Gestational Trophoblastic Tumors

Gestational trophoblastic tumors are a proliferation of Trophoblastgewebes in pregnant or have recently given birth women. Symptoms may include excessive uterine enlargement, vomiting, vaginal bleeding, and preeclampsia, especially in early pregnancy. The diagnosis involves the determination of ?-hCG (human chorionic gonadotropin), ultrasound examination of the pelvis as well as the diagnosis by biopsy. The tumors are removed by suction curettage. If the disease persists after initial resection, chemotherapy is indicated.

Gestational trophoblastic tumors originate from the trophoblast which surrounds the blastocyst and to chorion and amnion developed (amniotic cavity and placenta). This disease can occur during or after an intrauterine or ectopic pregnancy. Typical clinical symptoms of a pregnancy, there is typically spontaneous abortion, eclampsia or fetal death; the fetus survives rare. Some forms are malignant, others are benign, but behave aggressively.

Gestational trophoblastic tumors are a proliferation of Trophoblastgewebes in pregnant or have recently given birth women. Symptoms may include excessive uterine enlargement, vomiting, vaginal bleeding, and preeclampsia, especially in early pregnancy. The diagnosis involves the determination of ?-hCG (human chorionic gonadotropin), ultrasound examination of the pelvis as well as the diagnosis by biopsy. The tumors are removed by suction curettage. If the disease persists after initial resection, chemotherapy is indicated. Gestational trophoblastic tumors originate from the trophoblast which surrounds the blastocyst and to chorion and amnion developed (amniotic cavity and placenta). This disease can occur during or after an intrauterine or ectopic pregnancy. Typical clinical symptoms of a pregnancy, there is typically spontaneous abortion, eclampsia or fetal death; the fetus survives rare. Some forms are malignant, others are benign, but behave aggressively. The pathology classification is morphologically: hydatidiform mole (also referred hydatidiform): In this abnormal pregnancy Villi edematous (hydropic) and the trophoblast are proliferated. Chorionadenoma destruens (invasive hydatidiform mole): The myometrium is affected locally by a hydatidiform mole. Choriocarcinoma: This invasive, usually extended metastatic tumor consists of malignant trophoblast cells and has no hydropic villi; most of these tumors develop after a molar pregnancy. Trophoblastic tumors in the region of the placenta: These rare tumors consist of intermediate trophoblast cells which continue to exist after a term pregnancy; they can penetrate into adjacent tissue or metastasize. Hydatidiform moles are most common in women <17 or> 35 years and in those who had previously had gestational trophoblastic tumors. In the US, they occur in about 1/2000 pregnancies. For unknown reasons, the incidence reached in Asian countries 1/200. Most (> 80%) molar pregnancies are benign. The rest can persist and tends to be invasive. 2-3% of hydatiformen Molen pull a choriocarcinoma by itself. Symptoms and complaints The initial signs of a molar pregnancy are reminiscent of an early pregnancy, but the uterus is often greater than within the first 10-16 weeks of pregnancy expected. Vaginal bleeding, severe vomiting, lack of fetal movement and lack of filial heart sounds are common in women with a positive pregnancy test. The disposal of grape-like tissue is a further indication of this diagnosis. Possible complications exist in uterine infection, sepsis, hemorrhagic shock, and preeclampsia. Trophoblastic tumors in the placenta tend to bleeding. The choriocarcinoma manifests itself mostly with metastatic symptoms. Gestational trophoblastic not impair fertility and not predispose to prenatal or perinatal complications (eg. As congenital malformations, spontaneous abortions). Diagnosis ?-subunit of human chorionic gonadotropin (?-hCG) ultrasound of the pelvis A gestational Trophoblasttumor is considered in women with a positive pregnancy test and one of the following: the uterus is significantly larger than for the appointment expected symptoms or symptoms of preeclampsia disposal grape-like tissue suspects characters (eg. as mass with multiple cysts and lack of fetus and no amniotic fluid) in the ultrasound that is done to verify a pregnancy Unexplained metastases in women of childbearing age Unexpectedly high ?-hCG levels in pregnancy test unexplained pregnancy complications tips and risks In early pregnancy, an ultrasound should be performed when the uterus is significantly larger than it was expected for the event, and there are symptoms or symptoms of pre-eclampsia or when the ?-hCG levels are unexpectedly high. If a gestational Trophoblasttumor is suspected, the diagnosis includes the determination of ?-hCG in serum and, if not already done so, ultrasound of the pelvis. Findings such. As very high ?