Persistent Trophoblastic Neoplasia (Lecture 13)

What is PTN?

Persistent trophoblastic neoplasia

- Invasive/metastatic form of GTD

- Can occur after complete/partial molar preg, choriocarcinomas, other GTNs, or normal pregnancies

TRUE or FALSE: PTN can develop after a normal pregnancy.

TRUE

What are risk factors for PTN?

- Over 40 years old

- Previous molar preg or severe trophoblastic proliferation

Explain bhCG levels for PTN.

Plateau then rise again from leftover trophoblastic cells

What is the CP for invasive mole and choriocarcinoma?

1. bhCG elevated

2. PTN after molar preg

- presents within 6-12 months

- bleeding

- uterine enlargement

- persistent ovarian enlargement

3. PTN after normal preg

- late postpartum bleeding

- symptoms of elevated bhCG (pt feels like they're preg)

- symptomas of metastases

What is the m/c form of PTN?

Invasive (hydatidiiform) mole

What is invasive mole? When do they occur? What are its SF?

- Proliferation of trophoblasts and presence of chorionic villi within endo and myo

- Almost always arise after molar preg (CHM)

SF:

- Hydropic placenta invading myo

- inc flow, low resistance = malignant

What is choriocarcinoma? When do they occur? What is its SF? (HINT: 3)

- Abn proliferation of trophoblasts w/o chorionic villi invading into myo

- 50% occur after molar preg; can occur after normal preg (RPOC) or abortion

SF

- Mixed cystic and solid endo centrally w/ indistinct margins suggesting uterine invasion

- Hemorrhage and necrosis

What is the most aggressive form of GTN?

Choriocarcinoma

What is the m/c site of spread for choriocarcinomas?

Lungs

What is placental-site trophoblastic tumour (PSTT)? What is its CP? When does it occur? What are its SF? What is the treatment?

- Rarest and most fatal form of PTN that arises from nonvillous trophoblast (not syncytio or cytotrophoblasts)

- CP: low/slightly elevated bhCG (bc doesn't involve trophoblasts), vaginal bleeding/amenorrhea, enlarged uterus,

- 90% occur after normal term delivery

- SF: can be confined to uterus or locally invasive to pelvis

- Surgery (hysterectomy or only remove tumour)

What are the treatments for invasive mole and choriocarcinomas?

- Suction/D&C

- Hysterectomy (if fertility not a concern)

- Multi-agent chemotherapy

- F/u for bhCG levels up to 1 yr