Distinct gestational trophoblastic neoplasia - different entities, specific management

Abstract

Gestational trophoblastic diseases are abnormalities of the trophoblastic tissue development. They have Β-hCG as tumour marker, similar clinical manifestations but different pathological features, management and prognosis. Gestational trophoblastic neoplasia includes all forms of gestational trophoblastic disease that are invasive and/or metastasize and correspond to 10% of this group of diseases. The authors performed a retrospective review of all patients referred to our department between 1st January 2011 and 30th June 2016. Presenting symptoms, Β-hCG levels, obstetric and personal history and microscopic features were reviewed. 4 cases were identified - 2 invasive complete and 1 partial hydatidiform moles and 1 placental site trophoblastic tumour. Management and follow-up were individualized. Neither persistence nor recurrences were diagnosed after primary treatment. These case series highlights the importance of an accurate diagnosis and a long-term follow-up considering the risk of persistency or malignancy, as gestational trophoblastic neoplasia usually have good response to the adequate therapy.

Gestational Trophoblastic Disease and Gestational Trophoblastic Neoplasm - An Experience at Tertiary Care Hospital

“…These case series highlights the importance of an accurate diagnosis and a long term follow-up considering the risk of persistency or malignancy as gestational trophoblastic neoplasia usually has good response to the adequate therapy 2 . In most cases (90%) persistent high levels corresponded to invasive moles, except after non-molar pregnancies, in which persistent levels of β-hCG were always due to choriocarcinoma or placental site trophoblastic tumour 2 . It was observed in one study that during monitoring, out of 40 cases 27 had undetectable β-hCG by 6-8 weeks 1 .…”

“…Low socioeconomic status, illiteracy and inability to understand the importance of follow-up were the major contributing factors in our region as well as majority of them were from remote areas and lack of facilities to reach tertiary care hospitals. Thirteen (32.5%) cases were labelled as post molar GTN during follow up on FIGO criteria for the diagnosis of post molar GTN 2 . GTN represents <1% gynaecological malignancies and have high cure rate if treated early and on well established guide-Gestational Trophoblastic Disease and Gestational Trophoblastic Neoplasm -An Experience at Tertiary Care Hospital lines.…”

“…Gestational trophoblastic disease (GTD) represents a group of abnormalities of trophoblastic tissue development 1 . All of them arise from the placental trophoblastic epithelium so they all have human chorionic gonadotropin (HCG) β-sub unit as tumour marker 2 . They can be divided into distinct group on the basis of their histology; the abnormalities of chorionic villi development, named hydatidi-form mole (HM), complete HM or partial HM which may be persistent or invasive (complete HM infiltrating myometrium); and malignant tumours arising from different components of the trophoblastic tissue, namely choriocarcinoma (in contrast to an invasive mole choriocarcinoma does not shows chorionic villi), placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT) 1,3 .…”

Tspan5 inhibits proliferation and migration of JEG-3 cells by inhibiting FAK and AKT phosphorylation

“…Choriocarcinoma is highly malignant with metastasis occurring early and extensively. It had a mortality rate of nearly to 100% before the advent of chemotherapy drugs [10,11]. Although post-chemotherapy prognosis has seen great improvement over the years, relapses or metastases still occur due to chemotherapy resistance.…”