Clinical Aspects

A. Pregnancy-Gestational Neoplasms

Gestational neoplasms are the group of related tumors that can occur as a consequence of pregnancy. Morphologically, gestational tumors can be categorized as (i) a hydatidiform mole occurring after a molar pregnancy and (ii) a choriocarcinoma, which can occur following any kind of gestation.

A hydatidiform mole is a gestational neoplasm that occurs as the trophoblast initiates the implantation process in the uterine endometrium. Normal fetal vascularity is lost, and the trophoblastic cells surrounding the villi show varying degrees of proliferation. Choriocarcinoma represents the more malignant histological type of gestational neoplasm.

The incidence of gestational neoplasms is low: 1 in 2000 to 1 in 15,000. Further, of 900 patients studied at the New England Trophoblastic Disease Center, 71% had a molar pregnancy, and in the remaining 29% there was no evidence of metastases; an overall cure rate of 93% was achieved.

In instances of molar pregnancy and choriocarcinoma there is frequently massive production of human chorionic gonadotropin (hCG). Thus, plasma determination of hCG is quite useful for diagnosis as well as for evaluation of the success of management of the disease.

B. Anomalies of Sex Determinants

There is an extremely wide spectrum of endocrine disorders that may arise from perturbations in the many processes contributing to sexual organization. Thus, there are clinical problems present at each level of sex definition, that is, genetic sex, gonadal sex, somatic sex, and phenotypic sex (see Table 14-4). It is beyond the scope of this chapter to consider other than a few of these disorders

Hormones, Second Edition

Baby first cried

Periods of suckling ZZZZZ

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