Presentation
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]
Time to the presentation can widely vary between 1 week and 14 years. Presenting symptoms can include either abnormal vaginal bleeding and amenorrhea 6. Up to 30% of patients may present with metastases at the time of diagnosis 10. [radiopaedia.org]
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]
Entire Body System
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Pseudotumor
PSTT, a neoplasm of implantation site intermediate trophoblastic cells, is a rare form of gestational trophoblastic disease (GTD) 3% of GTD cases Other previously used terms are atypical choriocarcinoma, syncytioma, chorioepitheliosis and trophoblastic pseudotumor [pathologyoutlines.com]
Trophoblastic pseudotumor of the uterus: an exaggerated form of "syncytial endometritis" simulating a malignant tumor. Cancer. 1976; 38 (3) : 1214 -26 [ PubMed ] 10. Guvendag Guven ES, Guven S, Esinler I, Ayhan A, Kucukali T, Usubutun A. [iranjradiol.com]
References Scully RE, Young RH (1981) Trophoblastic pseudotumor: a reappraisal. Am J SurgPathol5: 75-76. Hassadia A, Gillespie A, Tidy J, Evarard RGNJ, Wells M, et al. (2005) Placental site trophoblastic tumour: clinical features and management. [omicsonline.org]
[…] addition to choriocarcinoma which arises from the abnormal proliferation of both cytotrophoblasts and syncytiotrophoblasts. [1] PSTT is rare and presents 1%–2% of all GTDs and [2], [3] It was first described by Kurman and Scully in 1976 as trophoblastic pseudotumor [ijpmonline.org]
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Lymphadenopathy
No evidence of ascites nor lymphadenopathy (pelvic, abdominal, inguinal). All other structures were within normal limits. [bmcresnotes.biomedcentral.com]
Respiratoric
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Sputum
[…] 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 and yellowish sputum [ijpmonline.org]
Gastrointestinal
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Abdominal Mass
mass. [2] Other presenting symptoms include uterine rupture and nephrotic syndrome. [2], [3] The reported percentage of Stage IV disease (extrapulmonary metastasis) is variable in the literature and was reported to be 10%, 31%, and 35% in different studies [ijpmonline.org]
Skin
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Skin Lesion
However, the incidence rates of myelosuppression (white blood cell decline), gastrointestinal reactions (nausea, vomiting, dental ulcer, and diarrhea), skin lesions and phlebitis were lower in the tegafur group than in the 5-Fu group (P 0.05). [ncbi.nlm.nih.gov]
In the tegafur group, 7 cases (1.64%, 7/427) of grade I skin lesions were observed, but there were no grade II, III or IV skin lesions. [journals.plos.org]
The incidence of single umbilical artery in pregnancies complicated by chorioangioma is 2.7% compared to 0.7% in the control group, and the incidence of skin lesions is 12.2% versus 2.1% in the control group (28). [fetalultrasound.com]
Urogenital
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Foul Smelling Vaginal Discharge
Clinical examination confirmed an abdominal uterine mass of 22 weeks’ gestation with a foul-smelling vaginal discharge. [sajhivmed.org.za]
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Adnexal Mass
Ultrasonography was suggestive of development of left adnexal mass with multiple cysts with increased vascularity. Ultrasonography showed gradual increase in size of adnexal mass up to 5 x 3 x 2 cm inseparable from uterus and left ovary. [jpgo.org]
Workup
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]
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]
The extensive workup included a thoracic-abdominal-pelvic CT, which showed a large sized uterus displaying a heterogeneous rising with moderate bilateral ecstasy of the uterine veins. [frontiersin.org]
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]
X-Ray
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Mediastinal Mass
A postoperative work-up for extrauterine disease only revealed an anterior mediastinal mass, which was eventually sampled and found to be a benign thymoma. [nature.com]
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Anterior Mediastinal Mass
A postoperative work-up for extrauterine disease only revealed an anterior mediastinal mass, which was eventually sampled and found to be a benign thymoma. [nature.com]
Ultrasound
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Ovarian Mass
Epithelioid trophoblastic tumor of uterus presenting as an ovarian mass: A diagnostic and therapeutic dilemma. [ijpmonline.org]
Microbiology
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Candida
A vaginal pus swab cultured Candida species. [sajhivmed.org.za]
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Human Papillomavirus
Clinically, β-human chorionic gonadotropin levels and history of human papillomavirus infection can also be helpful, although they can be misleading. [archivesofpathology.org]
Treatment
All the cases were analyzed from the time of initial treatment. [journals.plos.org]
Follow up after treatment After treatment your specialist will monitor you closely. You might need ultrasound scans, MRI scans, CT scans and urine tests to check how well the treatment has worked and to monitor your progress. [cancerresearchuk.org]
The results of this study may provide useful data for the clinical application of tegafur in GTN treatment. [ncbi.nlm.nih.gov]
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]
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]
Prognosis
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]
While there can be a good prognosis with localized disease, the tumors tend to be less sensitive to chemotherapy than other forms of gestational trophoblastic disease 6. [radiopaedia.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]
Etiology
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]
Epidemiology
Epidemiology and pathology of hydatidiform mole in the General Hospital of Mexico, Amer. J. Obstet. Gynecol. 85: 856 (1963). Google Scholar 10. Yen, S. and MacMahon, B., Epidemiologic features of trophoblastic disease, Amer. J. Obstet. [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: Epidemiology, clinical manifestations and diagnosis. Chiang JW, Berek JS. In: UpToDate [Textbook of Medicine]. Basow, DS (Ed). [en.wikipedia.org]
Pathophysiology
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]
Prevention
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]
Presently, no effective preventive measures are available for Gestational Trophoblastic Tumors Women with a history of one or more molar pregnancies should consult their healthcare provider to understand the risk of future molar pregnancies What is the [dovemed.com]