ARRS 2022 Abstracts


E1410. The LD on GTD: A Review of Gestational Trophoblastic Disease
  1. Adam Kinzel; UCLA
  2. Jena Depetris; UCLA
  3. Simin Bahrami; UCLA
  4. Rinat Masamed; UCLA
  5. Maitraya Patel; UCLA
Gestational trophoblastic disease (GTD) describes a spectrum of both benign and malignant tumors arising from placental trophoblasts. These include hydatidiform moles (complete and partial) as well as gestational trohoblastic neoplasias (GTN), which encompass invasive moles, choriocarcinomas, placental site trophoblastic tumors (PSTT), and epithelioid trophoblastic tumors (ETT). Patients with molar pregnancy are often asymptomatic, as they present early in pregnancy. Common symptoms include vaginal bleeding at 6–16 weeks gestation, enlarged uterus, and hyperemesis. Patients with GTN often present with abnormal uterine bleeding and can occur following a molar pregnancy or even months to years after a normal pregnancy. Early recognition of these tumors is critical both for preservation of fertility as well as curability. The purpose of this educational exhibit is to provide an overview of GTD and describe the radiologic implications for staging, treatment, and follow-up of recurrence.

Educational Goals / Teaching Points
By the end of the exhibit, the viewer will be able to describe the spectrum of GTD, classification systems, epidemiology and risk factors, and clinical, lab and pathologic findings. In addition, they will be able to discuss the role of imaging and key findings in the diagnosis and staging (FIGO and WHO risk score) of GTD across multiple modalities. Finally, the viewer will be able to understand the treatment and surveillance for these diseases and recognize potential tumor and treatment-related complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pelvic ultrasound (transabdominal and transvaginal) is the modality of choice for detection of GTD. On ultrasound, a molar pregnancy will demonstrate a classic “snowstorm” or “cluster of grapes” appearing mass centered in the endometrium. GTN will show a nonspecific mass centered within the myometrium with variable extension into the endometrium and potentially into the parametrium on ultrasound. Chest radiographs, CT, and MRI are used in the staging and evaluation of metastatic disease. In the case of metastatic disease, the most frequent site of metastasis is to the lungs followed by vagina, liver, and brain. Finally, 10–15% of patients with GTD may demonstrate persistent uterine vascular malformations even after complete resolution of the disease. A small minority of these patients will require uterine artery embolization due to refractory vaginal bleeding.

GTD is a rare spectrum of tumors originating from the placenta following pregnancy. In the vast majority of women affected, GTD has a favorable outcome with approximately an 80–90% cure rate depending on the type of tumor and the metastatic burden at time of presentation. Radiologists play a vital role both for the diagnosis of GTD and to guide effective clinical management in these patients.