Question

Discuss the workup and evaluation of a suspected case of gestational trophoblastic neoplasia.

Hint:

The most important diagnostic tool in GTN is measuring hCG levels. Any unusual rise or persistence after pregnancy warrants further investigation.

Answer 1

Step 1: Initial Evaluation.
The evaluation of suspected gestational trophoblastic neoplasia (GTN) involves both clinical and laboratory investigations to confirm the diagnosis and assess the extent of the disease.
Step 2: Laboratory Workup.
(1) Serum hCG Measurement: Persistent or rising hCG levels post-pregnancy are a strong indication of GTN. hCG levels are monitored regularly to assess for resolution or progression.
(2) Ultrasound: A pelvic ultrasound may reveal abnormal growths or remnants of molar tissue in the uterus. It can also help identify any uterine mass or metastasis.
(3) Histopathological Examination: In cases of suspected molar pregnancy, tissue examination is critical to confirm the presence of trophoblastic tissue and differentiate benign from malignant disease.
Step 3: Imaging and Further Testing.
(1) Chest X-ray or CT Scan: For suspected metastasis, a chest X-ray or CT scan can identify lung involvement, which is common in metastatic GTN.
(2) MRI: An MRI may be used for further assessment of the extent of pelvic or uterine involvement, especially in invasive mole or choriocarcinoma cases.
(3) Liver and Brain Imaging: If symptoms suggest liver or brain involvement, CT or MRI imaging is necessary to evaluate these sites.