Gestational Trophoblastic Disease: Current Evaluation and Management
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( Obstet Gynecol . 2021;137:355–370) Gestational trophoblastic disease (GTD) refers to rare disease processes originating from the placenta that require timely and appropriate management. GTD includes partial or complete hydatidiform moles (HM), as well as severe gestational trophoblastic neoplasia (GTN) and related tumors. Obstetrician-gynecologists are more likely to be involved in the care of women with HM or who have unclear diagnosis related to human chorionic gonadotropin (hCG).Keywords:
Gestational Trophoblastic Disease
Gestational trophoblastic neoplasia
Human chorionic gonadotropin
Expectant management
Partial Hydatidiform Mole
Placenta Diseases
Gonadotropin
Molar Pregnancy
Gestational trophoblastic neoplasia
Gestational Trophoblastic Disease
Trophoblastic Tumor
Partial Hydatidiform Mole
Trophoblastic neoplasm
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Partial Hydatidiform Mole
Placenta Diseases
Trophoblastic Tumor
Mole
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Gestational trophoblastic disease is a spectrum of interrelated abnormal proliferations of the placental trophoblast, encompassing benign hydatidiform moles (complete and partial) as well as gestational trophoblastic neoplasia, which includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and its related epithelioid trophoblastic tumor. Early detection of hydatidiform moles with ultrasonography and advances in uterine evacuation techniques have decreased serious bleeding and medical complications of molar pregnancy. The availability of accurate tests for measuring human chorionic gonadotropin as a disease-specific tumor marker and the introduction of chemotherapy into the management of gestational trophoblastic neoplasia have significantly reduced deaths so that the overall cure rate in treating these tumors is greater than 90% even in the presence of widely metastatic disease.
Partial Hydatidiform Mole
Gestational Trophoblastic Disease
Trophoblastic Tumor
Molar Pregnancy
Gestational trophoblastic neoplasia
Human chorionic gonadotropin
Trophoblastic neoplasm
Trophoblast
Gonadotropin
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Gestational trophoblastic disease is a spectrum of abnormal proliferations of the placental trophoblast encompassing four main clinicopathologic forms: hydatidiform mole (complete and partial), invasive mole, choriocarcinoma, and placental site trophoblastic tumor and its related epithelioid trophoblastic tumor. The latter three conditions are collectively referred to as gestational trophoblastic neoplasia and have varying degrees of malignant potential. Early detection of hydatidiform moles with ultrasonography, advances in uterine evacuation techniques, the use of human chorionic gonadotropin as a disease-specific tumor marker, and the introduction of chemotherapy into the management of gestational trophoblastic neoplasia has significantly decreased the risk of death from gestational trophoblastic disease. This chapter will describe the epidemiology, pathology, clinical presentation and diagnosis of each of these trophoblastic disease variants.
Gestational Trophoblastic Disease
Partial Hydatidiform Mole
Trophoblastic Tumor
Gestational trophoblastic neoplasia
Human chorionic gonadotropin
Trophoblastic neoplasm
Trophoblast
Molar Pregnancy
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Gestational Trophoblastic Disease
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Gestational Trophoblastic Disease
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This chapter provides the background information of the gestational trophoblastic disease (GTD), and discusses its prevention, diagnosis, treatment, and prognosis. GTD comprises a spectrum of premalignant to malignant conditions that originate from the placenta. Histologically distinct diseases within the spectrum of GTD include complete and partial hydatidiform moles (premalignant) to invasive moles, gestational choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Effective birth control can prevent this disease. The most common symptom is abnormal vaginal bleeding. Transvaginal ultrasonography is used to establish the diagnosis of molar pregnancy in combination with abnormally high level of human chorionic gonadotropin (hCG) (>100 000 mIU/mL). Serial monitoring of hCG is used for identification of postmolar gestational trophoblastic neoplasia. Patients with nonmetastatic GTN (Stage I) or low-risk metastatic GTN (Stage II or III) can be treated with single-agent chemotherapy.
Gestational Trophoblastic Disease
Trophoblastic Tumor
Molar Pregnancy
Partial Hydatidiform Mole
Gestational trophoblastic neoplasia
Human chorionic gonadotropin
Vaginal bleeding
Trophoblastic neoplasm
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Gestational Trophoblastic Disease (GTD) originates from placental tissue and is among the rare human tumors that can be cured even in the presence of widespread metastases. GTD include a spectrum of interrelated tumors including complete and partial hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor, that have different propensities for local invasion and spread. Although most GTD develop after a mole, they can follow any antecedent pregnancy.Transvaginal ultrasound, routinary dosage of beta-hCG and current approaches to chemotherapy, let most women with malignant gestational trophoblastic disease to be cured and their reproductive function preserved.
Partial Hydatidiform Mole
Molar Pregnancy
Gestational Trophoblastic Disease
Mole
Trophoblastic Tumor
Gestational trophoblastic neoplasia
Trophoblastic neoplasm
Trophoblast
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Placental site trophoblastic tumor (PSTT) is the rarest form of Gestational Trophoblastic Neoplasia (GTN). We present this case of uterine PSTT to illustrate the difficulties in the diagnosis of this tumor and how this led to delay in its appropriate management..
Trophoblastic Tumor
Gestational trophoblastic neoplasia
Trophoblastic neoplasm
Placenta Diseases
Gestational Trophoblastic Disease
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Molar Pregnancy
Gestational Trophoblastic Disease
Gestational trophoblastic neoplasia
Partial Hydatidiform Mole
Trophoblastic Tumor
Trophoblastic neoplasm
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