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Yeoh S, Yong SL, Teoh PI, Kang M. A positive urine pregnancy test with haemoperitoneum: misdiagnosed postpartum choriocarcinoma with uterine rupture mimicking ruptured ectopic pregnancy. Horm Mol Biol Clin Investig 2021; 43:85-88. [PMID: 34854654 DOI: 10.1515/hmbci-2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Choriocarcinoma after a term pregnancy is rare and can be life-threatening, especially when it perforates the uterus, resulting in massive haemoperitoneum. As uterine rupture due to choriocarcinoma is uncommonly encountered in the clinical practice, its diagnosis is often missed or delayed. CASE PRESENTATION We present a case of a 41-year-old para 4 + 1 who had acute abdomen and hypovolaemic shock secondary to haemoperitoneum at three months postpartum period. The urine pregnancy test was positive, and, therefore, a provisional diagnosis of a ruptured ectopic pregnancy was made. She was managed aggressively with fluids and blood product transfusion at the emergency department to achieve haemodynamic stability. Subsequently, she underwent an emergency laparotomy where intraoperatively noted a perforation at the left posterior uterine cornu with purplish tissue spillage. A wedge resection was performed, and the histopathological examination (HPE) was reported as atypical trophoblastic cells, in which choriocarcinoma could not be ruled out. The patient then underwent a total abdominal hysterectomy three weeks later. The final HPE confirmed the diagnosis of choriocarcinoma. CONCLUSIONS The clinical presentation of postpartum choriocarcinoma can be indistinguishable from a ruptured ectopic pregnancy. A high index of suspicion is crucial to allow early diagnosis.
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Affiliation(s)
- Shakti Yeoh
- Department of Obstetrics and Gynecology, Sibu Hospital, Ministry of Health, Sibu, Sarawak, Malaysia
| | - Soon-Leong Yong
- Department of Obstetrics and Gynaecology, Tengku Ampuan Afzan Hospital, Ministry of Health, Kuantan, Pahang, Malaysia
| | - Pak-Inn Teoh
- Department of Pathology, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Marcus Kang
- Department of Obstetrics and Gynecology, Sibu Hospital, Ministry of Health, Sibu, Sarawak, Malaysia
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102
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Huang L, Huang SY, Lee AL, Hung TH. Choriocarcinoma in a viable pregnancy with the rare presentation of intractable lower back pain. Taiwan J Obstet Gynecol 2021; 60:1098-1102. [PMID: 34794745 DOI: 10.1016/j.tjog.2021.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We present a case of choriocarcinoma in a viable pregnancy with the rare presentation of intractable lower back pain. CASE REPORT The patient is a 34-year-old multiparous woman with her second pregnancy, and a history of scoliosis with spinal fixation. Her first pregnancy was uneventful, with a term vaginal delivery. She was hospitalized four times due to intractable back pain from 25 to 31 weeks, and terminated at 31 weeks. The placenta was unremarkable on gross examination. Postpartum, the patient developed obstructive ileus, requiring a rectosigmoid resection. She was diagnosed with metastatic choriocarcinoma to the liver, para-aortic lymph nodes, and mesentery. A week later, she developed micro-thrombosis of all limbs, massive ascites, pleural effusion. Patient refused chemotherapy and died on post-operative Day 15. CONCLUSION Presentation of choriocarcinoma in pregnancy varies widely. Clinicians should consider the differential diagnosis of choriocarcinoma when faced with abnormal unexplained symptoms during pregnancy.
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Affiliation(s)
- Lulu Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Shi-Yin Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Ai-Lun Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Tai-Ho Hung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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103
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Sutrisno S, Farida L, Defri D. Complete Molar Pregnancy in Postmenopausal Woman: A Rare Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Molar pregnancy, the form of the gestational trophoblastic disease (GTD), generally occurs in women of the reproductive age group, and rarely occurs in postmenopausal women. To present a rare case of molar pregnancy in a postmenopausal woman.
CASE REPORT: A multiparous woman aged 54 years was referred to the outpatient department at Raja Ahmad Tabib General Hospital of Riau Island, Indonesia with the main symptoms of nausea and vomiting profusely with 1 month before, lower abdominal pain, lump in the abdomen, abnormal vaginal bleeding, and a positive urine pregnancy test. Her last menstrual bleeding was 14 months ago. Physical examination found stable hemodynamic within blood pressure 150/95 mmHg. Laboratory results showed Hb 11.7 g/dL, positive urine pregnancy test, and serum β-HCG 292,876.1 mIU/mL. Ultrasound examination showed a vesicular pattern in the uterine cavity without fetal tissue. The patient was managed by elective total abdominal bilateral hysterectomy salpingo-oophorectomy. The intraoperative finding was softened, enlarged uterus size of 14–16 weeks of pregnancy, and no local spreading of disease. The patient was discharged on the 3 day after surgery.
CONCLUSION: Even though molar pregnancy is rare, it can occur in the postmenopausal woman. Therefore, GTD has remained in the differential diagnosis of postmenopausal bleeding which can prevent delay in diagnosis and management. Definitive treatment with total abdominal hysterectomy has been chosen in menopausal women who do not wish to preserve their fertility and prevent any malignant sequelae.
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Purbadi S, Tjahjadi H, Purwoto G, Kusuma F, Winarto H, Utami TW, Indarti J, Sotarduga GE. Early Gestational Age Placenta Accreta Case Report: Can We Avoid Missed Diagnosis? AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934168. [PMID: 34719664 PMCID: PMC8570201 DOI: 10.12659/ajcr.934168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Case series
Patients: Female, 34-year-old • Female, 35-year-old • Female, 32-year-old
Final Diagnosis: Placenta accrete
Symptoms: Vaginal bleeding
Medication: —
Clinical Procedure: —
Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Sigit Purbadi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Hartono Tjahjadi
- Department of Pathology and Anatomy, University of Indonesia Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Gatot Purwoto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Fitriyadi Kusuma
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Hariyono Winarto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Tofan Widya Utami
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Junita Indarti
- Department of Obstetrics and Gynecology, University of Indonesia Dr. Cipto Mangunkusumo National Referral Hospital Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Gilbert Elia Sotarduga
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
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Hoeijmakers YM, Eysbouts YK, Massuger LFAG, Dandis R, Inthout J, van Trommel NE, Ottevanger PB, Thomas CMG, Sweep FCGJ. Early prediction of post-molar gestational trophoblastic neoplasia and resistance to methotrexate, based on a single serum human chorionic gonadotropin measurement. Gynecol Oncol 2021; 163:531-537. [PMID: 34602288 DOI: 10.1016/j.ygyno.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Clinicians are unable to provide individualized counseling regarding risk of progression for patients with a complete hydatidiform mole (CHM). We developed nomograms enabling early prediction of post-molar gestational trophoblastic neoplasia (GTN) and resistance to methotrexate (MTX) based on a single serum human chorion gonadotropin (hCG) measurement. METHODS We generated two nomograms with logistic regression: to predict post-molar GTN, and MTX resistance. For patients with high probability to progress to post-molar GTN or MTX resistance, we determined hCG cut-offs at 97.5% specificity to select patients for additional- or adjustments in current treatment. RESULTS The nomograms had a good to excellent ability to distinguish either between patients with uneventful hCG regression versus progression to post molar GTN, or between patients cured by MTX versus patients in whom resistance would occur. At 97.5% specificity, we identified 66% (95%CI 56-75) of the 149 patients who would progress to post-molar GTN, four weeks after initial curettage. For patients treated with MTX, we identified 55% (95%CI 23-83) of the 43 patients who would become resistant, preceding their third course at 97.5% specificity. CONCLUSION The nomograms and cut-off levels can be used to assist in counseling for patients diagnosed with CHM.
