title: Changes in clinical presentation of postterm choriocarcinoma at the New England Trophoblastic Disease Center in recent years.
abstract: OBJECTIVE
  To review the last 15 year experience of choriocarcinoma following a term gestation at the New England Trophoblastic Disease Center (NETDC) and compare these results to earlier data to determine any changes in the clinical presentation and outcome of this disease.
  
  
  METHODS
  Women with postterm choriocarcinoma from 1996 through 2011 followed by the NETDC were identified by diagnosis codes. Twenty charts were identified and reviewed. These data were then compared to published results from the NETDC of 44 women from 1964 to 1996.
  
  
  RESULTS
  Time from antecedent pregnancy to diagnosis of choriocarcinoma was significantly longer in the current series, 46.1 vs. 19.7 weeks (p = 0.03). Despite this change, patient outcomes remained comparable, with similar overall mortality rates (13% vs. 10%, p = NS). However, patient presentation was notably different. In the early series, five (11%) infants suffered hydrops or stillbirth, while in the recent series there were no adverse infant outcomes (p = 0.08). Six women in the current series presented in the absence of symptoms suspicious for choriocarcinoma (either by an incidental positive pregnancy test without other symptoms or by placental pathology), compared to one woman in the prior series (30% vs. 2%, p = 0.001).
  
  
  CONCLUSIONS
  In recent years postterm choriocarcinoma is being diagnosed or referred later after the antecedent pregnancy at our regional referral center. Recent patients more commonly have no other symptoms than a question of pregnancy and are less likely diagnosed due to the presence of fetal hydrops or stillbirth. Despite later diagnoses, survival with postterm choriocarcinoma continues to be high.
authors.affiliation: Brigham and Women's Hospital/Massachusetts General Hospital Integrated Residency Program in Obstetrics and Gynecology, 75 Francis St, CWN-3, Boston, MA 02115, USA. ediver@partners.org
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Diver
authors.forename: Taymaa
authors.initials: T
authors.lastname: May
authors.forename: Roberto
authors.initials: R
authors.lastname: Vargas
authors.forename: Marilyn
authors.initials: M
authors.lastname: Bernstein
authors.forename: Donald
authors.initials: D
authors.lastname: Goldstein
authors.forename: Ross
authors.initials: R
authors.lastname: Berkowitz
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002822:Choriocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology; D050498:Live Birth; D009511:New England; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000097:blood / Q000175:diagnosis*; D050497:Stillbirth; D047929:Term Birth; D013997:Time Factors; D014594:Uterine Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin
keywords: Choriocarcinoma; GTN; Postterm; Trophoblastic