Gestational trophoblastic disease
Gestational trophoblastic disease (GTD) results from the abnormal proliferation of trophoblastic tissue and encompasses a wide spectrum of diseases, including:
- hydatidiform mole
- invasive mole ~10%
- choriocarcinoma (gestational choriocarcinoma) ~1%
- placental site trophoblastic tumor (PSTT)
- epithelioid trophoblastic tumor (ETT)
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
-
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
- invasive mole: ≈15%
- choriocarcinoma: ≈5%
-
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)
-
invasive mole
- 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 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
-
placental site trophoblastic tumor (PSTT)
- rare form
- produces small amounts of β-hCG
-
epithelioid trophoblastic tumor (ETT) 9
- extremely rare form
Related Radiopaedia articles
First trimester of pregnancy
-
first trimester
- ultrasound findings in early pregnancy
- confirming intrauterine gestation
- pregnancy of unknown location (PUL)
- first trimester vaginal bleeding
- early structural scan
- aneuploidy testing
Ultrasound - obstetric
- ultrasound (introduction)
- obstetric ultrasound
- first trimester and early pregnancy
- ectopic pregnancy
- multiple gestations
- subchorionic hematoma
- failed early pregnancy
-
second trimester
- fetal biometry
- fetal morphology assessment
- fetal echocardiography views
- non-visualization of the fetal stomach
-
soft markers
- nuchal fold thickness
- ventriculomegaly
- absent nasal bone
- choroid plexus cysts
- enlarged cisterna magna
- shortened fetal long bones
- echogenic intracardiac focus (EIF)
- echogenic fetal bowel
- aberrant right subclavian artery
- fetal pyelectasis / fetal renal pelvic dilatation
- single umbilical artery
- sandal gap toes
- amnioreduction
- Doppler ultrasound
- nuchal translucency
- 11-13 weeks antenatal scan
- chorionic villus sampling (CVS) and amniocentesis
- placenta
- other