Trophoblastic neoplasm

Trophoblastic neoplasm
Micrograph of intermediate trophoblast and a hydatidiform mole (bottom of image). H&E stain.
SpecialtyOncology Edit this on Wikidata

Gestational trophoblastic neoplasia (GTN) is group of rare diseases related to pregnancy and included in gestational trophoblastic disease (GTD) in which abnormal trophoblast cells grow in the uterus.[1] GTN can be classified into benign and malignant lesions. Benign lesions include placental site nodule and hydatidiform moles while malignant lesions have[2] four subtypes including invasive mole, gestational choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT).[3] The choriocarcinoma has 2 significant subtypes including gestational and non-gestational and they are differentiated by their different biological feature and prognosis.[4] Signs and symptoms of GTN will appear vary from person to person and depending upon the type of the disease. They may include uterine bleeding not related to menstruation, pain or pressure in pelvis, large uterus and high blood pressure during pregnancy. The cause of this disease is unknown but the identification of the tumor based on total beta-human chorionic gonadotropin (β-hCG) in the serum.

Management of GTN requires pathology review, treatment options and monitoring of hCG. Therefore, it can be treated with curettage, hysterectomy and single agent or multi agent chemotherapy.[4] Although this group of diseases are highly susceptible to chemotherapy, prognosis depends on the type of GTN and whether the tumor has spread to other areas of the body.[5]

Cause and Risk factors

The exact cause of gestational trophoblastic neoplasia (GTN) is unknown. GTN often arises after molar pregnancies but can also occur after any gestation including miscarriages and term pregnancies.[6] Although risk factors may impact on the development of the tumor, most do not directly cause of disease. According to some studies, the risk of complete molar pregnancy is highest in women over age 35 and younger than 20. The risk is even higher for women over age 45.[7][8]

Signs and Symptoms

The symptoms of GTN will vary from person to person. People with the same disease may not have all the symptoms listed.[citation needed]

  • Most common presenting symptom is vaginal bleeding, which is associated with mild elevation of serum β hCG (< 2,500 IU/L). Vaginal bleeding may also occur after delivery that continues for longer than normal.[citation needed]
  • A uterus that is larger than expected during pregnancy[citation needed]
  • Pain or pressure in the pelvis.[citation needed]
  • Severe nausea and vomiting during pregnancy.[citation needed]
  • High blood pressure with headache and swelling of feet and hands early in the pregnancy.[citation needed]
  • Fatigue, shortness of breath, dizziness, and a fast or irregular heartbeat caused by anemia.[citation needed]
  • If metastases are present, signs and symptoms associated with the metastatic disease and more severe symptoms may be present.[9]

Diagnosis

Initial screening tests for GTN include:

  • Internal pelvic exam: to check for lumps or anything unusual changes.
  • Ultrasound exam of the pelvis: Also called a sonogram, an ultrasound creates a picture of the internal organ. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and directed at the uterus to take the pictures.[10]
  • Blood chemistry studies: It can be done to check the levels of certain hormones and other substances that may be impacted by the presence of GTN.[11]
  • Serum tumor marker test: For GTN, the blood is checked for the level of β-hCG, a hormone that is made by the body during pregnancy. β-hCG in the blood of a woman who is not pregnant may be a sign of GTN and also helpful tests to monitor a woman’s recovery during and after treatment. Placental side trophoblastic tumor (PSTT) is differentiated by low β-hCG levels because it is a neoplastic proliferation of intermediate trophoblastic cells.[12]
  • Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, bacteria, and the level of β-hCG.[13]
  • Spinal tap: Cerebrospinal fluid is tested for high amounts of the hormone β-hCG if the GTN has spread to the brain or spinal cord.
  • Computed tomography (CT): A CT scan can be used to measure the tumor's size.
  • Chest x-ray: It may be done if the tumor has spread outside of the uterus.

