Complete molar pregancy with development of non-metastatic persistent trophoblastic disease
A case report, reflection of rules of care and decision-making processes Forensic responsibility and the position of doctor in the general gynecologic and obstetric outpatient practice

Authors: S. Zeman 1;  P. Trávník 2 ;  K. Dvořáková 3;  J. Zemanová 1
Authors‘ workplace: Gynekologicko-porodnická ambulance, Velké Meziříčí, MUDr. S. Zeman 1;  REPROMEDA, Centrum reprodukční medicíny a preimplantační diagnostiky, Brno, ředitelka MUDr. K. Veselá Ph. D. 2;  Patologicko-anatomické oddělení nemocnice, Jihlava, prim. MUDr. M. Kheck 3
Published in: Ceska Gynekol 2017; 82(5): 396-406


To define the forensic responsibility and the position of doctor in the general gynecologic and obstetric outpatient practice in care of the complete molar pregancy.

Case report and review article.

General gynecologic and obstetric outpatient practice Velké Meziříčí; Sanatorium REPROMEDA, Centre of reproductive medicine and preimplantation genetics, Brno; Histopatology department of Hospital Jihlava.

Case report:
The changing clinical presentation of complete molar pregnancy with development of non-metastatic gestational trophoblastic disease: management. Subsequent early pregnancies outcome following complete hydatiform molar pregnancy.

Discussed are the forensic responsibility and the position of doctor in the general gynecologic and obstetric outpatient practice with the collaboration of Trophoblastic Disease Center based on the detail expert knowledges: rules of care and decision-making processes and potential controversies, the pitfalls of the histopathologic diagnosis, the genetics of complete hydatiform mole: new lights on a disease, outpatient follow-up and possibility and the risks of the subsequent pregnancy.

The conclusion is trying to guide quickly a doctor in the general gynecologic and obstetric outpatient practice in the decision-making processes through the crossings of any situation of the complete molar pregnancy and outpatient follow-up, alternatively with the collaboration of Trophoblastic Disease Center.

complete hydatiform mole, persistent gestational trophoblastic disease/neoplasia, GTN, chemotherapy, general gynecologic and obstetric outpatient practice, Trophoblastic Disease Center, molar pregnancy, trofoblast, genetics, outpatient follow-up, forensic responsibility


1. Al-Hussaini, TK., Abd el-Aal, DM., Van den Veyver, IB. Recurrent pregnancy loss due to familial and non-familial habitual molar pregnancy. Int J Gynaecol Obstet, 2003, 83(2), p. 179–186.

2. Alifrangis, C., Agarwal, R., Short, D., et al. EMA/CO for high-risk gestational trophoblastic neoplasia: Good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol, 2012, 1(2), p. 280–286.

3. Cole, LA., Miller, CY. Hyperglycosylated hCG in the management of quiscent and chemorefractory gestational trophoblastic disease. Gynecol Oncol, 2010, 116(1), p. 3–9.

4. de Pedro, M., Otero, B., Martin, B. Fertility preservation and breast cancer: a review. Ecancemedicalscience, 2015, 9, p. 503.

5. Deveault, C., Qian, JH., Chebaro, W., et al. NLRP7 mutations in women with diploid androgenetic and triploid moles: a proposed mechanism for mole formations. Hum Mol Genet, 2009, 18(5), p. 888–897.

6. Fallahian, M. Familial gestational trophoblastic disease. Placenta, 2003, 24(7), p. 797–799.

7. Familliari, G., Caggiati, A., Nottola, SA., et al. Ultrastructure of human ovarian primordial follicles after combination chemotherapy for Hodgkin´s disease. Hum Reprod, 1993, 8(12), p. 2080–2087.

8. Fisher, RA., Hodges, MD. Genomic imprinting in gestational trophoblastic disease – a review. Placenta, 2003, Suppl. A:S, p. 111–118.

9. Fong, PY., Xue, WC., Ngan, HY., et al. Mcl-1 expression in gestational trophoblastic disease correlates with cloníc aoutcome: a differential expression study. Cancor, 2005, 103(2), p. 268–276.

10. Fulop, V., Mok, SC., Berkowitz, RS. Molecular biology of gestational trophoblastic neoplasia: a review. J Repris Med, 2004, 49(6), p. 415–422.

11. Garner, EI., Felmate, CM., Goldstein, DP., et al. The curative effect of second curettage in persistent trophoblastic disease: a retrospective cohort survey. Gynecol Oncol, 2005, 99(1): p. 3–5.

12. Garner, EI., Garrett, A., Goldstein, DP., et al. Significance of chest computed tomography findings in the evaluation and treatment of persistent gestational trophoblastic neoplasia. J Reprod Med, 2004, 49(6): p. 411–414.

13. Goldstein, DP., Zanten-Przybysz, I., Bernstain, MR., et al. FIGO staging system for gestational trophoblastic tumors. J Reprod Med, 1998, 43, p. 37–43.

