Gestational trophoblastic neoplasia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]

Overview

Choriocarcinoma must be differentiated from non neoplastic diseases, neoplastic diseases, and other causes of bleeding during pregnancy.

Differentiating choriocarcinoma from other diseases

Choriocarcinoma must be differentiated from other non-neoplastic diseases such as:

• Hydatidiform mole

Choriocarcinoma must be differentiated from other neoplastic diseases such as:

• Invasive hydatidiform mole
• Placental site trophoblastic tumor (PSTT)
• Mixed germ cell tumor - esp. for testicular and ovarian tumors

Choriocarcinoma must be differentiated from other causes of bleeding during pregnancy:

• Spontaneous abortion
• Ectopic pregnancy
• Normal term pregnancy

Differential Diagnosis	Clinical Features					Karyotype	Immunostaining							Management
	Presenting Complaints	Potential for Neoplastic Conversion	Beta Human Chorionic Gonadotropin (Beta-hCG) Baseline Levels	History of Pregnancy	Metastatic Route		Cytokeratin 18	HLA-G	Human Chorionic Gonadotropin (hCG)	Transformation-Related Protein 63 (P63)	Human Placental Lactogen (hPL)	Melanoma Cell Adhesion Molecule (Mel-CAM)	Ki67

Clinical Features	Complete Hydatidiform Mole	Partial Hydatidiform Mole	Invasive Molar Pregnancy	Choriocarcinoma	Placental-site trophoblastic tumor (PSTT) and Epithelioid trophoblastic tumor (ETT)
Presenting Complaints	Vaginal bleeding Inappropriately large for date uterine size Hyperemesis	Vaginal bleeding	Vaginal bleeding Elevated beta-hCG	Vaginal bleeding	Vaginal bleeding
Neoplastic Conversion	High rate of progression (15-20%)	< 5 % progression rate	Neoplastic	Neoplastic	Neoplastic
Beta Human Chorionic Gonadotropin (Beta-hCG) baseline levels	Extremely high levels ( > 100000 mIU/ml in half of the patients	Highly elevated ( > 100000 mIU/ml in one in ten patients)	High	High	Moderatley elevated (< 1000 mIU/ml in majority of patients)
History of Pregnancies	Not related	Not related	Consequence of molar pregnancy	Approximately half of the cases occur as a consequence of molar pregnancy Quarter of the cases follow abortion or tubal pregnancy Rest follow term or pre-term pregnancy	About 60% follow term pregnancy 40 % follow molar pregnancy or abortion
Metastatic Route	Benign	Benign	Hematogenous	Hematogenous	Lymphatic
Management	Dilation and curettage (suction)	Dilation and curettage (suction)	Chemotherapy (Methotrexate)	Chemotherapy (Methotrexate)	Hysterectomy