Trophoblastic disease (TD) presents a group of neoplasms of the residual placental tissue. It is one of the rare tumors that is curable. If managed optimally, even patients with multiple metastases are potentially curable. Early detection remains problematic, because of the diverse symptomatology. There are two main types of TD, each with sub-groups (in brackets), and sub-sub-groups listed below:

(1) Germ cell tumor of ovary (pure choriocarcinoma, and mixed choriocarcinoma)

(2) Gestational TD (benign and malignant)

2.1 Benign includes - Hydatidiform Mole, and Partial Mole.

2.2. Malignant includes - Nonmetastatic, and Metastatic Mole

2.2.1 Nonmetastatic Mole includes- Persistent Hydatidiform mole, Invasive mole

(Chorioadenoma Destruens), Placental-site trophoblastic tumor (PSTT), and Choriocarcinoma

2.2.2. Metastatic Mole includes- Epitheloid trophoblastic tumor (atypical choriocarcinoma) - ETT, which in itself has two subgroups: Low risk and High risk

For all types, the mandatory investigations include: serum beta-hCG (human chorionic gonadotropin), citology and mitotic index (MI), pelvic sonography, pelvic amniogram, X-ray of chest and abdomen, Positron emission tomography (PET), and computed tomography (CT) of various organs. Additional tests may be required.

Running differential diagnostics for your daughter, based on your description and question, would be both unprofessional and unethical. I will only clarify (theoretically) the mitotic index (MI) for each type, to show to which type requires chemotherapy. The higher the MI, the more invasive is the disease and the poorer is the chemotherapy response.

Hydatidiform mole : the hCG is around 40,000 mIU/ml, and the average MI is 0,1 / 10 high power field (HPF)

Partial mole : the hCG is lows and the average MI is 0,04 / 10 HPF

Chorioadenoma destruens: hCG > 10,000 IU/mL, the average MI is 4.2 /10 HPF

PSTT: hCG is low (100-2,000 IU/mL), the MI is 14.9 /10 HPF

Choriocarcinoma: hCG is low, MI is 6.12 /10 HPF

ETT: hCG is low (50-500 IU/mL)), the MI is 4.3 /10 HPF

Note: these numbers are the average estimates extracted from several empirical studies.

As you may notice, the most invasive subtypes are Invasive Mole, Choriocarcinoma, and PSTT. Follow up is required every three months in the first year of chemo, then once in 3 years, 9 years and 15 years. Among the prognostic factors are: intervals between the former pregnancies, size of the tumor, number and site of metastases, and the response to chemotherapy.

I believe your daughter is in professional hands. Feel free to ask any questions at any time. Best wishes.