[Quantitative immunoenzyme technic in the evaluation of specificity of the beta 1-g-globulin test in trophoblastic tumors]

The method of guantitative immunoenzymatic determination of beta 1-G-globulin (TSG) in the blood serum has been developed. The sensitivity of the method is 6 ng/ml TSG. It has been shown that elevated levels (12-100 ng/ml and higher) are usually observed in trophoblastic tumours of the uterus. The TSG ectopic synthesis is found to proceed in some tumours of the gastrointestinal tract and testicular teratoblastomas.

Ultrasonography in trophoblastic disease

Five cases of trophoblastic disease evaluated by gray scale ultrasonography were reviewed. The ultrasonographic findings of trophoblastic disease are discussed and illustrated. Theca-lutein cyst is reported to be associated with high levels of human chorionic gonadotropin (HCG). From our limited study, there was no correlation between theca-lutein cyst formation or size and the HCG titers of the patients at the time of examination. Molar evacuation must be followed in correlation with abdominal ultrasound and frequent monitoring of HCG levels.

Southern Regional Trophoblastic Disease Center, 1972--1977

The experience of the Southern Regional Trophoblastic Disease Center includes 222 patients who were referred from January 1972 to October 1977. The initial tissue diagnosis was hydatidiform mole in 212 patients and choriocarcinoma in ten. There was spontaneous remission of 142 (69%) of the moles and one of the choriocarcinomas, and 77 patients developed persistent trophoblastic disease. Of these, 58 had no evidence of metastasis, and all achieved remission with single-drug therapy. Nineteen patients developed metastases; 13 were in the "good prognosis" category, and all achieved remission with single-drug therapy. Five (83%) of the six patients with metastases in the "poor prognosis" group achieved remission with triple chemotherapy; one died of her disease.

Sonographic patterns in trophoblastic diseases

A range of sonographic patterns in patients with hydatidiform moles can be appreciated with gray scale ultrasonography, which more readily reveals areas of internal hemorrhagic degeneration and fetal growth within a molar mass. Sonography may be used to evaluate patients suspected of having recurrent or invasive trophoblastic disease; a focus of invasive trophoblastic tumor can be identified as a cluster of high-amplitude echoes within the myometrium, which is frequently associated with echo-free areas of hemorrhage. The enlargement or regression of theca lutein cysts associated with these disease processes can also be monitored.

Trophoblastic pseudotumour of the uterus. A case report

A 52-year-old woman with vaginal bleedings had hysterectomy because curettings prompted suspicion of malignancy. A uterine tumour with deep infiltration of trophoblastic cells in the myometrium was revealed. Postoperative quantitative analysis for urinary human choriongonadotropin gave 1500 IU/1. The patient got no other treatment and is well 3 years after operation. The histopathological picture and the clinical course were consistent with the recently introduced diagnosis of benign "trophoblastic pseudotumour", which should perhaps replace the old terms "syncytioma" and "chorionepitheliosis".

Primary mediastinal trophoblastic teratomas

Three cases of primary mediastinal trophoblastic teratoma are described. One patient died from respiratory failure during the initial chemotherapy, Another patient with advanced disease is now apparently free from disease after multiple-drug chemotherapy. The third patient is alive and well four years after a combination of surgery, radiotherapy, and multiple-drug chemotherapy. In the diagnosis and assessment of response to treatment in these tumours emphasis is placed on the measurement of the tumour cell markers, chorionic gonadotrophin and alpha-fetoprotein, by radioimmunoassay. The efficacy of multiple-drug regimens is discussed together with a review of the literature.

Gestational trophoblastic neoplasms: morphologic considerations

Abnormal trophoblastic proliferation is the hallmark of a spectrum of lesions constituting the gestational trophoblastic neoplasms. Rapid proliferation, infiltration, vascular invasion, hematogenous dissemination, and spontaneous regression are features of both normal and neoplastic trophoblast. Trophoblastic hyperplasia without hydrops, hydatidiform mole, invasive mole, and gestational choriocarcinoma are related lesions, characterized by increasingly aberrant trophoblastic growth and worsening prognosis, if untreated. Difficulties in diagnosis may arise with respect to the normal early implantation site, the hydropic abortus, and postgestational, involuting, residual trophoblast. Histologic grading or hydatidiform moles is relevant to their prognosis and biologic behavior. Trophoblastic neoplasia may begin at any stage of pregnancy or puerperally with immediate or late and local or distant manifestations in the mother or the child. Cognizance of the capricius potential behavior of trophoblast permits successful management of its proliferative lesions, monitored by serial measurement of gonadotropin secretion.

Development of radioimmunoassay for pregnancy-specific beta1-globulin and its measurement in serum of patients with trophoblastic and non-trophoblastic tumours

Levels of human pregnancy-specific or trophoblast-specific beta1-globulin (TBG) were measured by double-antibody radioimmunoassay (RIA) in 103 patients with trophoblastic tumours and in 114 patients with a variety of non-trophoblastic tumours. The sensitivity of RIA for TBG was about 1 ng per ml. Twenty healthy adult females and males had levels below 1 ng per ml. Using the RIA for measurement of TBG in sera which were selected from immunodiffusion-TBG-negative samples, we detected elevated TBG levels in 76.7% of cases with trophoblastic tumours and in 15% of different cases with non-trophoblastic malignancies. The diagnostic and prognostic significance of the measurement of TBG levels by RIA in patients with trophoblastic tumours is discussed.

Chorionepitheliosis: A rare benign tropholblastic disease

Chorionepitheliosis, a benign trophoblastic disease, is a rare entity since only 26 cases have been published. The diagnosis was made in two instances and microscopic, biological and clinical data are presented. The lesion must be distinguished from syncytial endometritis, chorioadenoma destruens and choriocarcinoma. The possible histogenesis is discussed.

The histopathology of trophoblastic tumours

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Quantitative analysis of radioisotopic angiography in trophoblastic neoplasia

The diagnostic significance of radioisotopic angiography in the clinical management of trophoblastic neoplasia was studied by analyzing the patterns of radioisotope (RI)-dynamic curve obtained by processing sequential image with a computer, and an attempt was made to express numerically the size of tumors present in vivo. It was demonstrated that the total activities of RI in the abnormal phase of RI-dynamic curves in trophoblastic neoplasia were closely correlated with the sizes of the intrauterine tumors actually resected.

Follow-up of hydatidiform mole by radioimmunoassay of human chorionic gonadotrophin

An improved method for the follow-up of patients delivered of a hydatidiform mole using radioimmunoassay of human chorionic gonadotrophin is employed to ensure adequate sensitivity. Four illustrative case histories are described. Their HCG findings are presented to show that this is the principal basis on which decisions should be made.There are three aspects to the work of the laboratory. The technical work of the assay, the clerical effort of patient follow-up, and the clinical interpretation of results. The laboratory keeps a close check on follow-up (one of its most important functions) and receives specimens direct from patients. Overall control of all three aspects is by a clinician. It has been found useful to organize a special clinic for these patients to be seen. In this region it has been possible for this to be run by the same clinician.