CHORIOCARCINOMA ADALAH PDF

If you have symptoms of cancer contact your doctor. Read our information about coronavirus and cancer. Persistent trophoblastic disease PTD and choriocarcinoma are conditions that develop from placental cells. They are types of gestational trophoblastic disease GTD for short.

Author:Manos Zolobar
Country:Jamaica
Language:English (Spanish)
Genre:Career
Published (Last):2 September 2008
Pages:197
PDF File Size:6.70 Mb
ePub File Size:13.2 Mb
ISBN:420-7-51467-358-6
Downloads:73569
Price:Free* [*Free Regsitration Required]
Uploader:Arabar



NCBI Bookshelf. Bradie N. Bishop ; Peter F. Authors Bradie N. Bishop 1 ; Peter F. Edemekong 2. Gestational trophoblastic diseases were first described in BC by Hippocrates. Choriocarcinoma develops from an abnormal trophoblastic population undergoing hyperplasia and anaplasia, most frequently following a molar pregnancy. The former arises following a hydatidiform mole, normal pregnancy, or most commonly, abortion, while non-gestational choriocarcinoma arises from pluripotent germ cells.

Choriocarcinoma is a very rare neoplasm with varied incidence worldwide. Choriocarcinoma composes less than 0. Choriocarcinoma can also occur in males, usually those between ages 20 to The exact pathogenesis of choriocarcinoma has not been fully explained or understood, but studies have shown cytotrophoblastic cells function as stem cells and undergo malignant transformation.

The neoplastic cytotrophoblast further differentiates into intermediate trophoblasts and syncytiotrophoblast. Overexpression of p53 and MDM2 have been demonstrated in choriocarcinoma, with no evidence of somatic mutation.

Following chemotherapy, the cytotrophoblasts may predominate, making the diagnosis more difficult. Intra-placental choriocarcinoma demonstrates trophoblast proliferation around villi in a third-trimester placenta, usually otherwise normal in appearance.

In mixed germ cell tumors, choriocarcinoma will also have a mixture of syncytiotrophoblasts and cytotrophoblasts and varying components of other germ cell tumors. In women, clinicians should pay particular attention to reproductive history because spontaneous abortions and molar pregnancies increase the risk for choriocarcinoma.

One should consider post-menopausal bleeding suspicious. Choriocarcinoma tends to metastasize, and clinicians should note symptoms that arise from other organ systems, for example, hemoptysis or gastrointestinal GI bleeding.

Due to elevations in hCG levels, patients can present with abnormal uterine bleeding, gynecomastia in men , or hyperthyroidism. Many laboratory tests can assess for choriocarcinoma, including complete blood count CBC , coagulation studies, body chemistries, renal function panels, liver function panels, type and screen, and quantitative hCG.

The United Kingdom registers and monitors all patients with hydatidiform or molar pregnancies and utilizes the following criteria to start chemotherapy for gestational trophoblastic disease [1] :. Following the diagnosis of choriocarcinoma, the healthcare professional should evaluate patients for metastasis; the lungs are the most common site for metastasis.

Evaluate the brain via computer tomography or magnetic resonance imaging MRI. In males who have developed choriocarcinoma, the testicular anatomy primarily usually very small or even regressed, leaving only metastatic disease and cells.

Low-risk cumulative score less than 7, see staging section below and stage I to III choriocarcinoma can be treated with a single agent, either methotrexate or actinomycin D chemotherapy. High-risk a cumulative score greater than 7, see staging section below and stage II to IV disease are treated with multi-agent chemotherapy, adjuvant radiation, and surgery.

Following treatment and hCG normalization, quantitative hCG levels should be checked monthly for one year with physical exam twice in the same time frame. The differential diagnosis includes [3] [7] :. In the United Kingdom, gestational choriocarcinoma is usually treated with a combination of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine. The World Health Organization and International Federation of Gynecology and Obstetrics developed the following staging system for choriocarcinoma [12] [1] :.

Furthermore, the patients are then stratified into low- and high-risk groups to determine treatment based on the following criteria:. Gestational choriocarcinoma and non-gestational choriocarcinoma have different prognoses with non-gestational choriocarcinoma, having a much worse prognosis. Genotyping highlights the difference in gestational and non-gestational choriocarcinoma; gestational choriocarcinoma usually has a paternal chromosome complement while non-gestational choriocarcinoma has DNA that matches the patient, with occasional karyotype abnormalities.

Adverse risk factors making death more likely include stage IV disease or a cumulative score greater than 12 in women. Without treatment, choriocarcinoma can result in death. Utilization of chemotherapy is not without its risks, to include the development of secondary malignancies, nausea, vomiting, hair loss, diarrhea, fevers, infections, and the need for transfusion of blood productions.

Women who experience a molar pregnancy, whether complete or incomplete, should be counseled as to the risk for development of choriocarcinoma. Any woman who has given birth, but particularly if she is a high risk, should be counseled to return for continued post-partum bleeding. High clinical suspicion should be maintained for choriocarcinoma in women with hemoptysis and molar pregnancy, current, or recent pregnancy, or irregular vaginal bleeding.

