Abstract：
Gestational trophoblastic diseases (GTD) encompass a spectrum of rare pre-malignant and malignant entities originating from trophoblastic tissue. This updated review will highlight important radiological features, pathology and classification, and provide insight into the clinical management of these uncommon disorders. There is a wide geographic variation with the incidence of hydatidiform mole varying between 0.57 and 2 per 1000 pregnancies. The use of ultrasound (US) in the management of early pregnancy symptoms and complications has positively impacted the earlier detection of these diseases and resulted in diminished morbidity. Additional imaging modalities are reserved for problem solving or assessment of pulmonary manifestations of molar pregnancy. Having an awareness of their pleomorphic sonographic presentation and additional pathology that can mimic GTD is critical to avoiding pitfalls. Histologic and molecular analysis further aids in differential diagnosis. Gestational trophoblastic neoplasia (GTN) is inclusive of all malignant GTDs, and arises after 20% of molar pregnancies but can also be seen with non-molar gestations. Biochemical monitoring with human chorionic gonadotrophin is imperative for ongoing monitoring and surveillance and allows early detection of this entity. Doppler US is used for confirmation of diagnosis with magnetic resonance imaging (MRI) reserved for problem solving or assessment of myometrial invasion. This is of heightened relevance in patients undergoing surgical management. Cross sectional imaging is reserved for patients in the setting of GTN for the purposes of staging, prognostication and in the setting of recurrent disease. This may require a combination of computed tomography, MRI and positron emission tomography. Doppler US can provide insight into chemotherapeutic response/predict resistance in patients with GTN. As our understanding of these disorders evolves, there has been maturation in management options with a shift from traditional chemotherapy to innovative immunotherapy, particularly in the setting of resistant or high-risk disease.
摘要：
妊娠滋养细胞疾病（GTD）包括一系列源自滋养细胞组织的罕见的恶性前和恶性实体。这项更新的审查将突出重要的放射学特征，病理学和分类，并深入了解这些罕见疾病的临床管理。葡萄胎的发病率在每1000例妊娠0.57至2例之间变化，地理差异很大。在早期妊娠症状和并发症的管理中使用超声（US）对这些疾病的早期检测产生了积极影响，并降低了发病率。保留其他成像方式以解决问题或评估磨牙妊娠的肺部表现。了解他们的多形性超声表现和可以模仿GTD的其他病理学对于避免陷阱至关重要。组织学和分子分析进一步有助于鉴别诊断。妊娠滋养细胞瘤（GTN）包括所有恶性GTD，并且在20％的磨牙妊娠后出现，但也可以在非磨牙妊娠中看到。使用人绒毛膜促性腺激素进行生化监测对于持续监测和监视是必不可少的，并且可以早期发现该实体。多普勒超声用于通过磁共振成像（MRI）确认诊断，以解决问题或评估肌层浸润。这在接受手术治疗的患者中具有更高的相关性。为了进行分期，保留了GTN设置的患者的横截面成像，预后和复发性疾病的设置。这可能需要结合计算机断层扫描，MRI和正电子发射断层扫描。多普勒超声可以深入了解GTN患者的化疗反应/预测耐药性。随着我们对这些疾病的理解的发展，随着从传统化疗到创新免疫疗法的转变，管理选择已经成熟，特别是在耐药或高风险疾病的背景下。
