Gestational Trophoblastic Neoplasia Differential Diagnoses

Updated: Mar 05, 2015
  • Author: Enrique Hernandez, MD, FACOG, FACS; Chief Editor: Warner K Huh, MD  more...
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DDx

Diagnostic Considerations

Note the following:

  • The differential diagnosis will depend on whether or not metastasis has occurred and to what organs.
  • In the absence of an identifiable preceding pregnancy, the possibility of an hCG-secreting germ cell tumor needs to be entertained. In the presence of stable low levels of serum hCG, the differential diagnosis includes a false positive or "phantom" hCG, pituitary hCG, or quiescent gestational trophoblastic disease. [57, 58, 59]
  • A normal intrauterine pregnancy needs to be excluded if the serum hCG levels start to rise in a patient being observed after evacuation of a hydatidiform mole.

Important considerations

Perform a systematic search for metastases in patients who have a malignant hydatidiform mole, an invasive mole, or a choriocarcinoma.

Follow serum human chorionic gonadotropin (hCG) levels.

Special concerns

The salvage rate of patients who relapsed after chemotherapy with EMA/CO is very high. Other chemotherapy protocols with or without surgery can be tried. [13, 60] This includes high-dose chemotherapy with peripheral stem cell transplant. [61]

Differential Diagnoses