations include amenorrhea, ruptured uterus, abdominal pain and postmenopausal bleeding in decreasing order of frequency. [5], [9] Our case presented with amenorrhea which is not a common presentation of the disease. [advbiores.net]

Due to its rarity and varied biological behavior, it presents a specific diagnosis as it is distinct from other GTNs. 2. Case Presentation A 22-year-old G1P1 woman presented to Royan institute with a recent history of several months of amenorrhea. [iranjradiol.com]

Due to the characteristic of GTN, clinical manifestations can be varied like in the present patient who presented symptoms other than the typical symptoms of GTN, which can cause confusion in managing patients. [synapse.koreamed.org]

• Respiratory Distress

  She died secondary to poor performance status, severe immune suppression, metastatic choriocarcinoma and a Staphylococcus and Candida sepsis when she developed acute respiratory distress syndrome (ARDS). [sajhivmed.org.za]

  Her vital signs were a pulse of 126 beats per minute, temperature of 36.5 °C (97.7 °F), respiratory rate of 18 breaths per minute, blood pressure of 116/82 mmHg, and an oxygen saturation of 98% on room air. [westjem.com]

  Features such as hyperemesis, abnormal uterine enlargement, hyperthyroidism, anaemia, respiratory distress and pre-eclampsia are now rare as a result of routine use of ultrasound in early pregnancy [ 5 ]. [patient.info]

  Causes include Acute Respiratory Distress Syndrome, pulmonary edema from fluid overload, high-output cardiac failure caused by severe anemia or hyperthyroidism, pulmonary embolism, or trophoblastic embolization. [clinicaladvisor.com]

• Cough

  If it spreads to your lungs, you may have symptoms such as coughing, difficulty breathing and chest pain. [nhs.uk]

  Cystic enlargement of the ovaries Hyperthyroidism GTN Most common symptom is abnormal vaginal bleeding during or after a pregnancy Commonly presents with metastatic symptoms Pulmonary metastatic disease is most common – hemoptysis, shortness of breath, cough [arupconsult.com]

  Symptoms Women who develop choriocarcinoma may be symptom-free or experience symptoms based on which organ(s) are involved: Uterus: Vaginal bleeding, discharge Lung: Coughing up blood, shortness of breath or chest pain Liver: Abdominal pain Brain: Headache [foundationforwomenscancer.org]

  Figure 3: Computed tomography scan of the abdomen and pelvis shows metastatic deposits in both adrenals (blue arrows) and left kidney (black arrow) Click here to view During her admission, the patient developed fever and neutropenia with a productive cough [ijpmonline.org]

• Pneumonia

  Supportive management included granulocyte-stimulating factor (G-CSF) and intravenous antibiotics according to the sensitivity of a positive blood culture ( Klebsiella pneumonia ). A vaginal pus swab cultured Candida species. [sajhivmed.org.za]

  […] amphotericin B 8 Captopril in Treating Patients Undergoing Bone Marrow or Stem Cell Transplantation Completed NCT00004230 Phase 3 captopril;cyclophosphamide 9 Ribavirin With or Without Monoclonal Antibody Therapy in Treating Patients Who Develop RSV Pneumonia [malacards.org]

  However, on the fifth postoperative day, the patient developed marked pyrexia (39.6℃) which was thought to be due to aspiration pneumonia. [synapse.koreamed.org]

• Jaundice

  Women with choriocarcinoma will usually present with symptoms associated with metastases (weight loss, headaches, jaundice, lethargy, fatigue, shortness of breath) while women with PSTT may present with abnormal uterine bleeding, a mass in the endometrial [sharinginhealth.ca]

  […] if a hemoperitoneum has occurred due to bleeding from an abdominal metastasis Bleeding from a metastasis could also result in signs and symptoms of hemorrhagic shock [2, 3] Neurologic deficits, from lethargy to coma, if brain metastasis has occurred Jaundice [emedicine.medscape.com]

• Chest Pain

  If it spreads to your lungs, you may have symptoms such as coughing, difficulty breathing and chest pain. [nhs.uk]

  pain Other sites – vagina, central nervous system (CNS), liver Most ETTs present many years after full-term delivery; similar pattern for PSTTs Most common sign and symptom is amenorrhea or abnormal vaginal bleeding ARUP Lab Tests Tests generally appear [arupconsult.com]

