title: Choriocarcinoma and partial hydatidiform moles.
abstract: BACKGROUND
  Partial hydatidiform moles (PMs) rarely require chemotherapy and have never previously been proven to transform into choriocarcinoma, the most malignant form of gestational trophoblastic disease (GTD). Consequently, some have questioned whether women with PMs need human chorionic gonadotropin (hCG) follow-up. Here, we investigate whether PMs can transform into choriocarcinomas.
  
  
  METHODS
  Patients with a PM who developed a subsequent choriocarcinoma were identified from our GTD database. The histology of both PM and ensuing choriocarcinoma was reviewed and flow cytometry used to verify the triploid status of the PMs. To determine whether the choriocarcinoma arose from the PM, DNA from the PM and choriocarcinoma in each patient was compared using microsatellite polymorphisms.
  
  
  RESULTS
  Of the 3000 patients with PM, 15 required chemotherapy for persisting GTD. This was identified as choriocarcinoma in three cases. In one patient, the local pathologist could not differentiate between a PM or a hydropic abortion and neither central histological review nor hCG follow-up were obtained. This patient nearly died before the diagnosis of choriocarcinoma was made. Fortunately, the local pathologists correctly diagnosed PM in the two other patients who were then registered for hCG follow-up. Some months later, the hCG was rising and repeat uterine evacuation revealed choriocarcinoma. The PM was confirmed to be triploid in all three cases and genetic analysis showed that the subsequent choriocarcinomas contained identical single maternal and two paternal alleles at several independent loci.
  
  
  CONCLUSIONS
  Our results show that PMs can transform into choriocarcinoma. All patients with suspected PM should be reviewed centrally and, if confirmed, need hCG follow-up.
authors.affiliation: Department of Medical Oncology, Imperial College, London, UK. m.seckl@ic.ac.uk
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.forename: G
authors.initials: G
authors.lastname: Salerno
authors.forename: H
authors.initials: H
authors.lastname: Rees
authors.forename: F J
authors.initials: FJ
authors.lastname: Paradinas
authors.forename: M
authors.initials: M
authors.lastname: Foskett
authors.forename: E S
authors.initials: ES
authors.lastname: Newlands
mesh_terms: D000328:Adult; D000483:Alleles; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002822:Choriocarcinoma / Q000175:diagnosis* / Q000628:therapy; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis* / Q000628:therapy; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D008297:Male; D018895:Microsatellite Repeats; D011123:Polyploidy; D011247:Pregnancy; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000628:therapy
chemical_list: D006063:Chorionic Gonadotropin