Persistent Trophoblastic Neoplasia

Part of the Current Clinical Pathology book series (CCPATH)


In 2002, FIGO introduced the term “persistent trophoblastic neoplasia” or gestational trophoblastic neoplasia (GTN) to include persistent mole, invasive mole, metastatic mole, choriocarcinoma, and trophoblastic tumors under one clinical term for management purposes (Int J Gynecol Cancer 11(1):73–77, 2001), because all patients with such a diagnosis require chemotherapy (N Engl J Med 360(16):1639–1645, 2009). The criteria include serial hCG does not return to normal after evacuation (4 or more hCG levels that show a plateau for more than 3 weeks; an increase of 10% or more in three or more measurements for at least 2 weeks or persistence of detectable hCG 6 months after evacuation; evidence of metastasis; and a tissue diagnosis of gestational choriocarcinoma). This is a rather important development resulting in a clinical treatment decision based on clinical and serum hCG marker evaluation without a need of tissue diagnosis. Thereafter, histological diagnosis under the sequelae after a molar pregnancy in an individual patient has become uncertain since the introduction of GTN.


Persistent trophoblastic neoplasia Differential diagnosis 


  1. 1.
    Kohorn EI. The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. Int J Gynecol Cancer. 2001;11(1):73–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy. N Engl J Med. 2009;360(16):1639–45.PubMedCrossRefGoogle Scholar
  3. 3.
    Seckl MJ, Fisher RA, Salerno G, Rees H, Paradinas FJ, Foskett M, et al. Choriocarcinoma and partial hydatidiform moles. Lancet. 2000;356(9223):36–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Menczer J, Girtler O, Zajdel L, Glezerman M. Metastatic trophoblastic disease following partial hydatidiform mole: case report and literature review. Gynecol Oncol. 1999;74(2):304–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Medeiros F, Callahan MJ, Elvin JA, Dorfman DM, Berkowitz RS, Quade BJ. Intraplacental choriocarcinoma arising in a second trimester placenta with ­partial hydatidiform mole. Int J Gynecol Pathol. 2008;27(2):247–51.PubMedGoogle Scholar
  6. 6.
    Hancock BW, Nazir K, Everard JE. Persistent gestational trophoblastic neoplasia after partial hydatidiform mole incidence and outcome. J Reprod Med. 2006;51(10):764–6.PubMedGoogle Scholar
  7. 7.
    Rice LW, Berkowitz RS, Lage JM, Goldstein DP, Bernstein MR. Persistent gestational trophoblastic tumor after partial hydatidiform mole. Gynecol Oncol. 1990;36(3):358–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Bagshawe KD, Lawler SD, Paradinas FJ, Dent J, Brown P, Boxer GM. Gestational trophoblastic tumours following initial diagnosis of partial hydatidiform mole. Lancet. 1990;335(8697):1074–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Goto S, Yamada A, Ishizuka T, Tomoda Y. Development of postmolar trophoblastic disease after partial molar pregnancy. Gynecol Oncol. 1993;48(2): 165–70.PubMedCrossRefGoogle Scholar
  10. 10.
    Matsui H, Iizuka Y, Sekiya S. Incidence of invasive mole and choriocarcinoma following partial hydatidiform mole. Int J Gynaecol Obstet. 1996;53(1):63–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Elston CW. The histopathology of trophoblastic tumours. J Clin Pathol Suppl (R Coll Pathol). 1976;10: 111–31.Google Scholar
  12. 12.
    Mandal D, Nandi N, Dey RP, Biswas RR, Bhattacharya AK, Biswas SC. Partial invasive molar pregnancy – 2 case reports. Al Ameen J Med Sci. 2010;3(1):91–3.Google Scholar
  13. 13.
    Szulman AE, Ma HK, Wong LC, Hsu C. Residual trophoblastic disease in association with partial hydatidiform mole. Obstet Gynecol. 1981;57(3):392–4.PubMedGoogle Scholar
  14. 14.
    Bagshawe KD, Garnett ES. Radiological changes in the lungs of patients with trophoblastic tumours. Br J Radiol. 1963;36:673–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Thiele RA, De Alvarez RR. Metastasizing benign trophoblastic tumors. Am J Obstet Gynecol. 1962;84: 1395–406.PubMedGoogle Scholar
  16. 16.
    Meyer JS. Benign pulmonary metastasis from hydatidiform mole. Report of a case. Obstet Gynecol. 1966;28(6):826–9.PubMedGoogle Scholar
  17. 17.
    Driscoll SG. Gestational trophoblastic neoplasia: surgical pathologic considerations with clinical emphasis. Clin Obstet Gynecol. 1984;27(1):160–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Smith DB, Holden L, Newlands ES, Bagshawe KD. Correlation between clinical staging (FIGO) and prognostic groups with gestational trophoblastic disease. Br J Obstet Gynaecol. 1993;100(2):157–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Smith DB, O’Reilly SM, Newlands ES. Current approaches to diagnosis and treatment of gestational trophoblastic disease. Curr Opin Obstet Gynecol. 1993;5(1):84–91.PubMedGoogle Scholar
  20. 20.
    Berkowitz RS, Goldstein DP. Chorionic tumors. N Engl J Med. 1996;335(23):1740–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PathologyYale University School of MedicineNew HavenUSA

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