Gestational trophoblastic neoplasia differential diagnosis: Difference between revisions

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* Hysterectomy
* Hysterectomy
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|'''Ovarian Tumors'''<ref name="pmid2050306">{{cite journal |vauthors=Farahmand SM, Marchetti DL, Asirwatham JE, Dewey MR |title=Ovarian endodermal sinus tumor associated with pregnancy: review of the literature |journal=Gynecol. Oncol. |volume=41 |issue=2 |pages=156–60 |date=May 1991 |pmid=2050306 |doi= |url=}}</ref><ref name="pmid3806533">{{cite journal |vauthors=Hopkins MP, Duchon MA |title=Adnexal surgery in pregnancy |journal=J Reprod Med |volume=31 |issue=11 |pages=1035–7 |date=November 1986 |pmid=3806533 |doi= |url=}}</ref><ref name="pmid3532382">{{cite journal |vauthors=Lavery JP, Koontz WL, Layman L, Shaw L, Gumpel U |title=Sonographic evaluation of the adnexa during early pregnancy |journal=Surg Gynecol Obstet |volume=163 |issue=4 |pages=319–23 |date=October 1986 |pmid=3532382 |doi= |url=}}</ref><ref name="pmid2722058">{{cite journal |vauthors=Dgani R, Shoham Z, Atar E, Zosmer A, Lancet M |title=Ovarian carcinoma during pregnancy: a study of 23 cases in Israel between the years 1960 and 1984 |journal=Gynecol. Oncol. |volume=33 |issue=3 |pages=326–31 |date=June 1989 |pmid=2722058 |doi= |url=}}</ref>
|'''Ovarian Tumors'''<ref name="pmid2050306">{{cite journal |vauthors=Farahmand SM, Marchetti DL, Asirwatham JE, Dewey MR |title=Ovarian endodermal sinus tumor associated with pregnancy: review of the literature |journal=Gynecol. Oncol. |volume=41 |issue=2 |pages=156–60 |date=May 1991 |pmid=2050306 |doi= |url=}}</ref><ref name="pmid3806533">{{cite journal |vauthors=Hopkins MP, Duchon MA |title=Adnexal surgery in pregnancy |journal=J Reprod Med |volume=31 |issue=11 |pages=1035–7 |date=November 1986 |pmid=3806533 |doi= |url=}}</ref><ref name="pmid3532382">{{cite journal |vauthors=Lavery JP, Koontz WL, Layman L, Shaw L, Gumpel U |title=Sonographic evaluation of the adnexa during early pregnancy |journal=Surg Gynecol Obstet |volume=163 |issue=4 |pages=319–23 |date=October 1986 |pmid=3532382 |doi= |url=}}</ref><ref name="pmid2722058">{{cite journal |vauthors=Dgani R, Shoham Z, Atar E, Zosmer A, Lancet M |title=Ovarian carcinoma during pregnancy: a study of 23 cases in Israel between the years 1960 and 1984 |journal=Gynecol. Oncol. |volume=33 |issue=3 |pages=326–31 |date=June 1989 |pmid=2722058 |doi= |url=}}</ref><ref name="pmid20651229">{{cite journal |vauthors=Lengyel E |title=Ovarian cancer development and metastasis |journal=Am. J. Pathol. |volume=177 |issue=3 |pages=1053–64 |date=September 2010 |pmid=20651229 |pmc=2928939 |doi=10.2353/ajpath.2010.100105 |url=}}</ref>
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* Vagina bleeding or discharge
* Vagina bleeding or discharge
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* Germ cell and epithelial tumors are most common
* Germ cell and epithelial tumors are most common
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* Absent
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* Direct extension or seeding
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* 46,XX
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Revision as of 14:59, 4 March 2019

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)
  • Absent
  • Absent
  • Extremely elevated
  • Absent
  • Absent
  • Absent
  • Absent
  • Dilation and curettage (suction)
Partial Hydatidiform Mole
  • < 5 % progression rate
  • Highly elevated ( > 100000 mIU/ml in one in ten patients)
  • Not related
  • Absent
  • Benign
  • 69,XXY or XYY
  • Absent
  • Absent
  • Highly elevated
  • Absent
  • Absent
  • Absent
  • Absent
  • Dilation and curettage (suction)
Invasive Molar Pregnancy
  • High
  • Consequence of molar pregnancy
  • May be present
  • Hematogenous
  • 69,XXY or XYY
  • Positive
  • Positive
  • Highly elevated
  • Absent
  • Absent
  • Absent
  • Absent
Choriocarcinoma
  • Neoplastic
  • High
  • Present
  • Hematogenous
Placental-site Trophoblastic tumor (PSTT) and Epitheloid Trophoblastic Tumor (ETT)
  • Neoplastic
  • Moderatley elevated (< 1000 mIU/ml in majority of patients)
  • Absent
  • Lymphatic
  • 46,XX or XY
  • Positive
  • Positive
  • Negative (Positive in ETT)
  • Positive (Negative in ETT)
  • Positive (Negative in ETT)
  • Positive ( >1% in PSTT and >10% in ETT)
  • Hysterectomy
Ovarian Tumors[1][2][3][4][5]
  • Vagina bleeding or discharge
  • Weight loss
  • Urinary frequency/urgency
  • Change in bowel habits
  • Loss of appetite
  • Pelvic pressure/pain
  • Abdominal pain
  • Neoplastic
  • Elevated (Dysgerminoma and Embryonal carcinoma)
  • Overall incidence in pregnancy is 2.4-5.7% (1/300 to 1/556 pregnancies)
  • Incidence of malignancy is 1/15,000 to 1/32,000 pregnancies
  • Germ cell and epithelial tumors are most common
  • Absent
  • Direct extension or seeding
  • 46,XX
Spontaneous Abortion
  • Vaginal bleeding
  • Lower abdominal pain
  • Lower back pain
  • Vaginal passage of fetal tissue
  • Reduced uterine size and regression of signs and symtoms of pregnancy
  • Firm cervix
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
Beta Human Chorionic Gonadotropin (Beta-hCG) baseline levels
  • High
  • High
History of Pregnancies
Metastatic Route
Management

References

  1. ↑ Farahmand SM, Marchetti DL, Asirwatham JE, Dewey MR (May 1991). "Ovarian endodermal sinus tumor associated with pregnancy: review of the literature". Gynecol. Oncol. 41 (2): 156–60. PMID 2050306.
  2. ↑ Hopkins MP, Duchon MA (November 1986). "Adnexal surgery in pregnancy". J Reprod Med. 31 (11): 1035–7. PMID 3806533.
  3. ↑ Lavery JP, Koontz WL, Layman L, Shaw L, Gumpel U (October 1986). "Sonographic evaluation of the adnexa during early pregnancy". Surg Gynecol Obstet. 163 (4): 319–23. PMID 3532382.
  4. ↑ Dgani R, Shoham Z, Atar E, Zosmer A, Lancet M (June 1989). "Ovarian carcinoma during pregnancy: a study of 23 cases in Israel between the years 1960 and 1984". Gynecol. Oncol. 33 (3): 326–31. PMID 2722058.
  5. ↑ Lengyel E (September 2010). "Ovarian cancer development and metastasis". Am. J. Pathol. 177 (3): 1053–64. doi:10.2353/ajpath.2010.100105. PMC 2928939. PMID 20651229.
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