II. Pathophysiology

  1. Malignant transformation of trophoblast
  2. Villus formation absent
  3. Trophoblast cells invade myometrium and blood vessels

III. Etiology: Origin of neoplasm

  1. Molar Pregnancy (50%)
  2. Spontaneous or Elective Abortion (25%)
  3. Postpartum delivery of viable fetus (20%)
  4. Ectopic Pregnancy (5%)
    1. Represents 5x the risk of intrauterine pregnancy

IV. Labs

V. Radiology

VI. Management

  1. Surgery (risk of metastases)
    1. Suction Curettage while Oxytocin administered
    2. Hysterectomy if >40 years old
  2. Chemotherapy
    1. Methotrexate 15-30 mg IV x5 days every 2weeks
    2. Actinomycin D 10 ug/kg x5 days every 2weeks
    3. Combination therapy for metastases
  3. Radiation Therapy
    1. Indicated for Liver or CNS metastases

VII. Monitoring: Serum Quantitative bhCG

  1. bHCG every 2 weeks for 2 months then
  2. bHCG every month for 3 months then
  3. bHCG every 2 months for 6 months then
  4. bHCG every 6 months

VIII. Course: Dissemination

  1. Local Spread
    1. Vagina
    2. Pelvic organs
  2. Distant Metastases
    1. Liver
    2. Lungs

IX. Prognosis

  1. Low Risk Patients: 100% five year survival
    1. Under 4 month history suggesting metastatic disease
    2. Serum HCG <50 mIU/ml
    3. No signs of Liver or CNS metastases
  2. High Risk Patients: 50% five year survival
    1. Over 4 month history of metastatic disease
    2. Serum HCG >50 mIU/ml
    3. Liver or CNS metastases
    4. Tumor development follows term pregnancy
    5. Chemotherapy failure

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Ontology: Hydatidiform Mole, Invasive (C0008493)

