Gestational Trophoblastic Disease

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Questions and Answers

What is the distinctive feature of malignant disease mentioned in the text?

Genetic predisposition

Metastasis

Invasion (correct)

Vascularization

Why do some repeat molar pregnancies occur according to the text?

Maternal age

Oral contraceptive use

Due to changes in partner

Familial or sporadic biparental molar disease (correct)

Which trophoblastic tumors are highly invasive and vascular?

Healthy trophoblast

Placental-site trophoblastic tumor

Choriocarcinoma (correct)

Hydatidiform mole

What is the approximate frequency of choriocarcinoma development in deliveries mentioned in the text?

1 in 50,000 Signup and view all the answers

Which hormonal factors are associated with an increased risk of gestational trophoblastic neoplasia according to the text?

Previous oral contraceptive use after menarche Signup and view all the answers

What is the percentage of cases of gestational trophoblastic disease that placental-site trophoblastic tumor accounts for in the UK?

~0.2% Signup and view all the answers

Which stage of gestational trophoblastic neoplasia extends to the lungs with or without extension to the genital tract?

Stage III Signup and view all the answers

What is the low-risk score range for resistance to monochemotherapy based on the International Federation of Gynecology and Obstetrics scoring system?

0-6 Signup and view all the answers

What does hCG stand for in the context of the text?

Human Chorionic Gonadotropin Signup and view all the answers

How is a patient's risk level for resistance to monochemotherapy determined according to the scoring system mentioned?

By totaling individual prognostic factor scores Signup and view all the answers

What should not be scored in the International Federation of Gynecology and Obstetrics scoring system for gestational trophoblastic neoplasia?

Placental-site trophoblastic tumor Signup and view all the answers

How are most patients treated after a short hospital stay for monitoring any bleeding?

They are treated at home Signup and view all the answers

What risk level is indicated by a score of 0–6 in patients with gestational trophoblastic neoplasia?

Low risk Signup and view all the answers

What percentage of patients with hydatidiform mole who develop neoplasia are at low risk of resistance?

95% Signup and view all the answers

When do results from anatomical staging aid clinical decisions in patients with gestational trophoblastic neoplasia?

In comparing results between medical centers Signup and view all the answers

In patients with stage I neoplasia, what is the controversial aspect related to secondary dilatation and curettage?

Its effectiveness in avoiding the need for chemotherapy Signup and view all the answers

What hCG concentration level indicates that secondary surgery is of no value in patients with hydatidiform mole?

< 5000 IU/L Signup and view all the answers

For most low-risk patients with gestational trophoblastic neoplasia, which treatment method is preferred according to the text?

Chemotherapy with methotrexate or dactinomycin Signup and view all the answers

What additional information can doppler ultrasonography provide in the context of gestational trophoblastic neoplasia?

Assessing vascularisation Signup and view all the answers

Why are women with an hCG concentration of more than 400,000 IU/L unlikely to be cured by methotrexate with folinic acid rescue?

Need for multidrug treatment Signup and view all the answers

How do patients with brain metastases from gestational trophoblastic neoplasia typically present?

With seizures and headaches Signup and view all the answers

What is a common symptom in patients with lung metastasis from gestational trophoblastic neoplasia?

Shortness of breath Signup and view all the answers

Why is it important for clinicians to consider gestational trophoblastic neoplasia in the differential diagnosis of metastatic disease?

To prevent misdiagnosis Signup and view all the answers

What imaging investigations are recommended for patients suspected of gestational trophoblastic neoplasia?

Brain MRI and Doppler ultrasonography Signup and view all the answers

What is the main issue with false-negative hCG results in cancer diagnosis and management?

Both delayed diagnosis and premature withdrawal of chemotherapy. Signup and view all the answers

Which of the following statements is true regarding the use of hCG assays in cancer diagnosis and management?

