Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image

amboss

Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Gestational trophoblastic disease

Last updated: February 23, 2021

Summarytoggle arrow icon

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.

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

Fetal parts may be present in partial moles.

Some moles may not produce HCG at all.

Treatment

Prognosis

Definition

Etiology [7]

Pathophysiology

Clinical features

Diagnostics [8]

Treatment [10]

Prognosis

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

  1. Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid. 1995; 5 (5): p.425-434. doi: 10.1089/thy.1995.5.425 . | Open in Read by QxMD
  2. Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy.. N Engl J Med. 2009; 360 (16): p.1639-45. doi: 10.1056/NEJMcp0900696 . | Open in Read by QxMD
  3. Placenta - Gestational trophoblastic disease - Complete hydatidiform mole. http://www.pathologyoutlines.com/topic/placentacompletemole.html. Updated: August 13, 2020. Accessed: August 25, 2020.
  4. Berkowitz RS, Goldstein DP, Horowitz NS. Hydatidiform mole: Epidemiology, clinical features, and diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/hydatidiform-mole-epidemiology-clinical-features-and-diagnosis.Last updated: April 14, 2017. Accessed: April 27, 2017.
  5. Berkowitz RS, Goldstein DP, Horowitz NS. Hydatidiform mole: Management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/hydatidiform-mole-management.Last updated: April 14, 2017. Accessed: April 27, 2017.
  6. Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. 2010; 203 (6): p.531-539. doi: 10.1016/j.ajog.2010.06.073 . | Open in Read by QxMD
  7. Berkowitz RS, Goldstein DP, Horowitz NS. Gestational trophoblastic neoplasia: Epidemiology, clinical features, diagnosis, staging, and risk stratification. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/gestational-trophoblastic-neoplasia-epidemiology-clinical-features-diagnosis-staging-and-risk-stratification.Last updated: April 19, 2017. Accessed: April 27, 2017.
  8. Uterine choriocarcinoma. https://radiopaedia.org/articles/uterine-choriocarcinoma. . Accessed: April 27, 2017.
  9. Complete Molar Gestation: Role of Ultrasound. https://sonoworld.com/ArticleDetails/Complete_Molar_Gestation__Role_of_Ultrasound.aspx?ArticleId=15. . Accessed: April 27, 2017.
  10. Berkowitz RS, Goldstein DP, Horowitz NS. Initial management of high-risk gestational trophoblastic neoplasia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/initial-management-of-high-risk-gestational-trophoblastic-neoplasia.Last updated: April 6, 2017. Accessed: April 27, 2017.
  11. Berkowitz RS, Goldstein DP, Horowitz NS. Initial management of low-risk gestational trophoblastic neoplasia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/initial-management-of-low-risk-gestational-trophoblastic-neoplasia.Last updated: September 12, 2016. Accessed: April 27, 2017.
  12. Le T, Bhushan V, Sochat M, Petersen M, Micevic G, Kallianos K. First Aid for the USMLE Step 1 2014. McGraw-Hill Medical ; 2014
  13. Moore LE. Hydatidiform Mole. Hydatidiform Mole. New York, NY: WebMD. http://emedicine.medscape.com/article/254657-overview#showall. Updated: November 15, 2016. Accessed: April 27, 2017.
  14. Hernandez E. Gestational Trophoblastic Neoplasia. Gestational Trophoblastic Neoplasia. New York, NY: WebMD. http://emedicine.medscape.com/article/279116-overview. Updated: March 5, 2015. Accessed: April 27, 2017.
  15. Le T, Bhushan V,‎ Sochat M, Chavda Y, Abrams J, Kalani M, Kallianos K, Vaidyanathan V. First Aid for the USMLE Step 1 2019. McGraw-Hill Medical
  16. Getrajdman J, Kolev V, Brody E, Chuang L. Case of maternal and infantile choriocarcinoma following normal pregnancy. Gynecologic Oncology Case Reports. 2012; 2 (3): p.102-104. doi: 10.1016/j.gynor.2012.05.002 . | Open in Read by QxMD