title: Ectopic gestational trophoblastic disease: a case series review.
abstract: OBJECTIVE
  To highlight the clinical presentation, treatment, histological review and outcome of patients referred to the Sheffield Centre with possible ectopic gestational trophoblastic disease (GTD).
  
  
  METHODS
  A retrospective case note review of patients with possible ectopic GTD referred to the Sheffield Centre between 1997 and 2010 was performed.
  
  
  RESULTS
  During the 13 years of this retrospective study 6,708 patients were registered at the Centre with GTD, of whom 42 had possible ectopic GTD. Most patients presented with abdominal pain and/or vaginal bleeding (67%). Ectopic pregnancy was diagnosed by ultrasound scan in 19%. Laparoscopic removal of ectopic pregnancy was carried out in 50% of cases; the rest underwent laparotomy for removal of ectopic conceptus. Histological review of slides was performed in 19 cases for whom there was clinical concern. This resulted in 12 confirmed cases of ectopic GTD: 4 choriocarcinomas, 5 partial moles and 3 complete moles. No evidence of metastasis was recorded in any of the cases. Three patients diagnosed with ectopic choriocarcinoma needed chemotherapy. Two responded to methotrexate and 1 needed second-line chemotherapy. All patients are alive and free of disease.
  
  
  CONCLUSIONS
  Ectopic GTD is rare and still overdiagnosed. Presentation is the same as for conventional ectopic pregnancy. Central review of the histology should be undertaken, especially in cases where there is clinical, hCG level or histopathologic concern. Conventional chemotherapy for gestational trophoblastic neoplasia is effective. Prognosis remains excellent.
authors: Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, UK. aymanhassadia@hotmail.co.uk
authors: Ayman
authors: A
authors: Hassadia
authors: Fiona M
authors: FM
authors: Kew
authors: John A
authors: JA
authors: Tidy
authors: Michael
authors: M
authors: Wells
authors: Barry W
authors: BW
authors: Hancock
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002822:Choriocarcinoma / Q000175:diagnosis / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005185:Fallopian Tube Neoplasms / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis / Q000628:therapy*; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000209:etiology
chemical_list: D000964:Antimetabolites, Antineoplastic; D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin; D008727:Methotrexate