GESTATIONAL TROPHOBLASTIC DISEASE ACOG PDF

The following summary is from Orphanet , a European reference portal for information on rare diseases and orphan drugs. Orpha Number: Gestational trophoblastic tumors GTT are malignant forms of gestational trophoblastic disease. The tumor always follows pregnancy, most often molar pregnancy hydatidiform mole; see this term. Four histological subtypes have been described: invasive mole, gestational choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor see these terms. Exceptionally, metastasis may be a sign of the disease in women of childbearing age.

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Most cases of persistent GTD are invasive moles, but in rare cases they are choriocarcinomas or placental site trophoblastic tumors see below.

Invasive mole An invasive mole formerly known as chorioadenoma destruens is a hydatidiform mole that has grown into the muscle layer of the uterus.

Invasive moles can develop from either complete or partial moles, but complete moles become invasive much more often than do partial moles. Invasive moles develop in less than 1 out of 5 women who have had a complete mole removed.

The risk of developing an invasive mole in these women increases if: There is a long time more than 4 months between their last menstrual period and treatment.

The uterus has become very large. The woman is older than 40 years. The woman has had gestational trophoblastic disease in the past. Invasive moles can sometimes go away on their own, but most often more treatment is needed. A tumor or mole that grows completely through the wall of the uterus might result in bleeding into the abdominal or pelvic cavity.

This bleeding can be life threatening. Sometimes after removing a complete hydatidiform mole, the tumor spreads metastasizes to other parts of the body, most often the lungs.

Choriocarcinoma Choriocarcinoma is a malignant form of gestational trophoblastic disease GTD. It is much more likely than other types of GTD to grow quickly and spread to organs away from the uterus.

Half of all gestational choriocarcinomas start off as molar pregnancies. About one-quarter develop in women who have a miscarriage spontaneous abortion , intentional abortion, or tubal pregnancy the fetus develops in the fallopian tube, rather than in the uterus. Rarely, choriocarcinomas that are not related to pregnancy can develop. These can be found in areas other than the uterus, and can occur in both men and women.

They may develop in the ovaries, testicles, chest, or abdomen. In these cases, choriocarcinoma is usually mixed with other types of cancer, forming a type of cancer called a mixed germ cell tumor. These tumors are not considered to be gestational related to pregnancy and are not discussed in this document. Non-gestational choriocarcinoma can be less responsive to chemotherapy and may have a less favorable prognosis outlook than gestational choriocarcinoma.

For more information about these tumors, see Ovarian Cancer and Testicular Cancer. Placental-site trophoblastic tumor Placental-site trophoblastic tumor PSTT is a very rare form of GTDthat develops where the placenta attaches to the lining of the uterus.

This tumor most often develops after a normal pregnancy or abortion, but it may also develop after a complete or partial mole is removed.

Most PSTTs do not spread to other sites in the body. But these tumors have a tendency to grow into invade the muscle layer of the uterus.

Instead, they are treated with surgery , to completely remove disease. Epithelioid trophoblastic tumor Epithelioid trophoblastic tumor ETT is an extremely rare type of gestational trophoblastic disease that can be hard to diagnose. ETT used to be called atypical choriocarcinoma because the cells look like choriocarcinoma cells under the microscope, but it is now thought to be a separate disease.

Because it can be found growing in the cervix, it can also sometimes be confused with cervical cancer. Like placental-site trophoblastic tumors, ETT most often occurs after a full-term pregnancy, but it can take several years after the pregnancy for the ETT to occur. Also, like placental-site trophoblastic tumors, ETT does not respond very well to chemotherapy drugs, so the main treatment is surgery.

It might have already metastasized when it is diagnosed which carries a poorer prognosis outlook.

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