Gestational Trophoblastic Diseases - A Clinicopathological Study

The term ‘gestational trophoblastic disease’, includes lesions, some of which are categorized as true neoplasms, and others that are representative of placentas that are malformed. It refers to various lesions that accompany the premalignant type, some of which are hydatidiform moles of the partial or the whole variety. The malignant type of lesions (GTD / GTN), include the following: choriocarcinoma, epithelioid trophoblastic tumour, placental site trophoblastic tumour, and invasive moles. METHODSA total number of thirty-four cases of GTD during the last two years at a tertiary care hospital was studied, relevant data was collected, and histological features studied. RESULTS79.41% of GTDs in the present study were complete mole, 58.82% of GTDs occurred in nullipara, 52.94% cases had GTDs seen in the third decade, 14.70% cases had history of previous GTD, 5.88% cases had history of previous abortion, 2.94% cases had a history of previous ectopic pregnancy, and case with choriocarcinoma had the highest HCG levels. In contrast, case with epithelioid trophoblastic tumour had the least HCG levels. CONCLUSIONSIn this particular study, it was found that most of the GTDs occurred in nulliparous women in their thirties and their occurrence increased with risk factors like a previous history of GTD, abortions, or ectopic pregnancy.

Clinical study of gestational trophoblastic disease in a tertiary care hospital

Background: Gestational trophoblastic diseases (GTDs) had been associated with significant morbidity and mortality till recently. Wide variation in incidences have been reported worldwide. The present study was planned with the objective of determination of incidence, assessment of risk factors, clinical presentation, management protocols and outcomes in GTD cases in Indian population at a tertiary care centre.Methods: All the diagnosed cases of GTD reporting to study centre during study period of 1.5 years were included. Detailed history taking, examination and relevant investigations (Hb%, blood grouping, thyroid functions, serum ß-hCG, USG and chest X-ray) were undertaken. Suction and evacuation were done for all patients as primary mode of management and samples were sent for histopathological examination. Comprehensive follow ups were done, including weekly ß-hCG until normal for 3 consecutive weeks followed by monthly determination until the levels were normal for 6 consecutive months.Results: Total 22 cases out of 19500 deliveries were diagnosed as GTD (incidence rate-1.13/1000 deliveries). Mean age was 23.64±3.89 years with 50% participants being primigravida. The commonest symptom after amenorrhea 22 (100%) was bleeding per-vaginum 15 (68.2%). Maximum cases were of complete hydatidiform mole histopathology 16 (72.73%), USG 19 (86.4%). Clinical characteristics were statistically comparable between patients of complete mole and partial mole. Out of 22 cases, 1 (4.5%) was diagnosed as GTN.Conclusions: Early diagnosis and treatment along with regular follow up is the key in GTD. There is need to establish a centralized disease specific registry in future.

Caracterización clínica y epidemiológica de pacientes diagnosticadas con embarazo molar durante los años 2012-2019 en el Hospital de Chillán / Clinical and epidemiological characterization of patients diagnosed with molar pregnancy during the years 2012-2019 in Hospital de Chillán

La enfermedad trofoblástica gestacional (ETG) constituye un conjunto heterogéneo de afecciones malignas y benignas derivados de la proliferación anormal del trofoblasto o de las células germinales de ambos sexos. La ETG tiene una incidencia variable a lo largo del mundo. A nivel nacional, no se han realizado estudios de caracterización epidemiológica de esta población y, frecuentemente, los datos manejados están basados en estudios extranjeros. Objetivo: Determinar las características clínicas y epidemiológicas de las pacientes diagnosticadas con embarazo molar en el período transcurrido entre el año 2012 y 2019, en el hospital Clínico Herminda Martin de Chillán. Materiales y métodos: Estudio observacional transversal de serie temporal, se consideró el número total de fichas clínicas del Hospital Clínico Herminda Martin de Chillán durante los años 2012 al 2019, con diagnóstico confirmado de Embarazo Molar. Los datos se registraron en la hoja de recolección de datos elaborada, realizándose los análisis estadísticos pertinentes. Resultados: Se analizaron 44 pacientes, la edad promedio de presentación fue de 30.96 años. Los principales síntomas de consulta fueron metrorragia 52.27% (n=23) y dolor abdominal 20.45% (n=9). El principal tratamiento efectuado fue aspiración y legrado en un 77,27% (n=34). El 4.54% (n=2) presentó recurrencia, presentando un segundo episodio de embarazo molar. Conclusiones: El embarazo molar es una patología poco frecuente, pero es un diagnóstico diferencial a tener en cuenta, sobre todo cuando nos enfrentamos a mujeres en edad fértil que consultan por metrorragia o dolor abdominal.

