Skip to main content

Advertisement

SpringerLink
Log in

Gestational trophoblastic disease: an update

  • Special Section : Cancer in Pregnancy
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Gestational trophoblastic diseases (GTD) encompass a spectrum of rare pre-malignant and malignant entities originating from trophoblastic tissue. This updated review will highlight important radiological features, pathology and classification, and provide insight into the clinical management of these uncommon disorders. There is a wide geographic variation with the incidence of hydatidiform mole varying between 0.57 and 2 per 1000 pregnancies. The use of ultrasound (US) in the management of early pregnancy symptoms and complications has positively impacted the earlier detection of these diseases and resulted in diminished morbidity. Additional imaging modalities are reserved for problem solving or assessment of pulmonary manifestations of molar pregnancy. Having an awareness of their pleomorphic sonographic presentation and additional pathology that can mimic GTD is critical to avoiding pitfalls. Histologic and molecular analysis further aids in differential diagnosis. Gestational trophoblastic neoplasia (GTN) is inclusive of all malignant GTDs, and arises after 20% of molar pregnancies but can also be seen with non-molar gestations. Biochemical monitoring with human chorionic gonadotrophin is imperative for ongoing monitoring and surveillance and allows early detection of this entity. Doppler US is used for confirmation of diagnosis with magnetic resonance imaging (MRI) reserved for problem solving or assessment of myometrial invasion. This is of heightened relevance in patients undergoing surgical management. Cross sectional imaging is reserved for patients in the setting of GTN for the purposes of staging, prognostication and in the setting of recurrent disease. This may require a combination of computed tomography, MRI and positron emission tomography. Doppler US can provide insight into chemotherapeutic response/predict resistance in patients with GTN. As our understanding of these disorders evolves, there has been maturation in management options with a shift from traditional chemotherapy to innovative immunotherapy, particularly in the setting of resistant or high-risk disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18

Similar content being viewed by others

References

  1. Jin-Lin Hou 1, Xi-Run Wan, Yang Xiang, Qing-Wei Qi, Xiu-Yu Yang. Changes of clinical features in hydatidiform mole: analysis of 113 cases. J Reprod Med. 2008;53(8):629–33.

  2. V Soto-Wright 1, M Bernstein, D P Goldstein, R S Berkowitz. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86(5):775–9.

  3. Sue Yazaki Sun 1, Alexander Melamed 2, Donald P Goldstein 2, Marilyn R Bernstein 2, Neil S Horowitz 2, Antonio Fernandes Moron 1, Izildinha Maestá 3, Antonio Braga 4, Ross S Berkowitz 5. Changing presentation of complete hydatidiform mole at the New England Trophoblastic Disease Center over the past three decades: does early diagnosis alter risk for gestational trophoblastic neoplasia? Gynecol Oncol. 2015;138(1):46–9.

  4. Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, et al. Diagnosis and management of gestational trophoblastic disease: 2021 update. Int J Gynecol Obstet. 2021;155(S1):86–93.

    Article  CAS  Google Scholar 

  5. Zalel Y, Dgani R. Gestational trophoblastic disease following the evacuation of partial hydatidiform mole: a review of 66 cases. Eur J Obstet Gynecol Reprod Biol. 1997;71(1):67–71.

    Article  CAS  PubMed  Google Scholar 

  6. Jacobs PA, Szulman AE, Funkhouser J, Matsuura JS, Wilson CC. Human triploidy: relationship between parental origin of the additional haploid complement and development of partial hydatidiform mole. Ann Hum Genet. 1982;46(3):223–31.

    Article  CAS  PubMed  Google Scholar 

  7. Hui P, Buza N, Murphy KM, Ronnett BM. Hydatidiform Moles: Genetic Basis and Precision Diagnosis. Annu Rev Pathol Mech Dis. 2017;12(1):449–85.

    Article  CAS  Google Scholar 

  8. Sebire NJ, Fisher RA, Rees HC. Histopathological Diagnosis of Partial and Complete Hydatidiform Mole in the First Trimester of Pregnancy. Pediatr Dev Pathol. 2003;6(1):69–77.

