Management of gestational trophoblastic neoplasia

It is just 100 years since Marchand [1] identified choriocarcinoma as a tumour arising from placental villous trophoblast. Earlier description of similar tumours failed to identify their tissue of origin. Gestational Trophoblastic Disease (GTD) is the terminological umbrella now used to span the spectrum of cellular proliferations ranging from villous forms of hydatiform mole through invasive mole and choriocarcinoma to placental site tumours [2]. Each form of GTD presents its own particular set of problems ranging from social to therapeutic. These proliferations are unique in several aspects. In the first place there is no known homolog of hydatiform mole in any other species. The rare identification of choriocarcinoma like tumours remains restricted to a rhesus monkey [3] and an armadillo [4]. In the human, histologically characterized choriocarcinoma behaves in a broadly similar manner whether it is genetically identical with the host as in germ cell origin, or whether it arises from a normal conception or an androgenetic hydatiform mole.