الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Gestational trophoblastic disease (GTD) encompasses four clinicopathologic forms: (I) Hydatidiform mole, (2) Invasive mole, (3) Choriocarcinoma, and (4) Placental site trophoblastic tumor. The term gestational trophoblastic tumor has been applied to the latter three conditions because the diagnosis and decision to institute treatment are often undertaken without knowledge of the histology. These diseases are unique because of (I) the elaboration of the tumor marker human chorionic gonadotropin (HCG), (2) the inherent sensitivity of trophoblastic tumors to chemotherapy, and (3) the immuno-biological relationship between the disease and its host (Lurain, 1996).
The epidemiology of GTD is not well understood. Methodologic problems, such as lack of clear and precise case definition, case ascertainment, and identification of the population at risk, limit the interpretation of published studies. GTD accounts for fewer than I% of gynecologic malignancies in the USA. All gestational trophoblastic tumors are derived from a fertilization event (Lage and Sheikh 1997) and form a heterogeneous group of interrelated lesions, which are characterized by an abnormal proliferation of the different types of trophoblastic epithelium (Horn and Bilek, 1997).
Increasingly, patients with molar pregnancy are being treated before they develop the classic clinical signs and symptoms due to frequent use of ultrasound in early pregnancy in women with vaginal bleeding and even asymptomatic women. Most hydatidiform moles are detected between 8-24 weeks of gestation, with a peak around 14 weeks (Rustin, 1997). Essentially all patients with hydatidiform mole have delayed menses for varying periods, and most patients are considered to be pregnant (DiSaia and Creasman, 1997). The most common symptom is vaginal bleeding. Other clinical criteria include: excessive uterine size, preeclampsia, hyperemesis, anemia, hyperthyroidism and respiratory distress. The symptom most suggestive of invasive mole or choriocarcinoma is continued uterine bleeding after evacuation of a molar pregnancy or following any pregnancy event (Lurain, 1996).