Trophoblastic Disease

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Trophoblastic Disease

• Dept OB/GYN
• WAN Xirun

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• Gestational trophoblastic disease
• hydatidiform mole, HM
• invasive mole, IM
• choriocarcinoma, CC
• placenta-site trophoblastic tumor, PSTT
• Primary choriocarcinoma

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hydatidiform mole, HM

• Complete vs incomplete
• Higher incidence in Far East and Southeast Asia
• 1/1238 (0.81/1000) pregnancies

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Pathology

• Gross features
• Histologic features
• edema of the villus stroma
• absent of fetal vessels
• trophoblast hyperplasia

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Clinical features

• Vaginal bleeding
• Uterine size
• Hyperemesis
• Toxemia
• Theca lutein ovarian cyst
• Others

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Lab findings

• human chorionic gonadotropin, hCG
• Normal pregnancy
• 70-80d, median 1105mIU/ml,max 2105
• 34w
• 3w postpartum
• HM much higher
• B scan diffuse vesicular change

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Management

• hCG measurement, chest CT
• Suction D C
• Follow up

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Chemoprophylaxis

• Risk factors
• hCGgt 1106mIU/ml,excessive uterine size, gt40 yrs
  old, repeat HM
• Single agent

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Malignancies

• invasive mole, IM
• choriocarcinoma, CC
• placenta-site trophoblastic tumor, PSTT

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FIGO 2000 risk factor scoring system
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FIGO staging

• I disease confined to the uterus
• II extends outside the uterus but is limited to
  the genital structures
• III extends to the lungs
• IV all others metastatic sites

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Management

• Chmetherapy
• Sugery
• Radiologic interventions
• Regional treatment
• Follow up

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