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Affiliation(s)
- Yvonne M Hoeijmakers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Yalck K Eysbouts
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rana Dandis
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joanna Inthout
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - N E van Trommel
- Center for Gynecologic Oncology Amsterdam, location Antoni van Leeuwenhoek- the Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Chris M G Thomas
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fred C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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106
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Alpay V, Kaymak D, Erenel H, Cepni I, Madazli R. Complete Hydatidiform Mole and Co-Existing Live Fetus after Intracytoplasmic Sperm Injection: A Case Report and Literature Review. Fetal Pediatr Pathol 2021; 40:493-500. [PMID: 31997691 DOI: 10.1080/15513815.2019.1710790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Twin pregnancy with complete hydatidiform mole and co-existing fetus (CHMCF) is an uncommon obstetric entity and may occur after assisted reproductive technologies. These pregnancies are associated with severe complications for both mother and fetus and the management is challenging. Case Report: We report a twin pregnancy after intracytoplasmic sperm injection (ICSI) treatment with CHMCF which delivered at 26 gestation weeks due to severe preeclampsia. The 625g neonate survived without any complication. The woman had persistent trophoblastic disease with lung metastasis and was treated with single agent methotrexate. We also present a brief review of the literature about the outcomes of CHMCF after ICSI. Conclusion: CHMCF may occur after ICSI treatment. Pregnancies with CHMCF are associated with severe complications however under close follow-up successful outcomes could be achieved in such pregnancies.
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Affiliation(s)
- Verda Alpay
- Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Didem Kaymak
- Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Hakan Erenel
- Obstetrics and Gynecology, Division of Perinatology, Istanbul Universitesi Cerrahpasa Tip Fakultesi, Istanbul, Turkey
| | - Ismail Cepni
- Obstetrics and Gynecology, Istanbul Üniversitesi-Cerrahpasa, Istanbul, Turkey
| | - Riza Madazli
- Obstetrics and Gynecology, Istanbul Üniversitesi-Cerrahpasa, Istanbul, Turkey
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107
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Descargues P, Hajri T, Massardier J, Lotz JP, Devouassoux-Shisheboran M, Allias Montmayeur F, You B, Golfier F, Bolze PA. Gestational trophoblastic neoplasia after human chorionic gonadotropin normalization in a retrospective cohort of 7761 patients in France. Am J Obstet Gynecol 2021; 225:401.e1-401.e9. [PMID: 34019886 DOI: 10.1016/j.ajog.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The risk of malignant transformation of molar pregnancies after human chorionic gonadotropin levels return to normal is low, roughly 0.4%, but may justify an adaptation of monitoring strategies for certain patients. OBJECTIVE This study aimed to determine the risk of gestational trophoblastic neoplasia after human chorionic gonadotropin normalization in women with molar pregnancy and identify risk factors for this type of malignant transformation to optimize follow-up protocols after human chorionic gonadotropin normalization. STUDY DESIGN This was a retrospective observational national cohort study based at the French National Center for Trophoblastic Diseases of 7761 patients, treated between 1999 and 2020 for gestational trophoblastic disease, whose human chorionic gonadotropin levels returned spontaneously to normal. RESULTS Among 7761 patients whose human chorionic gonadotropin levels returned to normal, 20 (0.26%) developed gestational trophoblastic neoplasia. The risk of malignant transformation varied with the type of mole, from 0% (0 of 2592 cases) for histologically proven partial mole to 0.36% for complete mole (18 of 5045) and 2.1% (2 of 95) for twin molar pregnancy. The median time to diagnosis of malignant transformation after human chorionic gonadotropin normalization was 11.4 months (range, 1-34 months). At diagnosis, 16 of 20 patients (80%) had the International Federation of Gynecology and Obstetrics stage I tumor, and 10 of 20 patients (50%) had a tumor classified as low risk in terms of the International Federation of Gynecology and Obstetrics score. In 9 of 20 patients (45%), the most common first-line treatment was combination chemotherapy. A quarter of these tumors (5 of 20) were histologically proven placental site or epithelioid trophoblastic tumors. In univariate analysis, the factors significantly associated with a higher risk of developing gestational trophoblastic neoplasia after the end of the normal human chorionic gonadotropin monitoring period were age of ≥45 years (odds ratio, 8.3; 95% confidence interval, 2.0-32.7; P=.004) and time to human chorionic gonadotropin normalization of ≥8 weeks (odds ratio, 7.7; 95% confidence interval, 1.1-335; P=.03). The risk was even higher for human chorionic gonadotropin normalization times of ≥17 weeks (odds ratio, 19.5; 95% confidence interval, 3.3-206; P<.001). CONCLUSION In this group of patients with gestational trophoblastic disease, none of the those with pathologically verified partial mole had malignant transformation, supporting the current recommendation of stopping human chorionic gonadotropin monitoring after 3 successive negative tests. In cases of complete mole or twin molar pregnancy, we proposed to extend the monitoring period with quarterly human chorionic gonadotropin measurements for an additional 30 months in patients with the identified risk factors for late malignant transformation (age, ≥45 years; time to human chorionic gonadotropin normalization, ≥8 weeks).
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Affiliation(s)
- Pierre Descargues
- Department of Gynecological Surgery and Oncology, Obstetrics, University of Lyon 1, University Hospital Lyon Sud, Pierre-Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre-Bénite, France.
| | - Touria Hajri
- Department of Gynecological Surgery and Oncology, Obstetrics, University of Lyon 1, University Hospital Lyon Sud, Pierre-Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre-Bénite, France
| | - Jérôme Massardier
- Department of Gynecological Surgery and Oncology, Obstetrics, University of Lyon 1, University Hospital Lyon Sud, Pierre-Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre-Bénite, France
| | - Jean-Pierre Lotz
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
| | | | | | - Benoit You
- Medical Oncology, Investigational Center for Treatments in Oncology and Hematology of Lyon, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - François Golfier
- Department of Gynecological Surgery and Oncology, Obstetrics, University of Lyon 1, University Hospital Lyon Sud, Pierre-Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre-Bénite, France
| | - Pierre-Adrien Bolze
- Department of Gynecological Surgery and Oncology, Obstetrics, University of Lyon 1, University Hospital Lyon Sud, Pierre-Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, Pierre-Bénite, France
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108
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Frega G, Kepp O, Turchetti D, Rizzo A, Pantaleo MA, Brandi G. Hypothesis on the possible relevance of the immunogenic cell death in the treatment of gestational trophoblastic neoplasms. Transl Oncol 2021; 14:101224. [PMID: 34592590 PMCID: PMC8482038 DOI: 10.1016/j.tranon.2021.101224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022] Open
Abstract
The genetic background and the antigenic landscape of cancer cells play a critical role in the response to immunotherapies. A high tumor antigenicity, together with an increased adjuvanticity potentially induced by a peculiar type of cell death, namely immunogenic cell death (ICD), could foster the response to immunogenic therapies. The gestational trophoblastic neoplasm (GTN) is a one-of-a-kind cancer in the oncological landscape due to its exclusive genomic makeup. The prognosis of GTN is significantly better than non-gestational trophoblastic neoplasm (nGTN). Due to its peculiar genetic inheritance, GTN potentially constitutes a singular archetype in the immuno-oncological field.