Definition (NCI_NCI-GLOSS) A type of cancer that grows into the muscular wall of the uterus. It is formed after conception (fertilization of an egg by a sperm). It may spread to other parts of the body, such as the vagina, vulva, and lung.
Definition (NCI) A complete hydatidiform mole or very rarely a partial mole that invades the myometrium.(NICHD)
Definition (MSH) A uterine tumor derived from persistent gestational TROPHOBLASTS, most likely after a molar pregnancy (HYDATIDIFORM MOLE). Invasive hyadatiform mole develops in about 15% of patients after evacuation of a complete mole and less frequently after other types of gestation. It may perforate the MYOMETRIUM and erode uterine vessels causing hemorrhage.
Concepts Neoplastic Process (T191)
MSH D002820
ICD10 M9100/1 , D39.2
SnomedCT 74153005, 154643005, 189444004, 18799007, 416669000
English Invasive Mole, Chorioadenoma, Chorioadenomas, Hydatidiform Mole, Invasive, Hydatidiform Moles, Invasive, Invasive Hydatidiform Moles, Invasive Moles, Moles, Invasive, Moles, Invasive Hydatidiform, Mole, Invasive, Mole, Invasive Hydatidiform, [M]Chorioadenoma destruens, [M]Chorioadenoma, [M]Invasive hydatidiform mole, invasive hydatidiform mole (diagnosis), invasive hydatidiform mole, molar pregnancy, invasive (non-metastatic GTD), Hydatidiform mole malignant, Hydatidiform Mole, Invasive [Disease/Finding], malignant moles, Mole;malignant, Molar pregnancy with invasive hydatidiform mole, Malignant hydatidiform mole (disorder), Molar pregnancy with malignant hydatidiform mole, Molar pregnancy with chorioadenoma destruens, Molar pregnancy with chorioadenoma, Choriadenoma (destruens), Molar pregnancy with invasive mole, Molar pregnancy with invasive hydatidiform mole (disorder), Invasive hydatidiform mole, Chorioadenoma destruens, Malignant hydatidiform mole, Invasive mole, Invasive hydatidiform mole (morphologic abnormality), chorioadenoma destruens, GTT, invasive mole, chorioadenoma, gestational trophoblastic tumor, invasive mole, invasive mole, destructive; mole, hydatidiform mole; invasive, hydatidiform mole; malignant, invasive; hydatidiform mole, invasive; mole, malignant; hydatidiform mole, malignant; mole, hydatidiform, mole; destructive, mole; hydatidiform, invasive, mole; hydatidiform, malignant, mole; invasive, mole; malignant, hydatidiform mole, Invasive mole, NOS, Invasive Hydatidiform Mole, Chorioadenoma Destruens, Invasive Gestational Trophoblastic Neoplasm, Malignant hydatid mole, IM - Invasive mole, Invasive mole - placenta, Invasive hydatidiform mole (disorder), malignant mole
Italian Mola idatiforme maligna, Corioadenoma, Corioadenoma destruente, Mola vescicolare invasiva, Mola invasiva idatiforme
French Môle hydatiforme malin, Môle hydatiforme maligne, Chorio-adénome destruens, Môle invasive, Môle disséquante
German Hydatidenmole boesartig, boesartige hydatidiforme Mole, Blasenmole, invasive, Chorioadenom, Invasive Blasenmole, Mola destruens
Portuguese Mole hidatiforme maligna, Mola hidatiforme maligna, Corioadenoma, Mola Hidatiforme Invasiva, Mola Invasiva
Japanese 悪性胞状奇胎, アクセイホウジョウキタイ, 浸潤性ブドウ状奇胎, 胞状奇胎-侵入, 侵入胞状奇胎, 浸潤性胞状奇胎, 破壊性奇胎, 破壊性絨毛腺腫, 破壊性胞状奇胎, 破奇, 絨毛腺腫(胞状奇胎), 胞状奇胎-破壊性
Swedish Hydatidmola, invasiv
Czech chorioadenom, Hydatidiformní mola maligní, Maligní mola hydatidosa
Finnish Invasiivinen rypäleraskaus
Russian ZANOS INVAZIVNYI, PUZYRNYI ZANOS INVAZIVNYI, KHORIONADENOMA, ЗАНОС ИНВАЗИВНЫЙ, ПУЗЫРНЫЙ ЗАНОС ИНВАЗИВНЫЙ, ХОРИОНАДЕНОМА
Spanish Mola Hidatiforme Invasiva, embarazo molar con mola hidatiforme invasiva, embrarazo molar con corioadenoma, embarazo molar con mola hidatiforme maligna, embarazo molar con mola hidatiforme invasiva (trastorno), embarazo molar con mola invasiva, embarazo molar con coriocarcinoma destruens, (M) New term, (M)corioadenoma, (M)mola hidatiforme invasiva, corioadenoma destruens, corioadenoma, mola hidatiforme invasora (anomalía morfológica), mola hidatiforme invasora, mola hidatiforme maligna, mola invasiva, Mola hidatiforme maligna, mola hidatiforme invasiva, mola hidatiforme invasora (trastorno), Corioadenoma, Mola Invasiva
Polish Zaśniad groniasty inwazyjny, Gruczolak kosmówkowy
Hungarian Rosszindulatú hydatidiform mola
Norwegian Invasiv hydatidmola, Invasiv blæremola
Dutch destruens; mola, hydatidiforme mola; invasief, hydatidiforme mola; maligne, invasief; hydatidiforme mola, invasief; mola, maligne; hydatidiforme mola, maligne; mola, hydatiform, mola; destruens, mola; hydatidosa, invasief, mola; hydatidosa, maligne, mola; invasief, mola; maligne, hydatiforme mola, hydatidiforme mola maligne, Chorioadenoom, Invasieve mola, Invasieve mola hydatidosa, Mola hydatidosa, invasieve

Ontology: Choriocarcinoma (C0008497)

