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Gestational trophoblastic neoplasia (GTN) refers to a spectrum of malignant trophoblastic tumors that arise from abnormal proliferation of placental trophoblasts. It follows molar pregnancy, abortion, ectopic pregnancy, or even term pregnancy.

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https://www.youtube.com/watch?v=75DiSUxvhVA

https://www.youtube.com/watch?v=o1iQgnXW9Fw

Classification

Type	Origin	hCG Levels	Spread
‣	From hydatidiform mole	Elevated	Locally invasive to myometrium
‣	Any pregnancy event	Markedly elevated	Hematogenous spread: lungs, brain, liver
Placental site trophoblastic tumor (PSTT)	Intermediate trophoblasts	Low or normal	Local invasion; late metastases
Epithelioid trophoblastic tumor (ETT)	Rare; epithelial variant	Low/normal or mildly elevated	Lung and lymph node metastasis

Clinical Features

Irregular uterine bleeding postpartum or after molar evacuation
Persistently elevated or rising β-hCG levels
Uterine enlargement
Symptoms from metastases: lungs (dyspnea, hemoptysis), brain (neurologic deficits), liver (RUQ pain)

Diagnostic Criteria for GTN (FIGO):

GTN is diagnosed when one or more of the following are present:

Plateau of β-hCG for 4 values over 3 weeks
Rise in β-hCG for 3 values over 2 weeks
Histologic diagnosis of choriocarcinoma
Persistence of β-hCG >6 months after evacuation

Classification

Clinical Features

Radiology