No commercial hCG assay is currently licensed for use in cancer diagnosis and management. Signup and view all the answers

Which of the following statements best describes the approach taken by the authors in the UK for monitoring gestational trophoblastic disease?

They use a non-commercial rabbit polyclonal antibody that detects all forms of hCG. Signup and view all the answers

Based on the information provided in the text, which of the following statements is true regarding the assay used in the UK for monitoring gestational trophoblastic disease?

It has a low false-negative rate compared to other assays. Signup and view all the answers

What is the potential advantage of using a hyperglycosylated hCG assay in the diagnosis of gestational trophoblastic disease?

It can differentiate between benign and malignant forms of the disease. Signup and view all the answers

Based on the information provided in the text, which of the following statements is true regarding false-positive hCG results?

False-positive results are rare when monitoring gestational trophoblastic disease using the assay employed in the UK. Signup and view all the answers

What could be a potential reason for the higher frequency of gestational trophoblastic disease in Asia compared to North America and Europe?

Differences in reporting between hospital-based and population-based data Signup and view all the answers

What role does the Department of Histopathology play at the Charing Cross Gestational Trophoblastic Disease Centre?

Providing central pathology review Signup and view all the answers

What is the significance of the New England Trophoblastic Disease Center in relation to gestational trophoblastic disease?

Offering expertise in the management of trophoblastic disease Signup and view all the answers

What factor might contribute to the variable frequency of gestational trophoblastic disease across different regions?

Discrepancies between hospital-based and population-based data Signup and view all the answers

Why is it important to consider both prevalence and central pathology review when assessing the frequency of gestational trophoblastic disease?

To ensure accurate data reporting for research purposes Signup and view all the answers

Which aspect might contribute to disparities in the reported frequency of gestational trophoblastic disease among different continents?

Quality of healthcare databases used for reporting Signup and view all the answers

What is the recommended method of evacuation for patients suspected of hydatidiform mole who wish to preserve fertility?

Suction curettage Signup and view all the answers

What intervention is recommended for rhesus-negative patients at the time of evacuation to prevent complications?

Rhesus immunoglobulin Signup and view all the answers

Why is histological examination impracticable after every termination in patients suspected of gestational trophoblastic neoplasia?

Logistical challenges Signup and view all the answers

What is recommended to ensure a return to normal hCG levels after treatment for gestational trophoblastic neoplasia?

Check hCG concentrations at 3–4 weeks post-treatment Signup and view all the answers

How can the risk of uterine perforation be reduced during surgical evacuation for hydatidiform mole?

Intraoperative ultrasonography Signup and view all the answers

What is a crucial reason for considering treatment in patients with gestational trophoblastic neoplasia according to the text?

Histological diagnosis of choriocarcinoma Signup and view all the answers

In patients with gestational trophoblastic neoplasia, what hCG concentration level, one month after evacuation, suggests spontaneous remission is unlikely according to the text?

More than 20,000 IU/L Signup and view all the answers

What imaging technique is recommended to confirm the absence of pregnancy and assess disease spread in patients with gestational trophoblastic neoplasia as per the text?

Doppler pelvic ultrasonography Signup and view all the answers

Which aspect of disease vascularity is assessed by Doppler pelvic ultrasonography in patients with gestational trophoblastic neoplasia?

Vascularity of the disease Signup and view all the answers

When should clinicians consider detailed investigation rarely needed for patients suspected of gestational trophoblastic neoplasia, based on the text?

When there is a histological diagnosis of choriocarcinoma Signup and view all the answers

What information can be used to make therapy decisions for patients with gestational trophoblastic neoplasia as mentioned in the text?

Clinical histories and examination only Signup and view all the answers

What is a distinguishing feature of partial hydatidiform moles when compared to complete moles?

Associated with complete miscarriages Signup and view all the answers

What is a common characteristic ultrasonographic finding of a complete mole?

Heterogeneous mass without associated fetal development Signup and view all the answers

Why is ultrasound not always diagnostic of complete mole in early pregnancy?