    Article  PubMed  Google Scholar 

  9. Buza N, Hui P. Partial Hydatidiform Mole: Histologic Parameters in Correlation with DNA Genotyping. Int J Gynecol Pathol. 2013;32(3):307–15.

    Article  PubMed  Google Scholar 

  10. Fisher RA, Tommasi A, Short D, Kaur B, Seckl MJ, Sebire NJ. Clinical utility of selective molecular genotyping for diagnosis of partial hydatidiform mole; a retrospective study from a regional trophoblastic disease unit. J Clin Pathol. 2014;67(11):980–4.

    Article  PubMed  Google Scholar 

  11. Sumigama S, Itakura A, Yamamoto T, Nagasaka T, Yamamoto E, Ino K, et al. Genetically Identified Complete Hydatidiform Mole Coexisting with a Live Twin Fetus: Comparison with Conventional Diagnosis. Gynecol Obstet Invest. 2007;64(4):228–31.

    Article  PubMed  Google Scholar 

  12. Ronnett BM. Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis. Arch Pathol Lab Med. 2018 Dec 1;142(12):1485–502.

    Article  PubMed  Google Scholar 

  13. Buza N, Hui P. Immunohistochemistry and other ancillary techniques in the diagnosis of gestational trophoblastic diseases. Semin Diagn Pathol. 2014;31(3):223–32.

    Article  PubMed  Google Scholar 

  14. Banet N, DeScipio C, Murphy KM, Beierl K, Adams E, Vang R, et al. Characteristics of hydatidiform moles: analysis of a prospective series with p57 immunohistochemistry and molecular genotyping. Mod Pathol. 2014;27(2):238–54.

    Article  CAS  PubMed  Google Scholar 

  15. Bynum J, Murphy KM, DeScipio C, Beierl K, Adams E, Anderson D, et al. Invasive Complete Hydatidiform Moles: Analysis of a Case Series with Genotyping. Int J Gynecol Pathol. 2016;35(2):134–41.

    Article  CAS  PubMed  Google Scholar 

  16. Fukunaga M. Immunohistochemical characterization of p57(KIP2) expression in early hydatidiform moles. Hum Pathol. 2002;33(12):1188–92.

    Article  CAS  PubMed  Google Scholar 

  17. Allen SD, Lim AK, Seckl MJ, Blunt DM, Mitchell AW. Radiology of gestational trophoblastic neoplasia. Clin Radiol. 2006;61(4):301–13.

    Article  CAS  PubMed  Google Scholar 

  18. Fine C, Bundy AL, Berkowitz RS, Boswell SB, Berezin AF, Doubilet PM. Sonographic diagnosis of partial hydatidiform mole. Obstet Gynecol. 1989 Mar;73(3 Pt 1):414–8.

    CAS  PubMed  Google Scholar 

  19. Kirk E, Papageorghiou AT, Condous G, Bottomley C, Bourne T. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Ultrasound Obstet Gynecol. 2007;29(1):70–5.

    Article  CAS  PubMed  Google Scholar 

  20. Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Routine pre‐evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol. 2006;27(1):56–60.

    Article  CAS  PubMed  Google Scholar 

  21. Newhouse I, Spacey A, Scragg B, Szczepura K. The diagnostic value and accuracy of ultrasound in diagnosing hydatidiform mole: A systematic review and meta-analysis of the literature. Radiography. 2022;28(4):897–905.

    Article  CAS  PubMed  Google Scholar 

  22. Jauniaux E, Memtsa M, Johns J, Ross JA, Jurkovic D. New insights in the pathophysiology of complete hydatidiform mole. Placenta. 2018; 62:28–33.

    Article  CAS  PubMed  Google Scholar 

  23. Jain KA. Gestational trophoblastic disease: pictorial review. Ultrasound Q. 2005;21(4):245–53.

    Article  PubMed  Google Scholar 

  24. Zhou Q, Lei XY, Xie Q, Cardoza JD. Sonographic and Doppler Imaging in the Diagnosis and Treatment of Gestational Trophoblastic Disease: A 12-Year Experience. J Ultrasound Med. 2005;24(1):15–24.