Tumor staging

FIGO (International Federation of Gynecology and Obstetrics) 2000 Anatomical staging is commonly used to evaluate stage of GTN.

Stage I - Disease confined to the uterus

Stage II - GTN extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament)

Stage III - GTN extends to the lungs, with or without known genital tract involvement

Stage IV - All other metastatic sites[14]

Pathophysiology

High magnification micrograph of choriocarcinoma. H&E stain.

All types of gestational trophoblastic neoplasia originate from the placenta. A placenta develops in the uterus during pregnancy and becomes first site of nutrient and gas exchange between mother and fetus. It has two components such as fetal component and mother component. A fetal component is composed of cytotrophoblast and syncytiotrophoblast.[15] The exact pathogenesis of choriocarcinoma has not been fully understood, but studies have shown cytotrophoblast cells function as stem cells and transform into malignant form. The neoplastic cytotrophoblast further differentiates into either intermediate trophoblasts or syncytiotrophoblast.[citation needed]

Treatment

Several treatment methods are available for GTN that include surgery, chemotherapy or combination of these. Surgery treatment is most common initial method for some types of the disease but it depends on the stage of the tumor. Common surgical options include dilation and curettage, and hysterectomy.

Prognosis

FIGO modified Prognostic Scoring System. The system evaluates the patients to those with GTN as low-risk and high-risk based on several risk factors such as age, pregnancy or interval of pregnancies, size or metastases of tumor and prior chemotherapy. Each risk factors are rated at levels 0-4 scores. The numbers are then added up, and the overall score determines a woman's risk level.

  • Women with a score of 6 or less are at low risk and tend to have a good prognosis regardless of how far the cancer has spread which usually respond well to chemotherapy.
  • Women with a score of 7 or more are at high risk, and their tumors tend to respond less well to chemotherapy, even if they haven't spread much. They may require more intensive chemotherapy.[16]

Therefore, some studies have shown that the condition is harder to cure if the cancer has spread to the liver or brain or β-hCG level is higher than 40,000 mIU/mL when treatment begins, cancer returns after having chemotherapy or symptoms/ pregnancy occurred for more than 4 months before treatment.[17]

Epidemiology

According to studies, GTN is found more frequently in Asia compared to North America or Europe.[15] As of 2020, the reported incidence of choriocarcinoma ranges from 1 in 40 000 pregnancies in North America and Europe, to 9.2 and 3.3 per 40 000 pregnancies in Southeast Asia and Japan, respectively. Epidemiological studies have reported that hydatidiform mole appears to be caused by abnormal gametogenesis and fertilization more frequent at the extremes of reproductive age of younger than 15 and older than 45 years of age and pregnancies at these ages are a risk factor for hydatidiform mole. The risk increases after age 35 and there is a 5–10 times increased risk after 45 years.[18]

Research

Recently, in order to provide more comprehension tools of GTN pathogenesis, epigenetic modifications and molecular biology techniques could be applied for proper diagnosis, management, and treatment of such neoplasia. The progression of anti-angiogenesis therapy and molecular targeted cancer therapies would be capable of improving the therapeutic perspective among patients with drug resistance.[19] Although chemotherapy and hysterectomy are currently used in a clinical setting, the use of diverse treatments including anti-body and gene therapy also being attempted to cure GTN. In addition, gene delivery tools using genetically engineered neural stem cells are presently being examined for the treatment of GTN and previous studies have indicated a significant inhibitory effect on tumor growth.[20]