The snowstorm appearance is not visible in the first trimester Signup and view all the answers

What percentage of cases initially thought to be molar on sonography were diagnosed as nonmolar hydropic abortions on histological review?

Less than 10% Signup and view all the answers

What is the main reason for the difficulty in diagnosing some cases as molar through sonography in routine clinical practice?

Similarity between molar and non-molar features Signup and view all the answers

What was the range of detection percentage of cases as molar by sonography in routine clinical practice according to large studies?

20–40% Signup and view all the answers

According to the indications listed in Panel 2, when would chemotherapy be initiated for gestational trophoblastic disease in the UK?

All of the above Signup and view all the answers

What is the definition of a plateaued hCG concentration in the context of gestational trophoblastic disease, according to the text?

Four or more equivalent values of hCG for at least 3 weeks, or two consecutive increases in hCG concentration of 10% or more for at least 2 weeks Signup and view all the answers

Based on the information provided, which of the following is NOT an indication for chemotherapy in the UK for gestational trophoblastic disease?

Serum hCG concentration of 10,000 IU/L or more, 6 weeks after evacuation Signup and view all the answers

In which scenario would chemotherapy be initiated in the UK for gestational trophoblastic disease, despite a falling hCG concentration?

When there is heavy vaginal bleeding that necessitates transfusion Signup and view all the answers

Based on the information provided, what is the significance of a serum hCG concentration of $20,000$ IU/L or more, $4$ weeks or more after evacuation in gestational trophoblastic disease?

It indicates a high risk of uterine perforation, necessitating chemotherapy Signup and view all the answers

According to the indications listed in Panel 2, which of the following scenarios would NOT warrant chemotherapy for gestational trophoblastic disease in the UK?

Serum hCG concentration of 15,000 IU/L, 6 weeks after evacuation Signup and view all the answers

What is recommended in the text for the management of patients with suspected hydatidiform mole who want to preserve fertility?

Surgical evacuation with suction curettage Signup and view all the answers

What intervention is recommended for rhesus-negative patients during evacuation to prevent complications?

Rhesus immunoglobulin Signup and view all the answers

What imaging technique mentioned in the text can reduce the risk of uterine perforation during surgical evacuation?

Doppler ultrasonography Signup and view all the answers

Why is it recommended in the text to check hCG concentrations at 3–4 weeks after treatment?

To ensure a return to normal hCG range Signup and view all the answers

What is the significance of ultrasonography as per the text in confirming molar disease?

It has limited utility in diagnosing molar disease Signup and view all the answers

Why are partial hydatidiform moles more challenging to diagnose compared to complete moles using ultrasonographic scans?

Their characteristic features are not visible in the first trimester. Signup and view all the answers

What is a common pitfall in using ultrasonography for the diagnosis of complete mole during early pregnancy?

Misinterpretation of hydropic abortions as complete moles. Signup and view all the answers

What proportion of cases initially suspected to be molar by sonography were later diagnosed as nonmolar hydropic abortions on histological review?

40-50% Signup and view all the answers

Why do large studies indicate a lower detection rate of molar pregnancies by sonography in routine clinical practice?

Characteristic features of molar pregnancies are not always visible early on. Signup and view all the answers

In early pregnancy, why can ultrasonography be challenging in diagnosing complete mole accurately?

Snowstorm pattern is not always visible in the uterine cavity. Signup and view all the answers

What contributes to the difficulty in diagnosing partial hydatidiform moles compared to complete moles using ultrasonography?

Presence of fetal development mimicking normal pregnancy. Signup and view all the answers

What imaging techniques are recommended to exclude more widespread disease affecting the brain or liver in patients with gestational trophoblastic neoplasia?

Brain MRI and body CT Signup and view all the answers

What is the main purpose of using the combined prognostic score in predicting resistance to monochemotherapy with methotrexate or dactinomycin?