    Article  PubMed  Google Scholar 

  25. Lin LH, Bernardes LS, Hase EA, Fushida K, Francisco RPV. Is Doppler ultrasound useful for evaluating gestational trophoblastic disease? Clin Sao Paulo Braz. 2015;70(12):810–5.

    Article  Google Scholar 

  26. Agarwal R, Strickland S, McNeish IA, Patel DC, Foskett M, Boultbee JE, et al. Doppler ultrasonography of the uterine artery and the response to chemotherapy in patients with gestational trophoblastic tumors. Clin Cancer Res Off J Am Assoc Cancer Res. 2002;8(5):1142–7.

    Google Scholar 

  27. Hricak H, Demas BE, Braga CA, Fisher MR, Winkler ML. Gestational trophoblastic neoplasm of the uterus: MR assessment. Radiology. 1986;161(1):11–6.

    Article  CAS  PubMed  Google Scholar 

  28. 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.

    PubMed  Google Scholar 

  29. Wolfberg AJ, Berkowitz RS, Goldstein DP, Feltmate C, Lieberman E. Postevacuation hCG Levels and Risk of Gestational Trophoblastic Neoplasia in Women with Complete Molar Pregnancy: Obstet Gynecol. 2005;106(3):548–52.

    CAS  PubMed  Google Scholar 

  30. Seckl MJ, Fisher RA, Salerno G, Rees H, Paradinas FJ, Foskett M, et al. Choriocarcinoma and partial hydatidiform moles. The Lancet. 2000;356(9223):36–9.

    Article  CAS  Google Scholar 

  31. Eiriksson L, Dean E, Sebastianelli A, Salvador S, Comeau R, Jang JH, et al. Guideline No. 408: Management of Gestational Trophoblastic Diseases. J Obstet Gynaecol Can. 2021;43(1):91–105.e1.

  32. Sebire N, Foskett M, Short D, Savage P, Stewart W, Thomson M, et al. Shortened duration of human chorionic gonadotrophin surveillance following complete or partial hydatidiform mole: evidence for revised protocol of a UK regional trophoblastic disease unit. BJOG Int J Obstet Gynaecol. 2007;114(6):760–2.

    Article  CAS  Google Scholar 

  33. Schmitt C, Doret M, Massardier J, Hajri T, Schott AM, Raudrant D, et al. Risk of gestational trophoblastic neoplasia after hCG normalisation according to hydatidiform mole type. Gynecol Oncol. 2013;130(1):86–9.

    Article  CAS  PubMed  Google Scholar 

  34. Coyle C, Short D, Jackson L, Sebire NJ, Kaur B, Harvey R, et al. What is the optimal duration of human chorionic gonadotrophin surveillance following evacuation of a molar pregnancy? A retrospective analysis on over 20,000 consecutive patients. Gynecol Oncol. 2018;148(2):254–7.

    Article  CAS  PubMed  Google Scholar 

  35. Sebire NJ, Fisher RA, Foskett M, Rees H, Seckl MJ, Newlands ES. Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. BJOG Int J Obstet Gynaecol. 2003;110(1):22–6.

    Article  CAS  Google Scholar 

  36. Rice LW, Lage JM, Berkowitz RS, Goldstein DP, Bernstein MR. Repetitive complete and partial hydatidiform mole. Obstet Gynecol. 1989;74(2):217–9.

    CAS  PubMed  Google Scholar 

  37. Vargas R, Barroilhet LM, Esselen K, Diver E, Bernstein M, Goldstein DP, et al. Subsequent pregnancy outcomes after complete and partial molar pregnancy, recurrent molar pregnancy, and gestational trophoblastic neoplasia: an update from the New England Trophoblastic Disease Center. J Reprod Med. 2014;59(5–6):188–94.

    PubMed  Google Scholar 

  38. Gillespie AM, Lidbury EA, Tidy JA, Hancock BW. The clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation. Int J Gynecol Cancer. 2004;14(2):366–9.

