Gestational trophoblastic diseases - literature review and atypical case reports

Gestational trophoblastic disease (GTD) arises from the abnormal development of trophoblastic tissue and encompasses a wide range of benign and malignant conditions. There is evidence that malignant transformation can occur in atypical areas of the placenta. A complete diagnosis of GTD involves assessing the signs and symptoms, with the most common being vaginal bleeding and pelvic-abdominal pain, alongside laboratory data and variations in human chorionic gonadotropin (hCG) levels. Imaging exploration, both local and distant, is critical for assessing tumor areas, utilizing various techniques such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT. Furthermore, a detailed histopathological analysis is essential, which includes classical examination with Hematoxylin-Eosin (HE) staining to highlight the presence of abnormal villi or transformed trophoblasts. Immunohistochemical staining with antibodies like anti-cytokeratin 7 (CK7) marks tumor cells with trophoblastic origin, while anti-p57 is present in incomplete hydatidiform moles (HMs) and absent in complete HMs (CHMs). The tumor proliferation index, obtained by calculating the density of tumor cells undergoing division and immunolabeled with the anti-Ki67 antibody, along with the invasion into the myometrial structure among myocytes immunolabeled with anti-alpha-smooth muscle actin (α-SMA) antibody, helps establish a definitive diagnosis and classify GTD. Diagnosis remains a challenge even among expert gynecologists and pathologists. This study has gathered data from literature and analyzed the evolution of a series of atypical cases and the management strategies related to the diagnosis and therapeutic opportunities of GTD.