Download MBBS Gestational Trophoblastic Neoplasia Lecture PPT

---

--- Content provided by FirstRanker.com ---

--- Content provided by‍ FirstRanker.com ---

--- Content provided by​ FirstRanker.com ---

GESTATIONAL
TROPHOBLASTIC DISEASE
MALIGNANT GESTATIONAL

--- Content provided by‌ FirstRanker.com ---

PREMALIGNANT
NEOPLASIA
CONDITIONS
1.PARTIAL
VILLOUS

--- Content provided by​ FirstRanker.com ---

INTERMEDIATE TROPHOBLAST
MOLE
TROPHOBLAST
2.COMPLETE
PLACENTAL SITE TROPHOBLASTIC

--- Content provided by‍ FirstRanker.com ---

MOLE
1.INVASIVE MOLE
TUMOUR
(PSTT)
2.CHORIOCARCINOMA

--- Content provided by‌ FirstRanker.com ---

EPITHELIOID TROPHOBLASTIC
TUMOUR

---

--- Content provided by FirstRanker.com ---

--- Content provided by​ FirstRanker.com ---

#MALIGNANTGESTATIONALTROPHOBLASTIC
DISEASEorPERSITENTGESTATIONAL
TROPHOBLASTICDISEASE

---

Incidence is about 1 in 5000

--- Content provided by​ FirstRanker.com ---

pregnancies in oriental countries
50%-molar pregnancy
25% after abortion and ectopic
pregnancy and a few after normal
pregnancy

--- Content provided by‌ FirstRanker.com ---

Non metastatic (locally invasive}lesions
-15%
Metastatic lesions -4% after molar
evacuation

---

--- Content provided by‍ FirstRanker.com ---

INVASIVE
MOLES(80%)
POSTMOLAR
PREGNANCY
CHORIOCARCI

--- Content provided by‌ FirstRanker.com ---

GTN
NOMAS(20%)
NON MOLAR
Almost always a
PREGNANCY

--- Content provided by‍ FirstRanker.com ---

CHORIOCARCI
NOMA

---

Persistent GTN is evidenced by the persistance of
trophoblastic activity following evacuation of

--- Content provided by‍ FirstRanker.com ---

molar pregnancy
1
2
3

---

--- Content provided by‌ FirstRanker.com ---

After molar evacuation beta Hcg
become normal in about 7-9 weeks.

---

--- Content provided by⁠ FirstRanker.com ---

GTN should be suspected in a women of

--- Content provided by‍ FirstRanker.com ---

reproductive age group presenting with
metastatic disease from an unknown primary

---

invasive mole
.

--- Content provided by‍ FirstRanker.com ---

---

CHORIADENOMA DESTRUENS
EXTENSIVE TISSUE INVASION BY
TROPHOBLAST AND WHOLE VILLI
PENETRATION IS DEEP INTO

--- Content provided by‍ FirstRanker.com ---

MYOMETRIUMSOMETIMES WITH THE
INVOLVMENT OF THE PERITONEUM
ADJACENT PARAMETRIUM OR VAGINAL
VAULT.

---

--- Content provided by⁠ FirstRanker.com ---

DIAGNOSIS

--- Content provided by‌ FirstRanker.com ---

*

---

---

--- Content provided by FirstRanker.com ---

CHORIOCARCINOMA
Carcinoma of the CHORIONIC
EPITHELIUM
Follows term pregnancy or miscarriage.

--- Content provided by​ FirstRanker.com ---

Only third of cases follow a molar gestation
Choriocarcinoma are commonly accompanied
by ovarian theca-lutein cysts.

---

PRIMARY SITE ANYWHERE IN UTERUS

--- Content provided by​ FirstRanker.com ---

RARLEY- IN OVARY OR TUBE

---

--- Content provided by FirstRanker.com ---

GROSS
MICROSCOPY

--- Content provided by‌ FirstRanker.com ---

---

---

--- Content provided by‍ FirstRanker.com ---

---

--- Content provided by‍ FirstRanker.com ---

---

--- Content provided by​ FirstRanker.com ---

HISTORYOFMOLARPREGNANCY/TERM
PREGNANCY/ABORTION/ECTOPICPREGNANCY

---

A
hbenSyaomltrmhaluterinebleeding,Persitentill

--- Content provided by⁠ FirstRanker.com ---

ptomspertain gtometastasielsewher
1.Hemoptysi(lung-75%)
2
h.Feadtaurcheso,cfInvtraulsicroan.ciaolsmpaaceocupyinglesion-
3.Vaginalmetastasi(50%)