Definition (NCI) An aggressive malignant tumor arising from trophoblastic cells. The vast majority of cases arise in the uterus and represent gestational choriocarcinomas that derive from placental trophoblastic cells. Approximately half of the cases develop from a complete hydatidiform mole. A minority of cases arise in the testis or the ovaries. There is often marked elevation of human chorionic gonadotropin (hCG) in the blood. Choriocarcinomas disseminate rapidly through the hematogenous route; the lungs are most frequently affected.
Definition (NCI_NCI-GLOSS) A malignant, fast-growing tumor that develops from trophoblastic cells (cells that help an embryo attach to the uterus and help form the placenta). Almost all choriocarcinomas form in the uterus after fertilization of an egg by a sperm, but a small number form in a testis or an ovary. Choriocarcinomas spread through the blood to other organs, especially the lungs. They are a type of gestational trophoblastic disease.
Definition (NCI_CDISC) A malignant neoplasm arising from placental trophoblast cells. They generally arise in the uterus.
Definition (CSP) malignant metastatic form of trophoblastic tumors, contains sheets of undifferentiated cytotrophoblasts and syncytiotrophoblasts; characterized by the large amounts of chorionic gonadotropin produced; tissue origins can be placental (fetal) or non-placental.
Definition (MSH) A malignant metastatic form of trophoblastic tumors. Unlike the HYDATIDIFORM MOLE, choriocarcinoma contains no CHORIONIC VILLI but rather sheets of undifferentiated cytotrophoblasts and syncytiotrophoblasts (TROPHOBLASTS). It is characterized by the large amounts of CHORIONIC GONADOTROPIN produced. Tissue origins can be determined by DNA analyses: placental (fetal) origin or non-placental origin (CHORIOCARCINOMA, NON-GESTATIONAL).
Concepts Neoplastic Process (T191)
MSH D002822
ICD10 C58 , M9100/3
SnomedCT 44769000, 189444004, 188188009
English Choriocarcinomas, [M]Choriocarcinoma, [M]Chorioepithelioma, choriocarcinoma, choriocarcinoma (diagnosis), Choriocarcinoma, no ICD-O subtype, chorionepithelioma NOS, choriocarcinoma NOS, Choriocarcinoma [Disease/Finding], Choriocarcinoma NOS, chorionepithelioma, chorioblastoma, Choriocarcinoma, no ICD-O subtype (morphologic abnormality), Choriocarcinoma, no International Classification of Diseases for Oncology subtype (morphologic abnormality), Choriocarcinoma, no International Classification of Diseases for Oncology subtype, chorioepithelioma, CHORIOEPITHELIOMA, CHORIOCARCINOMA, MALIGNANT, chorionic carcinoma, Chorionepithelioma, Chorioepithelioma, Syncytioma, Choriocarcinoma (disorder), Choriocarcinoma, NOS, Choriocarcinoma, Chorioepithelioma NOS, Choriocarcinoma (morphologic abnormality)
Dutch choriocarcinoom NAO, choriocarcinoom, Carcinoom, chorio-, Choriocarcinoom
French Choriocarcinome SAI, Choriocarcinome, Chorio-épithéliome, Carcinome trophoblastique, Chorio-carcinome, Chorioépithéliome
German Choriokarzinom NNB, Choriokarzinom, Chorionepitheliom
Italian Coriocarcinoma NAS, Coriocarcinoma, Corioncarcinoma
Portuguese Coriocarcinoma NE, Coriocarcinoma
Spanish Coriocarcinoma NEOM, (M)corioepitelioma, coriocarcinoma (anomalía morfológica), coriocarcinoma, sin subtipo CIE-O (anomalía morfológica), coriocarcinoma, sin subtipo CIE-O, coriocarcinoma, no clasificado como subtipo en CIE-O, coriocarcinoma, no clasificado como subtipo en CIE-O (anomalía morfológica), coriocarcinoma (trastorno), coriocarcinoma, corioepitelioma, sincicioma, [M]coriocarcinoma, [M]corioepitelioma, Coriocarcinoma
Japanese 絨毛癌NOS, 絨毛癌, ジュウモウガンNOS, ジュウモウガン
Swedish Koriokarcinom
Czech choriokarcinom, Choriokarcinom, Choriokarcinom NOS
Finnish Istukkasyöpä
Russian KHORIONKARTSINOMA, ХОРИОНКАРЦИНОМА
Polish Rak kosmówkowy, Nabłoniak kosmówkowy, Kosmówczak
Hungarian Choriocarcinoma, Choriocarcinoma k.m.n.
Norwegian Koriokarsinom

