{"id":2609,"date":"2020-08-13T16:13:36","date_gmt":"2020-08-13T16:13:36","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=195"},"modified":"2021-05-09T20:52:36","modified_gmt":"2021-05-09T20:52:36","slug":"50-gestational-trophoblastic-neoplasia-gtn","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/50-gestational-trophoblastic-neoplasia-gtn\/","title":{"rendered":"50. Gestational Trophoblastic Neoplasia (GTN)"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/75DiSUxvhVA\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 5:33<\/p>\n<input type='hidden' bg_collapse_expand='69e9b5a5402675027603610' value='69e9b5a5402675027603610'><input type='hidden' id='bg-show-more-text-69e9b5a5402675027603610' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b5a5402675027603610' value='Hide Transcript'><button id='bg-showmore-action-69e9b5a5402675027603610' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b5a5402675027603610' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 50<br \/>\n00:02<br \/>\ngestational trophoblastic neoplasia<br \/>\n00:04<br \/>\ngestational trophoblastic disease or GTD<br \/>\n00:07<br \/>\nare abnormal proliferation of<br \/>\n00:09<br \/>\ntrophoblast from the placenta<br \/>\n00:10<br \/>\ngestational trophoblastic neoplasia or<br \/>\n00:13<br \/>\nGTN otherwise known as malignant GTD<br \/>\n00:16<br \/>\ninclude choriocarcinoma placental side<br \/>\n00:18<br \/>\ntrophoblastic tumor and invasive moles<br \/>\n00:20<br \/>\nthese may follow a normal pregnancy or a<br \/>\n00:23<br \/>\nhydatid afore mole in the past the<br \/>\n00:26<br \/>\nmajority of patients with GTN localized<br \/>\n00:28<br \/>\nto the uterus were cured with<br \/>\n00:29<br \/>\nhysterectomy but metastatic disease was<br \/>\n00:32<br \/>\nassociated with extremely high mortality<br \/>\n00:33<br \/>\nrates now with the ability to measure<br \/>\n00:36<br \/>\nbeta HCG levels and highly effective<br \/>\n00:38<br \/>\nchemotherapy most remove the GTN can be<br \/>\n00:41<br \/>\ncured and their reproductive function<br \/>\n00:42<br \/>\npreserved the objectives of this video<br \/>\n00:45<br \/>\nare to describe the symptoms and<br \/>\n00:47<br \/>\nphysical exam findings of a patient with<br \/>\n00:49<br \/>\nGTN including molar pregnancy to<br \/>\n00:51<br \/>\ndescribe the diagnostic methods<br \/>\n00:53<br \/>\ntreatment options and follow-up for GTN<br \/>\n00:55<br \/>\nincluding molar pregnancy and to<br \/>\n00:57<br \/>\nrecognize the difference between molar<br \/>\n00:58<br \/>\npregnancy and malignant GTN high data<br \/>\n01:01<br \/>\nfor moles otherwise known as molar<br \/>\n01:03<br \/>\npregnancies are non-invasive localized<br \/>\n01:06<br \/>\ntumors that result from abnormal<br \/>\n01:07<br \/>\nfertilization events that result in<br \/>\n01:09<br \/>\nproliferation of trophoblastic tissues<br \/>\n01:11<br \/>\nthey are classified as partial or<br \/>\n01:14<br \/>\ncomplete molar pregnancies partial and<br \/>\n01:16<br \/>\ncomplete Hydra to deform moles are<br \/>\n01:18<br \/>\ndistinct disease processes although they<br \/>\n01:20<br \/>\nare managed similarly in a partial molar<br \/>\n01:23<br \/>\npregnancy a haploid ovum is fertilized<br \/>\n01:26<br \/>\nby two sperm this results in a triploid<br \/>\n01:29<br \/>\nkaryotype of 69 XXX or 69 x XY there is<br \/>\n01:34<br \/>\noften a fetus present that a small for<br \/>\n01:36<br \/>\ngestational age that usually dies in<br \/>\n01:38<br \/>\nutero these rarely go on to become<br \/>\n01:40<br \/>\nmalignant complete molar pregnancies are<br \/>\n01:43<br \/>\na result of two sperm fertilizing an<br \/>\n01:45<br \/>\nempty ovum the carrier type will be 46 x<br \/>\n01:49<br \/>\nx or 46 XY the fetus will be absent and<br \/>\n01:52<br \/>\nthere is a 6 to 32 percent chance of a<br \/>\n01:54<br \/>\ncomplete mole becoming malignant<br \/>\n01:56<br \/>\ngestational trophoblastic neoplasia or<br \/>\n01:59<br \/>\nmalignant GTD can thus develop from an<br \/>\n02:01<br \/>\ninvasive HIDA to deform mole from a<br \/>\n02:03<br \/>\nchoriocarcinoma or a placental site<br \/>\n02:05<br \/>\ntrophoblastic tumor invasive moles are<br \/>\n02:08<br \/>\ncharacterized by a demo disc chorionic<br \/>\n02:10<br \/>\nvilli with trophoblast proliferation<br \/>\n02:12<br \/>\nthat can invade<br \/>\n02:13<br \/>\nto the myometrium choriocarcinoma z&#8217; can<br \/>\n02:16<br \/>\ncome from normal pregnancies or molar<br \/>\n02:18<br \/>\npregnancies and they are composed of<br \/>\n02:20<br \/>\nneoplastic since EO trophoblast and<br \/>\n02:22<br \/>\nSaito trophoblast<br \/>\n02:23<br \/>\nwithout chorionic villi placental side<br \/>\n02:26<br \/>\ntrophoblastic tumors are relatively rare<br \/>\n02:28<br \/>\nand are characterized by an absence of<br \/>\n02:30<br \/>\nthe ly with proliferation of<br \/>\n02:31<br \/>\nintermediate trophoblast cells the three<br \/>\n02:34<br \/>\nmajor risk factors for gestational<br \/>\n02:35<br \/>\ntrophoblastic disease are one advanced<br \/>\n02:38<br \/>\nmaternal age two history of gestational<br \/>\n02:40<br \/>\ntrophoblastic disease and three Asian<br \/>\n02:42<br \/>\nNative American or African ancestry<br \/>\n02:45<br \/>\nlet&#8217;s now move to signs and symptoms the<br \/>\n02:48<br \/>\nmost common symptom of a molar pregnancy<br \/>\n02:50<br \/>\nis abnormal vaginal bleeding for a<br \/>\n02:53<br \/>\ncomplete molar pregnancy<br \/>\n02:54<br \/>\nsigns and symptoms can include uterine<br \/>\n02:56<br \/>\nenlargement greater than expected for<br \/>\n02:57<br \/>\ngestational age absent fetal heart tones<br \/>\n03:00<br \/>\ncystic enlargement of the ovaries<br \/>\n03:01<br \/>\nhyperemesis gravidarum and an abnormally<br \/>\n03:04<br \/>\nhigh level of HCG for gestational age<br \/>\n03:06<br \/>\nfor a partial molar pregnancy the signs<br \/>\n03:09<br \/>\nand symptoms are often similar to<br \/>\n03:11<br \/>\nmiscarriage with vaginal bleeding and<br \/>\n03:12<br \/>\nabsent fetal heart tones women with<br \/>\n03:15<br \/>\nmalignant GTD may have subtle signs and<br \/>\n03:17<br \/>\nsymptoms of disease making the diagnosis<br \/>\n03:19<br \/>\nmore difficult abnormal bleeding for<br \/>\n03:21<br \/>\nmore than six weeks following any<br \/>\n03:23<br \/>\npregnancy normal or abnormal should be<br \/>\n03:25<br \/>\nevaluated with beta HCG testing to<br \/>\n03:27<br \/>\nexclude a new pregnancy or GTD let&#8217;s now<br \/>\n03:31<br \/>\ndiscuss diagnosis a complete molar<br \/>\n03:33<br \/>\npregnancy can be identified an<br \/>\n03:35<br \/>\nultrasound with a diffuse heterogeneous<br \/>\n03:37<br \/>\necho genetic pattern that is referred to<br \/>\n03:39<br \/>\nas a