    Article  CAS  PubMed  Google Scholar 

  39. Yamada Y, Ohira S, Yamazaki T, Shiozawa T. Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature. Case Rep Obstet Gynecol. 2016; 2016:1–7.

    Article  Google Scholar 

  40. Sebire NJ, Foskett M, Paradinas FJ, Fisher RA, Francis RJ, Short D, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet Lond Engl. 2002;359(9324):2165–6.

    Article  Google Scholar 

  41. Giorgione V, Cavoretto P, Cormio G, Valsecchi L, Vimercati A, De Gennaro A, et al. Prenatal Diagnosis of Twin Pregnancies with Complete Hydatidiform Mole and Coexistent Normal Fetus: A Series of 13 Cases. Gynecol Obstet Invest. 2017;82(4):404–9.

    Article  PubMed  Google Scholar 

  42. Wu TWJ, Li YL, Wong KH. The lambda (twin peak) sign. Abdom Radiol. 2018;43(7):1841–1841.

    Article  Google Scholar 

  43. McNally L, Rabban JT, Poder L, Chetty S, Ueda S, Chen L may. Differentiating complete hydatidiform mole and coexistent fetus and placental mesenchymal dysplasia: A series of 9 cases and review of the literature. Gynecol Oncol Rep. 2021; 37:100811.

  44. Galeva S, Gil MM, Konstantinidou L, Akolekar R, Nicolaides KH. First-trimester screening for trisomies by cfDNA testing of maternal blood in singleton and twin pregnancies: factors affecting test failure. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2019;53(6):804–9.

    Article  CAS  Google Scholar 

  45. Tse KY, Chiu KWH, Chan KKL, Chu MMY, Ngu SF, Cheung ANY, et al. A Case Series of Five Patients with Pure or Mixed Gestational Epithelioid Trophoblastic Tumors and a Literature Review on Mixed Tumors. Am J Clin Pathol. 2018;150(4):318–32.

    Article  PubMed  Google Scholar 

  46. Jones WB, Wagner-Reiss KM, Lewis JL. Intracerebral choriocarcinoma. Gynecol Oncol. 1990;38(2):234–43.

    Article  CAS  PubMed  Google Scholar 

  47. Bakri YN, Berkowitz RS, Khan J, Goldstein DP, von Sinner W, Jabbar FA. Pulmonary metastases of gestational trophoblastic tumor. Risk factors for early respiratory failure. J Reprod Med. 1994;39(3):175–8.

  48. Yingna S, Yang X, Xiuyu Y, Hongzhao S. Clinical Characteristics and Treatment of Gestational Trophoblastic Tumor with Vaginal Metastasis. Gynecol Oncol. 2002;84(3):416–9.

    Article  PubMed  Google Scholar 

  49. Gadducci A, Carinelli S, Guerrieri ME, Aletti GD. Placental site trophoblastic tumor and epithelioid trophoblastic tumor: Clinical and pathological features, prognostic variables and treatment strategy. Gynecol Oncol. 2019;153(3):684–93.

    Article  PubMed  Google Scholar 

  50. Kuru O, Cetin C, Iyibozkurt C, Yavuz E. Placental site trophoblastic tumor: report of a tertiary center experience. Eur J Gynaecol Oncol. 2015;36(6):708–10.

    CAS  PubMed  Google Scholar 

  51. Hui P. Gestational Trophoblastic Tumors: A Timely Review of Diagnostic Pathology. Arch Pathol Lab Med. 2019;143(1):65–74.

    Article  PubMed  Google Scholar 

  52. Savage J, Adams E, Veras E, Murphy KM, Ronnett BM. Choriocarcinoma in Women: Analysis of a Case Series with Genotyping. Am J Surg Pathol. 2017;41(12):1593–606.

    Article  PubMed  Google Scholar 

  53. Kaur B, Short D, Fisher RA, Savage PM, Seckl MJ, Sebire NJ. Atypical Placental Site Nodule (APSN) and Association with Malignant Gestational Trophoblastic Disease; A Clinicopathologic Study of 21 Cases: Int J Gynecol Pathol. 2015;34(2):152–8.

