Management and Therapy of Early Pregnancy Complications by Antonio Malvasi Andrea Tinelli & Gian Carlo Renzo

Author:Antonio Malvasi, Andrea Tinelli & Gian Carlo Renzo
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

9.4.13 Persistent Gestational Trophoblastic Disease

Gestational trophoblastic tumors can develop after any type of antecedent pregnancy, most frequently after HM. Approximately 15 % of patients with complete HM and 0.5–1 % of patients with partial HM will exhibit persistent trophoblastic activity, which requires chemotherapy [61, 67]. This condition is defined as persistent gestational trophoblastic disease (PGTD) [67]. Most of these will have an invasive mole, while approximately 3 % will have choriocarcinoma or rarely PSTT or ETT [67]. The hCG regression curve serves as a reliable guide for chemotherapy administration, but can also be a means of identifying patients who are going to develop a persistent GTD [61].

Some patients develop PGTD after a non-molar pregnancy, i.e., non-molar abortions, ectopic pregnancies, or live births, and they account for approximately 17 % of the cases [58]. Differential diagnosis in these cases includes numerous primary non-gestational tumors with trophoblastic differentiation and hCG production, such as carcinomas of the bronchus, stomach, bladder, colon, etc. In these circumstances the genetic analysis of tumor origin is a valuable instrument for diagnosis, as the presence of paternal alleles reveal the gestational nature of the tumor [74, 88].

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