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Affiliation(s)
- G Frega
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n.15, 40138 Bologna, Italy.
| | - O Kepp
- Equipe labellisée par la Ligue contre le cancer, INSERM UMR1138, Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Paris, France; Metabolomics and Cell Biology Platforms, Gustave Roussy, Villejuif, France
| | - D Turchetti
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy; U.O. Genetica Medica, Policlinico S. Orsola-Malpighi, Centro di Ricerca sui Tumori Ereditari, Bologna Italy
| | - A Rizzo
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n.15, 40138 Bologna, Italy
| | - M A Pantaleo
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n.15, 40138 Bologna, Italy
| | - G Brandi
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n.15, 40138 Bologna, Italy
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109
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Ao H, Li HW, Lu LK, Fu JX, Han MH, Guo YF, Wang XT. Sensitive Tumor Cell Line for Annonaceous Acetogenins and High Therapeutic Efficacy at a Low Dose for Choriocarcinoma Therapy. J Biomed Nanotechnol 2021; 17:2062-2070. [PMID: 34706806 DOI: 10.1166/jbn.2021.3175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Annonaceous acetogenins (ACGs) have attracted much attention because of excellent antitumor activity. However, the lack of selectivity and the accompanying serious toxicity have eventually prevented ACGs from entering clinical application. To decrease the side effects of ACGs, the cytotoxicity of ACGs on 10 types of tumor cell lines was investigated by the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) test to identify one that was very sensitive to ACGs. Meanwhile, ACGs nanoparticles (ACGs-NPs) were prepared using poloxamer 188 (P188) as an excipient so as to solve the problem of poor solubility and the in vivo delivery of ACGs. ACG-NPs were 163.9±2.5 nm in diameter, negatively charged, and spherical with a high drug loading content (DLC) of 44.9±1.2%. MTS assays demonstrated that ACGs had strong cytotoxicity against JEG-3, HeLa, SiHa, MCF-7, A375, A2058, A875, U-118MG, LN- 229, and A431 cells, among which JEG-3 cell line was extremely sensitive to ACGs with a 50% inhibitory concentration (IC50) value of 0.26 ng/mL, a very encouraging discovery. ACGs-NPs demonstrated very good dose-dependent antitumor efficacy in a broad range of 45?1200 μg/kg on JEG-3 tumor-bearing mice. At a very low dose (1200 μg/kg), ACGs-NPs achieved a high tumor inhibition rate (TIR) of 77.6% through oral administration, displaying a significant advantage over paclitaxel (PTX) injections that are currently used as first-line anti-choriocarcinoma drugs. In the acute toxicity study, the half lethal dose (LD50) of ACGs-NPs was 135.5 mg/kg, which was over 100 times as of the effective antitumor dose, indicating good safety of ACGs-NPs. ACGs-NPs show promise as a new type of and potent anti-choriocarcinoma drug in the future.
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Affiliation(s)
- Hui Ao
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Haidian District, Beijing, 100193, PR China
| | - Hao-Wen Li
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Haidian District, Beijing, 100193, PR China
| | - Li-Kang Lu
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Haidian District, Beijing, 100193, PR China
| | - Jing-Xin Fu
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Haidian District, Beijing, 100193, PR China
| | - Mei-Hua Han
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Haidian District, Beijing, 100193, PR China
| | - Yi-Fei Guo
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Haidian District, Beijing, 100193, PR China
| | - Xiang-Tao Wang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Haidian District, Beijing, 100193, PR China
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Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, Lurain JR, Massuger L. Diagnosis and management of gestational trophoblastic disease: 2021 update. Int J Gynaecol Obstet 2021; 155 Suppl 1:86-93. [PMID: 34669197 PMCID: PMC9298230 DOI: 10.1002/ijgo.13877] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Gestational trophoblastic disease (GTD) arises from abnormal placenta and is composed of a spectrum of premalignant to malignant disorders. Changes in epidemiology of GTD have been noted in various countries. In addition to histology, molecular genetic studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by ultrasound has resulted in changes in clinical presentation and decreased morbidity from uterine evacuation. Follow-up with human chorionic gonadotropin (hCG) is essential for early diagnosis of gestational trophoblastic neoplasia (GTN). The duration of hCG monitoring varies depending on histological type and regression rate. Low-risk GTN (FIGO Stages I-III: score <7) is treated with single-agent chemotherapy but may require additional agents; although scores 5-6 are associated with more drug resistance, overall survival approaches 100%. High-risk GTN (FIGO Stages II-III: score ≥7 and Stage IV) is treated with multiagent chemotherapy, with or without adjuvant surgery for excision of resistant foci of disease or radiotherapy for brain metastases, achieving a survival rate of approximately 90%. Gentle induction chemotherapy helps reduce early deaths in patients with extensive tumor burden, but late mortality still occurs from recurrent treatment-resistant tumors.
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Affiliation(s)
- Hextan Y. S. Ngan
- Department of Obstetrics and GynecologyUniversity of Hong KongQueen Mary HospitalHong KongChina
| | - Michael J. Seckl
- Department of Medical OncologyCharing Cross Trophoblastic Disease CenterCharing Cross Campus of Imperial College LondonLondonUK
| | - Ross S. Berkowitz
- Department of Obstetrics and GynecologyDivision of Gynecologic OncologyBrigham and Women's HospitalDana‐Farber Cancer InstituteHarvard Medical SchoolBostonMassachusettsUSA
| | - Yang Xiang
- Department of Obstetrics and GynecologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - François Golfier
- Department of Obstetrics and GynecologyFrench Trophoblastic Disease Reference CentreLyon University HospitalClaude Bernard Lyon 1 UniversityLyonFrance
| | - Paradan K. Sekharan
- Department of Obstetrics and GynecologyInstitute of Maternal and Child HealthMedical CollegeCalicutIndia
| | - John R. Lurain
- John I. Brewer Trophoblastic Disease CenterNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Leon Massuger
- Department of Obstetrics and GynecologyDivision of Gynecologic OncologyRadboud University Medical Centre NijmegenNijmegenThe Netherlands
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111
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Real-world data of 14 cases of brain metastases from gestational trophoblastic neoplasia and a literature review. Arch Gynecol Obstet 2021; 305:929-935. [PMID: 34542678 DOI: 10.1007/s00404-021-06238-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the diagnosis, treatment, and prognosis of patients with brain metastases from gestational trophoblastic neoplasia (GTN) in the real world. METHODS Analyzing the clinicopathological characteristics, treatment process, and prognosis of 14 GTN patients with brain metastases admitted to the West China Second University Hospital between January 2006 and December 2020. RESULTS The median FIGO prognostic score was 15 points (range 11-21 points), with 12 cases having 13 points or more (extremely high risk). All patients received combination chemotherapy. The first-line regimen included 5-Fluorouracil, dactinomycin, and intrathecal methotrexate (5-FU + KSM + intrathecal MTX), and etoposide + methotrexate + actinomycin D/cyclophosphamide and vincristine (EMA-CO). Two patients died during the early period after diagnosis of brain metastases. A further patient with GTN Stage III failed to achieve a negative serum β human chorionic gonadotropin (hCG) after receiving chemotherapy in another hospital. Ten months after self-discontinuation of treatment, the disease progressed and she was admitted to our hospital with suspected liver and brain metastases, after which she abandoned treatment and was lost to follow-up. Among the remaining 11 patients, one relapsed once and two relapsed three times. Aside from the two patients who died and the one who was lost to follow-up, the remaining 11 patients had a median follow-up time of 89 months (range 35-148 months) and all achieved complete remission. CONCLUSION The overall survival rate of the patients in the present study was 78.57% through combination chemotherapy, symptomatic treatment, and co-treatment with brain radiotherapy for some patients. Enhancing the understanding of this disease and standardizing treatment are key to improving the overall survival rate of GTN patients with brain metastases.
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Gidlöf S. Is the scalpel the greatest proof of the failure of medicine? Acta Obstet Gynecol Scand 2021; 100:1755. [PMID: 34528712 DOI: 10.1111/aogs.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Sebastian Gidlöf
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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113
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Liu X, Pan X, Liu H, Ma X. Gut Microbial Diversity in Female Patients With Invasive Mole and Choriocarcinoma and Its Differences Versus Healthy Controls. Front Cell Infect Microbiol 2021; 11:704100. [PMID: 34513727 PMCID: PMC8428518 DOI: 10.3389/fcimb.2021.704100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To investigate variation in gut microbiome in female patients with invasive mole (IM) and choriocarcinoma (CC) and compare it with healthy controls. Methods Fecal microbiome of 12 female patients with IM, 9 female patients with CC, and 24 healthy females were analyzed based on 16s rDNA sequencing. Alpha (α) diversity was evaluated using Shannon diversity index and Pielou evenness index, while beta (β) diversity was assessed using principle coordinate analysis (PCoA) of unweighted Unifrac distances. The potential functional changes of microbiomes were predicted using Tax4Fun. The relative abundance of microbial taxa was compared using Welch’s t test. The role of varied gut microbiota was analyzed via receiver operating characteristic (ROC) curve. Results The α diversity and β diversity were significantly different between IM patients and controls, but not between CC patients and controls. In addition, the abundance of cancer-related genes was significantly increased in IM and CC patients. Notably, a total of 19 families and 39 genera were found to have significant differences in bacterial abundance. ROC analysis indicated that Prevotella_7 may be a potential biomarker among IM, CC, and controls. Conclusion Our study demonstrated that the diversity and composition of gut microbiota among IM patients, CC patients, and healthy females were significantly different, which provides rationale for using gut microbiota as diagnostic markers and treatment targets, as well as for further study of gut microbiota in gestational trophoblastic neoplasia (GTN).
