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Gestational trophoblastic disease
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Fieke E M Froeling, Michael J Seckl
Gestational trophoblastic disease (GTD) is an uncommon complication of pregnancy. An average consultant obstetrician may deal with only one new case every second year. The term gestational trophoblastic disease describes a group of inter-related diseases, including the pre-malignant disorders of partial and complete hydatidiform mole (PHM and CHM) and the malignant diseases of invasive mole, choriocarcinoma and the rare placental site trophoblastic tumour/epithelioid trophoblastic tumour (PSTT/ETT). The malignant diseases are also collectively named gestational trophoblastic neoplasia (GTN). Although persistent GTD most commonly follows a molar pregnancy, it can be seen after any type of gestation, including term pregnancy, abortion and ectopic pregnancy. Gestational trophoblastic tumours produce hCG which is important in the diagnosis, management and follow-up of these patients, providing an example of an 'ideal' tumour marker. The first complete responses to methotrexate chemotherapy were described in the 1950s, and presently almost 100 percent of patients are cured.
Gestational trophoblastic neoplasia
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Fieke E.M. Froeling, Michael J. Seckl
Epithelioid trophoblastic tumour is a recently described neoplastic proliferation of intermediate trophoblast that is thought by some investigators to be distinct from PSTT and choriocarcinoma. It has been proposed that ETT arises from the intermediate trophoblasts of the chorionic leaves.41 Histologically, ETT displays a relatively uniform, nodular proliferation of intermediate-sized epithelioid trophoblasts, forming nests and cords. Islands of trophoblast are typically surrounded by areas of hyalinization or eosinophilic debris simulating tumour cell necrosis, resembling keratinous material in a squamous cell carcinoma. ETT can furthermore be associated with focal replacement of the cervical glandular epithelium with stratified neoplastic cells, simulating squamous cervical intra-epithelial neoplasia. The cells are positive for cytokeratin, epithelial membrane antigen and inhibin-a, whereas trophoblastic markers hPL, hCG and melanoma cell adhesion molecule are only focally expressed.48 Whether ETT is really a clinically distinct disease entity from PSTT in the GTD spectrum remains unclear.49
Diffuse large B-cell lymphoma of the endometrium: an unusual site for primary presentation
Published in Southern African Journal of Gynaecological Oncology, 2019
The clinical differential diagnosis in a female of reproductive age who presents with abnormal bleeding includes both cervical and endometrial pathology. Cervical causes of bleeding encompass cervicitis including tuberculosis, schistosomiasis and viral warts. In addition, squamous cell carcinoma and adenocarcinoma must be considered. Endometrial causes of bleeding include endometritis, endometrial polyps, submucosal or pedunculated leiomyomas. Despite the patient being of reproductive age, an endometrial carcinoma should be considered in the differential diagnosis. Exogenous hormones in contraceptives or endogenous oestrogen-producing ovarian tumours may also present with abnormal bleeding. Furthermore, gestational trophoblastic neoplasias such hydatidiform mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour must be included in the clinical differential diagnosis.
Gestational trophoblastic disease managed at Grey's Tertiary Hospital: a five-year descriptive study
Published in Southern African Journal of Gynaecological Oncology, 2019
Bongumusa S Makhathini, Greta Dreyer, Eckhart J Buchmann
GTD mainly affects women of reproductive age and has a wide range of treatment guidelines with varying outcomes. It represents a group of tumours arising from the trophoblastic tissue of the placenta ranging from benign hydatidiform molar pregnancy (HMP) to malignant gestational trophoblastic neoplasia (GTN). GTN includes invasive mole, choriocarcinoma (CC), placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). While histologic confirmation is desirable, it is not essential for the currently used clinical classification.1