Gestational trophoblastic disease (GTS) is a heterogeneous group of malignant and benign conditions derived from abnormal proliferation of the trophoblast or germ cells of both sexes. GTS has a variable incidence throughout the world. Nationally, no epidemiological characterization studies have been carried out for this population and, frequently, the data handled is based on foreign studies. Objective: To determine the clinical and epidemiological characteristics of patients diagnosed with molar pregnancy between the period between 2012 and 2019 at the Hospital Clinico Herminda Martin of Chillan. Materials and methods: Retrospective observational descriptive cross-sectional study, considering the pregnancies registered at the Hospital Clinico Herminda Martin of Chillan during the years 2012 to 2019, with a confirmed diagnosis of Molar Pregnancy, as sample of study. The data were recorded on the prepared data collection sheet, performing the relevant statistical analyzes. Results: 44 patients were analyzed, the average age of presentation was 30.96 years. The main symptoms of consultation were metrorrhagia 52.27% (n = 23) and abdominal pain 20.45% (n = 9). The main treatment was aspiration and curettage in 77.27% (n = 34). 4.54% (n = 2) presented recurrence, presenting a second episode of molar pregnancy. Conclusions: Molar pregnancy is a rare pathology, but it is a differential diagnosis to take into account, especially when we are faced with women of childbearing age who consult due to bleeding or abdominal pain.

Scenario of molar pregnancy in a tertiary care centre in Delhi, India

Background: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases with incidence varying with geographic region. Aim was to review all molar pregnancies admitted at our institution and to study the incidence, clinical presentation, management, complications and outcome of molar pregnancies.Methods: An observational study was done in department of obstetrics and gynaecology at Dr. BSA Medical College and Hospital among women with molar pregnancy over two years.Results: The incidence of molar pregnancy of the institute was 1.05/1000 deliveries. 21- 25 years age group and nulliparous women constituted 28.1% of patients. Amenorrhea (100.0%) was the commonest presenting complaints followed by abnormal vaginal bleeding (90.62%). Anemia (37%) was the commonest complication followed by acute hemorrhage (31%) and hyperthyroidism (18%). Suction evacuation was done in 96.8% of patients and 87.5% required blood transfusion. Only 6.2% (2/32) of patients had post evacuation chemotherapy. None of the cases developed choriocarcinoma. Limitation of the study was that the incidence of subsequent pregnancies after complete treatment of molar pregnancies was not studied.Conclusions: Early diagnosis of complete molar pregnancy can change the clinical presentation, diagnosis, and treatment of molar pregnancy. There is need for early recognition, timely referral, prompt and proper treatment of this condition. Adequate follow-up of the patients and need for contraception should be reinforced.

Adesão ao seguimento ambulatorial de pacientes com doença trofoblástica gestacional atendidas em um centro de referência / Adherence to follow­up in patients with gestational trophoblastic disease treated at a referral center

Objetivo Avaliar a adesão das pacientes com doença trofoblástica gestacional (DTG) ao seguimento ambulatorial pós­molar em um centro de referência na região Centro­Oeste do Brasil. Métodos Estudo observacional, retrospectivo, que incluiu todas as pacientes diagnosticadas com DTG na Maternidade­Escola da Universidade Federal de Goiás em um ano. Foram colhidos dados referentes a idade, paridade e valores de B­hCG. A adesão ao seguimento ambulatorial e o exame histopatológico do produto do esvaziamento uterino foram obtidos pela revisão de prontuários. Resultados Entre as 55 pacientes incluídas no estudo, apenas 27 (49%) prosseguiram com o tratamento de forma completa; das quais 11 (40,7%) tiveram indicação de quimioterapia segundo o protocolo do Serviço. Conclusão A taxa de adesão ao seguimento ambulatorial foi baixa. O alto índice de pacientes com necessidade de quimioterapia determina um cenário alarmante sobre o prognóstico das pacientes que não concluíram o seguimento pós­molar. Esse estudo aponta a necessidade de estratégias efetivas para o manejo e o controle da doença.

Objective To evaluate the adherence to outpatient follow­up among patients with gestational trophoblastic disease (GTD) in a reference center in the Midwest region of Brazil. Methods This was an observational, retrospective study that included all patients diagnosed with GTD in the Maternity School of the Universidade Federal de Goiás in one year. Data were collected regarding age, parity and B­hCG values. Adherence to follow­up and histopathological examination of the uterine evacuation product were obtained by chart review. Results Among the 55 patients included in the study, only 27 (49%) continued with the treatment properly; of which 11 (40.7%) had chemotherapy indication by the protocol service. Conclusion The adherence rate to outpatient follow­up was low. The high rate of patients in need of chemotherapy determines an alarming scenario on the prognosis of patients who did not complete the follow­up. This study highlights the need for effective strategies for the management and control of the disease.