• Clinical science

Gestational trophoblastic disease (Trophoblastic tumors)

Abstract

Gestational trophoblastic diseases (GTD) include hydatidiform moles (both complete and partial), invasive moles, and choriocarcinoma. They typically arise from the abnormal fertilization of the ovum. Hydatidiform moles are benign, whereas invasive moles and choriocarcinoma are malignant lesions with a tendency to metastasize to other organs, especially the lungs. Patients with GTD frequently present with vaginal bleeding and pelvic tenderness. Complete hydatidiform moles are associated with several additional clinical features (e.g., enlarged uterus, hyperemesis gravidarum, preeclampsia). Diagnosis is established based on a significantly elevated serum β-HCG and ultrasound findings (e.g., a mass that resembles a bunch of grapes in complete hydatidiform moles). If malignancy is suspected, workup must include an x-ray of the chest to screen for lung metastases. Hydatidiform moles are normally treated via dilation and curettage, whereas choriocarcinoma typically requires chemotherapy.

Hydatidiform mole

Definition

  • Classified as complete or partial moles (see “Etiology” below)
  • Benign trophoblastic disease
  • Proliferates within the uterus without myometrial infiltration or hematogenic dissemination
  • May develop malignant traits and become an invasive mole

Etiology

Complete mole is the result of paternal disomy!
Partial mole is the result of triploidy!

Pathophysiology

Clinical features

Diagnostics

  • Laboratory tests: β-HCG level measurement (initial test of choice); , which should reveal β-HCG that is markedly elevated (higher than expected for the gestational age)
  • Transvaginal ultrasound
  • Uterine evacuation: (for definite diagnosis and treatment): histopathological examination of evacuated uterine specimen (also see “Treatment” below)
  • Chest x-ray: in case of dyspnea or chest pain

Some moles may not produce HCG at all!

Treatment

  • Uterine evacuation by dilation and suction curettage: Complete moles have a 20% risk of becoming invasive and a 2% risk of developing into choriocarcinoma. Therefore, complete evacuation of the uterine cavity is the mainstay of treatment.
  • Monitor β-HCG levels until in reference range (usually 8–12 weeks)
  • Chemotherapy (usually methotrexate) if unresolved, as indicated by any of the following:
    • β-HCG values do not decrease.
    • Histological features of malignant GTD are present.
    • If metastases are present on chest x-ray.

Prognosis

  • Most patients achieve normal reproductive function after recovery.

References:[1][2][3][4][5][6]

Choriocarcinoma

Definition

  • Highly aggressive, malignant tumor consisting of trophoblastic tissue
  • Exhibits histological signs of malignancy and a tendency to metastasize early

Etiology

Choriocarcinoma only develops after fertilization and implantation of the egg; . Most cases of choriocarcinoma are preceded by a hydatidiform mole:

Pathophysiology

Clinical features

Diagnostics

Treatment

Prognosis

  • Cure rate of 95–100%; worse prognosis in the case of advanced-stage disease

References:[1][1][5][7][8][9][10][11]