"I spoke to a lovely nurse who explained that I had gestational trophoblastic disease
," Anna added.
Gestational trophoblastic disease
(GTD) is a spectrum of disorders extending from premalignant conditions of hydatidiform mole, which can be further classified into partial (PHM) and complete (CHM) hydatidiform mole, to malignant conditions including invasive mole, choriocarcinoma, and placental site trophoblastic tumor (PSTT).
(19) Therefore, when diagnostic separation of residual molar trophoblastic proliferation in a curettage specimen from an early choriocarcinoma cannot be reached histologically and additional tissue confirmation is not available, a diagnosis of "atypical trophoblastic proliferation consistent with persistent trophoblastic disease
or gestational trophoblastic neoplasia" is appropriate and sufficient for clinical patient management.
Congenital uterine AVM is thought to develop from a defect during embryologic differentiation leading to abnormal vascular connections, whereas acquired uterine AVM has been reported to occur due to a previous uterine trauma, such as curettage or cesarean delivery, or to be associated with neoplastic disorders, including gestational trophoblastic disease
(GTD) and endometrial adenocarcinoma.
Hydatidiform mole (HM) is the most frequently encountered form of gestational trophoblastic disease
and fetal developmental defect, where abnormal trophoblast cells develop inside the uterus following conception (1).
Gestational trophoblastic neoplasia (GTN), also known as gestational trophoblastic disease
(GTD), can occur when tumors develop in the cells that would normally form the placenta during pregnancy.
Neil Horowitz, MD, director of clinical research in gynecologic oncology at the Dana-Farber Cancer Institute in Boston, works with colleagues in one of those referral centers, the New England Trophoblastic Disease
Center, and is familiar with the new guidelines.
Choriocarcinoma is another rare variety of gestational trophoblastic disease
. Most choriocarcinomas are preceded by a complete mole that occurs in about 1-2% of complete moles.
Gestational trophoblastic disease
is a group of disorders caused by the overgrowth of placental tissue and is defined as the spectrum of disease that has at one extreme the benign hydatidiform mole which could be complete or partial mole, the locally Invasive mole, Placental site trophoblastic tumor, Gestational tropho-blastic neoplasia and at the other end, the highly malignant Choriocarcinoma, based on genetic and histopathological features1.
Previous gynaecological procedures, multiple pregnancies, infections, curettage, trophoblastic disease
and endometrial or cervical malignancies favour such an occurrence.
The potential diagnosis of hydatidiform mole is often made by ultrasound, but histological examination of the evacuated material is essential to confirm the diagnosis. In our case, empty uterus coexisting with high level of [sz]-HCG suggested first an ectopic pregnancy, and gestational trophoblastic disease
(GTN) was less probable.
Only the Siemens Immulite 2000 assay gave consistently acceptable results for all hCG variants and was recommended as the assay of choice for diagnosing and monitoring trophoblastic disease
and nontrophoblastic cancer and, more generally, for all applications requiring recognition of both intact hCG and hCG metabolic products (45).