  54. Shih IM, Kurman RJ. The Pathology of intermediate trophoblastic tumors and tumor-like lesions. Int J Gynecol Pathol. 2001;20(1):31–47.

    Article  CAS  PubMed  Google Scholar 

  55. Hui P, Wang HL, Chu P, Yang B, Huang J, Baergen RN, et al. Absence of Y chromosome in human placental site trophoblastic tumor. Mod Pathol. 2007;20(10):1055–60.

    Article  CAS  PubMed  Google Scholar 

  56. Cirstoiu MM, Sajin M, Baros A, Vasilescu S, Turcan N. The role of the ultrasound examination in atypical placental site trophoblastic tumour differential diagnosis and management. A case reports. Med Ultrason [Internet]. 2021 Jul 1 [cited 2022 Oct 28]; Available from: https://medultrason.ro/medultrason/index.php/medultrason/article/view/3149

  57. Chaves MM, Maia T, Cunha TM, Veiga VF. Placental site trophoblastic tumour: the rarest subtype of gestational trophoblastic disease. BMJ Case Rep. 2020;13(10): e235756.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Brandt KR, Coakley KJ. MR appearance of placental site trophoblastic tumor: a report of three cases. Am J Roentgenol. 1998;170(2):485–7.

    Article  CAS  Google Scholar 

  59. Kani KK, Lee JH, Dighe M, Moshiri M, Kolokythas O, Dubinsky T. Gestational trophoblastic disease: multimodality imaging assessment with special emphasis on spectrum of abnormalities and value of imaging in staging and management of disease. Curr Probl Diagn Radiol. 2012;41(1):1–10.

    Article  PubMed  Google Scholar 

  60. Zhou Y, Lu H, Yu C, Tian Q, Lu W. Sonographic characteristics of placental site trophoblastic tumor: Placental site trophoblastic tumor. Ultrasound Obstet Gynecol. 2013 Jun;41(6):679–84.

    Article  CAS  PubMed  Google Scholar 

  61. Sita-Lumsden A, Short D, Lindsay I, Sebire NJ, Adjogatse D, Seckl MJ, et al. Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000–2009. Br J Cancer. 2012 Nov;107(11):1810–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Balachandran K, Salawu A, Ghorani E, Kaur B, Sebire NJ, Short D, et al. When to stop human chorionic gonadotrophin (hCG) surveillance after treatment with chemotherapy for gestational trophoblastic neoplasia (GTN): A national analysis on over 4,000 patients. Gynecol Oncol. 2019 Oct;155(1):8–12.

    Article  CAS  PubMed  Google Scholar 

  63. Bouchard-Fortier G, Ghorani E, Short D, Aguiar X, Harvey R, Unsworth N, et al. Following chemotherapy for gestational trophoblastic neoplasia, do residual lung lesions increase the risk of relapse? Gynecol Oncol. 2020 Sep;158(3):698–701.

    Article  PubMed  Google Scholar 

  64. Mangili G, Lorusso D, Brown J, Pfisterer J, Massuger L, Vaughan M, et al. Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2014 Nov;24(9 Suppl 3): S109-116.

    Article  Google Scholar 

  65. Santaballa A, García Y, Herrero A, Laínez N, Fuentes J, De Juan A, et al. SEOM clinical guidelines in gestational trophoblastic disease (2017). Clin Transl Oncol. 2018 Jan;20(1):38–46.

    Article  CAS  PubMed  Google Scholar 

  66. Amin MB, American Joint Committee on Cancer, American Cancer Society, editors. AJCC cancer staging manual. Eight edition / editor-in-chief, Mahul B. Amin, MD, FCAP; editors, Stephen B. Edge, MD, FACS [and 16 others]; Donna M. Gress, RHIT, CTR-Technical editor; Laura R. Meyer, CAPM-Managing editor. Chicago IL: American Joint Committee on Cancer, Springer; 2017. 1024 p.

  67. Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, et al. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynecol Obstet. 2018 Oct; 143:79–85.

