Gestational trophoblastic neoplasia natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Patients with gestational trophoblastic neoplasia (GTN) initially present with abnormal vaginal bleeding. The vaginal bleeding can also be associated with elevation of βhCG. In rare instances, patients can also initially present with symptoms related to distant metastasis to different organs. Patients can experience nausea and vomiting similar to the course of normal pregnancy. If left untreated, patients with gestational trophoblastic neoplasia (GTN) may develop metastatic lesions in different organs and can result in death. Complications of gestational trophoblastic neoplasia (GTN) include disseminated disease, hemorrhagic shock, massive hemoptysis, Acute abdomen, ovarian hyperstimulation, renal hemorrhage, severe hyperthyroidism, cardiothyreosis, and death. Poor prognostic factors include age > 35 years, interval since the last pregnancy of over 2 years, deep myometrial invasion, advanced stage, maximum βhCG level > 1000 mIU/ml, extensive coagulative necrosis, high mitotic rate, and presence of cells with clear cytoplasm.

Natural History, Complications, and Prognosis

Natural History

Patients with gestational trophoblastic neoplasia (GTN) initially present with abnormal vaginal bleeding.^[1]
The vaginal bleeding can also be associated with elevation of βhCG.^[2]
In rare instances, patients can also initially present with symptoms related to distant metastasis to different organs.^[3]
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.^[4]

Complications

Prognosis

Poor prognosis of gestational trophoblastic neoplasia (GTN) can be determined by the following factors:^[12]

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

↑ 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.
↑ ^3.0 ^3.1 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.
↑ ^4.0 ^4.1 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.
↑ ^6.0 ^6.1 ^6.2 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.
↑ ^10.0 ^10.1 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)

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[pmid22838240-1] 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.

[pmid12477457-2] 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.

[pmid28411623-3] 3.0 ^3.1 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.

[pmid30571055-4] 4.0 ^4.1 Bishop BN, Edemekong PF. PMID 30571055. Missing or empty |title= (help)

[pmid25118474-5] 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.

[pmid29969941-6] 6.0 ^6.1 ^6.2 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.

[pmid29353908-7] 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.

[pmid27399862-8] 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.

[pmid27352577-9] 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.

[pmid26559442-10] 10.0 ^10.1 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.

[pmid30116304-11] 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.

[12] 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)

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