  Symptoms Women who develop choriocarcinoma may be symptom-free or experience symptoms based on which organ(s) are involved: Uterus: Vaginal bleeding, discharge Lung: Coughing up blood, shortness of breath or chest pain Liver: Abdominal pain Brain: Headache [foundationforwomenscancer.org]

  She denied fever, chills, emesis, syncope, dyspnea, chest pain, or vaginal bleeding, and she had no urinary symptoms. [westjem.com]

• Aggressive Behavior

  Ki-67 proliferation index stains 8%–20% of tumor cells. [6], [8] The prognosis of PSTT is highly variable with no consensus on the prognostic factors that may predict an aggressive behavior. [ijpmonline.org]

  Although histologic features to predict outcome are not well established, some have suggested an association between high mitotic index and more aggressive behavior. [archivesofpathology.org]

  Cases with c-erbB-2 amplification and expression in combination with DNA hyperploidy showed higher proliferation and more aggressive behavior (2 complete hydatidiform moles with lung and liver metastases, 2 invasive moles and 1 choriocarcinoma). [link.springer.com]

  Invasive moles have more aggressive behavior than either complete or partial HMs, and they are treated similarly to choriocarcinoma (i.e., with chemotherapy). However, unlike choriocarcinoma, they may regress spontaneously. [northshore.org]

• Seizure

  If it spreads to your brain, it may cause headaches or seizures. Chemotherapy is used to treat choriocarcinoma and usually successfully cures it. [nhs.uk]

  Metastatic disease very rarely presents with dyspnoea or abnormal neurology, including seizures. Investigations Urine and blood levels of hCG. [patient.info]

  The overwhelming majority of patients with high-risk metastases from GTN have symptoms related to the site of extrapulmonary disease including headaches or seizures with brain metastases, abdominal pain with liver or spleen metastases, hematuria with [clinicaladvisor.com]

• Convulsions

  […] choriocarcinoma may be symptom-free or experience symptoms based on which organ(s) are involved: Uterus: Vaginal bleeding, discharge Lung: Coughing up blood, shortness of breath or chest pain Liver: Abdominal pain Brain: Headache, trouble with vision, convulsion [foundationforwomenscancer.org]

  […] free or experience symptoms based on which organ(s) are involved: Uterus: Vaginal bleeding, discharge Lung: Coughing up blood, shortness of breath, chest pain Liver: Abdominal pain Brain: Headache, trouble with vision, weakness or loss of function, convulsion [mymolarpregnancy.com]

For example, the section on noninvasive hydatidiform mole recommends the tests that should be routinely performed during workup, followed by surgery with either suction, dilation and curettage – preferably under ultrasound guidance – or hysterectomy for [mdedge.com]

Diagnostic workup includes complete bloodwork, HCG and CT chest/abdomen/pelvis +/- CT or MR brain. [bccancer.bc.ca]

1859 Infectious Agents and Cancer 549 1860 Cancer of the Skin 1863 Melanoma 1889 Diagnostic Studies and Pretreatment Staging 1001 1908 Principles of Isolation Perfusion 701 1923 Intraocular Melanomas 1951 Invasion and Metastasis 117 1952 Metastatic WorkUp [books.google.ro]

In borderline cases, the final diagnosis of invasion versus non-invasion is confirmed only by histopathology and hence all the evacuated moles need to undergo a complete pathological workup. [sonoworld.com]

Metastatic workup with CT scan of chest, abdomen, and pelvis done on February 2, 2013 showed innumerable pulmonary nodules scattered in both lungs, largest 8.4 mm in right middle lobe. [bmcresnotes.biomedcentral.com]

Hysterectomy can of course not be considered for first-line treatment in women who wish to become pregnant, unless there is no option. [orpha.net]

follow-up, and counselling [2015] Europe European Society for Medical Oncology Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up [2013] Germany, Switzerland, Austria Geburtshilfe und Frauenheilkunde [gfmer.ch]

Hyman et al. describe the presentation, treatment, and outcome of 17 cases of PSTT in Memorial Sloan-Kettering Cancer Center. [advbiores.net]