An interprofessional treatment center with nurses and clinicians specializing in gestational trophoblastic disease may be beneficial. To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Choriocarcinoma Bradie N. Author Information Authors Bradie N.

Affiliations 1 Brooke Army Medical Center. Introduction Gestational trophoblastic diseases were first described in BC by Hippocrates. Etiology Choriocarcinoma develops from an abnormal trophoblastic population undergoing hyperplasia and anaplasia, most frequently following a molar pregnancy. Epidemiology Choriocarcinoma is a very rare neoplasm with varied incidence worldwide.

Pathophysiology The exact pathogenesis of choriocarcinoma has not been fully explained or understood, but studies have shown cytotrophoblastic cells function as stem cells and undergo malignant transformation.

Evaluation Many laboratory tests can assess for choriocarcinoma, including complete blood count CBC , coagulation studies, body chemistries, renal function panels, liver function panels, type and screen, and quantitative hCG. Differential Diagnosis The differential diagnosis includes [3] [7] : Placental site trophoblastic tumor.

Staging The World Health Organization and International Federation of Gynecology and Obstetrics developed the following staging system for choriocarcinoma [12] [1] : Stage I: Disease confined to the uterus. Prognosis Gestational choriocarcinoma and non-gestational choriocarcinoma have different prognoses with non-gestational choriocarcinoma, having a much worse prognosis. Complications Without treatment, choriocarcinoma can result in death.

Deterrence and Patient Education Women who experience a molar pregnancy, whether complete or incomplete, should be counseled as to the risk for development of choriocarcinoma.

Pearls and Other Issues Elevated hCG levels in a woman without confirmed intrauterine pregnancy should prompt a search for both ectopic pregnancy and the possibility of a malignancy secreting hCG. Lack of response to methotrexate makes a malignancy much more likely. False positive elevations in hCG can be due to heterophile human anti-mouse antibodies and should be considered before treating patients surgically or with systemic chemotherapy. In men, choriocarcinoma usually occurs as part of a mixed germ cell tumor; when occurring in a pure form, the primary tumor may be very small or even regressed while symptoms are all related to metastasis.

Intra-placental choriocarcinoma is a very rare variant usually, presenting with metastatic symptoms in the post-partum mother, and rarely with metastasis in the infant, and should be included on the differential diagnosis of elevated AFP in a postpartum patient. Questions To access free multiple choice questions on this topic, click here. References 1. Gestational trophoblastic disease. Bruce S, Sorosky J. Gestational Trophoblastic Disease. Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole.

Case Rep Oncol. Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series. J Med Case Rep. Ulbright TM. Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues.

Surg Pathol Clin. Immunohistochemistry of choriocarcinoma: an aid in differential diagnosis and in elucidating pathogenesis. Shih IeM. Gestational trophoblastic neoplasia--pathogenesis and potential therapeutic targets. Lancet Oncol. Liu J, Guo L. Intraplacental choriocarcinoma in a term placenta with both maternal and infantile metastases: a case report and review of the literature. Heller DS. Update on the pathology of gestational trophoblastic disease. Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia.

Obstet Gynecol. In: StatPearls [Internet]. In this Page. Related information. Similar articles in PubMed. A pure non-gestational ovarian choriocarcinoma with delayed solitary brain metastases: Case report and review of the literature.

J Neurosci Rural Pract. Use of short tandem repeat analysis in unusual presentations of trophoblastic tumors and their mimics. Hum Pathol. Epub Feb 4.

LA HISTORIA SECRETA DE LOS JESUITAS PDF

Persistent trophoblastic disease and choriocarcinoma

NCBI Bookshelf. Bradie N. Bishop ; Peter F. Authors Bradie N. Bishop 1 ; Peter F. Edemekong 2.

TEMPERAMENTOS CONTROLADOS POR EL ESPIRITU SANTO PDF

Choriocarcinoma

Gestational choriocarcinoma is a malignant trophoblastic tumour arising from any gestational event during pregnancy in the reproductive female. Most patients develop gestational choriocarcinoma shortly after gestational anomalies, but pathology may occur after a long latency of years. It may occur during pregnancy. Often, it happens after a growth of some sort in the womb pregnancy, tumor, mole, cyst [1]. Grossly, a red hemorrhagic mass is seen in the uterus , though it may vary in size. Often, diagnosis is presumptive, and based on clinical findings and the identification of a malignant trophoblast.

QUIUBOLE CON PARA CHAVOS PDF

About persistent trophoblastic disease and choriocarcinoma

If you have symptoms of cancer contact your doctor. Read our information about coronavirus and cancer. Persistent trophoblastic disease is when women who have had treatment to remove a molar pregnancy from the womb still have some molar tissue left behind. A molar pregnancy occurs when the fertilisation of the egg by the sperm goes wrong and leads to the growth of abnormal cells or clusters of water filled sacs inside the womb. This condition is one of a group of conditions known as gestational trophoblastic disease GTD.

Related Articles