Gestational trophoblastic disease: Pathology
- Rebecca N Baergen, MD
Rebecca N Baergen, MD
- Professor of Clinical Pathology and Laboratory Medicine
- Weill Medical College of Cornell University
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
Gestational trophoblastic disease comprises a heterogeneous group of related lesions arising from abnormal proliferation of trophoblast of the placenta. The pathogenesis of gestational trophoblastic disease is unique, because the maternal lesions arise from fetal, not maternal, tissue.
The histopathology of gestational trophoblastic disease is discussed here. The epidemiology, clinical manifestations, diagnosis, and treatment of hydatidiform moles and malignant gestational trophoblastic disease are reviewed separately. (see "Hydatidiform mole: Epidemiology, clinical features, and diagnosis" and "Hydatidiform mole: Management" and "Initial management of low-risk gestational trophoblastic neoplasia"). Differential diagnosis on clinical grounds may be difficult in a patient with an elevated serum beta-human chorionic gonadotropin (hCG) with abnormal tissue in the uterus on ultrasonography and therefore, histology is necessary for definitive diagnosis.
●Gestational trophoblastic disease (GTD) – Lesions characterized by abnormal proliferation of trophoblast of the placenta. This category is comprised of benign, nonneoplastic lesions, including placental site nodule, exaggerated placental site, and hydatidiform mole.
●Gestational trophoblastic neoplasia (GTN) – Gestational neoplasms include: choriocarcinoma, placental site trophoblastic tumor, epithelioid trophoblastic tumor, and invasive mole. In the absence of tissue for a definitive histopathologic diagnosis, disease diagnosed as a result of persistent elevation of human chorionic gonadotropin (hCG) after evacuation of a molar pregnancy is termed GTN.
Most, but not all, gestational trophoblastic disease (GTD) produces the beta subunit of human chorionic gonadotropin (hCG). Chromosomal abnormalities are characteristic of some GTD subtypes such as molar pregnancies; assessment of DNA content enhances the diagnostic accuracy of histologic diagnosis [1,2]. (See 'Genetics' below.)
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- Types of GTD
- - Benign nonneoplastic trophoblastic lesions
- - Hydatidiform mole
- - Gestational trophoblastic neoplasia (GTN)
- BENIGN NONNEOPLASTIC TROPHOBLASTIC LESIONS
- Exaggerated placental site
- Placental site nodule
- HYDATIFORM MOLE
- Genetics of molar pregnancy
- Complete mole genetics
- Partial mole genetics
- - Complete mole
- - Early complete mole
- - Partial mole
- - Invasive mole
- GESTATIONAL TROPHOBLASTIC NEOPLASIA
- GTN following molar pregnancy
- Types of GTN
- - Choriocarcinoma
- - Placental site trophoblastic tumors
- - Epithelioid trophoblastic tumor