To assess the potential for treatment resistance Signup and view all the answers

In patients with gestational trophoblastic neoplasia, what imaging technique is recommended to confirm the absence of pregnancy and assess disease spread?

Doppler pelvic ultrasonography Signup and view all the answers

What is the significance of using a hyperglycosylated hCG assay in the diagnosis of gestational trophoblastic disease?

It enhances the detection of trophoblastic neoplasia Signup and view all the answers

Why is chest CT not necessary when chest radiography findings are normal in patients with gestational trophoblastic neoplasia?

It does not provide additional information beyond radiography findings Signup and view all the answers

What factor aids in assessing the potential development of resistance to monochemotherapy in patients with gestational trophoblastic neoplasia?

Combination of prognostic scoring and anatomical staging systems Signup and view all the answers

Which type of cells form chorionic vesicles filled with blood or blood clots in a molar pregnancy lesion?

Trophoblast cells Signup and view all the answers

What are the two main types of molar pregnancies mentioned in the text?

Complete hydatidiform mole and partial hydatidiform mole Signup and view all the answers

What do proliferating trophoblasts transform into within a molar pregnancy lesion?

Large polygonal syncytial cells Signup and view all the answers

In which type of molar pregnancy are all of the placental villi abnormal and the conceptus absent or malformed?

Complete hydatidiform mole Signup and view all the answers

What characterizes the histological examination of placental tissue in a partial hydatidiform mole?

Abnormal placental villi with malformed fetus Signup and view all the answers

What type of cells form the outer layer in the lesion of a molar pregnancy?

Trophoblast cells Signup and view all the answers

Which group has a significantly higher risk of malignant disease according to the text?

Women aged 41-45 years Signup and view all the answers

What is the relative risk of malignant disease in women aged 41-45 compared to women older than 40 as per the text?

5 times higher Signup and view all the answers

In which age group is the risk of malignant disease not significantly elevated?

20-25 years Signup and view all the answers

What group experiences a lower risk of malignant disease according to the information given?

Women aged 31-35 Signup and view all the answers

Regarding malignant disease risk, what distinguishes menopausal women from those over 40?

Menopausal women have a lower risk Signup and view all the answers

Which type of molar pregnancy is characterized by a karyotype of 46 XX?

Mola completa Signup and view all the answers

What is the approximate proportion of cases where hCG levels in patients with mola completa exceed 100,000 mUI/mL?

25-30% Signup and view all the answers

In patients with GTN subsecuentes, what is the most common complication according to the text?

Lung metastasis Signup and view all the answers

Which characteristic differentiates a mola incompleta from a mola completa?

69 XXX o 69 XXY karyotype Signup and view all the answers

What is a common feature of pregnancies associated with quistes teca-luteínicos according to the text?

Low hCG levels Signup and view all the answers

What is the preferred method of approach mentioned in the text for managing gestational trophoblastic neoplasia?

AMEU method Signup and view all the answers

What is the recommended intervention to limit bleeding during gestational trophoblastic neoplasia management?

Oxitocina Signup and view all the answers

What is a crucial requirement mentioned in the text for managing gestational trophoblastic neoplasia effectively?

Anesthesia and IV access Signup and view all the answers

In women who are Rh-negative, what immunoglobulin is recommended in the management of gestational trophoblastic neoplasia?

IgG Signup and view all the answers

What should be considered by clinicians regarding the patient when managing gestational trophoblastic neoplasia based on the text?

Parity Signup and view all the answers

What intervention is not recommended due to an increase in blood loss and the risk of malignant sequelae?

Hysterectomy Signup and view all the answers

Why is the induction with prostaglandin or oxytocin not recommended?

Elevates the risk of abnormal placental implantation Signup and view all the answers

What procedure should be avoided during management due to its association with increased bleeding?

Curettage Signup and view all the answers

Which method of induction can elevate the risk of developing malignancies?

