Gestational trophoblastic disease: current management of hydatidiform mole

doi:10.1136/bmj.a1193

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This article has a correction

Please see: Gestational trophoblastic disease: current management of hydatidiform mole

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N J Sebire, reader in histopathology,
M J Seckl, professor of molecular oncology and director

¹Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, London W6 8RF

Correspondence to: M J Seckl m.seckl{at}imperial.ac.uk

Accepted 4 July 2008

Summary points

Hydatidiform moles are non-viable genetically abnormal conceptions with excess expression of paternal genes and abnormal proliferation of the placental trophoblast
Women diagnosed with hydatidiform mole should be registered with a regional centre for regular monitoring of human chorionic gonadotrophin to check for onset of malignancy
Gestational trophoblastic neoplasia occurs in 10% of women with molar pregnancy
If neoplasia is recognised early it can be cured in nearly every case, often with methotrexate alone

Gestational trophoblastic disease consists of a pregnancy related group of disorders that were often fatal in the past. Much has been learnt in the past 50 years, however, and most women can now be cured. The United Kingdom has a highly centralised system for registering, monitoring, and treating women with this disease that requires close collaboration with non-specialist units and general practitioners. We review the important features for detection and successful management of the most common form of this disease, hydatidiform mole. The evidence is based on published studies—mostly retrospective case series—and expert opinion.

How common is gestational trophoblastic disease?

Hydatidiform mole affects 1-3 in every 1000 pregnancies. About 10% of hydatidiform moles transform into one of the malignant forms of gestational trophoblastic disease, known as gestational trophoblastic neoplasia (box 1).

Box 1 Classification of gestational trophoblastic disease

Benign forms

Partial hydatidiform mole
Complete hydatidiform mole

Malignant forms

Invasive hydatidiform mole
Choriocarcinoma
Placental site trophoblastic tumour
Epithelioid trophoblastic tumour

What is hydatidiform mole and who gets it?

Hydatidiform moles are abnormal conceptions with excessive placental, and little or no fetal, development. The two major types—complete and partial—have distinctive histological and genetic features (boxes 2 and 3).1 2 3 4 5 6 7 Hydatidiform moles affect women throughout the reproductive age range but are more common at the extremes of the range.8 Women under 16 have a six times higher risk of developing the disease than those aged 16-40, and women who conceive aged 50 or more have a one in …