Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Gestational trophoblastic neoplasia (2).ppt44444


Published on

Published in: Health & Medicine
  • Be the first to comment

Gestational trophoblastic neoplasia (2).ppt44444

  2. 2. Definition:, Neoplastic proliferation of placental tissue. GTN is an abnormal proliferation of placental tissue involving both cytotrophoblasts and syncytiotrophoblasts,  it can be either benign or malignan . It is a disease of early pregnancy occuring mostly before the 16 weeks of gestation like ectopic pregnancy and miscarriage.
  3. 3. Classification of GTN 1. Benign gTn  Complete mole  Incomplete mole 2. Malignant GTN  Invasive mole  Choriocarcinoma
  4. 4. Benign (Hydatidiform mole) It is characterized histologically by cystic swelling of choronic villi accompanied by variable amount of trophoblastic proliferation. Have increased risk of invasive mole and choriocarinoma Currently diagnosed at early age b/c of USG and close monitoring of early pregnancy. Occurs at extremes of reproductive ages. More common in eastern world (Asia)
  5. 5. 2 types of hydatidiform mole Genetically either two sperms fertilize an empty ovum or one sperm duplicates / 46xx
  6. 6. Complete mole GTN Complete mole is the most common benign GTN which result from fertilization of an empty egg with a sigle x sperm resulting paternaly derived 46,xx karyotype. No fetus,umblical cord and amniotic fluid is seen. The uterus is filled with grape like vesicles composed of edematous avascular villi. Progression to malignancy is 20%. Beta HCg very high.
  7. 7. Excessive vomiting AND nausea Pregnancy with bleeding Large for dates uterus U/S – no fetus fetal heart sound absent Increased B – HCG levels Snow strom appearance on USG CLINICAL PRESENTION WITH LAB AND USG
  8. 8. Incomplete or partial mole Triploid – 2 sets of paternal and one set of maternal chromosomes
  9. 9. PRESENATION Patient presents with pregnancy and irregular vaginal bleeding U/S – Embryo with molar changes in placenta Early fetal death
  10. 10. Comparison b/w complete &partial mole
  11. 11. CHORIOCARCINOMA It is malignant neoplasm of trophoblastic cells derived from a previously normal or abnormal pregnancy. Rapidly invasive and metastasizes widely. Good response to chemotherapy in comparison to choriocarcioma arising in ovary from germ cell.
  12. 12. CHORIOCARCINOMA 1/20,000 t0 30,000 preg in US in AF 1/2500 50 % follow CM 25 % Non molar abortion 25 % term pregnancy 1/40 hydatidiform mole >>choriocarcinoma. 1/150,000 normal pregnancies. Patients present with irregular or heavy vaginal bleeding or symptoms due to Metastasis to brain, lung , liver.
  13. 13. Malignant GTN and prognosis  This is the gestational trophoblastic tumor which can develop into three categories, 1. Non metastatic disease is localized to uterus.cure rate is 100%. 2. Good prognosis metastatic disease has distant metastasis with the most common location being the pelvis or lung.cure rate is >95%. 3. Poor prognosis metastatic disease with most common metastasis to brain or liver.cure rate is 65%.
  14. 14. r
  15. 15. Case presentation of a molar pregnancy
  16. 16. Management
  17. 17. Gestational amenorrhea Bleeding prior to 16wks of GA Passage of grape like vesicles per vaginum Excessive nausea and vomiting Distension of abdomen at a higher rate. Previous history of molar , ectopic pregnancy or History of any abortion or miscarriage History of oedema feet , headache , pain epigestrum. HISTORY
  18. 18. Examination Abdominal examination Fundus larger then dates Absence of fetal heart tone Bilateral cystic enlagrgement of the overy No fetal movments Anemia in case of heavy bleedig Vaginal examination Spotting on vaginal examination Vesicles may also be seen
  19. 19. Clinical presentation
  20. 20. Investigations Baseline investigaion:  Cbc RBS  Blood group Rh incompatability  Screening for hep B nd C  Urine analaysis,….. SPECIFIC investigations b-hcg titer-------baseline for future comprison Chest x-ray-----to ruled out lung mestatasis USG……. On USG if there is complete mole,fetus will be absent and snowstorm appearance of uterus will be seen. If fetus is preset and thickened uterus with honeycomb appearance is seen then it will be incomplete mole
  21. 21. USG findings Complete mole no fetal tissue snow storm appeara Partial mole with some fetal tissue honey comb appearance
  22. 22. TREATMENT Treatment is based on the histoloy&location of metastasis;; After SUCTION & EVACUATIO to empty the uterus Will send the sample to histopathology lab to confirm either it is benign or malignant.. Hysterectomy at who have completed.
  23. 23. 3 things to notice here. fetus,2.uterus full of avascular cysts,3.rouund uterus inspite of ovoid shape. COMPLETE MOLE
  24. 24. If it is a benign GTN????? Give the pt ocp for the durion of thr follow up. Follow up weekly with serum beta HCG titer untill negative for 3 weeks,then monthly titer untill reamain it negative for 12 months. Follow up is for 1 year -ve means hCG <5mU/ml)
  25. 25. Its diagnosed as GTD and the patient should be evaluated for a metastatic workup ( CTscans of the brain,thorax,abdomin and the pelvis)D&C before initiation of chemotherapy. If serial b hCG titers plateau or rises then
  26. 26. For non metastatic or good prognosis metastatic disease 1. Administer single chemotherapeutic agent like methotrexate or actinomycin D untill weekly beta HCG level become negative for three weeks,then monthly titer untill negative for twelve months. 2. Follow up is for 1 year.
  27. 27. For poor prognosis metastatic disease Administer multiple agent chemotheray (like methotrexate,actinomycin D and cytoxan) Chemotherapy will be continued untill weekly beta HCG level become negative for three weeks,then monthly titer for 2 years,then every 3 months for another 3 years. Follow up is for 5 years
  28. 28. Prognosis Very good Five years survival after a course of chemotherapy even when metastasis have been demonstrated can even be expected in 85% of cases of choriocarcinoma.
  29. 29. THANK YOU