gestational trophoblastic neoplasia Flashcards
what are the types of GTNs?
invasive mole
choriocarcinoma
Placental site trophoblastic tumor
epithelioid trophoblastic tumor
what are the classifications of GTN ?
non-metastatic ( confined to the uterus )
metastatic spread to the lung, vagina, brain and liver
what are the conditions for the low risk metastatic GTN?
less than 4 months from last pregnancy
no previous chemotherapy TTT
no spread to the liver or brain
good prognosis
what are the conditions for high risk metastatic GTN ?
more than 4 months after previous pregnancy
failed chemotherapy
metastasis to liver or brain
poor prognosis
what is an invasive mole ?
locally malignant tumor with deep myometrial invasion
what does an invasive mole look like grossly ?
focal areas of necrosis and haemorrhage
what is a gestational choriocarcinoma ?
highly malignant GTN
early blood metastasis
what is the gross appearance for gestational chorioamnionitis ?
rapidly growing dark red friable mass that is invading both the myometrium and the blood vessels
how would we differentiate histologically between choriocarcinoma and invasive mole ?
invasive mole - whole villous formation
choriocarcinoma - no villous formation
what type of tumor is a placental site tumor ?
locally invasive GTN
where do placental site tumors arise from ?
placental site intermediate trophoblast
when do placental site tumors usually happen ?
after a term pregnancy
what is the treatment option for placental site tumors ?
resistant to chemotherapy so hysterectomy is the best management option
which women should be investigated for GTN after a non-molar pregnancy ?
- persistent vaginal bleeding for more than 8 weeks post partum
- a urine HCG test should be performed
- if there are any signs of malignancy or metastasis
what is the management for non-metastatic and low risk metastatic GTN ?
single dose methotrexate
give folinic acid given 24 hours after every dose of methotrexate
