Gestational trophoblastic disease
Last revised by Wedyan Yousef Alrasheed on 4 Feb 2023
Citation, DOI, disclosures and article data
Citation:
Gaillard F, Alrasheed W, Ashraf A, et al. Gestational trophoblastic disease. Reference article, Radiopaedia.org (Accessed on 19 Mar 2024) https://doi.org/10.53347/rID-1382
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rID:
1382
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Disclosures:
At the time the article was created Frank Gaillard had no recorded disclosures.
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Last revised:
4 Feb 2023,
Wedyan Yousef Alrasheed
Disclosures:
At the time the article was last revised Wedyan Yousef Alrasheed had no financial relationships to ineligible companies to disclose.
View Wedyan Yousef Alrasheed's current disclosures
Revisions:
28 times, by
23 contributors -
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Systems:
Tags:
Synonyms:
- Gestational trophoblastic neoplasia
- Gestational trophoblastic disease (GTD)
- Gestational trophoblastic tumours
- Gestational trophoblastic tumors
- GTD
- Gestational trophoblastic tumours (GTT)
- Gestational trophoblastic tumour
Gestational trophoblastic disease (GTD) results from the abnormal proliferation of trophoblastic tissue and encompasses a wide spectrum of diseases, including 14:
- tumor-like lesions
- exaggerated placental site reaction
- placental site nodule and plaque
- abnormal (non-molar) villous lesions
- molar pregnancies
- gestational trophoblastic neoplasms
- epithelioid trophoblastic tumor
- placental site trophoblastic tumor
- gestational choriocarcinoma
- mixed trophoblastic tumor
On this page:
Epidemiology
Women older than 40 years and younger than 20 years may be at higher risk.
Clinical presentation
The presentation is variable:
- uterus larger than pregnancy age
- abnormally high β-hCG
- hyperemesis
- hypertension
- theca-lutein cysts
Pathology
A common characteristic of all gestational trophoblastic disease is an abnormal proliferation of trophoblast, but different components predominate in different tumors.
Classification
Molar pregnancies:
-
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
-
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
- invasive mole: ≈15%
- choriocarcinoma: ≈5%
-
invasive and metastatic hydatidiform moles
- distorts uterine zonal structures
- boundaries between a tumor and myometrium are irregular and indistinct 3
- may also invade parametrial tissue and blood vessels 4
Gestational trophoblastic neoplasms (GTN):
-
placental site trophoblastic tumor (PSTT)
- rare form
- produces small amounts of β-hCG
- raise human placental lactogen (hPL) levels
-
epithelioid trophoblastic tumor (ETT) 9
- extremely rare form
-
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 the visualized 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
- mixed trophoblastic tumor
References
- 1. Chudleigh P, Thilaganathan B, Chudleigh T. Obstetric ultrasound, how, why and when. Churchill Livingstone. (2004) ISBN:0443054711. Read it at Google Books - Find it at Amazon
- 2. Wagner BJ, Woodward PJ, Dickey GE. From the archives of the AFIP. Gestational trophoblastic disease: radiologic-pathologic correlation. Radiographics. 1996;16 (1): 131-48. Radiographics (abstract) - Pubmed citation
- 3. Nagayama M, Watanabe Y, Okumura A et-al. Fast MR imaging in obstetrics. Radiographics. 22 (3): 563-80. Radiographics (full text) - Pubmed citation
- 4. Jung SE, Byun JY, Lee JM et-al. MR imaging of maternal diseases in pregnancy. AJR Am J Roentgenol. 2001;177 (6): 1293-300. AJR Am J Roentgenol (full text) - Pubmed citation
- 5. Green CL, Angtuaco TL, Shah HR et-al. Gestational trophoblastic disease: a spectrum of radiologic diagnosis. Radiographics. 1996;16 (6): 1371-84. Radiographics (abstract) - Pubmed citation
- 6. Allen SD, Lim AK, Seckl MJ et-al. Radiology of gestational trophoblastic neoplasia. Clin Radiol. 2006;61 (4): 301-13. doi:10.1016/j.crad.2005.12.003 - Pubmed citation
- 7. Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010;376 (9742): 717-29. doi:10.1016/S0140-6736(10)60280-2 - Pubmed citation
- 8. Narlawar RS, Shah J, Patkar D. Images in radiology: complete hydatidiform mole with live pregnancy in a twin gestation. J Postgrad Med. 46 (4): 291-2. J Postgrad Med (link) - Pubmed citation
- 9. Shih IM, Kurman RJ. Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma. Am. J. Surg. Pathol. 1998;22 (11): 1393-403. Am. J. Surg. Pathol. (link) - Pubmed citation
- 10. Preidler KW, Luschin G, Tamussino K et-al. Magnetic resonance imaging in patients with gestational trophoblastic disease. Invest Radiol. 1996;31 (8): 492-6. Invest Radiol (link) - Pubmed citation
- 11. Cavaliere A, Ermito S, Dinatale A et-al. Management of molar pregnancy. J Prenat Med. 2012;3 (1): 15-7. Free text at pubmed - Pubmed citation
- 12. Piura E, Piura B. Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature. European journal of gynaecological oncology. 35 (4): 359-67. Pubmed
- 13. Dhanda S, Ramani S, Thakur M. Gestational trophoblastic disease: a multimodality imaging approach with impact on diagnosis and management. Radiology research and practice. 2014: 842751. doi:10.1155/2014/842751 - Pubmed
- 14. W. H. O. Classification WHO Classification of Tumours Editorial Board, Who Classification of Tumours Editorial. Female Genital Tumours: Who Classification of Tumours. (2020) ISBN: 9789283245049 - Google Books
Incoming Links
Articles:
- Enhanced myometrial vascularity
- Ovarian hyperstimulation syndrome
- Fetal MRI
- Empty gestational sac
- Early pregnancy
- Antepartum haemorrhage
- Theca lutein cyst
- Pulmonary hypertension (differential)
- Choriocarcinoma
- Hydropic degeneration of the placenta
- Hyperthyroidism
- Differential diagnosis for PV bleeding in pregnancy
- Gestational choriocarcinoma
- Invasive mole
- Obstetric curriculum
- Simple hydropic degeneration of the placenta
- Molar pregnancy
- Placental site trophoblastic tumour
- Retained products of conception
- WHO classification of uterine tumours
Cases:
- Gestational trophoblastic disease - choriocarcinoma
- Complete hydatidiform mole
- Complete hydatidiform mole
- Pneumatometra
- Metastatic lung nodules
- Uterine arteriovenous malformation
- Hydatidiform mole
- Invasive mole
- Molar pregnancy
- Partial molar pregnancy
- Partial hydatidiform mole
- Complete hydatidiform mole
- Complete hydatidiform mole
- Gestational trophoblastic disease - invasive mole
- Complete hydatidiform mole
- Complete molar pregnancy and coexisting live fetus
- Complete hydatidiform mole
- Complete hydatidiform mole with bilateral theca lutein cysts
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first trimester
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-
second trimester
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first trimester
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