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Abstract

Gestational trophoblastic neoplasia (GTN) refers to a group of malignant conditions that develop due to abnormal fertilization causing abnormal proliferation of tissue. GTN is primarily treated with surgical evacuation of the underlying proliferative tissue. Approximately half of cases of GTN arise from molar pregnancy1. GTN include invasive moles, choriocarcinomas, placentalsite trophoblastic tumors and epithelioid trophoblastic tumors. The most common risk factors associated with GTN are prior molar pregnancy, advanced maternal age (>40 years of age), and Asian and Native American ancestry2-4. Following evaluation of a molar pregnancy, a post-molar GTN is diagnosed based on the International Federation of Gynecology and Obstetrics (FIGO) criteria, which includes elevated human chorionic gonadotropin (hCG) levels, hCG levels increasing >10% across three values recorded over a two-week duration, weekly hCG level plateauing (remaining within +/- 10% of the previous week’s results) over a three-week period, and persistence of detectable serum hCG for more than six months after molar evacuation5. A pathologic diagnosis of prior molar pregnancy by curettage with increased hCG levels also would be acceptable for diagnosis. According to the World Health Organization scoring system of GTN, factors including age, antecedent pregnancy, interval months from index pregnancy, pretreatment HCG, largest tumor size, site and number of metastases and previous failed chemotherapy help stratify the risk of patients and determine the type of treatment (table 1).

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