Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-2xdlg Total loading time: 0 Render date: 2024-07-03T11:18:10.260Z Has data issue: false hasContentIssue false

Chapter 8 - Gestational Trophoblastic Disease

from Section 2 - Early Pregnancy Problems

Published online by Cambridge University Press:  20 November 2021

Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Gestational trophoblastic disease (GTD) is due to the abnormal and uncontrolled proliferation of the trophoblastic cells in a pregnancy. It encompasses a spectrum of conditions from benign hydatidiform mole to invasive mole and malignant choriocarcinoma and the rarer forms of placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). The malignant forms of the disease, i.e. choriocarcinoma, PSTT and ETT, are collectively known as gestational trophoblastic neoplasia (GTN).

Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Obstetrics & Maternal-Fetal Medicine
, pp. 64 - 72
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jia, N, Chen, Y, Tao, X, et al. A gestational choriocarcinoma of the ovary diagnosed by DNA polymorphic analysis: a case report and systematic review of the literature. J Ovarian Res. 2017;10:46.Google Scholar
Savage, J, Adams, E, Veras, E, Murphy, KM, Ronnett, BM. Choriocarcinoma in women: analysis of a case series with genotyping. Am J Surg Pathol. 2017;41:15931606.CrossRefGoogle ScholarPubMed
Seckl, MJ, Sebire, NJ, Berkowitz, RS. Gestational trophoblastic disease. Lancet. 2010;376:717–29.Google Scholar
Seckl, MJ, Fisher, RA, Salerno, G, et al. Choriocarcinoma and partial hydatidiform moles. Lancet. 2000; 356: 36–9.CrossRefGoogle ScholarPubMed
Hassadia, A, Gillespie, A, Tidy, J, et al. Placental site trophoblastic tumour: clinical features and management. Gynecol Oncol. 2005;99:603–7.CrossRefGoogle ScholarPubMed
Vang, R, Gupta, M, Wu, LSF, et al. Diagnostic reproducibility of hydatidiform moles: ancillary techniques (p57 immunohistochemistry and molecular genotyping) improve morphologic diagnosis. Am J Surg Pathol. 2012;36:443–53.CrossRefGoogle ScholarPubMed
Hoffner, L, Surti, U. The genetics of gestational trophoblastic disease: a rare complication of pregnancy. Cancer Genet. 2012;205:6377.Google Scholar
Fukunaga, M, Ushigome, S. Malignant trophoblastic tumors: immunohistochemical and flow cytometric comparison of choriocarcinoma and placental site trophoblastic tumors. Hum Pathol. 1993;24:10981106.Google Scholar
Bagshawe, KD, Golding, PR, Orr, AH. Choriocarcinoma after hydatidiform mole. Studies related to effectiveness of follow-up practice after hydatidiform mole. Br Med J. 1969;3(5673):733–7.Google Scholar
Baergen, RN, Rutgers, J, Young, RH. Extrauterine lesions of intermediate trophoblast. Int J Gynecol Pathol. 2003;22:362–7.CrossRefGoogle ScholarPubMed
Fadare, O, Parkash, V, Carcangiu, ML, Hui, P. Epithelioid trophoblastic tumour: clinicopathological features with an emphasis on uterine cervical involvement. Mod Pathol. 2006;19:7582.Google Scholar
Ngan, HY, Bender, H, Benedet, JL, et al. Gestational trophoblastic neoplasia, FIGO 2000 staging and classification. Int J Gynecol Obstet. 2003;83:175–7.Google Scholar
Ngan, HY, Seckyl, MJ, Berkowitz, RS, et al. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynecol Obstet. 2018;143(Suppl 2):7985.Google Scholar
Hancock, BW, Newlands, ES, Berkowitz, RS. Gestational Trophoblastic Disease. London: Chapman & Hall Medical; 1997.Google Scholar
Mangili, G, Lorusso, D, Brown, J, et al. Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Int J Gynecol Cancer. 2014;24(9 Suppl 3):S109–16.Google Scholar
