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Gestational trophoblastic disease

Last revised by Yahya Baba ◉ on 22 Mar 2024

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Baba Y, Alrasheed W, et al. Gestational trophoblastic disease. Reference article, Radiopaedia.org (Accessed on 06 Dec 2024) https://doi.org/10.53347/rID-1382

DOI:

https://doi.org/10.53347/rID-1382

Permalink:

https://radiopaedia.org/articles/1382

rID:

1382

Article created:

2 May 2008, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

22 Mar 2024, Yahya Baba ◉

Disclosures:

At the time the article was last revised Yahya Baba had no financial relationships to ineligible companies to disclose.

View Yahya Baba's current disclosures

Revisions:

29 times, by 24 contributors - see full revision history and disclosures

Systems:

Obstetrics, Gynaecology, Oncology

Tags:

obstetric, ultrasound

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

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. Patricia Chudleigh, Basky Thilaganathan. Obstetric Ultrasound. (2004) ISBN: 0443054711 - Google Books
2. Wagner B, Woodward P, Dickey G. From the Archives of the AFIP. Gestational Trophoblastic Disease: Radiologic-Pathologic Correlation. Radiographics. 1996;16(1):131-48. doi:10.1148/radiographics.16.1.131 - Pubmed
3. Nagayama M, Watanabe Y, Okumura A, Amoh Y, Nakashita S, Dodo Y. Fast MR Imaging in Obstetrics. Radiographics. 2002;22(3):563-80; discussion 580. doi:10.1148/radiographics.22.3.g02ma03563 - Pubmed
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

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Gestational trophoblastic disease

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