Gestational Trophoblastic Disorders: An Update in 2015.

Area of Science:

• Gynecology
• Oncology
• Reproductive Medicine

Background:

• Gestational trophoblastic diseases (GTD) encompass a spectrum of rare pregnancy-related tumors, including premalignant moles and malignant gestational trophoblastic neoplasia (GTN).
• These conditions originate from abnormal trophoblastic tissue proliferation, forming characteristic vesicles.
• GTD can present initially, recur after treatment, or develop into metastatic disease, necessitating vigilant monitoring.

Approach:

• Diagnosis and monitoring of GTD rely heavily on serum levels of beta-human chorionic gonadotropin (β-hCG), especially when histological confirmation is uncertain.
• Premalignant moles are typically managed with suction curettage.
• Malignant or persistent/recurrent GTD requires systemic chemotherapy, including methotrexate or the EMA-CO regimen.

Key Points:

• Beta-human chorionic gonadotropin (β-hCG) is essential for diagnosing and tracking treatment efficacy in GTD.
• Histological diagnosis is often inconclusive, making β-hCG levels critical for identifying persistent or recurrent disease.
• Despite high cure rates (up to 98%), the potential for recurrence and metastasis underscores the need for regular follow-up.

Conclusions:

• Gestational trophoblastic diseases represent a rare but significant group of tumors requiring careful management.
• Effective treatment strategies involve surgical intervention for premalignant forms and systemic chemotherapy for malignant GTD.
• Consistent post-treatment surveillance is paramount to detect and manage any recurrence or metastatic spread of GTD.