GESTATIONAL TROPHOBLASTIC DISEASES - RESU LTS 1976-1992

Introduction: Gestational trophoblastic diseases (GTD) represent a spe ctrum of different disorders, derived from the human placental trophob last. GTDs are potentially fatal disorders and are of great importance for gynaecologists and pathologists. Study design: In recent years 14 8 GTDs were treated at department of Obstetrics and Gynaecology of Lei pzig University. We reexamined these cases with respect to diagnostic findings, diagnostic mistakes, the necessity of consecutive chemothera py and outcome. Results: The 148 relevant cases included 103 complete hydatidiform moles, 13 invasive moles and 32 choriocarcinomas. 61.5% s howed a spontaneous regression of HCG after molar evacuation. 57 cases developed persistent trophoblastic disease with consecutive mono-comb ined or polychemotherapy. An overall remission rate of 91.2% was achie ved. The two patients, who died, showed a late stage of disease. 5.3% of the cases had a recurrence of disease. The most frequent side effec t of chemotherapy was a moderate bone marrow depression in 58% of case s. 88.5% were diagnosed by suction curettage alone. Twelve patients ha d an operative intervention before chemotherapy, often due to diagnost ic misinterpretation of the symptoms. Eight cases needed a secondary o peration to attain complete remission. Conclusions: Initiating chemoth erapy is very important for therapy success. In cases of complete hyda tidiform mole, it is difficult to make a prognostic statement with ref erence to biological behaviour of the disease by morphological methods alone. The difficulties are discussed. These cases emphasise the need for appropriate clinical monitoring and close cooperation between the gynaecologist, the pathologist and the clinician.