    Article  Google Scholar 

  68. Organisation mondiale de la santé, Centre international de recherche sur le cancer, editors. Female genital tumours. 5th ed. Lyon: International agency for research on cancer; 2020. (World health organization classification of tumours).

  69. Osborne RJ, Filiaci VL, Schink JC, Mannel RS, Behbakht K, Hoffman JS, et al. Second Curettage for Low-Risk Nonmetastatic Gestational Trophoblastic Neoplasia. Obstet Gynecol. 2016 Sep;128(3):535–42.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Schink JC, Filiaci V, Huang HQ, Tidy J, Winter M, Carter J, et al. An international randomized phase III trial of pulse actinomycin-D versus multi-day methotrexate for the treatment of low-risk gestational trophoblastic neoplasia; NRG/GOG 275. Gynecol Oncol. 2020 Aug;158(2):354–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, et al. Phase III Trial of Weekly Methotrexate or Pulsed Dactinomycin for Low-Risk Gestational Trophoblastic Neoplasia: A Gynecologic Oncology Group Study. J Clin Oncol. 2011 Mar 1;29(7):825–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Ghorani E, Kaur B, Fisher RA, Short D, Joneborg U, Carlson JW, et al. Pembrolizumab is effective for drug-resistant gestational trophoblastic neoplasia. The Lancet. 2017 Nov;390(10110):2343–5.

    Article  Google Scholar 

  73. Gamer EIO, Garrett A, Goldstein DP, Berkowitz RS. Significance of chest computed tomography findings in the evaluation and treatment of persistent gestational trophoblastic neoplasia. J Reprod Med. 2004 Jun;49(6):411–4.

    PubMed  Google Scholar 

  74. Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C, et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol. 2013 Oct;24 Suppl 6:vi39–50.

  75. Parker VL, Winter MC, Whitby E, Parker WAE, Palmer JE, Tidy JA, et al. Computed tomography chest imaging offers no advantage over chest X-ray in the initial assessment of gestational trophoblastic neoplasia. Br J Cancer. 2021 Mar 16;124(6):1066–71.

    Article  CAS  PubMed  Google Scholar 

  76. Darby S, Jolley I, Pennington S, Hancock BW. Does chest CT matter in the staging of GTN? Gynecol Oncol. 2009 Jan;112(1):155–60.

    Article  PubMed  Google Scholar 

  77. Barber EL, Schink JC, Lurain JR. Hepatic metastasis in gestational trophoblastic neoplasia: patient characteristics, prognostic factors, and outcomes. J Reprod Med. 2014 Jun;59(5–6):199–203.

    PubMed  Google Scholar 

  78. Abu-Rustum NR, Yashar CM, Bean S, Bradley K, Campos SM, Chon HS, et al. Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw JNCCN. 2019 Nov 1;17(11):1374–91.

  79. Savage P, Kelpanides I, Tuthill M, Short D, Seckl MJ. Brain metastases in gestational trophoblast neoplasia: an update on incidence, management and outcome. Gynecol Oncol. 2015 Apr;137(1):73–6.

    Article  CAS  PubMed  Google Scholar 

  80. Bezzi C, Monaco L, Ghezzo S, Mathoux G, Bergamini A, Zambella E, et al. 18F-FDG PET/CT May Predict Tumor Type and Risk Score in Gestational Trophoblastic Disease. Clin Nucl Med. 2022 Jun 1;47(6):525–31.

    Article  PubMed  Google Scholar 

  81. Agarwal R, Harding V, Short D, Fisher RA, Sebire NJ, Harvey R, et al. Uterine artery pulsatility index: a predictor of methotrexate resistance in gestational trophoblastic neoplasia. Br J Cancer. 2012 Mar 13;106(6):1089–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Sita-Lumsden A, Medani H, Fisher R, Harvey R, Short D, Sebire N, et al. Uterine artery pulsatility index improves prediction of methotrexate resistance in women with gestational trophoblastic neoplasia with FIGO score 5-6. BJOG Int J Obstet Gynaecol. 2013 Jul;120(8):1012–5.