Artificial rupture of membranes Signup and view all the answers

What is the main reason to avoid hysteroscopy during treatment?

Potential for seeding tumor cells Signup and view all the answers

What is the recommended frequency for pelvic examination while hCG levels are elevated in patients with gestational trophoblastic neoplasia?

Every 2 weeks Signup and view all the answers

After the initial period of monitoring elevated hCG levels in gestational trophoblastic neoplasia, how frequently should hCG levels be checked monthly?

Bimonthly Signup and view all the answers

In addition to monitoring hCG levels, what is the recommended duration for contraceptive use after treatment in patients with gestational trophoblastic neoplasia?

6 months Signup and view all the answers

During the initial monitoring period, how often should hCG levels be checked in patients with gestational trophoblastic neoplasia?

Biweekly Signup and view all the answers

What is the recommended frequency for pelvic examinations while hCG levels are elevated in patients with gestational trophoblastic neoplasia?

Once a year Signup and view all the answers

What is the minimum number of hCG values that must show a plateau in a 3-week period according to the FIGO criteria for diagnosing post-molar trophoblastic disease?

4 values Signup and view all the answers

How many consecutive hCG values need to increase by more than 10% in a 2-week period to meet the FIGO criteria for post-molar trophoblastic disease diagnosis?

3 values Signup and view all the answers

How long must hCG values persist after molar evacuation to indicate post-molar trophoblastic disease according to the criteria?

6 months Signup and view all the answers

In the context of post-molar trophoblastic disease, how many 2-week periods are considered significant for detecting hCG level increases according to the FIGO guidelines?

2 periods Signup and view all the answers

What is the required percentage increase in hCG levels for it to be considered a clinical indicator of post-molar trophoblastic disease according to the findings?

+/- 10% Signup and view all the answers

What is the recommended chemotherapeutic regimen after molar evacuation?

Methotrexate + leucovorin Signup and view all the answers

In the context of gestational trophoblastic neoplasia, what is the recommended intervention for rhesus-negative patients?

Rh immunoglobulin administration Signup and view all the answers

What is the significance of using a hyperglycosylated hCG assay in the diagnosis of gestational trophoblastic disease?

Identifying partial moles Signup and view all the answers

What is the characteristic ultrasonographic finding of a complete mole?

Honeycomb pattern in cystic spaces Signup and view all the answers

How can the risk of uterine perforation be reduced during surgical evacuation for hydatidiform mole?

Using Doppler pelvic ultrasonography Signup and view all the answers

What is the potential consequence of trophoblastic neoplasias invading aggressively into the myometrium?

Susceptibility to metastasis Signup and view all the answers

What clinical manifestation is associated with the growth of trophoblastic tissue leading to myometrial perforation?

Hemorrhagic intraperitoneal bleeding Signup and view all the answers

In patients with suspected neoplasias, what characteristic feature might be observed in the lower genital tract?

Bluish vascular masses Signup and view all the answers

What diagnostic imaging modality is recommended for assessing the abdomen and pelvis in suspected cases of trophoblastic neoplasias?

Magnetic Resonance Imaging (MRI) Signup and view all the answers

What imaging technique is suggested for examining the brain in cases involving suspected trophoblastic neoplasias?

Brain MRI Signup and view all the answers

What is a potential reason for abnormal bleeding lasting over 6 months post-pregnancy?

Cervical polyps Signup and view all the answers

Which of the following would NOT be a likely symptom suggestive of neoplasias trofoblásticas?

Unexplained weight gain Signup and view all the answers

In the context of neoplasias trofoblásticas, which medical condition could potentially cause abnormal bleeding lasting over 6 months post-pregnancy?

Pelvic inflammatory disease Signup and view all the answers

Which condition could mimic symptoms suggestive of neoplasias trofoblásticas but would not be related to the given time frame of abnormal bleeding post-pregnancy?

