Abstract
<i>Background</i> – The aim of this study is to analyze the clinicopathological features, diagnosis and appropriate treatment outcome of patients with gestational trophoblastic neoplasia (GTN), a heterogenous group of disorder in a government tertiary care hospital center. <i>Method</i>– This is a retrospective study of 23 patients from 2002-2020 over 18 years. The patients were evaluated on the basis of their age, obstetric history and the treatment received. All the patients were scored according to Modified World Health Organization (WHO) prognostic scoring system as adapted by FIGO Year 2000. Low risk group patients were given injection Methotrexate + Calcium Leucovorin and high risk group were given EMACO regimen. After treatment, the patient follow up was till date or minimum up to 2 years. The response to treatment was evaluated by regular clinical and radiological examination and serum β-hCG level estimation. <i>Results</i> – Three out of 23 patients who relapsed after primary chemotherapy were given second line chemotherapy. All three patients achieved complete remission (CR) after salvage chemotherapy. Thus overall response rate is 100%. <i>Conclusion</i> – Proper diagnosis, close monitoring and follow up with β-hCG value is of utmost importance in the management of GTN, WHO/FIGO scoring should be done and managed with chemotherapy treatment according to the risk assessment.
Highlights
Gestational trophoblastic disease (GTD) is a spectrum of rare conditions that arise due to abnormal proliferation of trophoblastic cells in placental microvilli
They consist of Vesicular Mole (Complete and Partial), which are benign lesions that resolve following uterine evacuation in majority of cases; [1, 2] gestational trophoblastic neoplasia (GTN) [invasive mole, Choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT) and epethelioid trophoblastic tumors (ETT)] most commonly arise after a molar pregnancy, they can develop after any pregnancy
Repeat or second uterine evacuation has a role in selected cases of persistent trophoblastic disease whose β-hCG was less than 1500 IU/ml, and USG showed significant molar tissue
Summary
Gestational trophoblastic disease (GTD) is a spectrum of rare conditions that arise due to abnormal proliferation of trophoblastic cells in placental microvilli. They consist of Vesicular Mole (Complete and Partial), which are benign lesions that resolve following uterine evacuation in majority of cases; [1, 2] GTN [invasive mole, Choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT) and epethelioid trophoblastic tumors (ETT)] most commonly arise after a molar pregnancy, they can develop after any pregnancy. Partial hydatidiform mole occurs in 3-5% of molar pregnancies and metastatic disease is rare. GTN are highly curable in spite of metastatic disease due to high sensitivity to chemotherapeutic agents with cure rate reaching up to 100% while minimizing unnecessary excess chemotherapy
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