Imaging appearence of Gestational Trophoblastic Neoplasia (GTN).

Congress:

ECR 2011

Poster Number:

C-1057

Type:

Educational Exhibit

Keywords:

Abdomen, Genital / Reproductive system female, Obstetrics (Pregnancy / birth / postnatal period), Ultrasound, CT, MR

Authors:

B. Ginanni, E. Bozzi, L. Novaria, V. Vallini, F. Bianchi, A. Bulleri, D. Caramella, C. Bartolozzi; Pisa/IT

DOI:

10.1594/ecr2011/C-1057

DOI-Link:

https://dx.doi.org/10.1594/ecr2011/C-1057

Fig. 1: GTD classification.

Fig. 2: GTD: epidemiology, etiology, and pathogenesis.

Fig. 3: GTD: what is the trophoblast?

Fig. 4: GTD: clinical and laboratory features.

Learning objectives

To understand the pathogenesis of gestational trophoblastic disease To learn epidemiologic and clinical features and risk factors in gestational trophoblastic disease To identify the most common imaging findings To discuss the added value of imaging in invasive placental process in particular in differential diagnosis, staging and follow up

Background

Gestational trophoblastic disease (GTD) represents a spectrum of conditions that, although usually benign and easily treatable, occasionally progress to an aggressive, potentially fatal process [1]. GTD includes pregnancy-associated trophoblastic abnormalities, which are divided in (fig. 1): hydatidiform moles (CHM) partial hydatidiform moles (PHM) invasive hydatidiform moles(IHM) choriocarcinoma placental site trophoblastic tumors (PSTT) Epidemiology GTDusually occurs in a pregnant woman of any age, more commonly in teenagers and in women of advanced maternal age (40–50 years). It affects approximately 1 in 2500 pregnancies in Europe, 1...

Imaging findings OR Procedure details

♦ ULTRASOUND (US): COMPLETE MOLE (fig 1, 2a) appears as: - a heterogeneous echogenic endometrial mass with multiple variable size small anechoic cysts “snowstorm or granular appearance” (because of hydropic villi); - without fetal tissue; - increased vascularity with low-resistance waveforms in the spiral arteries of the uterus; - ovarian enlargement with multiloculated theca lutein cysts < 50% (because of the excessive production of β-hCG) [9, 13]. PARTIAL MOLE (fig 1, 2b) appears similar to complete moles even if fetal tissue is present. Distinction between...

Conclusion

In the diagnosis of GTD, US has a role in distinguishing between a normal pregnancy and GTD, alerting in cases of early disease. In addition, imaging studies like CT or MR, suggest GTD invasion of surrounding tissues and show the assessment of metastatic disease, resulting helpful guide in differential diagnosis between the different condictions of GTD.

Personal Information

Barbara Ginanni, MD ([email protected]) Department of Oncology, Transplants and New Technologies in Medicine Division of Diagnostic and Interventional Radiology University of Pisa ITALY

References

[1] Brentj Wagner, Maf USAF, MC, PaulaJ. Woodward, MD, Glenn E. Dickey, Lt Col, USAF, MC. From the Archives of the AFIP: Gestational Trophoblastic Disease: Radiologic-Pathologic Correlation. RadioGraphics 1996; 16:131-148 [2] Smith HO. Gestational trophoblastic disease epidemiology and trends. Clin Obstet. Gynecol 2003;46:541–56 [3] Kohorn EI. Dynamic staging and risk factor scoring for gestational trophoblastic disease.Int J Gynecol Cancer. 2007 Sep-Oct;17(5):1124-30 [4] Kohorn EI. Negotiating a staging and risk factor scoring system for gestational trophoblastic neoplasia. A progress report. J Reprod Med. 2002 Jun;47(6):445-50 [5]Kohorn...