Gestational Trophoblastic Neoplasia Clinical Presentation

Updated: Feb 16, 2018
  • Author: Enrique Hernandez, MD, FACOG, FACS; Chief Editor: Warner K Huh, MD  more...
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Presentation

History

Most cases of gestational trophoblastic neoplasia are diagnosed when the serum hCG levels plateau or rise in patients being observed after the diagnosis of hydatidiform mole. If metastases are present, signs and symptoms associated with the metastatic disease, such as hemoptysis, abdominal pain, hematuria, and neurologic symptoms, may be present.

The FIGO 2000 criteria for the diagnosis of GTN after evacuation of a hydatidiform mole include: Serum hCG plateau over 4 weekly measurements (day 1, 7, 14 and 21), more than 10% rise in serum hCG level of three consecutive weekly measurements, elevated serum hCG 6 or more months after evacuation of the mole, or a histologic diagnosis of choriocarcinoma. [59]

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Physical

Note the following:

  • Metastasis to the lower genital tract present as purple to blue-black papules or nodules. These are extremely vascular and might bleed profusely if biopsied. [1]

  • Abdominal tenderness may be present if liver or gastrointestinal metastases have occurred.

  • Abdominal guarding and rebound tenderness may be present if a hemoperitoneum has occurred due to bleeding from an abdominal metastasis. Bleeding from a metastasis could also result in signs and symptoms of hemorrhagic shock. [2, 3]

  • Neurologic deficits, from lethargy to coma, can be encountered if brain metastasis has occurred.

  • Jaundice may be present if liver metastasis causes biliary obstruction.

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Causes

Why some hydatidiform moles become malignant and others do not is unknown. However, mounting evidence shows different molecular profiles between nonmalignant and malignant gestational trophoblastic disease. [60, 61, 62]

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