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Affiliation(s)
- Xiaomei Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue Pan
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hao Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoxin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Androgenetic/Biparental Mosaic/Chimeric Conceptions With a Molar Component: A Diagnostic and Clinical Challenge. Int J Gynecol Pathol 2021; 40:510-517. [PMID: 33075020 DOI: 10.1097/pgp.0000000000000719] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hydatidiform moles (HM) are gestational trophoblastic diseases which arise due to an imbalance in genetic material and which are morphologically characterized by enlarged and irregular chorionic villi and trophoblastic hyperplasia, among other features. The morphologic differential diagnosis for HM encompasses a number of entities including androgenetic/biparental mosaic/chimeric (ABMC) conceptions, an interesting duo of lesions with a nonmolar form (placental mesenchymal dysplasia) and a molar form (typically with a complete HM component). ABMC conceptions contain a mixture of 2 cell populations (1 androgenetic and 1 biparental) and arise as a result of mosaicism (mitotic error in a zygote) or chimerism (fusion of 2 zygotes). Because of their unique molecular underpinnings, these rare lesions show a number of findings including the presence of multiple villous populations, discordant p57 immunostaining, and mixed genotypes. ABMC conceptions are important to accurately diagnose as the molar form in particular carries a risk for persistent gestational trophoblastic diseases and thus requires appropriate treatment and follow-up. In this report, we provide detailed characterizations of 2 such cases of ABMC conceptions with a molar component. Both patients (ages 34 and 31) were in the first trimester of pregnancy and had ultrasound findings concerning for HM. Increased comprehension of the pathogenesis and morphology of ABMC conceptions, combined with ancillary techniques including p57 immunohistochemistry, fluorescence in situ hybridization, and molar genotyping, has allowed us to accurately and efficiently identify these lesions. However, a number of pitfalls exist which may lead to misdiagnosis.
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Gu Q, Yan S, Lin J, Wu X, Chen L, Gan M, Luo H, Lv D, Lin L. Choriocarcinoma Masquerading as Lung Abscess or Lung Cancer: A Case with Atypical Imaging Findings. Onco Targets Ther 2021; 14:4407-4414. [PMID: 34408437 PMCID: PMC8364388 DOI: 10.2147/ott.s313147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Choriocarcinoma is a highly malignant trophoblastic tumor. However, the awareness surrounding its atypical clinical presentation is insufficient. The presence of a solitary lung lesion without uterine lesions often leads to misdiagnosis or missed diagnosis, which in turn causes delayed treatment or even multiple metastases throughout the body. Case Presentation We present the case of a 36-year-old female patient who was misdiagnosed with a lung abscess and received suboptimal anti-infective treatment. She then underwent left upper lobectomy and was misdiagnosed with lung cancer by abscess incision and drainage in thoracic surgery, however, the results after pleural effusion removal were suboptimal. During this time a breast nodule was found, and a large segment of the right breast was excised and misdiagnosed as breast cancer but was finally diagnosed as choriocarcinoma with multiple metastases of lung and breast. Multiple metastases were also detected in the head, liver, kidney, and bones. The patient underwent multiple adjuvant chemotherapies. The blood β-hCG level gradually declined to normal. When we reported this case, that is, seven months after the diagnosis, the patient was still alive, and the disease was stable without progress. Conclusion Choriocarcinoma with a solitary lung lesion as the first presentation and no lesions in the uterus is clinically rare. This may lead to a delay in diagnosis due to poor awareness of the disease and the appearance of multiple metastases throughout the body. Clinicians should be more aware of choriocarcinoma with an atypical presentation to reduce misdiagnosis and missed diagnosis.
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Affiliation(s)
- Qianqian Gu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
| | - Shuangquan Yan
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
| | - Jiang Lin
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
| | - Xiaomai Wu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
| | - Lanxi Chen
- Department of Pathology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
| | - Meifu Gan
- Department of Pathology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
| | - Huarong Luo
- Department of Pathology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
| | - Dongqing Lv
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
| | - Ling Lin
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 317000, People's Republic of China
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Lin YH, Liu YC, Lee WJ. Young Female With Lower Abdominal Pain. Ann Emerg Med 2021; 77:591-612. [PMID: 34030771 DOI: 10.1016/j.annemergmed.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Yu-Hui Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Chang Liu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Jing Lee
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
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Paspalj V, Polterauer S, Poetsch N, Reinthaller A, Grimm C, Bartl T. Long-term survival in multiresistant metastatic choriocarcinoma after pembrolizumab treatment: A case report. Gynecol Oncol Rep 2021; 37:100817. [PMID: 34258357 PMCID: PMC8253948 DOI: 10.1016/j.gore.2021.100817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 12/13/2022] Open
Abstract
•Checkpoint inhibitor therapy affecting PD-L1 as treatment for advanced solid tumors.•Success in trial pembrolizumab therapy in multiresistant metastatic choriocarcinoma.•Long-term remission after pembrolizumab therapy in multiresistant choriocarcinoma.•Only six reported cases, one with comparable follow-up and outcome.
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Key Words
- CPI, checkpoint inhibitor
- CT, computed tomography
- Choriocarcinoma
- ECOG, Eastern Cooperative Oncology Group
- ETT, epithelioid trophoblastic tumor
- GTD, gestational trophoblastic disease
- GTN
- GTN, gestational trophoblastic neoplasia
- PD-1/PDL-1, programmed cell death-1/ programmed cell death ligand-1
- PSTT, placental site trophoblastic tumor
- Pembrolizumab
- WHO, Worl Health Organization
- cMRI, cerebral magnetic resonance imaging
- β-HCG
- β-HCG, beta-human chorionic gonadotropin
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Affiliation(s)
- V. Paspalj
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - S. Polterauer
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - N. Poetsch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - A. Reinthaller
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - C. Grimm
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - T. Bartl
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Austria
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Shen C, Ai L, Li K, Cao Y, Wu H, Sun D. Choriocarcinoma brain metastasis in a patient in the third trimester: a case report. J Med Case Rep 2021; 15:417. [PMID: 34325722 PMCID: PMC8320190 DOI: 10.1186/s13256-021-02808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastatic choriocarcinoma in the third trimester of pregnancy is extremely rare. CASE PRESENTATION A 25-year-old Chinese woman (gravida 3, para 0) who was 28 weeks pregnant was admitted for sudden convulsion, aconuresis, and unconsciousness. The decision was made to perform an emergency cesarean delivery and craniotomy, hematoma clearance, and decompression. Pathological examination confirmed choriocarcinoma with brain metastasis. The patient underwent chemotherapy with the etoposide, cisplatin (EP) and etoposide, methotrexate and dactinomycin alternating with cyclophosphamide and vincristine (EMACO) regimens. A satisfactory result was achieved. CONCLUSIONS When encountering intracranial mass or bilateral pulmonary nodules in a pregnant woman, especially one in the third trimester, metastatic choriocarcinoma should be considered.
