Didactics-Gestational Trophoblastic Neoplasia Nov 2023

Pdf Summary

Gestational trophoblastic neoplasia (GTN) is a group of malignant neoplasms that occur after a hydatidiform mole or nonmolar pregnancy. GTN includes invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). A case is presented of a 34-year-old woman with vaginal bleeding and abdominal pain following a full-term delivery. On examination, a hydatidiform mole is diagnosed. The patient undergoes suction D&C, and pathology confirms complete molar pregnancy. The patient is advised to follow bHCG levels and use contraception. Complete molar pregnancies are characterized by abnormal trophoblastic proliferation and absence of fetal tissue. Partial moles, on the other hand, are associated with the presence of a fetus. GTN can occur after nonmolar pregnancies, with an overall incidence estimated at 1 in 40,000 pregnancies. The risk factors for GTN include a prior mole, poor diet, non-Caucasian ethnicity, and advanced maternal age. Diagnosis of GTN is based on hCG levels and ultrasound. Treatment options include chemotherapy with methotrexate or dactinomycin, and hysterectomy may be performed for local disease. Prognosis varies depending on the stage of GTN, with nonmetastatic GTN having a cure rate of 100% with chemotherapy treatment. Metastatic GTN has a cure rate of 75% with chemotherapy treatment. PSTT and ETT are rare variants of GTN that require individualized treatment. The most commonly used treatment for low-risk GTN is methotrexate or dactinomycin. Side effects of methotrexate include stomatitis. The use of certain chemotherapy agents, such as etoposide, has been associated with an increased risk of secondary malignancies. Heterophilic antibodies can cause false-positive results in serum bHCG level tests, and specialized testing may be needed to clarify the diagnosis.

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Siobhan Kehoe
November 2023

Keywords

gestational trophoblastic neoplasia

malignant neoplasms

hydatidiform mole

nonmolar pregnancy

invasive mole

choriocarcinoma

placental site trophoblastic tumor

epithelioid trophoblastic tumor

complete molar pregnancy

chemotherapy treatment