Trophoblastic Diseases

Abstract

Trophoblastic diseases are mainly hydatidiform mole and choriocarcinoma, where the latter is usually the sequela of molar pregnancy and malignant systemic disease with general metastases destructing various tissues and organs till she die. High level urinary hCG, real-time B-mode and color Doppler imaging detect hydatidiform mole in early gestation, postmolar persistent trophoblastic disease is diagnosed by urinary hCG, and treated by prophylactic chemotherapy against choriocarcinoma. Uterine choriocarcinoma and its metastases are diagnosed by hCG and B-mode, color and power Doppler and 3D images detecting rich tumor blood flow. Most choriocarcinoma was effectively treated by primary chemotherapy with methotrexate, etoposide, etc. Until complete remission where hCG is lower than the cut-off level. Placental site trophoblastic tumor (PSTT) and epitheloid trophoblastic tumor (ETT) were low in hCG level and high in human placental lactogen (hPL), and show rich tumor blood flow in color Doppler ultrsound. Nongestational choriocarcinoma is rare and usually chemotherapy resistant.

Complete Remission of Choriocarcinoma with Primary Mtx Therapy and its Prevention using Mtx

“…The author noticed a fact that molar cyst was difficult to be detected by real-time ultrasound imaging in early stage of complete mole, while the molar cyst was visible by repeated ultrasound 2 weeks later ( Figure 1) [4][5][6], namely, hydatidiform mole similar to blighted ovum should be repeatedly studied with B-mode ultrasound 2 weeks later to find hydatidiform mole. The color Doppler [7] and 4D live silhouette mode will be associated with real-time B-mode [8]. In another statistical report on hydatidiform mole case numbers in 1970s when ultrasound is introduced in obstetrics and gynecology, the number of moles reduced for 3 cases in 100,000 population.…”

A Case of Invasive Mole

“…Vascular invasion and metastasis rarely occur in invasive mole 6 . Demonstration of myometrial vascular mass without the evidence of fetal material on USG in the context of an elevated β-hCG is highly suggestive of GTN [7][8][9][10] . An invasive hydatidiform mole is a form of GTN that occurs due to abnormal proliferation of placental trophoblast 11 .…”