McConnell, TG, Murphy, KM, Hafez, M, Vang, R, Ronnett, BM. Diagnosis and subclassification of hydatidiform moles using p57 immunohistochemistry and molecular genotyping: validation and prospective analysis in routine and consultation practice settings with development of an algorithm approach. Am J Surg Pathol. 2009;33:805–17.Google Scholar
Lewis, GH, DeScipio, C, Murphy, KM, et al. Characterisation of androgenetic/biparental mosaic/chimeric conceptions, including those with a molar component: morphology, p57 immunohistochemistry, molecular genotyping, and risk of persistent gestational disease. Int J Gynecol Pathol. 2013;32:199214.Google Scholar
Tidy, JA, Gilliespie, AM, Bright, N, et al. Gestational trophoblastic disease: a study of mode of evacuation and subsequent need for treatment with chemotherapy. Gynecol Oncol. 2000;78:309–12.Google Scholar
Cole, LA. hCG, its free subunits and its metabolites. Roles in pregnancy and trophoblastic disease. J Reprod Med. 1998;43:310.Google ScholarPubMed
Sturgeon, CM, Berger, P, Bidart, JM, et al. Differences in recognition of the 1st WHO International Reference Reagents for hCG-related isoforms by diagnostic immunoassays for human chorionic gonadotropin. Clin Chem. 2009;55(8):1484–91.Google Scholar
Lybol, C, Sweep, FC, Ottevanger, PB, Massuger, LF, Thomas, CM. Linear regression of post evacuation serum human chorionic gonadotropin concentrations predicts postmolar gestational trophoblastic neoplasia. Int J Gynecol Cancer. 2013;23:1150–6.Google Scholar
Earp, K, Hancock, BW, Short, D, et al. Do we need post-pregnancy human chorionic gonadotrophin screening after previous molar pregnancy to identify patients with recurrent gestational trophoblastic disease? Eur J Obstet Gynecol Reprod Biol. 2019;234:117–19.CrossRefGoogle ScholarPubMed
Agarwal, R, Strickland, S, McNeish, IA, et al. Doppler ultrasonography of the uterine artery and the response to chemotherapy in patients with gestational trophoblastic tumours. Clin Cancer Res. 2002;8:1142–7.Google Scholar
McNeish, IA, Strickland, S, Holden, L, et al. Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol. 2002;20:1838–44.Google Scholar
Alazzam, M, Tidy, J, Osborne, R, et al. Chemotherapy for resistant or recurrent gestational trophoblastic neoplasia. Cochrane Database Syst Rev. 2012;2012(12). DOI: 10.1002/14651858.CD008891.pub3.Google Scholar
Ghorani, E, Kaur, B, Fisher, RA, et al. Pembrolizumab is effective for drug resistant gestational trophoblastic neoplasia. Lancet. 2017;390;2344–5.Google Scholar
Stockton, L, Green, E, Kaur, B, De Winton, E. Non-gestational choriocarcinoma with widespread metastases presenting with type 1 respiratory failure in a 39-year-old female: case report and review of the literature. Case Rep Oncol. 2018;11:151–8.Google Scholar
Osborne, R, Filiaci, V, Schink, JC, et al. Second curettage for low-risk nonmetastatic gestational trophoblastic neoplasia. Obset Gynecol. 2016;128:535–42.CrossRefGoogle ScholarPubMed
Chiofalo, B, Palmara, V, Laganà, AS, et al. Fertility sparing strategies in patients affected by placental site trophoblastic tumour. Curr Treat Options Oncol. 2017;18:58.CrossRefGoogle Scholar
Sebire, NJ, Fisher, RA, Foskett, M, et al. Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. BJOG. 2003;110:22–6.Google Scholar
Fallahian, M, Sebire, NJ, Savage, PM, Seckl, MJ, Fisher, RA. Mutations in NLRP7 and KHDC3L confer a complete hydatidiform mole phenotype on digynictriploid conceptions. Hum Mutation. 2013;34:301–8.CrossRefGoogle Scholar
Sebire, NJ, Foskett, M, Paradinas, FJ, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet. 2002;359:2165–6.Google Scholar
Seckl, MJ, Sebire, NJ, Fisher, RA, et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi39vi50.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×