Tumours arising from the trophoblast show a spectrum from benign hydatidiform mole to the frankly malignant choriocarcinoma.
Benign moles occur in 1 in 2500 to 1 in 5000 confinements in the UK, choriocarcinoma 1 in about 40,000. Five percent of moles are ultimately diagnosed as choriocarcinomas. One quarter arise from a normal or ectopic pregnancy.
Race, age, and a previous molar pregnancy are predisposing factors.
Pathologically, hydropic villi are commonly seen in benign lesions but are usually unidentifiable in choriocarcinoma. When present, metastases usually occur to the lower genital tract, lung, liver and brain.
Vaginal bleeding is a common early sign. All demonstrate raised beta-hCG which is used to monitor the course of the disease.
Treatment usually entails evacuation followed by chemotherapy and in highly metastatic disease, additionally, radiotherapy. Hysterectomy is usually advised in women over 40 years of age.
beta-hCG should be monitored for at least two years following initial treatment.
Tumours treated within 6 months of diagnosis enjoy a 95% cure rate.
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