Gestational trophoblastic diseases: current trends and perspectives.

Gestational trophoblastic diseases (GTD) include a spectrum of diseases from the potentially premalignant hydatidiform mole to the highly aggressive choriocarcinoma. Most complete moles have diploid chromosomes, nearly always of pure paternal origin, whereas most partial moles have triploid chromosomes, containing one haploid maternal set and two paternal sets. The first-line treatment of molar pregnancies is suction evacuation. In patients with persistent trophoblastic diseases or choriocarcinoma, single agent or multiagent chemotherapy is indicated, depending on the prognostic score of the individual patient. With careful follow-up and appropriate treatment, nearly all patients with gestational trophoblastic diseases can be cured. Although many advances have been made in the cytogenetics, molecular biology and immunobiology of GTD, the reasons for its unique curability remain unclear. Studies comparing induction of apoptosis and multidrug resistance gene expression, in normal trophoblasts and GTD, may elucidate the mechanism behind the good response of GTD to chemotherapy. This may give some innovative insight into chemoresistance.