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Affiliation(s)
- Chunjuan Shen
- Department of Obstetrics and Gynecology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, Zhejiang, China
| | - Ling Ai
- Department of Obstetrics and Gynecology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, Zhejiang, China.
| | - Kai Li
- Department of Orthopedics, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Yunfei Cao
- Department of Obstetrics and Gynecology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, Zhejiang, China
| | - Hanbing Wu
- Department of Obstetrics and Gynecology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, Zhejiang, China
| | - Dandan Sun
- Department of Obstetrics and Gynecology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, Zhejiang, China
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Blok LJ, Frijstein MM, Eysbouts YK, Custers J, Sweep F, Lok C, Ottevanger PB. The psychological impact of gestational trophoblastic disease: a prospective observational multicentre cohort study. BJOG 2021; 129:444-449. [PMID: 34314567 PMCID: PMC9292450 DOI: 10.1111/1471-0528.16849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the short-term psychological consequences of gestational trophoblastic disease (GTD). DESIGN A prospective observational multicentre cohort study. SETTING Nationwide in the Netherlands. POPULATION GTD patients. METHODS Online questionnaires directly after diagnosis. MAIN OUTCOME MEASURES Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), Impact of Event Scale (IES) and Reproductive Concerns Scale (RCS). RESULTS Sixty GTD patients were included between 2017 and 2020. Anxious feelings (47%) were more commonly expressed than depressive feelings (27%). Patients experienced moderate to severe adaptation problems in 88%. Patients who already had children were less concerned about their reproductivity than were patients without children (mean score 10.4 versus 15.0, P = 0.031), and patients with children experienced lower distress levels (IES mean score 25.7 versus 34.7, P = 0.020). In addition, patients with previous pregnancy loss scored lower for distress compared with patients without pregnancy loss (IES mean score 21.1 versus 34.2, P = 0.002). DISCUSSION We recommend that physicians monitor physical complaints and the course of psychological wellbeing over time in order to provide personalised supportive care in time for patients who have high levels of distress at baseline. CONCLUSIONS GTD patients experience increased levels of distress, anxiety and depression, suggesting the diagnosis has a substantial effect on the psychological wellbeing of patients. The impact of GTD diagnosis on intrusion and avoidance seems to be ameliorated in patients who have children or who have experienced previous pregnancy loss. TWEETABLE ABSTRACT Patients with gestational trophoblastic disease (GTD) experience short-term psychological consequences such as distress, anxiety and depression, suggesting that the diagnosis GTD has a substantial effect on the psychological wellbeing of patients. Various patient characteristics affect the impact of GTD diagnosis.
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Affiliation(s)
- L J Blok
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M M Frijstein
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Y K Eysbouts
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jae Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Fcgj Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Car Lok
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - P B Ottevanger
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Tsakiridis I, Giouleka S, Kalogiannidis I, Mamopoulos A, Athanasiadis A, Dagklis T. Diagnosis and Management of Gestational Trophoblastic Disease: A Comparative Review of National and International Guidelines. Obstet Gynecol Surv 2021; 75:747-756. [PMID: 33369685 DOI: 10.1097/ogx.0000000000000848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Gestational trophoblastic disease (GTD) is associated with increased mortality and morbidity in women of reproductive age, if managed in a suboptimal way, left untreated, or diagnosed after the development of extensive metastases. Objective The aims of this study were to review and compare the recommendations from published guidelines on these tumors of placental origin. Evidence Acquisition A descriptive review of guidelines from the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the European Society for Medical Oncology, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on GTD was carried out. Results All the guidelines agree that suction evacuation is the optimal management for hydatidiform molar pregnancy and that chemotherapy, either single-agent (for low risk) or multiagent (for high risk), is the preferred treatment modality for choriocarcinoma. There is also a consensus that a future pregnancy should be avoided during follow-up; therefore, an effective contraception method should be used. All medical societies recommend the registration of such patients to GTD screening centers, endorse the use of International Federation of Gynecology and Obstetrics 2000 scoring system, and mention that the diagnosis of gestational trophoblastic neoplasia (GTN) should be based on the clinical presentation (from the genital tract and the metastatic sites) and the human chorionic gonadotropin evaluation. Additionally, all 4 medical societies recommend the surgical management of placental site trophoblastic tumors or epithelioid trophoblastic tumors, as chemotherapy is less effective in these cases. However, there is controversy regarding the appropriate follow-up after the treatment of hydatidiform mole, the administration of anti-D immunoglobulin, the time of oxytocin infusion, and the salvage regimens that may be used in cases of resistant or recurrent GTN. Conclusions There is need for consistent international practice protocols, which will lead to an earlier diagnosis and eventually to a more effective management of GTD worldwide and decrease in the recurrence rate and in the associated morbidity and mortality.
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Affiliation(s)
| | | | | | - Apostolos Mamopoulos
- Professor, Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Professor, Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tantengco OAG, De Jesus FCC, Gampoy EFS, Ornos EDB, Vidal MS, Cagayan MSFS. Molar pregnancy in the last 50 years: A bibliometric analysis of global research output. Placenta 2021; 112:54-61. [PMID: 34274613 DOI: 10.1016/j.placenta.2021.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/01/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
Molar pregnancy is a gestational trophoblastic disease characterized by an abnormal growth of placental tissues because of a nonviable pregnancy. The understanding of the pathophysiology and management of molar pregnancy has significantly increased in the recent years. This study aims to determine the characteristics and trends of published articles in the field of molar pregnancy through a bibliometric analysis. Using the Scopus database, we identified all original research articles on molar pregnancy from 1970 to 2020. Bibliographic and citation information were obtained, and visualization of collaboration networks of countries and keywords related to molar pregnancy was conducted using VOSviewer software. We obtained a total of 2009 relevant papers published between 1970 and 2020 from 80 different countries. The number of publications continued to increase through the years. However, the number of publications in molar pregnancy is still low compared to the other research fields in obstetrics and gynecology. The USA (n = 421, 32.1%), Japan (n = 199, 15.2%), and the UK (n = 191, 14.6%) contributed the greatest number of publications in this field. The top journals which contributed to the field of molar pregnancy include AJOG (n = 91), Obstetrics and Gynecology (n = 81), and the Gynecologic Oncology (n = 57). The most cited articles in molar pregnancy include papers on the genetics and chromosomal abnormalities in molar pregnancies. The focus of current research in this field was on elucidating the molecular mechanism of hydatidiform moles. Our bibliometric analysis showed the global research landscape, trends and development, scientific impact, and collaboration among researchers in the field of molar pregnancy.
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Affiliation(s)
| | | | - Eloina Faye S Gampoy
- College of Medicine, University of the Philippines Manila, Ermita, Manila, Philippines
| | - Eric David B Ornos
- College of Medicine, University of the Philippines Manila, Ermita, Manila, Philippines
| | - Manuel S Vidal
- College of Medicine, University of the Philippines Manila, Ermita, Manila, Philippines
| | - Maria Stephanie Fay S Cagayan
- Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines Manila, Manila, Philippines; Division of Trophoblast Diseases, Department of Obstetrics and Gynecology, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines
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Nishino K, Yamamoto E, Oda Y, Watanabe E, Niimi K, Yamamoto T, Kajiyama H. Short tandem repeat analysis to identify the causative pregnancy of high-risk gestational trophoblastic neoplasia: Molar versus nonmolar pregnancy and its relation to the outcome. Placenta 2021; 112:28-35. [PMID: 34247032 DOI: 10.1016/j.placenta.2021.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/25/2021] [Accepted: 06/30/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Gestational trophoblastic neoplasia (GTN) include a group of malignant neoplasms that originate from the trophoblasts of placental tissue in molar or nonmolar pregnancy. Currently, it is unclear whether the prognosis of high-risk GTN or gestational choriocarcinoma succeeding molar pregnancy or that following a nonmolar one is better. Comparison of the genetic short tandem repeat (STR) patterns of the DNA extracted from the tumor, patient, and her partner allows the genetic origins of the choriocarcinoma to be distinguished - whether it is gestational or non-gestational and whether it is derived from a molar or nonmolar pregnancy in the event it is gestational. This study aimed to investigate the causative pregnancy of patients with high-risk GTN, especially those with poor outcomes, and assess the impact of the causative pregnancy on patient outcome. METHODS We evaluated 24 patients who were diagnosed with high-risk GTN between January 2000 and October 2019, including 15 cases of pathologically proven gestational choriocarcinomas and the causative pregnancy was investigated by STR analysis in which tumor DNA could be extracted. RESULTS In high-risk GTN without history of anteceding molar pregnancies, nonmolar pregnancy was the causative pregnancy, which was confirmed in three cases. Molar pregnancy appeared be the causative pregnancy of high-risk GTN in patients with a history of antecedent molar pregnancies either with or without interruption by subsequent nonmolar pregnancies prior to developing high-risk GTN. High-risk GTN in most of the evaluated deceased cases (three of four) was due to nonmolar pregnancy, while all but one case with molar pregnancy as the causative pregnancy survived. DISCUSSION STR analysis can distinguish the causative pregnancy of high-risk GTN, and nonmolar pregnancy as the causative pregnancy might have negative effects on the outcome of the disease.
