Pregnancy-induced trophoblast diseases--results from the years 1976-1992

Gestational trophoblastic diseases (GTD) represent a spectrum of different disorders, derived from the human placental trophoblast. GTDs are potentially fatal disorders and are of great importance for gynaecologists and pathologists. In recent years 148 GTDs were treated at department of Obstetrics and Gynaecology of Leipzig University. We reexamined these cases with respect to diagnostic findings, diagnostic mistakes, the necessity of consecutive chemotherapy and outcome. The 148 relevant cases included 103 complete hydatidiform moles, 13 invasive moles and 32 choriocarcinomas. 61.5% showed a spontaneous regression of HCG after molar evacuation. 57 cases developed persistent trophoblastic disease with consecutive mono-combined or polychemotherapy. An overall remission rate of 91.2% was achieved. The two patients, who died, showed a late stage of disease. 5.3% of the cases had a recurrence of disease. The most frequent side effect of chemotherapy was a moderate bone marrow depression in 58% of cases. 88.5% were diagnosed by suction curettage alone. Twelve patients had an operative intervention before chemotherapy, often due to diagnostic misinterpretation of the symptoms. Eight cases needed a secondary operation to attain complete remission. Initiating chemotherapy is very important for therapy success. In cases of complete hydatidiform mole, it is difficult to make a prognostic statement with reference to biological behaviour of the disease by morphological methods alone. The difficulties are discussed. These cases emphasise the need for appropriate clinical monitoring and close cooperation between the gynaecologist, the pathologist and the clinician.