--- Content provided by⁠ FirstRanker.com ---

4.Metastasialsocurto
Vulva-iregularandat imesbriskhemorhage
Liver?epigastricpain,jaundice
Signs-patientlooksill,pallorofvaryingdegre

---

--- Content provided by​ FirstRanker.com ---

BIMANUAL
1.CHEST XRAY
EXAMINATION
2.PELVIC
SUBINVOLUTION

--- Content provided by FirstRanker.com ---

SONOGRAPHY(to
OF UTERUS
differentiate from
normal pregnancy
PURPLISH RED

--- Content provided by⁠ FirstRanker.com ---

3.DIAGNOSTIC
NODULES IN THE
UTERINE CURETTAGE
LOWER THIRD OF
ANTERIOR

--- Content provided by‌ FirstRanker.com ---

4EXCISION BIOPSY OF
VAGINAL WALL
VAGINAL NODULES
5.CT SCAN OR MRI OF
BRAINL,LIVER

--- Content provided by​ FirstRanker.com ---

---

--- Content provided by​ FirstRanker.com ---

Histopathological diagnosis
on doing curettage for
irregular bleeding.

--- Content provided by‌ FirstRanker.com ---

Rapidly increasing levels of
serum beta hcg.
1.Chest x ray showing widespread metastatic lesions
2.Autopsy specimen with multiple hemorragic hepatic metastasis

---

--- Content provided by​ FirstRanker.com ---

---

--- Content provided by‍ FirstRanker.com ---

PLACENTAL SITE TROPHOBLASTIC

--- Content provided by‍ FirstRanker.com ---

TUMOUR

---

--- Content provided by⁠ FirstRanker.com ---

Incidence-

--- Content provided by‌ FirstRanker.com ---

15-20% OF
<1% of
PATIENTS
COMPOSED MAINLY OF
patients with

--- Content provided by‌ FirstRanker.com ---

DEVELOP
GTN
METASTASIS

---

--- Content provided by FirstRanker.com ---

*TREATMENT by hystrectomy is
preferred.
(locally invasive tumours are
ressistant to hystrectomy)
*For higher risk stage 1 and later

--- Content provided by‌ FirstRanker.com ---

stages,adjuvant multidrug
chemotherapy is given.

---

*Arise from

---

--- Content provided by​ FirstRanker.com ---

Primary treatment is hysterectomy because
this tumor is relatively resistant to
chemotherapy.
Metastatic disease is common, and
combination chemotherapy is employed

--- Content provided by⁠ FirstRanker.com ---

---

---

BETA
BIOPSY IS NOT
HCG

--- Content provided by⁠ FirstRanker.com ---

USUALLY
REQUIRED

---

SCORE
0

--- Content provided by‌ FirstRanker.com ---

1
2
4
AGE
<40

--- Content provided by FirstRanker.com ---

> or =to
-
-
40
ANTICEDENT

--- Content provided by FirstRanker.com ---

MOLE
Abortion
Term
-
PREGNANCY

--- Content provided by⁠ FirstRanker.com ---

Interval after index
<4
4-6
7-12
>12

--- Content provided by FirstRanker.com ---

pregnancy(mo)
Pretreatment serum beta <1000
1000-
10000- >or
hcg(mIU /mL)

--- Content provided by FirstRanker.com ---

10,000
10000 =to100000
0
Largest tumor
<3cm

--- Content provided by‌ FirstRanker.com ---

3-4cm
>or=5 -
size(including uterus)
cm
Site of metastasis

--- Content provided by‍ FirstRanker.com ---

-
Spleen,
GI
Liver, brain
kidney

--- Content provided by⁠ FirstRanker.com ---

Number of metastasis
-
1-4
5-8
8

--- Content provided by​ FirstRanker.com ---

Previous failed
-
-
1
> or=2

--- Content provided by‌ FirstRanker.com ---

chemotherapy drugs

---

STAGE 1

--- Content provided by‌ FirstRanker.com ---

DISEASE CONFINED TO THE UTERUS
STAGE 2
GTN EXTENDS OUTSIDE THE UTERUS BUT
LIMITED TO THE GENITAL STRUCTURES
(ADENEXA,VAGINA,BROAD LIGAMENT)

--- Content provided by FirstRanker.com ---

STAGE 3
GTN EXTENDS TO THE LUNGS WITH OR
WITHOUT GENITALTRACT INVOLVMENT
STAGE 4
ALL OTHER METASTATIC SITES

--- Content provided by⁠ FirstRanker.com ---

---

---