-hCG levels and classic ultrasound findings, present this diagnosis close, but it is a biopsy confirmation required. Suspected invasive hydatidiform mole and choriocarcinoma exists when the findings from the biopsy to invasive disease point or if the ?-hCG levels remain higher even after a treatment for a hydatidiform moles as expected (see below). Treatment tumor removal by suction curettage Further investigation of persistent disease and extent of the tumor chemotherapy in persistent disease contraception after treatment of persistent disease hydatidiform mole, invasive mole and trophoblastic tumors of the placenta area are removed by suction curettage. If no more children desire, alternatively, a hysterectomy may be performed. After tumor resection, the Trophoblasttumorerkrankung of pregnant women is clinically classified in order to decide whether a beyond treatment is required. The clinical classification system does not match the morphological classification system. Invasive mole and choriocarcinoma are clinically classified as persistent disease. It is used clinical classification because both are similarly treated and a hysterectomy would be needed for an accurate histological diagnosis. WHO point system for metastatic gestational trophoblastic tumors Prognostic Factor Finding Points * Age (years) <40 0 ? 40 1 Preceding pregnancy hydatidiform 0 Abort 1 Duration 2 interval (months) † <4 0 ? 4 and <7 1 ? 7 and <13 2 ? 13 4 hCG in serum (I.U./ml) before therapy <1000 0 1000 <1 10,000 10,000 <100,000 100,000 2 ? 4 Largest tumor, including all tumors of the uterus 3- <5 cm 1 ? 5 cm 2 lung metastases localization of 0 Spleen, kidneys gastrointestinal tract 1 2 brain, liver 4 number of detected metastases 1-4 5-8 1 2> 8 4 Number of attempted ineffective Chemotherapika 1 2 ? 2 4 * Total score by adding up the points for each prognostic factor: ? 6 = low risk of ? 7 = high risk † Between the end of the preceding pregnancy and the start of chemotherapy. hCG = human chorionic gonadotropin. Following the International Federation of Gynecology and Obstetrics (FIGO) Oncology Committee: FIGO staging for gestational trophoblastic neoplasia 2000. International Journal of Gynecology and Obstetrics; 77 (3): 285-287, 2002. A chest X-ray is performed and the ?-hCG levels in the serum. If the ?-hCG level does not normalize within 10 weeks, the disease is classified as persistent. Persistent disease requires further evaluation with CT of the skull, thorax, abdomen and pelvis. determine the results, whether the disease is classified as non-metastasized, or metastasized. In metastatic disease, the prognosis can (including mortality) adverse or beneficial (see table: WHO point system for metastatic gestational trophoblastic tumors). An unfavorable prognosis is when the following criteria (NIH [National Institutes of Health] Criteria): urinary hCG excretion> 100,000 IU / 24 h disease duration> 4 months (interval since previous pregnancy) Cerebral or hepatic metastasis disease after on-time pregnancy serum hCG> 40,000 mI.E./ml failing prior chemotherapy WHO score> 8 persistent disease is usually treated with chemotherapy. The treatment is considered successful if at least three ?-hCG levels are normal at weekly intervals. Typically, oral contraceptives (each is acceptable) is administered for 6-12 months; Alternatively, any effective method of birth control can be applied. A non-metastatic disease can be treated monotherapy with cytostatics (methotrexate or dactinomycin). Alternatively,> 40 years old or with sterilization request is considered a hysterectomy and also be necessary in cases of severe infection or uncontrolled bleeding for patients. With ineffective cytostatic monotherapy a hysterectomy or a cytostatic combination therapy is indicated. Almost 100% of patients with non-metastatic disease can be cured. A metastatic disease with low risk is treated cytostatic in monotherapy or combination therapy. A metastatic disease at high risk will be treated aggressively by cytostatic therapy. Cure rates are at 90-95% for Niedrigrisiko- and at 60-80% for high-risk disease. Recurrent hydatidiform occurs in approximately 1% of the sequence pregnancies. In patients with a molar pregnancy in the history of consecutive pregnancies, early ultrasound diagnosis is indicated, and the placenta should be examined pathologically. Summary A gestational Trophoblasttumor should be accepted if the uterus is significantly larger than was expected for the event, women have symptoms or symptoms of pre-eclampsia or ?-hCG levels during early pregnancy are unexpectedly high or if it in the ultrasonic appropriate findings indicate. The ?-hCG levels should be determined and ultrasound examination of the basin are carried out, and indicating an obstetric Trophoblasttumor the diagnosis is confirmed by a biopsy. The tumor is removed by suction curettage and classified on the basis of clinical criteria. Of persistent disease, patients treated with chemotherapy, and after the therapy is contraception.

Health Life Media Team

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