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Affiliation(s)
- Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Eiko Yamamoto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yukari Oda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Eri Watanabe
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Toshimichi Yamamoto
- Department of Legal Medicine and Bioethics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Jashnani K, Yagana A, Mahajan N. Double trouble: Extrauterine epithelioid trophoblastic tumor with uterine choriocarcinoma - An autopsy report. Indian J Cancer 2021; 57:463-466. [PMID: 33078754 DOI: 10.4103/ijc.ijc_220_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Gestational trophoblastic tumors (GTTs) include choriocarcinoma, epithelioid trophoblastic tumor, and placental site trophoblastic tumor. The occurrence of mixed GTT is rare. We report such a case in a 24-year-old woman who presented with menorrhagia since 2 months and obstetric history of two abortions, one of which was a molar pregnancy. She was undergoing evaluation for carcinoma cervix and treatment for pulmonary tuberculosis from another hospital when she was admitted at our institute for further workup and treatment. However, she succumbed and an autopsy was performed. Histologic evaluation after the autopsy revealed uterine choriocarcinoma with metastatic epithelioid trophoblastic tumor (ETT) in the lung and spleen.
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Affiliation(s)
- Kusum Jashnani
- Department of Pathology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Alshifa Yagana
- Department of Pathology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Niraj Mahajan
- Department of Obstetrics and Gynaecology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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124
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Hodgson JA, Pittman BP, Solomon JB, Elrefai A, Kristobak BM. Postoperative Thyroid Storm After Evacuation of a Complete Hydatidiform Mole: A Case Report. A A Pract 2021; 15:e01495. [PMID: 34170868 DOI: 10.1213/xaa.0000000000001495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Gestational trophoblastic disease can lead to excess thyroid hormone release and rarely, thyroid storm. We present a case of complete molar pregnancy with hyperthyroidism that was not identified or treated before surgical evacuation of uterine contents. Untreated hyperthyroidism preoperatively led to unanticipated thyroid storm immediately after emergence from anesthesia. It is important for anesthesia providers to recognize the link between gestational trophoblastic disease and thyrotoxicosis, and appreciate the severe consequences than can occur if left untreated. Anesthesia providers should strongly consider preoperative consultation and treatment. Being prepared to treat intraoperative symptoms and thyroid storm is paramount.
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Affiliation(s)
- John A Hodgson
- From the Department of Anesthesiology, Inova Fairfax Hospital, Falls Church, Virginia.,the Department of Anesthesiology Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Benjamin P Pittman
- the Department of Anesthesiology Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James B Solomon
- From the Department of Anesthesiology, Inova Fairfax Hospital, Falls Church, Virginia.,the Department of Anesthesiology Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Ahmed Elrefai
- From the Department of Anesthesiology, Inova Fairfax Hospital, Falls Church, Virginia
| | - Benjamin M Kristobak
- the Department of Anesthesiology Walter Reed National Military Medical Center, Bethesda, Maryland
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125
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Gestational trophoblastic neoplasia presenting as an interstitial ectopic pregnancy. Gynecol Oncol Rep 2021; 37:100813. [PMID: 34277918 PMCID: PMC8261002 DOI: 10.1016/j.gore.2021.100813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022] Open
Abstract
Gestational trophoblastic neoplasia (GTN) arising from interstitial ectopic pregnancy. Minimally invasive surgical management of interstitial ectopic pregnancy is feasible. GTN arising from interstitial ectopic pregnancies have favorable prognoses.
Gestational trophoblastic disease (GTD) is a group of benign and malignant tumors that develop from placental tissue and includes hydatidiform moles and gestational trophoblastic neoplasia (GTN). Invasive molar disease and choriocarcinoma are rare forms of GTN and can arise from any pregnancy event. An interstitial ectopic pregnancy occurs with implantation within the intramural portion of the fallopian tube covered by myometrium. We present two cases of an invasive mole with pathology consistent with choriocarcinoma in situ arising from an interstitial ectopic pregnancies. We review management strategies including a minimally invasive surgical approach. Additionally we present a review of the literature of gestational trophoblastic disease associated with interstitial ectopic pregnancies.
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126
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Mamede R, Beja M, Djokovic D, Costa C. Invasive mole presenting as a heavily bleeding vaginal lesion 3 weeks after uterine evacuation. BMJ Case Rep 2021; 14:14/6/e242208. [PMID: 34155019 DOI: 10.1136/bcr-2021-242208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gestational trophoblastic disease occurs in 1-3:1000 gestations worldwide. Up to one-fifth of complete hydatidiform moles undergo malignant transformation, with 2%-4% manifesting as metastatic disease. Of these, a third present with vaginal metastases, which can cause bleeding and discharge. We describe the case of a 49-year-old primiparous woman presenting with syncope and intense bleeding from an anterior vaginal lesion, 3 weeks after uterine evacuation for a presumed spontaneous abortion. A vaginal metastatic nodule was suspected; haemostasis was achieved with vaginal packing, precluding the need for surgical intervention. The patient was ultimately diagnosed with invasive mole with vaginal and lung metastases (stage III high-risk gestational trophoblastic neoplasia (GTN)) and started on multiple-agent chemotherapy. Two months later the lesion had regressed completely, and remission was reached 2 weeks later. Clinicians should consider the possibility of metastatic GTN with vaginal involvement whenever heavy vaginal bleeding follows a recent history of failed pregnancy.
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Affiliation(s)
- Rita Mamede
- Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Mariana Beja
- Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Dusan Djokovic
- Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,Obstetrics and Gynaecology Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Cristina Costa
- Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,Obstetrics and Gynaecology Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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Di Fiore R, Suleiman S, Felix A, O’Toole SA, O’Leary JJ, Ward MP, Beirne J, Sabol M, Ozretić P, Yordanov A, Vasileva-Slaveva M, Kostov S, Nikolova M, Said-Huntingford I, Ayers D, Ellul B, Pentimalli F, Giordano A, Calleja-Agius J. An Overview of the Role of Long Non-Coding RNAs in Human Choriocarcinoma. Int J Mol Sci 2021; 22:ijms22126506. [PMID: 34204445 PMCID: PMC8235025 DOI: 10.3390/ijms22126506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 02/08/2023] Open
Abstract
Choriocarcinoma (CC), a subtype of trophoblastic disease, is a rare and highly aggressive neoplasm. There are two main CC subtypes: gestational and non-gestational, (so called when it develops as a component of a germ cell tumor or is related to a somatic mutation of a poorly differentiated carcinoma), each with very diverse biological activity. A therapeutic approach is highly effective in patients with early-stage CC. The advanced stage of the disease also has a good prognosis with around 95% of patients cured following chemotherapy. However, advancements in diagnosis and treatment are always needed to improve outcomes for patients with CC. Long non-coding (lnc) RNAs are non-coding transcripts that are longer than 200 nucleotides. LncRNAs can act as oncogenes or tumor suppressor genes. Deregulation of their expression has a key role in tumor development, angiogenesis, differentiation, migration, apoptosis, and proliferation. Furthermore, detection of cancer-associated lncRNAs in body fluids, such as blood, saliva, and urine of cancer patients, is emerging as a novel method for cancer diagnosis. Although there is evidence for the potential role of lncRNAs in a number of cancers of the female genital tract, their role in CC is poorly understood. This review summarizes the current knowledge of lncRNAs in gestational CC and how this may be applied to future therapeutic strategies in the treatment of this rare cancer.
