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Gestational trophoblastic disease: an update.

Tanya Chawla1, Genevieve Bouchard-Fortier2, Gulisa Turashvili3

  • 1Joint Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. Tanya.Chawla@sinaihealth.ca.

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Gestational trophoblastic diseases (GTD) are rare pregnancy disorders. Early ultrasound detection and advanced imaging like MRI improve diagnosis and management, with a shift towards immunotherapy for resistant cases.

Keywords:
ChoriocarcinomaEpithelioid trophoblastic tumorGestational trophoblastic diseaseGestational trophoblastic neoplasiaMolar pregnancyPlacental site trophoblastic tumor

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Area of Science:

  • Reproductive medicine
  • Gynecologic oncology
  • Radiology

Background:

  • Gestational trophoblastic diseases (GTD) are rare pre-malignant and malignant conditions of trophoblastic tissue.
  • Incidence of hydatidiform mole varies geographically, but ultrasound (US) has improved early detection and reduced morbidity.
  • Gestational trophoblastic neoplasia (GTN) includes all malignant GTDs and can arise from molar or non-molar gestations.

Purpose of the Study:

  • To review radiological features, pathology, classification, and clinical management of GTD.
  • To highlight the impact of ultrasound in early detection and the role of advanced imaging in diagnosis and management.
  • To discuss evolving treatment strategies, including immunotherapy for resistant GTN.

Main Methods:

  • Review of radiological features, pathology, and classification of GTD.
  • Discussion of clinical management strategies, including diagnostic imaging and biochemical monitoring.
  • Analysis of evolving treatment options, from chemotherapy to immunotherapy.

Main Results:

  • Ultrasound is crucial for early GTD detection, with additional imaging for specific complications.
  • Histologic and molecular analysis aid differential diagnosis; human chorionic gonadotropin monitoring is essential for GTN surveillance.
  • Advanced imaging (MRI, CT, PET) is used for GTN staging and prognostication; Doppler US assesses treatment response.

Conclusions:

  • Awareness of GTD's varied presentation and mimics is critical for accurate diagnosis.
  • Biochemical monitoring and advanced imaging are vital for GTN management.
  • Treatment is evolving, with immunotherapy showing promise for high-risk or resistant GTN.