References

  1. ^ "Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version - National Cancer Institute". www.cancer.gov. 2020-05-11. Retrieved 2020-12-16.
  2. ^ Scott EM, Smith AL, Desouki MM, Olawaiye AB (2012-12-02). "Epithelioid trophoblastic tumor: a case report and review of the literature". Case Reports in Obstetrics and Gynecology. 2012: 862472. doi:10.1155/2012/862472. PMC 3518084. PMID 23243530.
  3. ^ "Gestational trophoblastic tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2020-12-16.
  4. ^ a b Bishop BN, Edemekong PF (2020). "Choriocarcinoma". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 30571055. Retrieved 2020-12-16.
  5. ^ "Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version - National Cancer Institute". www.cancer.gov. 2020-05-11. Retrieved 2020-12-16.
  6. ^ May T, Goldstein DP, Berkowitz RS (2011-05-11). "Current chemotherapeutic management of patients with gestational trophoblastic neoplasia". Chemotherapy Research and Practice. 2011: 806256. doi:10.1155/2011/806256. PMC 3265241. PMID 22312558.
  7. ^ "References: Gestational Trophoblastic Disease". www.cancer.org. 25 June 2012. Retrieved 2020-12-16.
  8. ^ "Gestational Trophoblastic Disease - Risk Factors". Cancer.Net. 2012-06-25. Retrieved 2020-12-16.
  9. ^ "Gestational Trophoblastic Neoplasia Clinical Presentation: History, Physical, Causes". emedicine.medscape.com. Retrieved 2020-12-16.
  10. ^ "Gestational Trophoblastic Disease - Diagnosis". Cancer.Net. 2012-06-25. Retrieved 2020-12-16.
  11. ^ "Gestational Trophoblastic Disease". www.hopkinsmedicine.org. Retrieved 2020-12-16.
  12. ^ Kim SJ (December 2003). "Placental site trophoblastic tumour". Best Practice & Research. Clinical Obstetrics & Gynaecology. 17 (6): 969–984. doi:10.1016/s1521-6934(03)00095-6. PMID 14614893.
  13. ^ "Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version - National Cancer Institute". www.cancer.gov. 2020-05-11. Retrieved 2020-11-02.
  14. ^ Table 1 in May, Taymaa; Goldstein, Donald P.; Berkowitz, Ross S. (2011). "Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia". Chemotherapy Research and Practice. 2011: 1–12. doi:10.1155/2011/806256. PMC 3265241. PMID 22312558.
  15. ^ a b AlJulaih GH, Muzio M (2020). "Gestational Trophoblastic Neoplasia". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32965896. Retrieved 2020-12-16.
  16. ^ "Gestational Trophoblastic Disease Stages". www.cancer.org. Retrieved 2020-12-17.
  17. ^ "Choriocarcinoma: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2020-12-17.
  18. ^ Ngan HY, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, et al. (October 2018). "Update on the diagnosis and management of gestational trophoblastic disease". International Journal of Gynaecology and Obstetrics. 143 (Suppl 2): 79–85. doi:10.1002/ijgo.12615. hdl:2066/196937. PMID 30306586.
  19. ^ Sharami SR, Saffarieh E (March 2020). "A review on management of gestational trophoblastic neoplasia". Journal of Family Medicine and Primary Care. 9 (3): 1287–1295. doi:10.4103/jfmpc.jfmpc_876_19. PMC 7266251. PMID 32509606.
  20. ^ Kim GS, Hwang KA, Choi KC (March 2019). "A promising therapeutic strategy for metastatic gestational trophoblastic disease: Engineered anticancer gene-expressing stem cells to selectively target choriocarcinoma". Oncology Letters. 17 (3): 2576–2582. doi:10.3892/ol.2019.9911. PMC 6396211. PMID 30867726.

Read other articles:

List of 7.62×51mm NATO firearms

The below table gives a list of firearms that can fire the 7.62×51mm NATO cartridge. This ammunition was developed following World War II as part of the NATO small arms standardization, it is made to replicate the ballistics of a pre-WWII full power rifle cartridge in a more compact package. Not all countries that use weapons chambered in this caliber are in NATO. This table is sortable for every column. Name Type Country Image Years of service Notes Steyr SSG 69 Bolt-action sniper rifle ...

