Gestational trophoblastic disease

Gestational trophoblastic disease (GTD) results from the abnormal proliferation of trophoblastic tissue and encompasses a wide spectrum of diseases, including:

Women older than 40 and younger than 20 may be at higher risk.

Presentation is variable:

A common characteristic of all gestational trophoblastic disease is an abnormal proliferation of trophoblast, but different components predominate in different tumours.

Classification
  • hydatidiform mole
    • complete hydatidiform mole (CHM)
      • commonest (up to 80%) manifestation of GTD
      • 46XX or 46XY: paternal chromosomes only
      • no fetus
      • β-hCG markedly elevated
      • atypia of cells present
      • treatment involves
        • curettage +/- hysterectomy in older women 11
        • follow-up urinary β-hCG for 6-12 months
      • may progress to
    • partial hydatidiform mole (PHM)
      • 69XXX or 69XXY (paternal and maternal chromosomes)
      • may have a fetus or fetal components
      • β-hCG moderately elevated
      • no cellular atypia
  • invasive mole
    • distorts uterine zonal structures
    • boundaries between the tumour and myometrium are irregular and indistinct 3
    • may also invade parametrial tissue and blood vessels 4
  • gestational choriocarcinoma
    • may look identical to hydatidiform mole
    • arises following known molar pregnancy (50%), miscarriage (30%), normal pregnancy (20%)
    • can appear to have less vascularity than an invasive mole
    • higher β-hCG levels even than a complete mole
    • solid component with visualised invasion
    • tends to invade myometrium through venous plexuses
      • patients often can present with multiple metastases without an easily identified primary, as it can often be small in an otherwise normal placenta
    • metastases can occur in
      • lungs: ~80%
      • vagina: ~30%
      • pelvis: 20% 
      • liver and brain: ~10% 12,13
  • placental site trophoblastic tumour (PSTT)
    • rare form
    • produces small amounts of β-hCG
  • epithelioid trophoblastic tumour (ETT) 9
    • extremely rare form
Ultrasound - obstetric
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Article information

rID: 1382
Section: Pathology
Synonyms or Alternate Spellings:
  • Gestational trophoblastic neoplasia
  • Gestational trophoblastic disease (GTD)
  • Gestational trophoblastic tumours
  • Gestational trophoblastic tumors
  • GTD
  • Gestational trophoblastic tumours (GTT)
  • Gestational trophoblastic tumour

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Cases and figures

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    Myometrial Invasi...
    Case 1: invasive mole
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    Uterus   Ovaries
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    Case 2: invasive mole with bilateral theca lutein cysts
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    Heterogeneously e...
    Case 3: hydatidiform mole
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    Case 4: choriocarcinoma
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    Case 5: complete mole on ultrasound
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    Case 5: complete mole on CT
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