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Affiliation(s)
- Riccardo Di Fiore
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
- Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
- Correspondence: (R.D.F.); (J.C.-A.); Tel.: +356-2340-3871 (R.D.F.); +356-2340-1892 (J.C.-A.)
| | - Sherif Suleiman
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Ana Felix
- Department of Pathology, Campo dos Mártires da Pátria, Instituto Portugues de Oncologia de Lisboa, NOVA Medical School, UNL, 130, 1169-056 Lisboa, Portugal;
| | - Sharon A. O’Toole
- Departments of Obstetrics and Gynaecology and Histopathology, Trinity St James’s Cancer Institute, Trinity College Dublin, 8 Dublin, Ireland;
| | - John J. O’Leary
- Department of Histopathology, Trinity College Dublin, Trinity St James’s Cancer Institute, 8 Dublin, Ireland; (J.J.O.); (M.P.W.)
| | - Mark P. Ward
- Department of Histopathology, Trinity College Dublin, Trinity St James’s Cancer Institute, 8 Dublin, Ireland; (J.J.O.); (M.P.W.)
| | - James Beirne
- Department of Gynaecological Oncology, Trinity St James Cancer Institute, St James Hospital, 8 Dublin, Ireland;
| | - Maja Sabol
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute, 10000 Zagreb, Croatia; (M.S.); (P.O.)
| | - Petar Ozretić
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute, 10000 Zagreb, Croatia; (M.S.); (P.O.)
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria;
| | | | - Stoyan Kostov
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria;
| | - Margarita Nikolova
- Saint Marina University Hospital—Pleven, Medical University Pleven, 5800 Pleven, Bulgaria;
| | - Ian Said-Huntingford
- Department of Histopathology, Mater Dei Hospital, Birkirkara Bypass, MSD 2090 Msida, Malta;
| | - Duncan Ayers
- Centre for Molecular Medicine & Biobanking, University of Malta, MSD 2080 Msida, Malta; (D.A.); (B.E.)
- Faculty of Biology, Medicine and Human Sciences, The University of Manchester, Manchester M1 7DN, UK
| | - Bridget Ellul
- Centre for Molecular Medicine & Biobanking, University of Malta, MSD 2080 Msida, Malta; (D.A.); (B.E.)
| | - Francesca Pentimalli
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Antonio Giordano
- Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
- Correspondence: (R.D.F.); (J.C.-A.); Tel.: +356-2340-3871 (R.D.F.); +356-2340-1892 (J.C.-A.)
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Harsono AB, Hidayat YM, Winarno GNA, Nisa AS, Alkaff FF. A Case of Rapid Transformation from Hydatidiform Mole to Invasive Mole: The Importance of β-hCG (Human Chorionic Gonadotropin) Serum Levels in Follow-Up Evaluation. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931156. [PMID: 34127641 PMCID: PMC8216494 DOI: 10.12659/ajcr.931156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/11/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) is a spectrum of disorders consisting of premalignant (ie, complete [CHM] and partial hydatidiform moles [PHM]) and malignant conditions (ie, invasive moles, choriocarcinoma, placental site trophoblastic tumors, and epithelioid trophoblastic tumor). If GTD persists after initial treatment and has persistent elevated beta human chorionic gonadotropin (ß-hCG), it is referred to as post-molar gestational trophoblastic neoplasia (pGTN). To date, there is no detailed information regarding how fast invasive moles can develop from CHM. However, the risk of developing any pGTN from CHM is rare within 1 month and is greatest in the first 12 months after evacuation, with most cases presenting within 6 months. CASE REPORT We present a case of a 46-year-old primigravida woman with rapid transformation of an invasive mole. In the beginning, the patient had a chief concern of a uterus size greater than the gestational dates. Laboratory evaluation showed high ß-hCG serum level (>300 000 mIU/mL), and ultrasonography evaluation revealed a hydatidiform mole. Suction evacuation and curettage procedures were then performed. Pathology evaluation afterwards revealed a complete hydatidiform mole without any sign of malignancy. Twenty-two days afterwards, the patient came to the emergency room with vaginal bleeding. ß-hCG serum level was high (53 969 mIU/mL), and ultrasonography examination showed the presence of fluid filling the uterine cavity. The patient was then diagnosed with GTN, and hysterectomy was chosen as the treatment of choice. After the surgery, her ß-hCG serum level gradually reverted back to normal. CONCLUSIONS Invasive moles can develop less than 1 month after suction evacuation and curettage procedure for CHM. Serial ß-hCG serum level evaluation according to the guideline should be performed to prevent late diagnosis, which could lead to the development of metastasis and worsen the prognosis.
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Affiliation(s)
- Ali Budi Harsono
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yudi Mulyana Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Gatot Nyarumenteng A. Winarno
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Aisyah Shofiatun Nisa
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Firas Farisi Alkaff
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
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129
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Kutz CJ, Kreshak A. An Unexpected "Delivery" in the Emergency Department: Hydatidiform Mole. J Emerg Med 2021; 61:327-329. [PMID: 34092441 DOI: 10.1016/j.jemermed.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Craig J Kutz
- Department of Emergency Medicine, University of California, San Diego, California
| | - Allyson Kreshak
- Department of Emergency Medicine, University of California, San Diego, California
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130
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Banerjee A, Oniah M, Cohn MR, Marsden L. Partial Hydatidiform Mole with a Coexistent Twin Pregnancy: A Successful Outcome with Expectant Management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 45:243-244. [PMID: 35589517 DOI: 10.1016/j.jogc.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
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131
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Iyengar V, Mistry H, Hibbitt C, Shimanovsky A. Diagnosis and management of a metastatic mixed gestational trophoblastic neoplasia with synchronous primary lung cancer. BMJ Case Rep 2021; 14:14/5/e240606. [PMID: 34039542 DOI: 10.1136/bcr-2020-240606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mixed gestational trophoblastic neoplasias (GTNs) are rare placental tumours that arise from abnormal fertilisation events. To date, only 34 patients with mixed GTNs have been reported in the literature. As such, the management of such cases remains challenging. This report presents a case of a mixed GTN that was further complicated by a synchronous primary lung adenocarcinoma. Our patient was initially treated with hysterectomy, with surveillance labwork showing persistence of her malignancy. She then began combination chemotherapy, at the end of which she appeared to be in remission clinically. Unfortunately, subsequent imaging showed the persistence of pulmonary nodules that were ultimately resected, demonstrating a new primary lung adenocarcinoma. At present, she remains free of both cancers 2 years after her initial diagnosis. The complexity of this case underscores the importance of patient-centred treatment for rare tumours and the role of a multidisciplinary team in the effort to provide holistic care.
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Affiliation(s)
- Varun Iyengar
- Alpert Medical School of Brown University, Providence, Rhode Island, USA .,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hetal Mistry
- Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Rhode Island Hospital, Providence, Rhode Island, USA
| | | | - Alexei Shimanovsky
- Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Rhode Island Hospital, Providence, Rhode Island, USA
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132
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Erfiandi F, Mantilidewi KI, Hidayat YM, Harsono AB, Suardi D, Salima S, Kurniadi A, Islami IP, Agustina H, Dewayani BM, Nisa AS, Toriq H. A Rare Case of Early Transformation of Gestational Trophoblastic Neoplasia Following Molar Pregnancy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930789. [PMID: 33972495 PMCID: PMC8126585 DOI: 10.12659/ajcr.930789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/11/2021] [Accepted: 03/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) encompasses a group of disorders that arise from abnormal growth of trophoblastic tissue. The spectrum of GTD includes 2 major groups: benign and malignant. The benign form is a hydatidiform mole, either complete or partial; the malignant forms, referred to as gestational trophoblastic neoplasia (GTN), consist of invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Most patients who undergo evacuation of a hydatidiform mole by curettage have a disease-free period before a new tumor develops that can be considered malignant. In rare cases, metastasis occurs rapidly and manifests coincidentally before the hydatidiform mole can be evacuated. CASE REPORT A 19-year-old woman in Bandung City, West Java, Indonesia, was diagnosed with a molar pregnancy with early evidence of a mass in her vagina that was suspicious for stage II GTN. The early emergence of a vaginal mass was a rare case of early transformation of a molar pregnancy into GTN. CONCLUSIONS Careful evaluation is warranted of patients with characteristics typical of an intrauterine molar pregnancy who have an early presentation of a vaginal mass because of the possibility that the diagnosis could be GTN.
