Gestational Trophoblastic Disease

Radiologic-Pathologic Correlation

Abstract Introduction Normal And Abnormal Trophoblast Epidemiologic Characteristics

Hydatidiform Mole Complete Hydatidiform Mole Invasive Mole Choriocarcinoma Partial Hydatidiform Mole

Placental Site Trophoblastic Disease Conclusions Source Information References

Conclusions

GTD is an unusual proliferative process that arises from a fertilized ovum (and thus has a genetic composition that is distinct from the patient). Complete hydatidiform mole is the most common of these conditions to be clinically recognized and is generally completely cured with dilation and curettage. Less than 20% of these patients develop persistent disease in the form of invasive mole or choriocarcinoma (and it should be remembered that a substantial portion of choriocarcinoma cases can arise from other forms of gestation, including spontaneous abortion, ectopic pregnancy, and term pregnancy). Invasive mole, although benign, is treated with systemic chemotherapy. Chemotherapy is also generally effective in cases of choriocarcinoma, despite the fact that this represents a very aggressive malignancy.

Partial hydatidiform mole is a distinct entity normally associated with an identifiable triploid fetus that does not survive and likely accounts for a large portion of spontaneous abortions (although seldom recognized as such). Compared with a complete hydatidiform mole, partial hydatidiform mole has a much lower chance of continuing as an invasive or malignant process. Placental site trophoblastic disease is a rare tumor of variable malignant potential that is treated surgically.

Compared with the radiologist's role in the diagnosis of other neoplastic or neoplastic-like conditions, the role for the radiologist in the diagnosis of GTD is somewhat limited. The two major factors that account for this are (a) the reliability of beta-hCG testing in the assessment of persistent or recurrent GTD and (b) the success of systemic chemotherapy (which obviates surgical resection in most patients). US has a role, however, in distinguishing between a normal pregnancy and GTD. Imaging studies may alert the referring physician to the possible diagnosis in cases of early disease. In addition, imaging studies may have a problem-solving role in examining patients with recurrent GTD or a confusing clinical picture. Invasion can sometimes be suggested on the basis of sonographic, CT, or MR imaging findings; the impact of radiologic findings on treatment decisions for these patients is unclear. Assessment of metastatic disease (especially to the lungs or brain) is a frequent role for imaging.

Abstract Introduction Normal And Abnormal Trophoblast Epidemiologic Characteristics

Hydatidiform Mole Complete Hydatidiform Mole Invasive Mole Choriocarcinoma Partial Hydatidiform Mole

Placental Site Trophoblastic Disease Conclusions Source Information References