Gestational Trophoblastic Neoplasia
Khalid Sait
FRCSC /Gynecologic Oncologist/Ass.
Prof
Faculty of Medicine
King Abdulaziz...
Key Words
n  Group of disease with wide range of
neoplastic potential
n  Create a lot of challenge for us in term of
dia...
Clinical pathology of gestational trophoblastic disease
n  1- Cytotrophoblast and syncytiotrophoblast
cells proliferation...
Risk Factors for Moler pregnancy
n  Extremes of reproductive years
n  Prior moler mole
n  Prior spontaneous abortion
n...
Diandric diploidy
Diandric triploidy
Clinical Features
n  Large for date 50 %
n  Hyper emesis 20 %
n  Early PIH 5%
n  Abscent FH ( except in partial mole o...
Management of molar
pregnancy
Risk of Persistent
GTT
Procedure
20 %Suction
Evacuation
5%Hysterectomy
Follow up of patient with molar
pregnancy after evacuation
n  HCG weekly serum determination until
normal for two values ...
If no proper decrease or BHCG
start to increase
Persistent GTD
Indication for initiating treatment
during post mole follow up
n  Serum BHCG values rising more than 10 % for 2
wk ( 3 we...
Work up of gestational
trophoblastic neoplasia
n  History and physical examination
n  chest XR ( if neg è CT )
n  Pret...
CLASSIFICATION OF GESTATIONAL
TROPHOBLASTIC DIS
n  Benign
1) complete mole
2) Partial mole
n  Malignant (invasive mole a...
Risk factors
(malignant GTD)
1.Disease present more that 4m(long
duration) or
2.pretreatment B-HCG greater than
40,000mlu/...
CHEMOTHERAPY FOR GTN
NON METASTATIC
or
GOOD PROGNOSIS
METASTATIC
*Single agent
chemotherapy
*survival 90-100%
METASTATIC P...
REMISSION OF GTN
DISEASE REMISSION
NON METASTATIC 100 %
GOOD PROGNOSIS METASTATIC 100 %
POOR PROGNOSIS METASTATIC 66 %
TOT...
SUMMARY
GTD IS A RARE ENTITY THAT IS HIGHLY
CURABLE , EVEN IN THE PRESENCE OF
WIDESPREAD METASTASES
GTN
Khalid Sait FRCSC
Prof of Gynecologic Oncology
Faculty of Medicine
King Abdulaziz University
Q&A
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  1. 1. Gestational Trophoblastic Neoplasia Khalid Sait FRCSC /Gynecologic Oncologist/Ass. Prof Faculty of Medicine King Abdulaziz University
  2. 2. Key Words n  Group of disease with wide range of neoplastic potential n  Create a lot of challenge for us in term of diagnosis and treatment n  Diagnosis and management will depends on the history, HCG level and metastasis work up
  3. 3. Clinical pathology of gestational trophoblastic disease n  1- Cytotrophoblast and syncytiotrophoblast cells proliferation Moler pregnancy Invasive mole Choriocarcinoma n  2- Intermediate trophoblastic cells derivative Placental – site tumor
  4. 4. Risk Factors for Moler pregnancy n  Extremes of reproductive years n  Prior moler mole n  Prior spontaneous abortion n  Vit A deficiency n  Race ( Indonesia 1:85, USA 1:1500)
  5. 5. Diandric diploidy
  6. 6. Diandric triploidy
  7. 7. Clinical Features n  Large for date 50 % n  Hyper emesis 20 % n  Early PIH 5% n  Abscent FH ( except in partial mole or twin pregnancy) n  Hyperthyroidism symptom and sign 5% n  Rarely presented with metastasis symptom and sign
  8. 8. Management of molar pregnancy Risk of Persistent GTT Procedure 20 %Suction Evacuation 5%Hysterectomy
  9. 9. Follow up of patient with molar pregnancy after evacuation n  HCG weekly serum determination until normal for two values ,then monthly for 6 to 12 months n  Contraception for 1 year n  Pelvic examination every 2 weeks until normal,then every 3 months n  Check histopathology
  10. 10. If no proper decrease or BHCG start to increase
  11. 11. Persistent GTD
  12. 12. Indication for initiating treatment during post mole follow up n  Serum BHCG values rising more than 10 % for 2 wk ( 3 weekly titre) n  Serum BHCG values on plateau for 3 wk or decline of less than 10 % n  Presence of metastasis n  Significant elevation of serum BHCG values after reaching normal levels n  Choriocarcinoma or invasive mole on histopathology n  HCG level still elevated 6 months after molar evacuation n  HCG > 20000 miu/ml 4 weeks after evacuation
  13. 13. Work up of gestational trophoblastic neoplasia n  History and physical examination n  chest XR ( if neg è CT ) n  Pretreatment HCG titre n  Hematological survey n  Serum chemistries n  CT of brain n  Ultrasound of pelvis n  Liver scan ( u/s or CT )
  14. 14. CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC DIS n  Benign 1) complete mole 2) Partial mole n  Malignant (invasive mole and choriocarcinoma) 1) nonmetastatic 2) metastatic a) low risk b) high risk
  15. 15. Risk factors (malignant GTD) 1.Disease present more that 4m(long duration) or 2.pretreatment B-HCG greater than 40,000mlu/ml or 3.presence of met to sites other than lungs or vagina i,e liver or brain etc.. 4. prior chemo 5 following Term pregnancy
  16. 16. CHEMOTHERAPY FOR GTN NON METASTATIC or GOOD PROGNOSIS METASTATIC *Single agent chemotherapy *survival 90-100% METASTATIC POOR PROGNOSIS *Combined chemotherapy * survival 50 %
  17. 17. REMISSION OF GTN DISEASE REMISSION NON METASTATIC 100 % GOOD PROGNOSIS METASTATIC 100 % POOR PROGNOSIS METASTATIC 66 % TOTAL 92 %
  18. 18. SUMMARY GTD IS A RARE ENTITY THAT IS HIGHLY CURABLE , EVEN IN THE PRESENCE OF WIDESPREAD METASTASES
  19. 19. GTN Khalid Sait FRCSC Prof of Gynecologic Oncology Faculty of Medicine King Abdulaziz University Q&A

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