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Ultrasound imaging of the uterus and ovaries was performed on 41 patients after completion of apparently successful cytotoxic chemotherapy for invasive mole and choriocarcinoma. Uterine volume was calculated and the echopattern of the uterus and ovaries assessed. Forty-nine per cent of subjects had an abnormal uterine appearance and 20% had ovarian...
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... However, abnormal imaging findings may temporarily persist after clinical improvement and β-hCG normalization (46). US usually shows a progressive decrease in the size and echogenicity of the uterine mass (71). ...
Gestational trophoblastic disease (GTD) is a spectrum of both benign and malignant gestational tumors, including hydatidiform mole (complete and partial), invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. The latter four entities are referred to as gestational trophoblastic neoplasia (GTN). These conditions are aggressive with a propensity to widely metastasize. GTN can result in significant morbidity and mortality if left untreated. Early diagnosis of GTD is essential for prompt and successful management while preserving fertility. Initial diagnosis of GTD is based on a multifactorial approach consisting of clinical features, serial quantitative human chorionic gonadotropin (β-hCG) titers, and imaging findings. Ultrasonography (US) is the modality of choice for initial diagnosis of complete hydatidiform mole and can provide an invaluable means of local surveillance after treatment. The performance of US in diagnosing all molar pregnancies is surprisingly poor, predominantly due to the difficulty in differentiating partial hydatidiform mole from nonmolar abortion and retained products of conception. While GTN after a molar pregnancy is usually diagnosed with serial β-hCG titers, imaging plays an important role in evaluation of local extent of disease and systemic surveillance. Imaging also plays a crucial role in detection and management of complications, such as uterine and pulmonary arteriovenous fistulas. Familiarity with the pathogenesis, classification, imaging features, and treatment of these tumors can aid in radiologic diagnosis and guide appropriate management. (©)RSNA, 2017.
... Ultrasound has been shown to aid the diagnosis of hydatidiform mole (MacVicar & Donald, 1963;Leopold, 1971) and Woo et al. (1985) suggested that it may be of use in monitoring the response to treatment of patients with persistent trophoblastic tumours. However, a subsequent study has shown that real-time ultrasound is not of use in predicting those patients who will relapse after first line chemotherapy (Long et al., 1990a). Studies using arteriographic techniques have demonstrated an abnormal uterine circulation in patients with invasive mole and choriocarcinoma (Borrell & Fernstom, 1958;Brewis & Bagshawe, 1968) but this did not aid clinical management. ...
The haemodynamics of the uterine arteries and myometrium were assessed using Doppler ultrasound in forty consecutive patients requiring treatment for invasive mole and choriocarcinoma. The investigations were performed prior to the commencement of chemotherapy and the subjects followed prospectively. The Doppler waveforms from the uterine arteries were analysed using the pulsatility index. It was found that patients with a pulsatility index of 1.1 or less were significantly more likely to develop drug resistance than those with a higher value (P < 0.04). There was no significant association between the pulsatility index and metastatic disease or uterine bleeding. Five out of eight patients who developed drug resistance could have avoided initial inadequate treatment if the Doppler findings were included in the scoring system for selecting chemotherapy for these tumours. It can be concluded that assessment of the uterine arteries using the pulsatility index prior to the treatment of patients with invasive mole and choriocarcinoma is of help in predicting those who will develop drug resistance.
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Ultrasound plays an important role in the diagnosis and management of patients with gestational trophoblastic disease (GTD), including molar pregnancy and gestational trophoblastic neoplasia (GTN). The initial diagnosis of complete hydatidiform mole (CHM) is generally made with a markedly elevated human chorionic gonadotropin (hCG) and an abnormal ultrasound, which exhibits the classic snowstorm or grapelike appearance of the hydropic villi. The initial diagnosis of partial hydatidiform mole (PHM) by ultrasound in early pregnancy is less reliable. Overall, ultrasound is 34–57% sensitive in diagnosing molar pregnancy in the first trimester. The use of transvaginal ultrasound and color Doppler enhances the ability to assess the presence and extent of intrauterine disease in patients with GTN. Ultrasound measurement of uterine artery pulsations is predictive of the need for chemotherapy and may provide an indication of chemosensitivity in the management of patients. Furthermore, ultrasound is useful for the long-term follow-up of patients with GTD who develop abnormal bleeding following treatment to identify persistent disease, a new pregnancy event, or arteriovenous malformations. Lastly, ultrasound is essential in evaluating subsequent pregnancies to exclude recurrent GTD.KeywordsGestational trophoblastic diseaseGestational trophoblastic neoplasiaMolar pregnancyChoriocarcinomaPlacental site trophoblastic tumorUltrasoundColor DopplerUterine artery DopplerResistive indicesPulsatility indexChemotherapy resistanceTheca lutein cystsUterine arteriovenous malformations
Ultrasound plays an important role in the diagnosis and management of patients with gestational trophoblastic disease (GTD), including molar pregnancy and gestational trophoblastic neoplasia (GTN). The initial diagnosis of complete hydatidiform mole (CHM) is generally made with a markedly elevated human chorionic gonadotropin (hCG) and an abnormal ultrasound which exhibits the classic snowstorm or grape-like appearance of the hydropic villi. The initial diagnosis of partial hydatidiform mole (PHM) by ultrasound in early pregnancy is less reliable. Overall, ultrasound is 34–57 % sensitive in diagnosing molar pregnancy in the first trimester. The use of transvaginal ultrasound and color Doppler enhances the ability to assess the presence and extent of intrauterine disease in patients with GTN. Ultrasound measurement of uterine artery pulsations is predictive of the need for chemotherapy and may provide an indication of chemosensitivity in the management of patients. Furthermore, ultrasound is useful for the long-term follow-up of patients with GTD who develop abnormal bleeding following treatment to identify persistent disease or arteriovenous malformations. Lastly, ultrasound is essential in evaluating subsequent pregnancies to exclude recurrent GTD.
