Gestational trophoblastic neoplasia differential diagnosis: Difference between revisions

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! rowspan="2" |Differential Diagnosis
! rowspan="2" |Differential Diagnosis
! colspan="5" |Clinical Features
! colspan="6" |Clinical Features
! rowspan="2" |Karyotype
! rowspan="2" |Karyotype
! colspan="7" |Immunostaining
! colspan="7" |Immunostaining
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|'''Beta Human Chorionic Gonadotropin (Beta-hCG) Baseline Levels'''
|'''Beta Human Chorionic Gonadotropin (Beta-hCG) Baseline Levels'''
|'''History of Pregnancy'''
|'''History of Pregnancy'''
|'''Theca Leutin Cysts'''
|'''Metastatic Route'''
|'''Metastatic Route'''
|'''Cytokeratin 18'''  
|'''Cytokeratin 18'''  
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|'''Complete Hydatidiform Mole'''
|'''Complete Hydatidiform Mole'''
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* [[Vaginal bleeding]]
* Inappropriately large for date [[uterine]] size
* [[Hyperemesis]]
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* High rate of progression (15-20%)
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* Extremely high levels ( > 100000 mIU/ml in half of the patients
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* Not related
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* Present
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* Benign
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* 46, XX or 46 XY (Paternal dispermy)
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* Not present
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* Not present
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* Extremely elevated
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* Not present
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* Not present
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* Not present
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* Not present
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* Dilation and curettage (suction)
|-
|-
|'''Partial Hydatidiform Mole'''
|'''Partial Hydatidiform Mole'''
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|'''Invasive Molar Pregnancy'''  
|'''Invasive Molar Pregnancy'''  
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|'''Choriocarcinoma'''
|'''Choriocarcinoma'''
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|'''Placental-site Trophoblastic tumor (PSTT) and Epitheloid Trophoblastic Tumor (ETT)'''
|'''Placental-site Trophoblastic tumor (PSTT) and Epitheloid Trophoblastic Tumor (ETT)'''
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|'''Ovarian Tumors'''
|'''Ovarian Tumors'''
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|'''Spontaneous Abortion'''  
|'''Spontaneous Abortion'''  
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|'''Ectopic Pregnancy'''  
|'''Ectopic Pregnancy'''  
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|'''Normal Term Pregnancy'''  
|'''Normal Term Pregnancy'''  
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Presenting Complaints'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Presenting Complaints'''
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* [[Vaginal bleeding]]
*  
* Inappropriately large for date [[uterine]] size
* [[Hyperemesis]]
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* [[Vaginal bleeding]]
* [[Vaginal bleeding]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Neoplastic Conversion'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Neoplastic Conversion'''
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* High rate of progression (15-20%)
*  
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* < 5 % progression rate
* < 5 % progression rate
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Beta Human Chorionic Gonadotropin (Beta-hCG) baseline levels'''  
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Beta Human Chorionic Gonadotropin (Beta-hCG) baseline levels'''  
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* Extremely high levels ( > 100000 mIU/ml in half of the patients
*  
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* Highly elevated ( > 100000 mIU/ml in one in ten patients)
* Highly elevated ( > 100000 mIU/ml in one in ten patients)
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''History of Pregnancies'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''History of Pregnancies'''
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* Not related
*  
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* Not related
* Not related

Revision as of 21:19, 28 February 2019

Gestational trophoblastic neoplasia Microchapters

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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

Choriocarcinoma must be differentiated from non neoplastic diseases, neoplastic diseases, and other causes of bleeding during pregnancy.

Differentiating choriocarcinoma from other diseases

Choriocarcinoma must be differentiated from other non-neoplastic diseases such as:

Choriocarcinoma must be differentiated from other neoplastic diseases such as:

  • Invasive hydatidiform mole
  • Placental site trophoblastic tumor (PSTT)
  • Mixed germ cell tumor - esp. for testicular and ovarian tumors

Choriocarcinoma must be differentiated from other causes of bleeding during pregnancy:

Differential Diagnosis Clinical Features Karyotype Immunostaining Management
Presenting Complaints Potential for Neoplastic Conversion Beta Human Chorionic Gonadotropin (Beta-hCG) Baseline Levels History of Pregnancy Theca Leutin Cysts Metastatic Route Cytokeratin 18 HLA-G Human Chorionic Gonadotropin (hCG) Transformation-Related Protein 63 (P63) Human Placental Lactogen (hPL) Melanoma Cell Adhesion Molecule (Mel-CAM) Ki67
Complete Hydatidiform Mole
  • High rate of progression (15-20%)
  • Extremely high levels ( > 100000 mIU/ml in half of the patients
  • Not related
  • Present
  • Benign
  • 46, XX or 46 XY (Paternal dispermy)
  • Not present
  • Not present
  • Extremely elevated
  • Not present
  • Not present
  • Not present
  • Not present
  • Dilation and curettage (suction)
Partial Hydatidiform Mole
Invasive Molar Pregnancy
Choriocarcinoma
Placental-site Trophoblastic tumor (PSTT) and Epitheloid Trophoblastic Tumor (ETT)
Ovarian Tumors
Spontaneous Abortion
Ectopic Pregnancy
Normal Term Pregnancy
Clinical Features Complete Hydatidiform Mole Partial Hydatidiform Mole Invasive Molar Pregnancy Choriocarcinoma Placental-site trophoblastic tumor (PSTT) and Epithelioid trophoblastic tumor (ETT)
Presenting Complaints
Neoplastic Conversion
  • < 5 % progression rate
Beta Human Chorionic Gonadotropin (Beta-hCG) baseline levels
  • Highly elevated ( > 100000 mIU/ml in one in ten patients)
  • High
  • High
  • Moderatley elevated (< 1000 mIU/ml in majority of patients)
History of Pregnancies
  • Not related
Metastatic Route
Management

References

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