 

 

Let's Fly

Let's FlyAlbum mini karya B1A4DirilisNovember 2014Direkam2014GenreRockDurasi21:09BahasaIndonesiaLabelFLY MUSICProduserBobby BlastaSingel dalam album Let's Fly Memang AkuDirilis: 21 November 2014 (2014-11-21) CemburuDirilis: 13 Juli 2015 (2015-07-13) Sebelum tiba adzabmuDirilis: 01 Juni 2016 (2016-06-01) Let's Fly adalah album mini debut oleh boyband Korea Selatan, B1A4 dan dirilis oleh WM Entertainment pada 21 April 2011. Disusun oleh Lee Sang-ho, tetapi Im Sanghyuk (pe...

 

 

Daftar acara Bali TV

Logo Bali TV Halaman ini memuat daftar acara yang ditayangkan di Bali TV. Acara saat ini Berita Seputar Bali Seputar Bali Pagi (Ditayangkan Setiap Senin - Jumat Pukul 05:30 WITA - 06:30 WITA) Seputar Bali Pagi Akhir Pekan (Ditayangkan Setiap Sabtu pukul 05:30 WITA - 06:30 WITA Dan Setiap Minggu Pukul 07:00 WITA - 08:00 WITA) Seputar Bali Petang (Ditayangkan Setiap Hari Pukul 17:00 WITA - 18:00 WITA) Seputar Bali Terkini (Ditayangkan Setiap Hari) Berita Siang (ditayangkan Setiap Senin - Jumat ...

The Snow (poem)

Medieval Welsh poem The Snow (Welsh: Yr Eira or Cywydd yr Eira) is a 14th- or 15th-century Welsh-language poem in the form of a cywydd evoking a landscape which, to the poet's chagrin, is covered with snow. It has been described as an imaginative tour de force.[1] Manuscripts of the poem mostly attribute it to Dafydd ap Gwilym, widely seen as the greatest of the Welsh poets,[2] though some name Dafydd ab Edmwnd or Ieuan ap Rhys ap Llywelyn as the author. Modern literary histor...

 

 

Mayor jenderal (Amerika Serikat)

Mayor jenderalTanda pangkat Mayor jenderal Angkatan Darat, Angkatan Udara dan Korps MarinirTanda pangkat pundak Mayor jenderalNegara Amerika SerikatCabang angkatan Angkatan Darat Amerika Serikat  Angkatan Udara Amerika Serikat Korps Marinir Amerika SerikatPangkatBintang duaPangkat NATOOF-7Pangkat non-NATOO-8Pangkat atasanLetnan jenderalPangkat bawahanBrigadir jenderalPangkat setaraLaksamana muda (Angkatan Laut Amerika Serikat dan Penjaga Pantai Amerika Serikat) Mayor jenderal d...

 

 

Basilika Santa Ursula, Köln

Basilika Santa UrsulaBasilika Minor Santa UrsulaJerman: Basilika Sankta Ursulacode: de is deprecated Basilika Santa UrsulaLokasiKölnNegara JermanDenominasiGereja Katolik RomaArsitekturStatusBasilika minorStatus fungsionalAktifAdministrasiKeuskupan AgungKeuskupan Agung Köln Interior Basilika Santa Ursula (Jerman: Basilika Sankta Ursulacode: de is deprecated ) adalah sebuah gereja basilika minor Katolik yang terletak di Köln, Rhine-Westphalia Utara, Jerman. Bangunan ini dibangun di atas...

Chris Ware

Pour les articles homonymes, voir Ware. Chris WareChris Ware à Austin en 2019.BiographieNaissance 28 décembre 1967 (56 ans)OmahaNationalité américaineDomiciles Nebraska, Oak ParkFormation Université du Texas à AustinBrownell-Talbot School (en)Activité Auteur de bande dessinéePériode d'activité 1988-2009Rédacteur à The New YorkerAutres informationsInfluencé par Frank King, Winsor McCay, Joseph CornellDistinctions Grand prix de la ville d'Angoulême (2021)Liste détailléeEis...

