Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation

Horowitz, Neil S.; Eskander, Ramez N.; Adelman, Marisa R.; Burke, William M.

doi:10.1016/j.ygyno.2021.10.003

Cited by 30 publications

(51 citation statements)

References 86 publications

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“…If HM is diagnosed at early gestational age, complications during or after evacuation are uncommon. 26 Most common complications are excessive bleeding, uterine perforation, and respiratory distress syndrome. 27 Respiratory distress syndrome may be caused by trophoblastic embolization, high-output congestive heart failure caused by anaemia, hyperthyroidism, preeclampsia, or iatrogenic fluid overload.…”

Section: Us Characteristicsmentioning

confidence: 99%

“…7,27 Hysterectomy, compared to uterine evacuation, has a significant advantage in preventing post-molar GTN with an approximately 80% reduction in risk. 26,28 Because hysterectomy does not eliminate the possibility of post molar gestational trophoblastic neoplasia these patients should also be monitored postoperatively with serial hCG measurements. 7 Prophylactic administration of either methotrexate or actinomycin D chemotherapy at the time of or immediately following molar evacuation is associated with a reduction in the incidence of post molar GTN to 3%-8%.…”

Section: Us Characteristicsmentioning

confidence: 99%

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Advances in diagnostics and management of gestational trophoblastic disease

Lukinovič

Malovrh

Takač

et al. 2022

Radiology and Oncology

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Background Gestational trophoblastic disease (GTD) is a heterogeneous group of rare tumours characterised by abnormal proliferation of trophoblastic tissue. It consists of benign or premalignant conditions, such as complete and partial molar pregnancy and variants of malignant diseases. The malignant tumours specifically are commonly referred to as gestational trophoblastic neoplasia (GTN). They consist of invasive mole, choriocarcinoma, placental-site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). Conclusions Patients with GTD are often asymptomatic, although vaginal bleeding is a common presenting symptom. With the advances in ultrasound imaging in early pregnancy, the diagnosis of molar pregnancy is most commonly made in the first trimester of pregnancy. Sometimes, additional imaging such as chest X-ray, CT or MRI can help detect metastatic disease. Most women can be cured, and their reproductive function can be preserved. In this review, we focus on the advances in management strategies for gestational trophoblastic disease as well as possible future research directions.

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Section: Us Characteristicsmentioning

confidence: 99%

Section: Us Characteristicsmentioning

confidence: 99%

Advances in diagnostics and management of gestational trophoblastic disease

Lukinovič

Malovrh

Takač

et al. 2022

Radiology and Oncology

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“…In contrast, diandric triploidy often demonstrates normal fetal growth with multiple placental cysts 1,2 . For pregnancies with a diagnosis of triploidy, serial human chorionic gonadotropin (HCG) tests are recommended to ensure complete removal of residual trophoblastic tissue 3,4 . Ultrasound visualized fetal abnormalities in triploidy include open neural tube defects, ventral wall defects, syndactyly, and other anatomic abnormalities 5 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 For pregnancies with a diagnosis of triploidy, serial human chorionic gonadotropin (HCG) tests are recommended to ensure complete removal of residual trophoblastic tissue. 3,4 Ultrasound visualized fetal abnormalities in triploidy include open neural tube defects, ventral wall defects, syndactyly, and other anatomic abnormalities. 5 The incidence of triploidy at approximately 11-13 weeks gestation has been estimated to be approximately 1 in 4800 pregnancies (Supplemental Table 1), decreasing to <1:27,000 in the second trimester.…”

Section: Introductionmentioning

confidence: 99%

Non‐invasive prenatal screening for fetal triploidy using single nucleotide polymorphism‐based testing: Differential diagnosis and clinical management in cases showing an extra haplotype

Kantor

Jelsema

et al. 2022

Prenatal Diagnosis

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Objective An extra haplotype is infrequently encountered in single nucleotide polymorphism(SNP)‐based non‐invasive prenatal testing (NIPT) and is usually attributed to an undetected twin or triploidy. We reviewed a large series to establish relative frequencies of these outcomes and identify alternative causes. Methods In 515,804 women receiving NIPT from September 2017 through March 2019, all results with an extra haplotype were reviewed. Known viable and vanished twin pregnancies were excluded. For positive cases, pregnancy outcome information was sought. Results Of 1005 results with an extra haplotype (1 in 513), pregnancy outcome was available for 773 cases: 11% were confirmed or suspected triploidy; 65% to vanished twin; 10% with pregnancy loss. Rare explanations included complete mole, chimera, undisclosed donor egg pregnancy, maternal organ transplant and one instance of maternal neoplasm. Among triploid cases that were detected and independently confirmed, 23/27 (85%) were diandric. Conclusion SNP‐based NIPT, with detection of an extra haplotype, is 11% predictive of triploidy. For results with an extra haplotype, ultrasound is recommended to establish viability, evaluate for twins (viable or vanished), and detect findings consistent with triploidy. Review of patient history, serum screening, and ultrasound will reduce the number of CVS or amniocenteses necessary to confirm a diagnosis of triploidy.

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“…Both platinum-based and multi-agent methotrexatebased treatments have been utilized for treating NGOCs. Most recent case reports describe treatment with Bleomycin, Etoposide, and Cisplatin (BEP), which had shown excellent activity in other malignant germ cell tumors; however, successful responses have been observed with other regimens [6,13,65,66].…”

Section: Chemotherapymentioning

confidence: 99%

Non-Gestational Ovarian Choriocarcinoma: A Rare Ovarian Cancer Subtype

et al. 2022

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Non-Gestational Ovarian Choriocarcinoma (NGOC) is an extremely rare ovarian tumor, with an incidence of less than 0.6% of malignant ovarian germ cell tumors. Its close pathologic resemblance to Gestational Ovarian Choriocarcinoma (GOC), however, requires special attention as the treatments differ greatly. NGOC typically affects patients in late adolescence or early reproductive years. As a result, NGOCs are often misdiagnosed as ectopic pregnancies due to their common presentation of bleeding, abdominal pain, adnexal mass, and positive serum beta-HCG. On pathologic examination, the tumor is indistinguishable from GOC, and only after review of tissue for paternal genetic components can the diagnosis of NGOC be made. Imaging studies often show highly vascular lesions with further investigation with computer topography (CT) sometimes showing metastatic lesions in the lungs, pelvis, vagina, and liver. These lesions are often hemorrhagic and can lead to catastrophic bleeding. Treatment is vastly different from GOC; NGOC requires treatment with both surgical resection and chemotherapy, with Bleomycin, Etoposide, and Cisplatin (BEP) being the most used regimen. With correct diagnosis and treatment, patients can often receive fertility sparing treatment with long term survival.

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Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation

Cited by 30 publications

References 86 publications

Advances in diagnostics and management of gestational trophoblastic disease

Advances in diagnostics and management of gestational trophoblastic disease

Non‐invasive prenatal screening for fetal triploidy using single nucleotide polymorphism‐based testing: Differential diagnosis and clinical management in cases showing an extra haplotype

Non-Gestational Ovarian Choriocarcinoma: A Rare Ovarian Cancer Subtype

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