14. Hancock, BW., Nazir, K., Everard, JE. Persistent gestational trophoblastic neoplasia after partial hydatidiform mole – Incidence and outcome. J Reprod Med, 2006, 51(10), p. 764–766.

15. Hernandez, E. Gestational Trophoblastic Neoplasia. Updated: Mar 05,2015

16. Hodges, MD., Rees, HC., Seckl, MJ., et al. Genetic refinement and physical mapping of a biparental complete hydatiform mole locus on chromosome 19q13.4. J Med Genet, 2003, 40(8):e p. 95.

17. Hron, F., Feyereisl, J., Korbel, M. Perzistující trofoblastická nemoc – diagnostika a léčba. 18.3.2015

18. Hron, F., Feyereisl, J., Korbel, M., Šafář, P. Současné trendy v diagnostice a léčbě trofoblastické nemoci. Actual Gyn, 2014, 6, s. 63–66.

19. Hron, F., Hejda, V., Feyereisl, J., et al. Neinvazivní trofoblastická nemoc. Čes Gynek, 2011, 76, 6, s. 443–446.

20. Hron, F., Hejda, V., Feyereisl, J., et al. Quiescent trophoblastic disease. Čes Gynek, 2011, 76, s. 443–446.

21. Ježová, M., Hotárková, S., Můčková, K., et al. Fetopatologie a vývojová patologie embrya a plodu. Gestační trofoblastická nemoc. Atlas fetální patologie.

22. Kashimura, Y., Kashimura, M., Sugimori, H., et al. Prophylactic chemotherapy for hydatidiform mole. Five to 15 years follow-up. Cancer, 1986, 58(3), p. 624–629.

23. Khanlian, SA., Cole, LA. Management of gestational tropho­blastic disease and other cases with low serum levels of human chorionic gonadotropin. J Reprod Med, 2006, 51(10), p. 812–818.

24. Kim, SJ., Park, SE., Lee, C., et al. Altered imprinting, promoter usage, and expression of insulin-like growth factor-II gene in gestational trophoblastic diseases. Gynecol Oncol, 2003, 88(3), p. 411–418.

25. Kohorn, EI. Dynamic staging and risk factor scoring for gestational trophoblastic disease. Int J Gynecol Cancer, 2007, 17, p. 1–7.

26. Kohorn, EI. Negotiating a staging and risk factor scoring system for gestational trophoblastic neoplasia. A progress report. J Repris Med, 2002, 47(6), p. 445–450.

27. Kohorn, EI. The FIGO 2000 staging and risk factors scoring systém for gestational trophoblastic neoplasia; A critical analysis. Int J Gynecol Cancer, 2001, 11, p. 205–215.

28. Kolařík, D., Halaška, M., Feyereisl, J. Repetitorium Gynekologie. 2. rozšířené vydání. Praha: Maxdorf Jessenius, 2011, s. 904–914.

29. Lawler, SD., Fisher, RA., Dent, JA. A prospective genetic study of complete and partial hydatiform loles. Am J Obstet Gynecol, 1991, 164(5Pt1), p. 1270–1277.

30. Massad, LS., Abu-Rustum, NR., Lee, SS., et al. Poor compliance with postmolar surveillance and treatment protocols by indigent women. Obstet Gynecol, 2000, 96(6), p. 940–944.

31. Matsui, H., Iitsuka, Y., Suzuka, K., et al. Risk of abnormal pregnancy completing chemotherapy for gestational trophoblastic tumor. Gynecol Onkol, 2003, 88(2), p. 104–107.

32. Meirow, D., Dor, J., Kaufman, B., et al. Cortical fibrosis and blood-vessels damage in human ovaries exposed to chemotherapy. Potential mechanisms of ovaria injury. Hum Reprod, 2007, 22(6), p. 1626–1633.

33. Moore, LE., Hernandez, E. Hydatiform Mole: Background, Pathophysiology, Epidemiology. Updated: Nov 30, 2015.

34. Ngan, HY. The FIGO staging for gestational trophoblastic neoplazm 2000. FIGO Report. Int J Gynecol Obstet, 2000, 77, p. 285–287.

35. Ngan, HY., Chan, FL., Au, VW., et al. Clinical outcome of micrometastasis in the lung in stage IA persistent gestational trophoblastic disease. Gynecol Oncol, 1998, 70(2), p. 192–194.

36. Olsen, TG., Barnes, AA., King, JA. Elevated hCG outside of pregnancy-diagnostic considerations and laboratory evaluation. Obstet Gynecol Surv, 2007, 62(10), p. 669–674; quiz p. 691.

37. Olsen, TG., Hubert, PR., Nycum, LR. Falsely elevated human chorionic gonadotropin leading to unnecessary therapy. Obstet Gynecol, 2001, 98(5 Pt 1), p. 843–845.

