GESTATIONAL TROPHOBLASTIC NEOPLASIA IN THE 1990S

Major advances have been achieved during the past 40 years in the epid emiology, etiology, pathology, endocrinology, immunology, diagnosis, a nd treatment of molar pregnancy (MP) and gestational trophoblastic neo plasia (GTN). MP is now recognized as composing two distinct entities- complete and partial, with distinct histopathology, genetics, and clin ical presentations. Proper management is dependent on a thorough under standing of each type. Early diagnosis and effective treatment of pati ents with GTN has resulted in 100 percent cure rates in non-metastatic disease and in the majority of patients with metastases. In most inst ances, resistant disease leading to death results from delayed diagnos is and overwhelming tumor burden. Moreover, in most instances successf ul treatment can be accomplished with preservation of fertility and no rmal pregnancy outcome anticipated. A rare variant of choriocarcinoma called placental site trophoblastic tumor (PSTT) has been described, w hich, although curable by surgery when localized, is usually fatal whe n disseminated. It is anticipated that during the decade of the nineti es the scientific work in progress will lead to earlier diagnosis and improved survival in resistant cases.