 

 

俄亥俄州

  「俄亥俄」重定向至此。关于其他用法，请见「俄亥俄 (消歧义)」。 俄亥俄州 美國联邦州State of Ohio 州旗州徽綽號：七葉果之州地图中高亮部分为俄亥俄州坐标：38°27'N－41°58'N, 80°32'W－84°49'W国家 美國加入聯邦1803年3月1日，在1953年8月7日追溯頒定（第17个加入联邦）首府哥倫布（及最大城市）政府 • 州长（英语：List of Governors of {{{Name}}}]]） •&...

 

 

Zail Singh

Zail Singhਜ਼ੈਲ ਸਿੰਘ Presiden India Ke-7Masa jabatan25 Juli 1982 – 25 Juli 1987Perdana MenteriIndira GandhiRajiv GandhiWakil PresidenMohammad HidayatullahRamaswamy VenkataramanPendahuluNeelam Sanjiva ReddyPenggantiRamaswamy VenkataramanMenteri Dalam NegeriMasa jabatan14 Januari 1980 – 22 Juni 1982Perdana MenteriIndira GandhiPendahuluYashwantrao ChavanPenggantiRamaswamy VenkataramanSekretaris Jenderal Gerakan Non-BlokMasa jabatan12 Maret 1983 – 6...

Wolfe Tone

Irish revolutionary figure (1763–1798) This article is about the Irish revolutionary leader associated with the rebellion in Ireland of 1798. For other uses, see Wolf tone (disambiguation). Wolfe TonePortrait in the National Gallery of Ireland, DublinBornTheobald Wolfe Tone(1763-06-20)20 June 1763Dublin, Kingdom of IrelandDied19 November 1798(1798-11-19) (aged 35)Dublin, Kingdom of IrelandBurial placeBodenstown Graveyard, Sallins, County Kildare, IrelandEducationTrinity College DublinK...

 

 

Jeanne Faivre d'Arcier

French novelist Jeanne Faivre d'ArcierBorn(1950-08-31)31 August 1950Paris, FranceOccupationNovelist; Short-story writerNationalityFrenchGenreThrillers; Noir fiction; FantasyNotable awardsPrix Ozone, 1998; Grand prix de l'Imaginaire, 2001 Jeanne Faivre d'Arcier (born 1950) is a French novelist, short-story writer and writer of children's stories. Early life Jeanne Faivre d'Arcier was born on 31 August 1950 in Paris. She studied classics at the Paris Nanterre University and at the Institute of ...

 

 

Hampstead

Area of Camden in London, England For other places with the same name, see Hampstead (disambiguation). Human settlement in EnglandHampsteadDownshire Hill in May 2009HampsteadLocation within Greater LondonOS grid referenceTQ265855London boroughCamdenCeremonial countyGreater LondonRegionLondonCountryEnglandSovereign stateUnited KingdomPost townLONDONPostcode districtNW3Dialling code020PoliceMetropolitanFireLondonAmbulanceLondon UK ParliamentHampstead and ...

Betsy Brandt

Betsy BrandtBrandt pada 2018 San Diego Comic-ConLahir14 Maret 1973 (umur 51)Bay City, Michigan, ASPendidikanUniversity of Illinois, Urbana-Champaign (BFA)Universitas Harvard (MFA)AlmamaterRoyal Conservatoire of ScotlandPekerjaanAktrisTahun aktif1998–sekarangDikenal atasBreaking BadLife in PiecesSuami/istriGrady Olsen ​(m. 1996)​Anak2 Betsy Brandt (lahir Maret 14, 1973)[1] adalah aktris Amerika Serikat. Ia memerankan Marie Schrader dalam Breaki...