    Article  CAS  Google Scholar 

  83. Sefidbakht S, Hosseini F, Bijan B, Hamedi B, Azizi T. Qualitative and quantitative analysis of diffusion-weighted imaging of gestational trophoblastic disease: Can it predict progression of molar pregnancy to persistent form of disease? Eur J Radiol. 2017 Mar; 88:71–6.

    Article  PubMed  PubMed Central  Google Scholar 

  84. She C, Li S, Wang X, Lu X, Liang H, Liu X. High-intensity focused ultrasound ablation as an adjuvant surgical salvage procedure in gestational trophoblastic neoplasia chemotherapy with chemoresistance or recurrence: two case reports. Int J Hyperth Off J Eur Soc Hyperthermic Oncol North Am Hyperth Group. 2021;38(1):1584–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Joint Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada

    Tanya Chawla

  2. Division of Gynecologic Oncology, Sinai Health System, University of Toronto, University Health Network, 610 University Avenue, OPG Wing, 6th Floor, Rm 814, Toronto, ON, M5G 2M9, Canada

    Genevieve Bouchard-Fortier

  3. Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA, 30322, USA

    Gulisa Turashvili

  4. Division of Gynecologic Oncology, Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Ray Osborne

  5. Departments Medical Imaging, Obstetrics & Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, MG 160, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Kalesha Hack & Phyllis Glanc

Authors
  1. Tanya Chawla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Genevieve Bouchard-Fortier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gulisa Turashvili
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ray Osborne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kalesha Hack
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Phyllis Glanc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tanya Chawla.

Ethics declarations

Competing interests

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Glossary of abbreviations

hCG

Human chorionic gonadotrophin

GTD

Gestational trophoblastic disease

GTN

Gestational trophoblastic neoplasia

HM

Hydatidiform mole

PHM

Partial hydatidiform mole

CHM

Complete hydatidiform mole

IHM

Invasive hydatidiform mole

PI

Pulsatility index

RI

Resistive index

UAPI

Uterine artery pulsatility index

RPOC

Retained products of conception

PID

Pelvic inflammatory disease

MRI

Magnetic resonance imaging

CS

Caesarian section

PMD

Placental mesenchymal dysplasia

IUGR

Intra uterine growth retardation

GCC

Gestational choriocarcinoma

MTT

Mixed trophoblastic tumour

PSTT

Placental site trophoblastic tumour

ETT

Epithelioid trophoblastic tumour

AV

Arteriovenous

AVM

Arteriovenous malformation

CXR

Chest X-ray

GGO

Ground glass opacity

MRI protocol for imaging pelvic GTD

Technique

Pulse sequence

FOV (cm)

Section thickness (mm)

Matrix

Coronal T2W

SSFSE or TSE

36–40

6, skip 0.5–1 mm

256 × 256

Sagittal T2W (no FS)

TSE or FSE

24–26

4

256 × 256

Sagittal DWI

b (50,500,1000)

28–32

4

80–128 × 80–128

Axial oblique T2W (perpendicular to long axis of uterus)

TSE or FSE

24–26

3–4, skip 0.5 mm

256–320 × 256–320

Axial oblique DWI in same plane as above

b (50,500,1000)

28–32

4

80–128 × 80–128

Axial T1W from bifurcation to perineum

TSE or FSE

30–34

5, skip 1 mm

256–320 × 256 -320

Sagittal pre and post contrast T1W

3D GRE

28

4

256 × 192

Axial oblique delayed post contrast (180 s)

3D GRE

28

3–4

256–320 × 192–224

Axial delayed post gad T1W

3D GRE

28

6

256 × 192

  1. FOV  field of view, FSE  fast spin echo, GRE gradient echo, SSFSE single-shot fast spin-echo, T1W  T1 weighted imaging, TSE turbo spin-echo, T2W T2 weighted imaging

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chawla, T., Bouchard-Fortier, G., Turashvili, G. et al. Gestational trophoblastic disease: an update. Abdom Radiol 48, 1793–1815 (2023). https://doi.org/10.1007/s00261-023-03820-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-023-03820-5

Keywords

Search

Navigation