A Pictorial Ultrasound Essay of Gestational Trophoblastic Disease

Abstract

Gestational trophoblastic disease (GTD) includes a wide variety of clinical and histopathologic entities that require prompt identification and definition by the integration of clinical, laboratory, and imaging data. Recently, the role of grayscale ultrasound and spectral and power/color Doppler techniques has become pivotal in the diagnosis, staging, and management of GTD, thanks to both technical improvements and the growing expertise of dedicated operators. The aim of this essay is to summarize the most recent data on the ultrasound and Doppler findings of GTD and to provide a pictorial overview, including useful prognostic and therapeutic implications for clinical practice.

Gestational trophoblastic disease: an update on pathology, diagnosis and stateof- the-art management

“…Their rarity makes diagnosis particularly challenging. US features are similar to other forms of GTN, i.e., the presence of myometrial nodules with a heterogeneous structure consisting of cystic cavities and solid masses (43). At US, they show different patterns of myometrial invasion: while ETT expands with sharp borders, PSTT penetrates between myometrium muscle fibers (47).…”

“…However, PHM presents subtler US features so that its diagnosis is less common than CHM during first trimester. Early PHMs are characterized by cystic changes and increased echogenicity of the decidua and placenta in presence of embryonic tissue that can be identified as amorphous echoes (42,43). In those few cases that proceed above 11 weeks (late PHMs), US features are characterized by enlarged and irregular molar placenta with focal villous edema and an abnormal triploid fetus carrying severe abnormalities (ventriculomegaly, hydrocephalus, holoprosencephaly, increased nuchal translucency, renal defects).…”

“…US findings of vascularized myometrial nodules after uterine evacuation can correlate with a high risk of malignant evolution (46). Arteriovenous shunts are also common due to neoangiogenesis phenomena occurring within the tumor (43).…”

“…This condition is normally diagnosed at the end of the second trimester (between 15 and 18 weeks) of pregnancy. Its US features are characterized by a complex cystic pattern adjacent to a normal placenta and a structurally normal fetus (43). In early first trimester, misdiagnosis with subchorionic hematoma is frequent (51).…”

<p>The Role of Contrast-Enhanced Ultrasound in Evaluating Gestational Trophoblastic Neoplasia: A Preliminary Study</p>

“…Transvaginal ultrasound (US) has acquired a substantial role in diagnosing and managing GTNs with the development of Doppler techniques. [7][8][9] GTNs and other benign pregnancy-related uterine diseases can sometimes appear similar on greyscale and colour Doppler US, manifesting as focal lesions with rich blood flow signals. 10 Hence, it is crucial to develop new imaging methods as a complement to conventional US for diagnosing GTNs.…”