 

 

Overman Automobile Company

Overman Wheel CompanyOverman Automobile Company Rechtsform Company Gründung 1882 Auflösung 1902 Auflösungsgrund Zusammenschluss Sitz Chicopee Falls, Massachusetts, USA Leitung Albert H. Overman Branche Fahrzeuge Hochrad von 1889 Overman Automobile Company, vorher Overman Wheel Company, war ein US-amerikanischer Hersteller von Fahrzeugen.[1][2] Inhaltsverzeichnis 1 Unternehmensgeschichte 2 Kraftfahrzeuge 3 Literatur 4 Weblinks 5 Einzelnachweise Unternehmensgeschichte Albert...

 

 

محمد الحاج حسن

الشيخ محمد الحاح حسن معلومات شخصية اسم الولادة محمد الحاج حسن الميلاد 1976 (العمر 47–48)شمسطار الإقامة أميركا الجنسية أميركي لبناني الديانة مسلم الحياة العملية المدرسة الأم الحرية المهنة رئيس تحرير موقع www.inn.nwes الحزب التيار الشيعي الحر مجال العمل منظمة AMC وموقع inn.news الموا�...

Norah Borges

Argentine artist, art critic (1901–1998) Norah BorgesBornLeonor Fanny Borges AcevedoMarch 4, 1901Palermo, Buenos Aires, ArgentinaDiedJuly 20, 1998(1998-07-20) (aged 97)Buenos Aires, Argentina Norah Borges and Guillermo de la Torre (1928) Leonor Fanny Norah Borges Acevedo (March 4, 1901 – July 20, 1998), was an Argentine visual artist and art critic, member of the Florida group, and sister of the Argentine writer Jorge Luis Borges. Early life and source of nickname She was the daughte...

 

 

لويس جيامبيتري

هذه المقالة يتيمة إذ تصل إليها مقالات أخرى قليلة جدًا. فضلًا، ساعد بإضافة وصلة إليها في مقالات متعلقة بها. (أبريل 2019) لويس جيامبيتري (بالإسبانية: Luis Giampietri)‏  مناصب عضو مجلس الشيوخ البيروفي[1][2]   في المنصب27 يوليو 2006  – 26 يوليو 2011  نائب رئيس بيرو   في المنصب2...

 

 

2020 Emilia-Romagna regional election

2020 Emilia-Romagna regional election ← 2014 26 January 2020 2024 → All 50 seats to the Regional Council of Emilia-RomagnaTurnout67.7% (30.0%)   Majority party Minority party   Candidate Stefano Bonaccini Lucia Borgonzoni Party Democratic Party Lega Alliance Centre-left Centre-right Seats won 29 19 Seat change 3 7 Popular vote 1,195,742 1,014,672 Percentage 51.4% 43.6% Swing 2.4% 11.1% Maps of the election result President before election Stefan...

Copenaghen Open 1994

Copenaghen Open 1994Sport Tennis Data28 febbraio - 7 marzo Edizione6a SuperficieSintetico indoor CampioniSingolare Evgenij Kafel'nikov Doppio Martin Damm / Brett Steven 1993 1995 Il Copenaghen Open 1994 è stato un torneo di tennis giocato sul sintetico indoor. È stata la 6ª edizione del Copenaghen Open che fa parte della categoria World Series nell'ambito dell'ATP Tour 1994. Si è giocato a Copenaghen in Danimarca dal 28 febbraio al 7 marzo 1994. Indice 1 Campioni 1.1 Singolare maschile 1....

 

 

صمويل ليند

صمويل ليند معلومات شخصية الميلاد 15 يونيو 1879(1879-06-15)ميكمينفيل  تاريخ الوفاة 12 فبراير 1965 (85 سنة) الإقامة الولايات المتحدة  مواطنة الولايات المتحدة  عضو في الأكاديمية الوطنية للعلوم،  والجمعية الفيزيائية الأمريكية  الحياة العملية المدرسة الأم معهد ماساتشوستس لل�...