malignant gestational trophoblastic disease choriocarcinoma

Malignant GTN:
The malignant GTN can be classified into the non-metastatic invasive mole and the metastatic: choriocarcinoma and the PSTT.
Malignant disease can be suspected when :
1- Plateauing or rising B-hCG value over a period of 3 consecutive weeks.
2- A rise of B-hCG over a period of 2 weeks.
3- Persistence of a detectable B-hCG after 6 months of evacuation..
The frankly malignant disease is further subdivided into:
Good prognosis group (low risk group)
And the poor prognosis group (high risk group).

Choriocarcinoma:
The incidence of Choriocarcinoma is varying between 1:10 000 to 1:70 000 in the west. And between 1:250 to 1:6000 in Asia.
It is purely epithelial tumour composed of syncytiotrophoblast and cytotrophoblast.
The antecedent pregnancy is H. mole in 50%, normal pregnancy in 25% and abortion or ectopic pregnancy in 25%.
The risk of Choriocarcinoma is 2-4% after H. Mole i.e. 1000 times greater than after normal pregnancy.
Histopathological features:
Sheets or foci of trophoblast on a back ground of haemorrhage and necrosis but there are no villi, it invade the myometrium and metastasizes to the lungs, brain, liver, and other organs.
Confirmation of the diagnosis is made by dilatation and curettage but it carry high risk of uterine perforation and dissemination of the disease, so it can be diagnosed basically depending on the clinical suspicion and B-hCG levels measurement