snowstorm pattern large cystic<br \/>\n03:41<br \/>\novaries an ultrasound can also support<br \/>\n03:43<br \/>\nthe diagnosis of a complete molar<br \/>\n03:45<br \/>\npregnancy post molar G TN is most<br \/>\n03:48<br \/>\nfrequently diagnosed from increasing or<br \/>\n03:50<br \/>\nplateau in beta HCG values after<br \/>\n03:52<br \/>\nevacuation of a mole with g TN following<br \/>\n03:55<br \/>\na normal pregnancy and elevated beta HCG<br \/>\n03:58<br \/>\nlevel and exclusion of pregnancy make<br \/>\n03:59<br \/>\nthe diagnosis let&#8217;s now move on to<br \/>\n04:02<br \/>\ntreatment the preferred method of<br \/>\n04:04<br \/>\nevacuation for a molar pregnancy is<br \/>\n04:06<br \/>\nsuction dilation and curettage a<br \/>\n04:08<br \/>\nhysterectomy can be performed for women<br \/>\n04:11<br \/>\nwho do not wish to preserve childbearing<br \/>\n04:13<br \/>\nfor follow-up patients should be<br \/>\n04:15<br \/>\nmonitored with serial beta HCG levels at<br \/>\n04:17<br \/>\n48 hours post evacuation every 1 to 2<br \/>\n04:20<br \/>\nweeks while elevated and then monthly<br \/>\n04:22<br \/>\nfor another 6 months during this time<br \/>\n04:25<br \/>\nthe patient should use a reliable<br \/>\n04:26<br \/>\nconscious<br \/>\n04:27<br \/>\noption if malignant GTD is diagnosed<br \/>\n04:30<br \/>\nmany patients will be referred to a<br \/>\n04:31<br \/>\ncancer specialist and there should be an<br \/>\n04:33<br \/>\nimmediate evaluation for metastasis this<br \/>\n04:36<br \/>\nincludes a number of blood tests as well<br \/>\n04:38<br \/>\nas imaging studies if there is no<br \/>\n04:41<br \/>\nmetastatic disease found the patient can<br \/>\n04:43<br \/>\nbe treated with weekly chemotherapy<br \/>\n04:45<br \/>\nwhich will be intramuscular methotrexate<br \/>\n04:46<br \/>\nwith a cure rate close to 100%<br \/>\n04:49<br \/>\nhysterectomy will shorten the duration<br \/>\n04:50<br \/>\nand amount of chemotherapy required but<br \/>\n04:53<br \/>\nit is not necessary for patients who<br \/>\n04:54<br \/>\nwish to preserve childbearing if<br \/>\n04:56<br \/>\nmetastatic disease is found and the<br \/>\n04:58<br \/>\npatient should be referred to a<br \/>\n04:59<br \/>\nspecialist for possible cancer staging<br \/>\n05:01<br \/>\nand treatment with multi agent<br \/>\n05:03<br \/>\nchemotherapy and possibly radiation<br \/>\n05:06<br \/>\npatients should use reliable<br \/>\n05:08<br \/>\ncontraception during treatment and for<br \/>\n05:09<br \/>\nthe first year after remission this<br \/>\n05:11<br \/>\nconcludes the applicable on gestational<br \/>\n05:13<br \/>\ntrophoblastic disease we have discussed<br \/>\n05:15<br \/>\nsigns symptoms and therapeutic options<br \/>\n05:17<br \/>\nfor this condition and women<\/p>\n<p><\/div>\n<hr \/>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 5:33<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":50,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2609","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2609","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=2609"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2609\/revisions"}],"predecessor-version":[{"id":2856,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2609\/revisions\/2856"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=2609"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}