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Fulltext Gestational trophoblastic disease

Loh KY, Sivalingam N, Suryani MY

Med J Malaysia, 2004 Dec;59(5):697-702; quiz 703.
PMID: 15889580

Gestational trophoblastic disease is a spectrum of pregnancy disorder arising from the placental trophoblastic tissues. It characterised by the secretion of a distinct tumour marker, the beta-HCG. This condition is highly curable even in the presence of metastasis. The incidence of this disease is higher in the Asian population. The major well-established risk factors for gestational trophoblastic disease are advanced maternal age and a past history of gestational trophoblastic disease. Common clinical presentations include vaginal bleeding in early trimester, uterus larger than gestational age, absence of fetal parts after 20 weeks of gestation. Ultrasonography is a reliable non-invasive tool for diagnosis of gestational trophoblastic disease in the clinical setting. All placental tissue following miscarriage or curettage should have histopathological evaluation to exclude gestational trophoblastic disease. Since this group of disorders is one of the highly curable neoplasms, early diagnosis and prompt treatment is necessary.

Matched MeSH terms: Gestational Trophoblastic Disease/diagnosis*; Gestational Trophoblastic Disease/etiology; Gestational Trophoblastic Disease/therapy*
Gestational trophoblastic neoplasia and human immunodeficiency virus infection: a 10-year review

Tayib S, van Wijk L, Denny L

Int. J. Gynecol. Cancer, 2011 Dec;21(9):1684-91.
PMID: 21997172 DOI: 10.1097/IGC.0b013e31822d8ffd

OBJECTIVES: The objective of the study was to describe the management of gestational trophoblastic neoplasia (GTN), with particular reference to concurrent human immunodeficiency virus (HIV) infection.
METHODS: This retrospective descriptive study comprised all cases of GTN managed at Groote Schuur Hospital over a 10-year period (1999-2008).
RESULTS: Seventy-six patients, with a median age of 30 years at presentation, were included in the study. Only 36 patients (47.4%) had known HIV status. Fourteen (18.4%) were HIV positive, and of these, 4 (28.6%) were on antiretroviral treatment (ARV). The mean CD4 count was 142 cells/μL for those on ARV and 543 cells/μL for those not on ARV (P = 0.001). Histologically, 44 patients (58%) had hydatidiform mole, and 21 (28%) had choriocarcinoma. In the remaining 10 cases, a clinical diagnosis was made. Based on the revised International Federation of Gynecology and Obstetrics (FIGO)/modified World Health Organization scoring, 43 patients (56.6%) were low risk, and 33 (43.4%) were high risk. Thirty-eight patients (50%) were staged as FIGO stage I. Of 73 patients who received chemotherapy, 56 (76.7%) achieved complete remission, 9 (12.3%) did not achieve any remission, 7 (9.6%) had a relapse, and 1 (1.4%) was lost to follow-up. Patients who never went into remission had frequent treatment delays due to poor compliance or inadequate blood counts. The overall survival at 60 months was 81.9%. Of the 13 patients (17.1%) who have died, 5 (38.5%) were HIV positive. The overall 5-year survival rates for FIGO stages I, II, III, and IV were 97.4%, 66.7%, 77.8%, and 46.2%, respectively. The overall 5-year survival for HIV-positive patients was 64.3% versus more than 85% for both the HIV-negative and HIV-unknown groups.
CONCLUSIONS: Apart from more advanced stage, HIV seropositivity and poor compliance with treatment also portend poorer outcome in GTN patients. In HIV-positive patients with poor CD4, little clarity is available whether ARV should be commenced speedily, and the administration of chemotherapy delayed until immune reconstitution occurs.

Matched MeSH terms: Gestational Trophoblastic Disease/diagnosis; Gestational Trophoblastic Disease/drug therapy*; Gestational Trophoblastic Disease/epidemiology; Gestational Trophoblastic Disease/virology*
Management of gestational trophoblastic disease in developing countries

Sivanesaratnam V

Best Pract Res Clin Obstet Gynaecol, 2003 Dec;17(6):925-42.
PMID: 14614890 DOI: 10.1016/S1521-6934(03)00097-X