38. Pařízek, A. Kniha o těhotenství a dítěti. Praha: Galén, 2009, 776 s.

39. Pezeshki, M., Hancock, BW., Silcocks, P., et al. The role of repeat uterine evacuation in the management of persistent gestational trophoblastic disease. Gynecol Oncol, 2004, 95(3), p. 423–429.

40. Rob, L. Gestační trofoblastická nemoc. Linkos>> Pro pacienty>> Diagnózy>> Gynekologické nádory (C51-54.C56-57) Datum vytvoření 4. 1. 2007.

41. Rob, L., Martan, A., Cittebart, K. Gynekologie. 2. vyd. Praha: Galén, 2008, 390 s. ISBN 978-80-7262-501-7.

42. Rustin, GJ., Newlands, ES., Lutz, JM., et al. Combination but not single-agent methotrexate-chemotherapy for gestational trophoblastic tumors increases the incidence of second tumors. J Clin Oncol, 1996, 14(10), p. 2769–2773.

43. Seckl, MJ., Fisher, RA., Salerno, GA., et al. Choriocarcinoma and partial hydatidiform moles. Lancet, 2000, 356(9223), p. 36–39.

44. Seckl, MJ., Sebire, NJ., Fisher, RA., et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24, p. 39–50.

45. Slim, R., Mehio, A. The genetics of hydatiform moles: new lights on an ancient disease. Clin Genet, 2007, 71(1), p. 25–34.

46. Smith, HO., Kohorn, E., Cole, LA. Choriocarcinoma and gestational trophoblastic disease. Obstet Gynecol Clin North Am, 2005, 32(4), p. 661–684.

47. Soper, JT. Gestational trophoblastic disease. Obstet Gynecol, 2006, 108(1), p. 176–187.

48. Takenchi, S. The report of the Registration Committee of the Japan Society of Gestational Trophoblastic Diseases. Acta Obstet Gynecol Japonica, 1987, 39, p. 871–880.

49. Tham, YL., Sexton, K., Weiss, H., et al. The rates of chemotherapy-induced amenorrhea in patients treated with adjuvant doxorubicin and cyclophosphamide followed by a taxane. Am H Clin Oncol, 2007, 30(2), p. 126–132.

50. Trávník, P. Embryonální vývoj člověka a jeho ovlivnění léčivými látkami I. Charakteristika etap vývoje a enviromentálních vlivů na zárodek. Prakt Lékáren, 2011, 7(1), s. 17–19.

51. van Trommel, NE., Massuger, LF., Verheijen, RH., et al. The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort survey. Gynecol Oncol, 2005, 99(1), p. 6–13.

52. Veselá, K., Kocur, T., Horák, J., et al. Asistovaná reprodukce a preimplantační genetická diagnostika u pacientek ohrožených karcinomem prsu. Klin Onkol, 2016, 29 (Suppl. 1), s. 93–99.

53. Vojtaššák, J., Vojtaššák, B. Genetické aspekty gestačních trofoblastových tumorov. Gynekol Prax, 2014, 12, s. 145–114.

54. Wiesma, S., Kerkmeijer, L., Bekkers, R., et al. Guidelines following hydatidiform mole: a reappraisal. Austral New Zealand J Obstet Gynaecol, 2006, 46(2), p. 112–118.

55. Wiesma, S., Kerkmeijer, L., Bekkers, R., et al. Persistent trophoblast disease following partial molar pregnancy. Austral New Zealand J Obstet Gynaecol, 2006, 46(2), p. 119–123.

56. Williams, CJ., Erickson, GE. Morphology and physiology of the ovary. In: Robert Rebar (Ed.) Endocrinology of female reproduction. Endotext, 2012. 45 pp.

57. Wolf, NG., Lage, JM. Genetic analysis of gestational tropho­blastic disease: a review. Semin Oncol, 1995, 22(2), p. 113–120.

58. Zavadil, M. Trofoblastická nemoc. Kapitola 24. In Roztočil, A. Moderní gynekologie. Praha: Grada Publishing, 2009.

59. Zavadil, M., Feyereisl, J., Krofta, L., et al. Nové diagnostické přístupy k různým typům hydatidózních mol, hydropickým abortům a příslušné klinické postupy. Čes Gynek, 2009, 74, 3, s. 177–182.

60. Zavadil, M., Feyereisl, J., Krofta, L., et al. Perzistující trofo­blastická nemoc v Centru pro trofoblastickou nemoc v ČR v letech 1955–2007. Čes Gynek, 2008, 73, 2, s. 73–79.

61. Zavadil, M., Feyereisl, J., Krofta, L., et al. Trofoblastická nemoc. Postgrad Med, 2007, 1.

62. Zavadil, M., Feyereisl, J., Šafář, P., et al. Syndrom perzistujících nízkých hladin humánních choriových gonadotropinů (hCG). Etiologie, klasifikace, diagnostika, postupy. Čes Gynek, 71, 2006, 2, s. 136–142.

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