Diagnosis
1. Made on the basis of D & C.
2. Ultrasound: complete moles－a characteristic vesicular sonographic pattern, "snowstorm" pattern; partial moles－focal cystic spaces in the placental tissues and an increase in the transverse diameter of the gestational sac.
 
Treatment and follow-up
1. Before evacuation, obtain the following laboratory studies: CBC, D/C, PT, APTT, blood chemistries, including lirer function tests, blood type and screen, and b–hCG; and CXR.
2. Evaluation of associated medical complications, including preeclampsia, hypothyroidism, anemia, infection, electrolyte imbalance and coagulopathy.
3. Suction curettage with oxytocin infusion.
4. Weekly serum b-hCG follow-up.
5. 3 consecutive weeks of undetectable serum b-hCG then monthly determinations for at least half a year.
Hydatidiform Mole:
Complete mole
Partiale mole
Hydatidiform moles categorised as either complete or partial moles.
　
Features of Complete and Partial Hydatidiform moles. 
A. Complete Mole :
Fetal or embryonic tissue : Absent
Hydatidiform swelling of chorionic villi  : Diffuse
Trophoblastic hyperplasia : Diffuse
Scalloping of chorionic villi : Absent
Trophoblastic stromal Inclusions : Absent
Karyotype   : 46XX; 46XY
　
　
B. Partial Mole
Fetal or embryonic tissue     :   Present
Hydatidiform swelling of chorionic villi  : Focal
Trophoblastic hyperplasia     : Focal
Scalloping of chorionic villi    : Present
Trophoblastic stromal Inclusions    : Present
Karyotype   :  69XXY; 69XYY
　
Gestational trophoblastic neoplasia:
Nonmetastatic trophoblastic disease
Good prognosis metastatic trophoblastic disease
Poor prognosis metastatic trophoblastic disease
Placental site trophoblastic tumor
 
Management of hydatidiform mole:
1. Beta-hCG determination every 1-2 weeks until negative two times
a. Then bimonthly for 1 year
b. Contraception for 6-12 months
2. Physical examination including pelvic every 2 weeks until remission
a. Then every 3 months for 1 year
3. Chest film initially
a. Repeat only if hCG titer plateaus or rises
4. Chemotherapy started immediately if:
a. hCG titer rises or plateaus (determined by 3 tests) during follow-up
b. Metastases are detected at any time
 
Classification of gestational trophoblastic neoplasia:
1. Nonmetastic disease: no evidence of disease outside uterus
2. Metastatic disease: any disease outside uterus
a. Good prognosis metastatic disease
Short duration (last pregnancy < 4 months)
Low pretreatment hCG titer (< 100,000 IU/24 hr or < 40,000 mlU/ml)
No metastasis to brain or liver
 No significant prior chemotherapy
b. Poor prognosis metastatic disease
Long duration (last pregnancy > 4 months)
High pretreatment hCG titer (> 100,000 IU/24 hr or > 40,000 mlU/ml)
Brain or liver metastasis
Significant prior chemotherapy
Term pregnancy
 
WHO Scoring System  Score
Prognostic factors 0  1 2 4
Age  ≦39  >39
Antecedent pregnancy HM Abortion Term
Months from pregnancy 4  4 to 6 7 to 12 12
hCG (IU/L) 103  103-104 104-105 105
ABO (female×male) O×A B A×O AB
Largest tumor (cm) 3 to 5 5
Site metastases Spleen GI Brain /Kidney/Liver
Number of metastases 1 to 4 4 to 8 8
Prior chemotherapy Single 2 or more

≦4: low risk
5-7: middle risk
≧8: high risk

FIGO Staging for trophoblastic tumors
Stage I   Disease confined to the uterus
Stage Ia Disease confined to the uterus with no risk factors
Stage Ib Disease confined to the uterus with one risk factor
Stage Ic Disease confined to the uterus with two risk factors
Stage II GTT extends outside of the uterus but is limited to the genital
structures (adnexa, vagina, broad ligament)
Stage IIa GTT involving genital structures without risk factors
Stage IIb GTT extends outside of the uterus but limited to genital structures
with one risk factor
Stage IIc GTT extends outside of the uterus but limited to the genital
structures with two risk factors
Stage III GTT extends to the lungs with or without known genital tract
involvement
Stage IIIa GTT extends to the lungs with or without genital tract involvement
and with no risk factors
Stage IIIb GTT extends to the lungs with or without genital tract involvement
and with one risk factor
Stage IIIc GTT extends to the lungs with or without genital tract involvement
and has two risk factors
Stage IV All other metastatic sites
Stage IVa All other metastatic sites without risk factors
Stage IVb All other metastatic sites with one risk factor
Stage IVc All other metastatic sites with two risk factors
　
Risk factors affecting staging include the following:
(1) hCG > 100,000 mlU/ml;
(2) duration of disease > 6 months from termination of the antecedent pregnancy.
The following factors should be considered and noted in reporting: (1) prior chemotherapy for known GTT;
(2) placental site tumors should be reported separately:
(3) histological verification of disease is not required.
 
Single-Agent Chemotherapy
1. Methotrexate 20-25 mg IM every day for 5 days (with a minimum 7-day rest if possible)
2. Methotrexate 1 mg/kg IM on days 1, 3, 5, and 7
Folinic acid 0.1 mg/kg IM on days 2, 4, 6, and 8 (with a minimum 7-day rest if possible)


EMA-CO Chemotherapy
Course 1 (EMA)
Day 1 Etoposide, 100 mg/m2, IV infusion in 200 ml of saline
Dactinomycin, 0.5 mg, IV stat
Methotrexate, 100 mg/ m2, IV stat  200 mg/ m2, IV infusion over 12 hours
Day 2 Etoposide, 100 mg/m2, IV infusion in 200 ml of saline over 30  minutes
Dactinomycin, 0.5 mg, IV stat
Folinic acid, 15 mg, IM or orally every 12 hours for 4 doses
beginning 24 hours after start of methotrexate
　
Course 2 (CO)
 Day 8 Vincristine, 1.0 mg/m2 IV stat
Cyclophosphamide, 600 mg/m2, IV infusion