Ectopic pregnancy Signup and view all the answers

What reproductive health issue would NOT typically manifest with abnormal bleeding lasting over 6 months post-pregnancy?

Tubal factor infertility Signup and view all the answers

What is the term used to describe a mola that invades extensively by trophoblasts into the myometrium, peritoneum, parametria, and vagina, being locally aggressive and having a lower tendency to metastasize?

Invasive mola Signup and view all the answers

Which term best describes a mola that avoids the process of dilatation and curettage?

Avoidant mola Signup and view all the answers

What is the primary characteristic of an invasive mola in terms of its metastatic behavior?

Low tendency to metastasize Signup and view all the answers

Which term best describes the invasiveness of a mola that penetrates into the myometrium, peritoneum, parametria, and vagina?

Locally aggressive Signup and view all the answers

What is the distinguishing feature of an invasive mola in terms of its behavior during dilatation and curettage procedures?

Avoidance of curettage Signup and view all the answers

What is the estimated incidence rate of choriocarcinoma in pregnancies?

1 in 30,000-50,000 pregnancies Signup and view all the answers

What is a common early metastatic route of choriocarcinoma?

Hematogenous route Signup and view all the answers

Which of the following is a common pathological feature of choriocarcinoma?

Presence of cytotrophoblast and syncytiotrophoblast cells Signup and view all the answers

What is a common visual characteristic of choriocarcinoma on the uterine surface?

Nodules with irregular edges Signup and view all the answers

Which of the following is often found accompanying choriocarcinoma in the ovary?

Teca-lutein cysts Signup and view all the answers

Which clinical manifestation is most commonly associated with choriocarcinoma?

Blood in urine Signup and view all the answers

What is a common characteristic of the tumor color in choriocarcinoma?

Red/purple Signup and view all the answers

Which primary symptom might lead to suspicion of choriocarcinoma in a patient?

Coughing up blood Signup and view all the answers

What is a notable characteristic of the growth pattern of choriocarcinoma?

Villous pattern Signup and view all the answers

Which type of bleeding could indicate possible choriocarcinoma in a patient?

Vaginal bleeding Signup and view all the answers

What is the recommended treatment for patients with placental-site trophoblastic tumor with resistance to chemotherapy and local invasion?

Total abdominal hysterectomy Signup and view all the answers

In post-molar trophoblastic disease, what is the diagnostic threshold for the proportion of free B-hCG values to indicate tumor trophoblastic del sitio placentario?

Greater than 40% Signup and view all the answers

What is the primary reason for performing a histerectomía in the majority of patients with placental-site trophoblastic tumors?

To confine disease to the uterus Signup and view all the answers

What distinguishes placental-site trophoblastic tumors from other trophoblastic neoplasms in terms of primary treatment approach?

Preference for surgical intervention Signup and view all the answers

What is a notable characteristic of placental-site trophoblastic tumors that influences their unique treatment strategy?

Being resistant to traditional chemotherapy Signup and view all the answers

What is the recommended chemotherapeutic regimen for patients with high-risk gestational trophoblastic neoplasia?

Combination chemotherapy (EMACO) Signup and view all the answers

How is the response to chemotherapy monitored in patients with gestational trophoblastic neoplasia?

Evaluation of hCG levels Signup and view all the answers

What is the primary treatment approach for gestational trophoblastic neoplasia?

Chemotherapy Signup and view all the answers

What criterion is used to determine when chemotherapy can be stopped in gestational trophoblastic neoplasia treatment?

Achievement of indetectable hCG levels Signup and view all the answers

What distinguishes the treatment approach for low-risk and high-risk gestational trophoblastic neoplasia?

Type of chemotherapy regimen used Signup and view all the answers

How often should hCG levels be monitored in future pregnancies following a history of molar pregnancy?

Every month for the first year Signup and view all the answers

What is the estimated risk of a second molar pregnancy in individuals with a history of molar?

