Recent advances in gestational trophoblastic neoplasia

Gestational trophoblastic neoplasia refers to the spectrum of conditions characterised by proliferation of conceptus-derived trophoblast, and includes partial and complete hydatidiform mole (HM), invasive mole, choriocarcinoma and placental site trophoblastic tumour and its variants. With changes in the management of early pregnancy complications in recent years, the majority of HMs are now evacuated in the late first trimester, at which time, it is now recognised, their histopathological features, although characteristic, may differ from those traditionally described following second-trimester evacuation. In view of these changes in presentation, updated histopathological criteria are presented and specific additional issues discussed, including recent advances in molecular genetics, ancillary investigations, recurrence risk, development of persistent trophoblastic neoplasia, intraplacental choriocarcinoma and mole with coexisting fetus.