Ontology: Trophoblastic Neoplasms (C0041182)

Definition (NCI) A gestational or non-gestational neoplasm composed of neoplastic trophoblastic cells. Representative examples include hydatidiform mole and choriocarcinoma.
Definition (MSH) Trophoblastic growth, which may be gestational or nongestational in origin. Trophoblastic neoplasia resulting from pregnancy is often described as gestational trophoblastic disease to distinguish it from germ cell tumors which frequently show trophoblastic elements, and from the trophoblastic differentiation which sometimes occurs in a wide variety of epithelial cancers. Gestational trophoblastic growth has several forms, including HYDATIDIFORM MOLE and CHORIOCARCINOMA. (From Holland et al., Cancer Medicine, 3d ed, p1691)
Concepts Neoplastic Process (T191)
MSH D014328
SnomedCT 134334000, 189858006, 189855009, 115234004
English Trophoblastic Tumor, Tumor, Trophoblastic, Tumors, Trophoblastic, Neoplasms, Trophoblastic, Trophoblastic Neoplasms, Neoplasm, Trophoblastic, Trophoblastic Tumors, Trophoblastic Neoplasm, Trophoblastic neoplasm NOS, Trophoblastic tumor, Trophoblastic tumour, [M]Trophoblastic neoplasm NOS, TROPHOBLASTIC NEOPL, TROPHOBLAST NEOPL, NEOPL TROPHOBLASTIC, [M]Trophoblastic neoplasms, Trophoblastic neoplasms, Neoplasm, Trophoblast, Neoplasms, Trophoblast, Trophoblast Neoplasm, Trophoblast Neoplasms, Trophoblast Tumor, Trophoblast Tumors, Tumor, Trophoblast, Tumors, Trophoblast, Trophoblastic Neoplasms [Disease/Finding], trophoblastic neoplasms, trophoblastic neoplasm, Trophoblastic tumor (qualifier value), [M]Trophoblastic neoplasms (morphologic abnormality), [M]Trophoblastic neoplasm NOS (morphologic abnormality), Trophoblastic tumors, Trophoblastic neoplasm (morphologic abnormality), Trophoblastic neoplasm, trophoblastic tumor, trophoblastic; tumor, tumor; trophoblastic
Swedish Trofoblasttumörer
Czech trofoblastické nádory
Finnish Trofoblastikasvaimet
Russian TROFOBLASTNAIA OPUKHOL', TROFOBLASTNYE NOVOOBRAZOVANIIA, ТРОФОБЛАСТНАЯ ОПУХОЛЬ, ТРОФОБЛАСТНЫЕ НОВООБРАЗОВАНИЯ
Japanese 栄養膜腫瘍, 絨毛性腫瘍, トロホブラスト疾患, トロホブラスト膜腫瘍, 栄養胚芽性腫瘍, 絨毛性疾患
Croatian Not Translated[Trophoblastic Neoplasms]
Polish Nowotwory trofoblastyczne
Norwegian Trofoblastsvulster, Trofoblastneoplasmer, Trofoblasttumorer
Spanish [M]neoplasias trofoblásticas (anomalía morfológica), [M]neoplasia trofoblástica, SAI (anomalía morfológica), tumor trofoblástico, [M]neoplasias trofoblásticas, [M]neoplasia trofoblástica, SAI, tumor trofoblástico (calificador), neoplasia trofoblástica (anomalía morfológica), neoplasia trofoblástica, Tumor Trofoblástico, Neoplasias Trofoblásticas
Dutch trofoblast; tumor, tumor; trofoblast, Gezwel, trofoblast-, Gezwellen, trofoblast-, Trofoblastgezwel, Trofoblastgezwellen, Trofoblasttumor
French Tumeur du trophoblaste, Tumeurs trophoblastiques
German Trophoblasttumoren, Trophoblastentumor
Italian Neoplasie trofoblastiche
Portuguese Neoplasias Trofoblásticas, Tumor Trofoblástico