Management of persistent, unexplained, low-level human chorionic gonadotropin elevation: a report of 5 cases.

BACKGROUND

Persistent low-level elevation of human chorionic gonadotropin (hCG) without a history of gestational trophoblastic disease has often been treated unsuccessfully with chemotherapy and/or hysterectomy on the presumption that this was trophoblastic disease.

CASES: We report on 5 patients diagnosed with this condition who were closely monitored and did not receive intensive or prolonged chemotherapy. Four patients received a short therapeutic trial of methotrexate without a significant change in hCG levels. All patients have remained healthy. Three patients successfully conceived, and 2 delivered healthy infants.

CONCLUSION

Immediate chemotherapy or hysterectomy can be avoided in patients with persistent, unexplained, low-level elevation of hCG. Failure of normalization of hCG levels with chemotherapy suggests that highly differentiated normal trophoblastic noninvasive cells, rather than invasive cytotrophoblastic cells, are responsible.