Gestational Trophoblastic Disease ECHO-Assessment and management of persistent low level hCG

Video Transcription

Video Summary

The presentation focused on how to assess and manage persistent, low-level, or rising hCG in women, especially when pregnancy is not clearly present. A detailed case from Cork, Ireland, showed a 35-year-old woman with rising hCG despite two methotrexate doses, negative ultrasound, negative laparoscopy, and no chorionic villi on curettage. Further imaging eventually revealed a mass near the right atrium, and biopsy suggested choriocarcinoma. Genetic testing at Charing Cross confirmed paternal alleles, proving it was gestational choriocarcinoma. She was treated with induction EP chemotherapy followed by EMA/CO, achieved hCG normalization, and later had a full-term pregnancy.<br /><br />The talk then reviewed the main causes of elevated hCG: pregnancy, gestational trophoblastic disease, hCG-producing tumors, false-positive assays, pituitary hCG, exogenous hCG, familial hCG syndrome, and quiescent GTD. It emphasized using urine testing, serial hCG trends, ultrasound, imaging, assay comparison, and expert biochemical/pathology review. The key message was that not all persistent hCG requires immediate surgery or chemotherapy; careful investigation and specialist input are crucial, and sometimes watchful waiting is safest.

Asset Caption

April 2026, Dr John Coulter (UK)

Keywords

persistent hCG

gestational choriocarcinoma

gestational trophoblastic disease

hCG-producing tumors

false-positive hCG

quiescent GTD

EMA/CO chemotherapy

ultrasound and imaging

hCG assay review