Gestational trophoblastic disease

Last updated: June 19, 2023

Summarytoggle arrow icon

Gestational trophoblastic disease (GTD) is a class of neoplastic conditions characterized by abnormal trophoblast-cell growth in the uterus. GTD is classified into hydatidiform moles (molar pregnancy), which are subclassified into complete and partial moles, and gestational trophoblastic neoplasia (GTN), which is subclassified into choriocarcinoma, invasive moles, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Hydatidiform moles are benign but have a malignant potential, whereas GTN are malignant lesions with a tendency to metastasize, especially to the lungs. Typical symptoms of GTD are vaginal bleeding and pelvic tenderness. Additional features of complete moles include enlarged uterus, hyperemesis gravidarum, and preeclampsia. Diagnosis of GTD is established on the basis of significantly elevated serum β-HCG and ultrasound findings. If GTN is suspected, workup must include x-ray of the chest to screen for lung metastases. Hydatidiform moles are typically treated via suction evacuation and curettage, whereas GTN treatment typically starts with chemotherapy.

Overviewtoggle arrow icon

Hydatidiform mole

A type of GTD resulting from abnormal fertilization of an egg that can invade the uterus and metastasize

Gestational trophoblastic neoplasia (GTN)

A type of malignant GTD characterized by a high risk of local invasion and metastasis

Overview of gestational trophoblastic disease
Hydatidiform mole Gestational trophoblastic neoplasia
Partial mole Complete mole Invasive mole Choriocarcinoma


  • Malignant transformation of cytotrophoblastic and syncytiotrophoblastic tissue
Clinical features
Diagnostics β-hCG
  • Increased in all types (GTN > complete mole > partial mole)
Histopathological exam Microscopy
  • Partial occurrence of hydropic villi, minimal trophoblastic proliferation
  • Diffuse hydropic villi, marked circumferential trophoblastic proliferation
P57 staining
  • Positive
  • Negative
  • N/A
  • Most patients achieve normal reproductive function after recovery.
  • Risk of GTN (15–20%)
  • Risk of recurrence < 1%

The risk of malignant GTN is higher in complete mole than in partial mole.

Hydatidiform moletoggle arrow icon

General principles [2]

Preeclampsia at < 20 weeks should raise suspicion for GTD.

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

Complete mole [2]

Partial mole

Fetal parts may be present in partial moles.

Some moles may not produce HCG at all. [9]

Gestational trophoblastic neoplasiatoggle arrow icon

Choriocarcinoma [2]

Invasive mole [2]

Referencestoggle arrow icon

  1. Soper JT. Gestational Trophoblastic Disease. Obstetrics & Gynecology. 2021; 137 (2): p.355-370.doi: 10.1097/aog.0000000000004240 . | Open in Read by QxMD
  2. Ngan HYS, Seckl MJ, Berkowitz RS, et al. Update on the diagnosis and management of gestational trophoblastic disease. International Journal of Gynecology & Obstetrics. 2018; 143: p.79-85.doi: 10.1002/ijgo.12615 . | Open in Read by QxMD
  3. 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
  4. Sebire NJ, Fisher RA, Foskett M, Rees H, Seckl MJ, Newlands ES. Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. BJOG: An International Journal of Obstetrics and Gynaecology. 2003; 110 (1): p.22-26.doi: 10.1046/j.1471-0528.2003.02388.x . | Open in Read by QxMD
  5. 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
  6. Cole LA. Biological functions of hCG and hCG-related molecules. J Endocrinol Reprod. 2010; 8 (1): p.102.doi: 10.1186/1477-7827-8-102 . | Open in Read by QxMD
  7. Placenta - Gestational trophoblastic disease - Complete hydatidiform mole. Updated: August 13, 2020. Accessed: August 25, 2020.
  8. Jauniaux E. Ultrasound diagnosis and follow-up of gestational trophoblastic disease. Ultrasound in Obstetrics and Gynecology. 1998; 11 (5): p.367-377.doi: 10.1046/j.1469-0705.1998.11050367.x . | Open in Read by QxMD
  9. Nodler JL, Kim KH, Alvarez RD. Abnormally low hCG in a complete hydatidiform molar pregnancy: The hook effect. Gynecologic Oncology Case Reports. 2011; 1 (1): p.6-7.doi: 10.1016/j.gynor.2011.10.003 . | Open in Read by QxMD
  10. Uterine choriocarcinoma. . Accessed: April 27, 2017.
  11. Complete Molar Gestation: Role of Ultrasound. . Accessed: April 27, 2017.
  12. Berkowitz RS, Goldstein DP, Horowitz NS. Initial management of high-risk gestational trophoblastic neoplasia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: April 6, 2017. Accessed: April 27, 2017.
  13. Berkowitz RS, Goldstein DP, Horowitz NS. Initial management of low-risk gestational trophoblastic neoplasia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: September 12, 2016. Accessed: April 27, 2017.
  14. 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

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