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GYNECOLOGICAL ONCOLOGY . . . CONT.

clinical presentation • watery discharge (most important) • vaginal bleeding • lower abdominal pain treatment • as for malignant ovarian tumours

G E S T A T I O N A L T R O P H O B L A S T I C N E O P L A S I A ( G T N ) r e f e r s t o a s p e c t r u m o f p r o l i f e r a t i v e a b n o r m a l i t i e s o f t h e t r o p h o b l a s t i n c i d e n c e 1 / 1 2 0 0 p r e g n a n c i e s m a r k e d g e o g r a p h i c v a r i a t i o n : i n A s i a n s ( 1 / 8 0 0 ) m o r e c o m m o n i n e x t r e m e s o f c h i l d b e a r i n g a g e r i s k i n c r e a s e s t e n - f o l d f o l l o w i n g o n e G T N c h a r a c t e r i s t i c s 8 0 % b e n i g n r i s k o f m a l i g n a n t s e q u e l a e g r e a t e r i n w o m e n > 4 0 y e a r s , p a r a 3 1 5 % l o c a l l y i n v a s i v e 5 % m e t a s t a t i c c l i n i c a l a n d p a t h o l o g i c a l c l a s s i f i c a t i o n s e e F i g u r e 1 1

PATHOLOGIC

Hydatidiform

Invasive

CLASSIFICATION

Mole

Mole

Choriocarcinoma

CLINICAL CLASSIFICATION

Benign GTN

Malignant GTN

Non-metastatic

Metastatic

Figure 11. Classification Scheme for GTN

Good prognosis

Printed with permission from Novak’s Textbook of Gynecology. 11th ed. E.R. Novak et al. (eds.) Williams and Wilkins Co., 1988.

Hydatidiform Mole (Benign GTN) complete mole • a proliferative or neoplastic trophoblast, hydropic swelling of chorionic villi, no fetal tissues or membranes • most common type of hydatidiform mole • 46 XX of paternal origin • 2 sperm fertilize empty egg • high malignant potential (15-20%) • marked edematous and enlarged villi • disappearance of villous blood vessels partial (or incomplete) mole • hydropic villi and focal trophoblastic hyperplasia are associated with a fetus or fetal parts • often triploid (XXY) • single ovum fertilized by two sperm • often associated with severe hypertension • low malignant potential (4%) • clinical features often less severe as compared with those of a complete mole • often associated with fetus that is clinically growth restricted and has multiple congenital malformations clinical presentation • vaginal bleeding (most common) • typically diagnosed as threatened abortion because of passage of tissue and vaginal bleeding (95%) and uterine cramps • uterus size large for dates (50-5 %) • hyperemesis gravidarum (25-30%) • early hypertension (15-20%)

MCCQE 2000 Review Notes and Lecture Series

Poor prognosis

Notes

Gynecology 49

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