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Gestational Trophoblastic Neoplasia Clinical Presentation

  • Author: Enrique Hernandez, MD, FACOG, FACS; Chief Editor: Warner K Huh, MD  more...
 
Updated: Mar 05, 2015
 

History

Most cases of gestational trophoblastic neoplasia are diagnosed when the serum hCG levels plateau or rise in patients being observed after the diagnosis of hydatidiform mole. If metastases are present, signs and symptoms associated with the metastatic disease, such as hemoptysis, abdominal pain, hematuria, and neurologic symptoms, may be present.

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Physical

Note the following:

  • Metastasis to the lower genital tract present as purple to blue-black papules or nodules. These are extremely vascular and might bleed profusely if biopsied.[1]
  • Abdominal tenderness may be present if liver or gastrointestinal metastases have occurred.
  • Abdominal guarding and rebound tenderness may be present if a hemoperitoneum has occurred due to bleeding from an abdominal metastasis. Bleeding from a metastasis could also result in signs and symptoms of hemorrhagic shock.[2, 3]
  • Neurologic deficits, from lethargy to coma, can be encountered if brain metastasis has occurred.
  • Jaundice may be present if liver metastasis causes biliary obstruction.
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Causes

Why some hydatidiform moles become malignant and others do not is unknown. However, mounting evidence shows different molecular profiles between nonmalignant and malignant gestational trophoblastic disease.[54, 55, 56]

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Contributor Information and Disclosures
Author

Enrique Hernandez, MD, FACOG, FACS Chairman, Department of Obstetrics and Gynecology, Director of Gynecologic Oncology, Abraham Roth Professor of Obstetrics, Gynecology and Reproductive Science, Professor of Pathology, Temple University Hospital, Temple University School of Medicine

Enrique Hernandez, MD, FACOG, FACS is a member of the following medical societies: Alpha Omega Alpha, American Cancer Society, Association of Professors of Gynecology and Obstetrics, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Gynecologic Oncology, American Society for Colposcopy and Cervical Pathology, Johns Hopkins Medical and Surgical Association, American Gynecological and Obstetrical Society, American College of Obstetricians and Gynecologists, American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jori S Carter, MD, MS Assistant Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Jori S Carter, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, Association of Women Surgeons, International Society for Magnetic Resonance in Medicine, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Chief Editor

Warner K Huh, MD Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Senior Scientist, Comprehensive Cancer Center, University of Alabama School of Medicine

Warner K Huh, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, Massachusetts Medical Society, Society of Gynecologic Oncology, American Society of Clinical Oncology

Disclosure: I have received consulting fees for: Merck; THEVAX.

Additional Contributors

Robert C Shepard, MD, FACP Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for Physician Leadership, European Society for Medical Oncology, Association of Clinical Research Professionals, American Federation for Clinical Research, Eastern Cooperative Oncology Group, Society for Immunotherapy of Cancer, American Medical Informatics Association, American College of Physicians, American Federation for Medical Research, American Medical Association, American Society of Hematology, Massachusetts Medical Society

Disclosure: Nothing to disclose.

References
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Histologic section of a complete hydatidiform mole stained with hematoxylin and eosin. Villi of different sizes are present. The large villous in the center exhibits marked edema with a fluid-filled central cavity known as cisterna. Marked proliferation of the trophoblasts is observed. The syncytiotrophoblasts stain purple, while the cytotrophoblasts have a clear cytoplasm and bizarre nuclei. No fetal blood vessels are in the mesenchyme of the villi.
In this microphotograph of a choriocarcinoma metastatic to the brain, the neuropil is seen on the right and the biphasic (2 cell populations) choriocarcinoma is seen to the left with hemorrhage at the left border of the photograph (H&E stain).
Table. Prognostic Scoring Index
Prognostic FactorPoints
Age ≥40 y1
Antecedent pregnancy terminated in abortion1
Antecedent full-term pregnancy2
Interval of 4-7 mo between antecedent pregnancy and start of chemotherapy1
Interval of 7-12 mo between antecedent pregnancy and start of chemotherapy2
Interval of more than 12 mo between antecedent pregnancy and start of chemotherapy4
Beta-hCG level in serum is 1,000 to < 10,000 mIU/mL1
Beta-hCG level in serum is 10,000 to < 100,000 mIU/mL2
Beta-hCG level in serum is ³100,000 mIU/mL4
Largest tumor is 3 cm to < 5 cm1
Largest tumor is ³5 cm2
Site of metastases is spleen or kidney1
Site of metastases is gastrointestinal tract2
Site of metastases is brain or liver4
Number of metastases is 1-41
Number of metastases is 5-82
Number of metastases is >84
Prior chemotherapy with single drug2
Prior chemotherapy with multiple drugs4
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