Poor prognosis was reported in cases with distant metastasis or delayed treatment. [iranjradiol.com]

All the cases were analyzed from the time of initial treatment. [journals.plos.org]

Prognosis The overall recovery rate is around 99%. The prognosis is very closely related to the rapidity of diagnosis, the risk level of the tumor (low or high) and the suitability of treatment. [orpha.net]

Prognosis The overall recovery rate is around 99%. The prognosis is very closely related to the rapidity of diagnosis, the risk level of the tumor (low or high) and the suitability of treatment. Last updated: 3/5/2011 [rarediseases.info.nih.gov]

A review of the literature suggests that CNS involvement has a better prognosis than liver metastases. The patient diagnosed to have MGTN by a gastroscopic biopsy is the first reported, to the best of out knowledge. [ncbi.nlm.nih.gov]

Treatment and prognosis The clinical behavior of an ETT is often difficult to predict and while most cases follow a benign course following resection, there is a potential for metastatic disease 3. Promoted articles (advertising) [radiopaedia.org]

Response to treatment for GTN is generally favourable; but the sequelae of HIV and/or AIDS, the resultant low CD4 counts, comorbidities, poor performance status and the extent of metastatic disease in patients receiving chemotherapy, compromise the prognosis [ajol.info]

Etiology The etiology of gestational trophoblastic tumors is not known. [orpha.net]

The etiology of the Klippel-Trenaunay syndrome. Ann Surg. 1985;202: 624-7. 2. Laurence A Cole LA. HCG, the wonder of today’s science. Reprod Biol Endocrinol. 2012;10:24. 3. [indianpediatrics.net]

(Etiology) The causative factor for each of the Gestational Trophoblastic Tumor type is as follows: Complete hydatidiform moles are caused when a sperm cell fertilizes an abnormal egg cell that has no nucleus or chromosomes. [dovemed.com]

Yen, S. and MacMahon, B., Epidemiologic features of trophoblastic disease, Amer. J. Obstet. Gynecol. 101: 126 (1968). Google Scholar 11. Prawirohardjo, S., Martiono, K. [link.springer.com]

Summary Epidemiology Exact annual incidence is not known but it is estimated to be about 1/1,000,000 women. [orpha.net]

Epidemiology Exact annual incidence is not known but it is estimated to be about 1/1,000,000 women. [rarediseases.info.nih.gov]

"Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole". [en.wikipedia.org]

Hsieh and Soong (48) illustrated how changes on intracardiac Doppler, rather than a change in tumor size, could reflect the pathophysiological situation in the presence of a chorioangioma. [fetalultrasound.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]

This review will describe the relevant pathophysiology and natural history of GTN, and the use of imaging techniques in the diagnosis and management of these conditions. Q 2006 The Royal College of Radiologists. Published by Elsevier Ltd. [slideshare.net]

(Lurain, 2010) return to top Pathophysiology Choriocarcinoma is an invasive, highly vascular, anaplastic trophblastic tissue made up of cytotrophoblasts and syncitotrophoblasts that secrete human chorionic gonadotropin (hCG) in high amounts (Goldstein [sharinginhealth.ca]

Pathophysiology A hydatidiform mole is considered malignant when the serum hCG levels plateau or rise during the follow-up period and an intervening pregnancy is excluded. [emedicine.medscape.com]

Completed NCT00045292 Phase 3 acyclovir;acyclovir sodium;valacyclovir 12 RCT on the Efficacy of Methotrexate for the Prevention of GTD Completed NCT01984099 Phase 3 Methotrexate;Vitamin B Complex 13 Surgery and Combination Chemotherapy in Treating Children [malacards.org]

Certain factors may increase your risk of developing a gestational trophoblastic tumor, including: Age over 35 Previous history of molar pregnancy Southeast Asian ethnicity Learn more about gynecologic cancer prevention and screening. [upmc.com]

Gestational Trophoblastic Disease Prevention There are no preventive medicines or treatments for GTD. The only way to prevent this very rare disease is to not become pregnant. [hopkinsmedicine.org]

GTD occurs after conception, when the trophoblast cells change and form a mass in the placenta, preventing a healthy fetus from developing. [cancercenter.com]