A simple lay understanding of Gestational Trophoblastic Diseases.
The USA hCG Reference Service has consulted on over 300 cases of complicated and confusing gestational trophoblastic diseases. From this experience they discovered Quiescent Gestational Trophoblastic Disease and Minimally Aggressive Gestational Trophoblastic Neoplasm (see home page G. Dr. Cole’s Pertinent Publications). Let us start by defining the different gestational trophoblastic diseases –
1. Partial hydatidiform mole
2. Complete hydatidiform mole
4. Gestational trophoblastic neoplasm (GTN)
5. Quiescent gestational trophoblastic disease
6. Minimally aggressive gestation trophoblastic neoplasm
7. Placental site trophoblastic tumor (PSTT)
8. Epithelioid gestational trophoblastic neoplasm
Briefly, it needs to be understood that the autocrine signal protein, hyperglycosylated hCG is made by cytotrophoblast cells (choriocarcinoma, GTN or invasive hydatidiform mole root placental cells). It binds and antagonizes a TGFß receptor on these same cells and as part of the normal pregnancy implantation mechanism, forces these cells to grow, and use digestive enzymes to invade deeper and deeper into uterine and multiple other tissues. This is a cancer-like malignancy process. If hyperglycosylated hCG is highly present then this invasion or malignancy maximally occurs, as in cases of choriocarcinoma, GTN and invasive hydatidiform mole. If production of hyperglycosylated hCG is limited by death of cytotrophoblast cells then minimally aggressive gestational trophoblastic neoplasm can occur, which may be resistant to chemotherapy. If hyperglycosylated hCG is absent then completely inactive or benign disease occurs as quiescent gestational trophoblastic disease.
Dr. Cole is the actual discoverer of hyperglycosylated hCG (see G. Dr. Cole’s Pertinent Publications), and Dr. Cole and the USA hCG Reference Service tests every referred case for the proportion of hyperglycosylated hCG being produced. Other trophoblastic disease like PSTT and epithelioid gestational trophoblastic neoplasm produce an hCG free ß-subunit. This is their invasive signal. The USA hCG Reference Service measures free ß-subunit also.