Typically, scant or no myometrium is recovered on a D&C specimen
Liver enzymes – May become elevated in patients with metastasis to the liver
Rarely is the diagnosis of PSTT made on a D&C specimen, since this usually presents as intermediate trophoblasts infiltrating the myometrium
MRI of the head (preferable to CT)
Pelvic ultrasonography – May show persistent molar tissue in the uterus
Uterine dilatation and curettage (D&C) performed in a woman with abnormal vaginal bleeding and a positive pregnancy test result may reveal a choriocarcinoma
CBC – May help detect anemia secondary to bleeding
CT scan of the chest (optional)
Stage III – Lung metastases
Bleeding from a metastasis could also result in signs and symptoms of hemorrhagic shock
Suction and careful sharp curettage could be performed in patients being observed for a hydatidiform mole who have persistent vaginal bleeding and tissue within the endometrial cavity on pelvic ultrasonography
A D&C may be part of the evaluation of a patient with an elevated serum hCG level of unknown origin
Rarely is a histopathologic diagnosis of an invasive mole made on a D&C specimen, because this requires the identification of destructive invasion of the myometrium by the trophoblasts
Examination may reveal a hydatidiform mole (complete or partial) or a choriocarcinoma
Abdominal guarding and rebound tenderness, if a hemoperitoneum has occurred due to bleeding from an abdominal metastasis
Abdominal tenderness, if liver or gastrointestinal metastases have occurred
CT scan of the abdomen and pelvis with contrast
Stage II – Limited to the genital structures
Serum quantitative hCG – To assess response to therapy and disease status
Neurologic deficits, from lethargy to coma, if brain metastasis has occurred
Stage IV – Other metastases
Jaundice, if liver metastasis causes biliary obstruction
The tissue is sent for histopathologic examination
Stage I – Confined to the uterus
Metastasis to the lower genital tract presents as purple to blue-black papules or nodules, which are extremely vascular and may bleed profusely if biopsied
Chest radiograph – Recommended because the lung is the most frequent site of metastasis