Gestational trophoblastic tumours (GTT) are unique in cancer biology since genetically they are either partially or completely paternally derived. GTT may occur after any form of pregnancy, but the most common presentation is with a hydatidiform mole (HM). The classical hydatidiform mole (CHM) is an androgenetic conceptus where the maternal genes have been deleted and the abnormal pregnancy presents between 8 and 12 weeks into gestation with vaginal bleeding and florid hydropic villi of trophoblast in the uterus and myometrium. Partial hydatidiform mole (PHM) is a triploid conceptus and again presents with vaginal bleeding, but with much less florid hydropic change in the trophoblastic villi; it commonly has some evidence of foetal development pathologically. Choriocarcinoma is a frank malignancy of the trophoblast and is an extremely vascular tumour, rapidly metastasising through the venous system to the lungs, brain and other sites. The incidence of malignancy following CHM is approximately 8% in the Charing Cross series and 0.5% after PHM. Choriocarcinoma can occur after molar pregnancies, full-term pregnancies and abortions. Over the last decade, a rare variant of choriocarcinoma, placental site trophoblastic tumour (PSTT), has been recognised pathologically and clinically. This tends to be a less widely metastasising tumour than choriocarcinoma and infiltrates locally in the pelvis.
Vaginal sonography has been the principal tool for the diagnosis of invasive mole and choriocarcinoma in Hochiminh City, Vietnam owing to its non-invasiveness, low cost and availability in the hospital. The typical images for diagnosis of invasive mole and choriocarcinoma were found in 60% and 75% cases, respectively. However, for other cases with atypical signs, the diagnosis could be feasible for clinicians in combination woth other tools, especially with urine beta-HCG which proved to be positive in 100% cases. Arteriography per se did not show to have a high value in diagnosis of trophoblastic tumor in the city. In the future, a prospective study should be conducted to look at the sensitivity and specificity of existing techniques used for the diagnosis of GTD in the hospital.
Fallbericht einer 29jährigen Patientin, die 3œ Monate nach vaginaler Geburt wegen anhaltender Metrorrhagie und positivem Schwangerschaftstest zugewiesen wurde. Vaginosonographisch wurde eine 3,5×4×4cm große, überwiegend echoreiche Raumforderung dargestellt, die das Myometrium im Bereich des rechten Uterusfundus breit infiltrierte. Ein ausgeprägter randständiger Blutfluß mit niedriger Impedanz wies in der farbkodierten Dopplersonographie auf einen Trophoblasttumor hin. Die Histologie des Curettement ergab ein Chorionkarzinom. Die Magnetresonanzuntersuchung stimmte bezüglich Tumorgröße mit dem Ultraschallbefund gut überein. Trophoblasttumoren nach normaler Geburt sind sehr selten. Die Verdachtsdiagnose kann durch die farbkodierte vaginale Dopplersonographie gestellt werden.
PurposeTo describe the sonographic morphological features of gestational choriocarcinoma.Materials and methodsRetrospective evaluation of 13 cases of gestational choriocarcinoma diagnosed by clinical and laboratory (BHCG) criteria in all cases and confirmed by histological data in 8 cases.ResultsThe tumor presented multiple features (nodular, submucosal, macrocystic, multicystic, compact and microcystic) often with involvement of surrounding tissues. All cases showed myometrial involvement. The size of the ovaries was normal with small corpus luteum cysts noted in only 5 cases. In 2 cases, ultrasound modified the clinical staging.Conclusion
Sonographic features of gestational choriocarcinoma are variable, and may mimic other diseases of the endometrium or myometrium. The involvement of multiple layers of the uterus suggests a malignant disease.
Gestational trophoblastic disease is a spectrum of disorders of varying malignant potential arising from trophoblastic cells and encompassing hydatidiform moles and persistent trophoblastic neoplasia. Ultrasound is the initial imaging investigation of choice when gestational trophoblastic disease is suspected. Complete hydatiform mole, the most common form of molar pregnancy, usually has a characteristic "cluster of grapes" appearance, especially on second-trimester ultrasounds. Persistent trophobastic neoplasia usually appears as a focal, hypervascular myometrial mass on pelvic ultrasound. Pelvic magnetic resonance imaging is often used as a problem-solving tool in equivocal or complicated cases of gestational trophoblastic disease to assess the degree of invasion into the myometrium and surrounding tissues. Chest x-ray, brain magnetic resonance imaging, and body computed tomography scans are primarily used for the evaluation of metastatic disease, which usually occurs in the context of choriocarcinomas. Choriocarcinoma metastases are usually hypervascular and have a tendency to bleed, features that are reflected in their imaging appearance.
Measuring beta hCG titers by either bioassay or radioimmunoassay has become the cornerstone in the management and treatment of hydatidiform mole. It is this very determination which will indicate either spontaneous remission or the need for chemotherapy treatment due to rising or plateauing titers. Herein, we report on the potential assistance of a unique ultrasonographic appearance of a hyperechogenic shadow located in the uterine wall, before and after an attempt for full evacuation of hydatidiform mole. The behavior of this echogenic area was more sensitive in predicting the course of the disease than did the beta hCG titers. Thus, using transvaginal sonography may serve as another predictor and indicator in evaluating the treatment of hydatidiform mole.