In Malaysia, the incidence of molar pregnancy and gestational trophoblastic neoplasia is 2.8 and 1.59 per 1000 deliveries, respectively; the disease is more common among the Chinese compared to the Malays and Indians. While uterine suction is the preferred method of uterine evacuation of hydatidiform mole, complete evacuation was not achieved at the first attempt in 25% of cases. Partial moles comprise 30% of all moles; these need follow up similar to that for complete moles as they are potentially malignant. In the management of invasive moles, chemotherapy should not be withheld in the presence of metastases or failure of regression of hCG. Placental site tumours are rare. Prophylactic hysterectomy and prophylactic chemotherapy are not recommended. However, in those patients with unsatisfactory hCG regression curves indicating 'at risk' in developing gestational trophoblastic neoplasia (GTN), 'selective preventive chemotherapy' appears appropriate. Chemotherapy remains the main modality of treatment for GTN. As tumour bulk and location of disease are important determinants in outcome, we categorized our patients into low, medium- and high-risk groups with survivals of 100, 98 and 61.7% respectively. Surgery and radiotherapy have a limited role.

Matched MeSH terms: Gestational Trophoblastic Disease/surgery; Gestational Trophoblastic Disease/therapy*
Fulltext Degenerated retained product of conception misdiagnosed as invasive trophoblastic disease

Tan AP

Med J Malaysia, 2015 Apr;70(2):100-1.
PMID: 26162386

Retained products of conception (POC) complicates nearly 1% of all pregnancies, occurring with greater frequency after termination of pregnancy than after vaginal or caesarean delivery. The presenting symptoms of retained products of conception are similar to those of gestational trophoblastic disease and hence accurate differentiation is difficult based on clinical history and physical examination alone. The distinction between these two entities is extremely important as the treatment differs dramatically. These patients often need to be further evaluated with either ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis. Hence, radiologists play a vital role in clinching the diagnosis although at times it may be challenging to differentiate between these two entities. Herein, we discuss a case of degenerated retained products of conception which was initially misdiagnosed as invasive trophoblastic disease in a 41-year-old woman whom last known pregnancy was 10 years ago.

Matched MeSH terms: Gestational Trophoblastic Disease
Fulltext Biochemical derangement in twin pregnancy: complete hydatidiform mole and viable foetus

Munirah, M., Khalidah, M.B., Dian Nasriana, N., Hanita, O.

Medicine & Health, 2018;13(2):180-187.
MyJurnal

Case of co-existence of twin pregnancy of complete hydatidiform molar with viable intrauterine pregnancy is extremely rare with low incidence of 1 case for 20,000 – 100,000. It is associated with high risk of spontaneous abortion, preterm delivery, intrauterine death, bleeding, pre-eclampsia, and persistence trophoblastic disease (PTD). It may associate with biochemical derangement that may induce symptomatic manifestation to the mother. There are few cases reported in Asia population with significant clinical dilemma and management to the maternal and foetus. Here, we report a case of a young woman with previous bad obstetric history who presented with antepartum per-vaginal bleeding and was noted to have a twin pregnancy with complete hydatidiform molar and viable foetus. It was complicated with markedly elevated human chorionic gonadotropin (hCG) and hyperthyroidism. Postpartumly, her hCG level was persistently high and her condition progressed into gestational trophoblastic neoplasm.

Matched MeSH terms: Gestational Trophoblastic Disease
Fulltext Choriocarcinoma after Caesarean Section – Repeated Misgivings

Roszaman, R., Ghazali Ismail

International Medical Journal Malaysia, 2006;5(1):1-4.
MyJurnal

Choriocarcinoma is a malignant proliferation of syncytial trophoblast cells that do not form placental villi. It is a relatively rare and highly malignant variant of gestational trophoblastic disease. Although choriocarcinoma is mostly observed after a molar pregnancy, it may be preceded by any gestational event. It has been shown that even a partial mole can transform into choricarcinoma. Incidence rates of choriocarcinoma differ widely throughout the world. In Europe and North America, choriocarcinoma is reported to affect one in every 30,000 to 40,000 pregnancies, and one in 40 molar pregnancies. In South East Asia, choriocarcinoma is reported to affect one in every 500-3000 pregnancies. Following livebirth, choriocarcinoma with metastatic disease are important sequele (31%)(Tidy et al 1995). In the same study the reported median interval between antecedent pregnancy and choriocarcinoma is five months. Multi agent chemotherapy is required in the majority of patients (82%) for the high risk group. The prognosis for choriocarcinoma after a normal gestation is poorer. The mortality rate is also significantly higher than non-molar abortion (21%). Effective treatment with oral Methotrexate in metastatic choriocarcinoma to the lung confirmed the highly sensitive nature of this tumour to chemotherapy agent.

Matched MeSH terms: Gestational Trophoblastic Disease