Clinical and radiological correlations in patients with gestational trophoblastic disease

Abstract

Gestational trophoblastic disease is an abnormality of pregnancy that encompasses a group of diseases that differ from each other in their propensity for regression, invasion, metastasis, and recurrence. In the past, it was common for patients with molar pregnancy to present with marked symptoms: copious bleeding; theca lutein cysts; uterus larger than appropriate for gestational age; early preeclampsia; hyperemesis gravidarum; and hyperthyroidism. Currently, with early diagnosis made by ultrasound, most patients are diagnosed while the disease is still in the asymptomatic phase. In cases of progression to trophoblastic neoplasia, staging-typically with Doppler flow studies of the pelvis and chest X-ray, although occasionally with computed tomography or magnetic resonance imaging-is critical to the choice of an appropriate antineoplastic therapy regimen. Because it is an unusual and serious disease that affects women of reproductive age, as well as because its appropriate treatment results in high cure rates, it is crucial that radiologists be familiar with gestational trophoblastic disease, in order to facilitate its early diagnosis and to ensure appropriate follow-up imaging.

Identification and treatment of gestational trophoblastic neoplasia located in the cesarean scar

“…Owing to arteriovenous communications, the representative vasculature will have a turbulent appearance, with color distortion, high velocity, and a low resistance index (Fig. ) . However, a rare type of CSP with a sonographic mass, which results from the presence of residual trophoblastic tissue after an incomplete abortion, is difficult to differentiate from GTN .…”

“…Hemorrhagic lesions appearing as areas of slightly high signal intensity than adjacent myometrium on T1‐weighted images can best be observed by dynamic contrast‐enhanced MRI (Fig. ) . In addition, chest X‐ray and computed tomography may provide clues as to whether there is pulmonary metastasis.…”

Postmenopausal pregnancy? Evaluation of elevated hCG in a 59-year-old woman

“…With normal intrauterine pregnancy, hCG levels are >50 IU/L within the first week of conception and double every 48 hours with peak hCG at gestation week 10 (range 27 300–233 000 IU/L)9 hCG levels >1 00 000 IU/L are expected in gestational trophoblastic neoplasia, with the understanding that overlap with normal pregnancy levels may exist 8. Given hCG level overlap in normal pregnancy and gestational trophoblastic disease, ultrasound is often necessary to differentiate 9.…”

“…Given hCG level overlap in normal pregnancy and gestational trophoblastic disease, ultrasound is often necessary to differentiate 9. Summary of hCG values is given in table 1.…”

Caso Clínico: Mola Hidatiforme Parcial. Resolución Obstétrica

“…El Acetato de Medroxiprogesterona es una opción para las mujeres que tienen dificultad para cumplir con el uso de anticonceptivos orales. Un dispositivo intrauterino no debe ser utilizado antes de que la BHCG se normalice debido al riesgo de perforación uterina por la subinvolución del útero o mola invasiva [1,8,9].En casos en que la medición de BHCG no disminuya > 10 % por 3 semanas o que persista niveles elevados por más de 6 meses se considera patología trofoblástica persistente, ameritando recibir quimioterapia a base de Metotrexate [9,11], en el caso citado el descenso de BHCG fue importante después del procedimiento con un valor de 25000 mUI/ml, a los 4 meses el valor de BHCG fue <1 mUI/ml por lo cual se decidió el alta definitiva.…”