2% Signup and view all the answers

What is the recommended evaluation for all future pregnancies for individuals with a history of molar pregnancy?

Early ultrasound assessment Signup and view all the answers

In the context of trophoblastic neoplasias, how frequently should hCG levels be monitored after remission?

Monthly for 1 year post-remission Signup and view all the answers

What is the recommended follow-up schedule for individuals post-remission of trophoblastic neoplasias?

Yearly hCG checks post-remission Signup and view all the answers

Study Notes

Molar Pregnancies

A molar pregnancy is a type of abnormal pregnancy characterized by rapid growth of nonviable tissue.
Histologically, a molar pregnancy is composed of abnormal placental villi with numerous trophoblast cells forming chorionic vesicles filled with blood or blood clots.
There are two types of molar pregnancies: complete hydatidiform mole and partial hydatidiform mole.

Complete Hydatidiform Mole

All placental villi are abnormal, and the conceptus is absent or malformed.
Placental tissue becomes enlarged and partially or entirely replaced by edematous vesicles with little or no villous tissue.

Partial Hydatidiform Mole

Placental villi are partly abnormal, and the fetus is either normal or malformed.

Diagnosis and Treatment

Histological examination of the placental tissue can confirm the presence of a molar pregnancy.
In a complete hydatidiform mole, the placental villi are replaced by cystic vesicles containing chorionic vesicles filled with blood or blood clots.
Suction curettage is the preferred method of evacuation, especially for those who want to preserve fertility.
Rhesus-negative patients should receive rhesus immunoglobulin at the time of evacuation.

Risks and Complications

Women over 40 years old have a 10 times higher risk of developing a molar pregnancy.
Adolescent girls and women between 36-40 years old have a 2 times higher risk.
Molar pregnancies can lead to gestational trophoblastic neoplasia (GTN), which is a type of cancer that occurs in the uterus.
GTN can spread to other parts of the body, such as the lungs, liver, and brain.

Gestational Trophoblastic Neoplasia (GTN)

GTN can occur after any type of pregnancy, not just molar pregnancies.
Symptoms of GTN include abnormal vaginal bleeding, seizures, headaches, and hemoptysis.
Diagnosis of GTN is based on a plateau or increase in hCG levels, vaginal bleeding, and histological examination.
Treatment of GTN includes chemotherapy, surgery, and radiation therapy.

Choriocarcinoma

Choriocarcinoma is a type of GTN that originates from the placenta.
It can occur after any type of pregnancy, not just molar pregnancies.
Symptoms of choriocarcinoma include abnormal vaginal bleeding, seizures, headaches, and hemoptysis.
Diagnosis of choriocarcinoma is based on histological examination and high levels of hCG.
Treatment of choriocarcinoma includes chemotherapy and surgery.### Imaging in Gestational Trophoblastic Neoplasia
Doppler ultrasound examination is used to visualize a complete hydatidiform mole with a vascular uterine mass.
Chest radiography is essential to detect pulmonary metastases, which are the most common type of metastasis.
Brain MRI is recommended to exclude haemorrhagic metastases, especially in patients with seizures.

Treatment Resistance and Staging

The FIGO prognostic scoring and anatomical staging systems are used to predict the potential for development of resistance to monochemotherapy with methotrexate or dactinomycin.
The combined prognostic score helps identify patients who are at risk of treatment resistance.
The FIGO system has been used since 2002 to allow comparison of data between physicians treating gestational trophoblastic neoplasia.

Radiographic Imaging

Chest CT is not necessary when chest radiography findings are normal, as discovery of micrometastases does not affect outcome.
If lesions are noted on chest radiograph, brain MRI and body CT are recommended to exclude more widespread disease.

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Description

Explore the epidemiology, origins, pathological changes, and clinical behavior of various forms of gestational trophoblastic disease in this seminar. Learn about the distinct features of malignant disease and the invasive nature of trophoblastic tumors.