Oncology and Fibroids
Recurrence of Gestational trophoblastic tumour can be associated with all except? (AIPG 2010)
|B||Persistence leutine cyst in ovaries|
|C||Plateu of HCG|
|D||Sub urethral nodule|
Plateau of HCG
1. Signs and Symptoms:-
a. Irregular vaginal bleeding, sometimes brisk.
b. Offensive, purulent discharge
c. Persistant illhealth
d. Continued amenorrhea due to very high levels of HCG secreted by the metastatic growth outside the uterus.
e. Symptoms of lung metastasis cough, dyspnoea haemoptysis and chest pain.
f. Headache, convulsions, paralysis coma due to brain metastasis
g. Irregular and brisk bleeding due to vaginal metastasis.
h. Epigasthic pain & Jaundice due to liver metastasis
i. Uterine enlargement
j. Purple haemorrhagic projections within vagina due to retrograde spread along venous channels of vaginal plexus.
k. PV examination reveals subinvolution of uterus , purplish red nodule, U/L or B/L enlarged ovaries.
a. No choronic villi is present. Growth consists of embryonic synctium, cytotrophoblast and degenerated blood cells. There is invasion of uterine wall.
a. Excess of 2 mIU/ ml in serum is of value if pregnancy is excludeD. If after a pregnancy serum HCG titres remain elevated or become positive after a negative report it is highly suggestive of developing choriocarcinomA. Metastatic brain lesion is suspected when the ratio of HCG in spinal fluid/ serum is more than 1:60.
b. Diagnostic Curretage reveals characteristic pathological changes. Caution is required because very brisk haemorrhge can occurs.
c. X-Ray Chest – Cannon ball appearance dur to secondaries
d. USG - diagnosis is confirmed
e. For metastatic lesions of:-
i. Vaginal noduces :- Excisional biopsy
ii. Brain:- HCG levels in spinal fluid & serum, CT scan , MRI
iii. Liver – CT scan
4. Vesicular mole is a pre malignant condition & can develop into choriocarcinomA.
5. In case of transformation of a molar pregnancy to choriocarcinoma the following features are seen:
a. Subinvolution of the uterus. The uterus remains enlarged & does not return back to normal size
b. Rising levels of HCG.(not plateau)
c. Theca leutin cysts will persist.
d. Sites of metastasis
e. Vagina: bluish nodule in the sub urethra region, irregular bleeding, purulent discharge