Gestational trophoblastic neoplasia with concurrent metastasis to the mother and child: a systematic literature review

Abstract

Gestational trophoblastic neoplasia (GTN) arising in the placenta and presenting as a metastatic disease concurrently in the mother and the baby is extremely rare. GTN poses a diagnostic dilemma to the treating clinicians. In the current review, an electronic search of Scopus, PubMed, Embase and other databases was conducted for case reports and case series of GTN co-existing or metastatic to both the mother and the baby, published to date. Globally, a total of twenty-two cases of GTN with metastasis to both the mother and baby was found. The previous history of histopathology confirmed molar pregnancy was present in 4/22 cases. The median time to diagnose GTN in the mother was six weeks post-partum. In the majority of cases, diagnosis of maternal disease was made after the infant presented with clinical manifestation. Overall survival was reported in 17/22 mothers up to varying latest follow-up and in 6/22 infants. A knowledge of the varied clinical presentation, eliciting a history of previous pregnancy loss/term pregnancy and serum beta human chorionic gonadotrophin (β-hCG) estimations were helpful for early diagnosis. The concurrent presence of GTN in the mother and baby is a rare entity and poses a diagnostic dilemma. Diagnosis in the mother often follows diagnosis in the baby after an infant presents with clinical manifestations. GTN is a highly chemo-sensitive tumour, but the main prognostic factors determining survival are the time to diagnosis following previous pregnancy and serum β-hCG levels.

Choriocarcinoma in neonates and infants: A severe but curable disease

“…As the biology of infants’ tumours is similar, an option could be to use this type of regimen in children too. No real comparison exists, and various regimens have been used in the past 16 …”

Cross‐individual cancer transmission to children during the gestational and perinatal periods

“…There have only been about 40 reported cases, including stillbirths. 23 , 24 , 25 , 26 , 38 In some cases, choriocarcinoma can simultaneously disseminate into both the fetus and the mother. According to the systematic review of Mangla et al., 38 22 cases of gestational trophoblastic neoplasia (GTN) with concurrent metastasis to mother and child have been reported so far.…”

“… 23 , 24 , 25 , 26 , 38 In some cases, choriocarcinoma can simultaneously disseminate into both the fetus and the mother. According to the systematic review of Mangla et al., 38 22 cases of gestational trophoblastic neoplasia (GTN) with concurrent metastasis to mother and child have been reported so far. Although genetic analyses of IC have rarely been conducted, many of the cases of IC are presumed to have developed in the concurrent pregnancy, and choriocarcinoma cells in the placenta cross over to the fetus through the umbilical cord.…”