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Affiliation(s)
- Febia Erfiandi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Kemala Isnainiasih Mantilidewi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yudi Mulyana Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Ali Budi Harsono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Dodi Suardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Siti Salima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Andi Kurniadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Indah P. Islami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hasrayati Agustina
- Department of Anatomical Pathology, Faculty of Medicine, Padjadjaran University– Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Birgitta Maria Dewayani
- Department of Anatomical Pathology, Faculty of Medicine, Padjadjaran University– Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Aisyah Shofiatun Nisa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Huda Toriq
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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Lu Y, Li X, Zuo Y, Xu Q, Liu L, Wu H, Chen L, Zhang Y, Liu Y, Li Y. miR-373-3p inhibits epithelial-mesenchymal transition via regulation of TGFβR2 in choriocarcinoma. J Obstet Gynaecol Res 2021; 47:2417-2432. [PMID: 33955122 DOI: 10.1111/jog.14809] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/24/2021] [Accepted: 04/18/2021] [Indexed: 12/19/2022]
Abstract
AIM Previous studies have indicated that early metastasis is a major cause of mortality in patients with choriocarcinoma. However, what determines whether early metastasis of choriocarcinoma has occurred is unknown. The emerging role of miRNA in regulating cancer development and progression has been recognized. miR-373 has been shown to play pivotal roles in tumorigenesis and metastasis. However, whether miR-373 functions to promote choriocarcinoma metastasis is not clear. The purpose of this study is to determine the function of miR-373-3p in the progression of this cancer. METHODS In this study, we first compared epithelial-mesenchymal transition (EMT)-related markers, which were inversely correlated with miR-373-3p expression in trophoblast and choriocarcinoma cell lines. Using PCR and Western blot, upregulation of miR-373-3p was observed to inhibit EMT progression. Similarly, gain- and loss-of-function studies revealed that ectopic miR-373-3p overexpression inhibited the migration by transwell methods of choriocarcinoma cells. RESULTS Our results revealed that miR-373-3p acted as an EMT inhibitor in JEG-3 and JAR cells; this was due to its mediation of the transforming growth factor-β (TGFβ) signaling pathway, which was responsible for EMT. miRNA microarray analysis demonstrated that miR-373-3p interacted with the 3' untranslated region of TGFβR2 mRNA, and then Western blot and dual-luciferase reporter gene assays verified this interaction. CONCLUSION Our findings suggest that miR-373-3p upregulation partly accounts for TGFβR2 downregulation and leads to a restraint of EMT and migration. miR-373-3p may therefore serve as a valuable potential target in the treatment of choriocarcinoma.
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Affiliation(s)
- Yanjie Lu
- Department of Pathology, Chengde Medical University, Chengde, Hebei, China.,Cancer Research Laboratory, Chengde Medical University, Chengde, Hebei, China
| | - Xiaoru Li
- Cancer Research Laboratory, Chengde Medical University, Chengde, Hebei, China.,Department of Gynaecology and Obstetrics, Chengde Central Hospital, Chengde, Hebei, China
| | - Yanzhen Zuo
- Cancer Research Laboratory, Chengde Medical University, Chengde, Hebei, China
| | - Qian Xu
- Cancer Research Laboratory, Chengde Medical University, Chengde, Hebei, China
| | - Lei Liu
- Cancer Research Laboratory, Chengde Medical University, Chengde, Hebei, China
| | - Haiying Wu
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Long Chen
- Department of Pathology, Chengde Medical University, Chengde, Hebei, China
| | - Ying Zhang
- Department of Pathology, Chengde Medical University, Chengde, Hebei, China
| | - Ying Liu
- Department of Pathology, Chengde Medical University, Chengde, Hebei, China
| | - Yuhong Li
- Department of Pathology, Chengde Medical University, Chengde, Hebei, China.,Cancer Research Laboratory, Chengde Medical University, Chengde, Hebei, China
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134
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Capobianco G, Tinacci E, Saderi L, Dessole F, Petrillo M, Madonia M, Virdis G, Olivari A, Santeufemia DA, Cossu A, Dessole S, Sotgiu G, Cherchi PL. High Incidence of Gestational Trophoblastic Disease in a Third-Level University-Hospital, Italy: A Retrospective Cohort Study. Front Oncol 2021; 11:684700. [PMID: 34026657 PMCID: PMC8135795 DOI: 10.3389/fonc.2021.684700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction to assess incidence, prognosis and obstetric outcome of patients treated for gestational trophoblastic disease GTD in a twenty-year period. Incidence, prognosis and obstetric outcome of gestational throphoblastic disease Methods retrospective study. Results Fifty-four cases of GTD: 46 (85.18%) cases of Hydatidiform mole (HM); 8 cases of Persistent Gestational Trophoblastic Neoplasia (GTN) (14.81%): 6/8 cases (75%) GTN not metastatic; 2/8 cases (25%) GTN metastatic. In both cases, the metastases occurred in the lungs. In 3 out of 8 GTN cases (37.5%) a histological picture of choriocarcinoma emerged. The incidence of GTD cases treated from 2000 to 2020 was 1.8 cases per 1000 deliveries and 1.3 cases per 1000 pregnancies. Of the 54 patients, 30 (55.56%) presented showed normal serum hCG levels without the need for chemotherapy. On the other hand, 24 patients (44.44%) developed a persistent trophoblastic disease and underwent adjuvant therapy. The negative prognostic factors that affected the risk of persistence of GTD were: serum hCG levels at diagnosis > 100,000 mUI/ml; characteristic “snow storm” finding at the ultrasound diagnosis; a slow regression of serum hCG levels during follow-up; the persistence of high serum hCG levels (especially if > 1000 mUI/ml one month after suction curettage) that was the main risk factor for resistance to first-line chemotherapy. There were 10 pregnancies in total following treatment. Patients’ survival in our study was 100%. Discussion Although GTD is a rare disease, its incidence was 1.3 cases per 1,000 pregnancies in Sardinia, Italy, higher if compared with mean national and worldwide incidence.
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Affiliation(s)
- Giampiero Capobianco
- Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Elettra Tinacci
- Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Francesco Dessole
- Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Giuseppe Virdis
- Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro Olivari
- Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Antonio Cossu
- Institute of Pathology, University of Sassari, Sassari, Italy
| | - Salvatore Dessole
- Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Pier Luigi Cherchi
- Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Qin J, Zhang S, Poon L, Pan Z, Luo J, Yu N, Wang L, Wu X, Cheng X, Xie X, Lu Y, LU W. Doppler-based predictive model for methotrexate resistance in low-risk gestational trophoblastic neoplasia with myometrial invasion: prospective study of 147 patients. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:829-839. [PMID: 32385928 PMCID: PMC8251727 DOI: 10.1002/uog.22069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This prospective clinical study aimed to evaluate the vascularization characteristics of low-risk gestational trophoblastic neoplasia (GTN) using Doppler imaging and to develop a predictive model for resistance to methotrexate (MTX). METHODS Patients with low-risk GTN receiving primary MTX treatment were enrolled from the Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China, from September 2012 to August 2018. The primary endpoint was to develop and internally validate a predictive model for resistance to MTX therapy in these patients. In the training set, clinical features and Doppler hemodynamic parameters before MTX therapy were analyzed using logistic regression to identify independent predictors of MTX resistance, which were integrated into the model. The predictive performance of the model was evaluated by leave-one-out cross-validation in the training dataset and internal validation in an independent-sample test dataset. RESULTS The entire imaging protocol was completed by 147 eligible patients, of which 110 comprised the training set and 37 the test set. In the training set, cases with myometrial invasion (81.8%; 90/110) showed vascular-enriched areas in the myometrium and high velocity and low impedance ratios of the uterine artery (UtA) compared to cases without myometrial invasion (18.2%; 20/110). On multivariate logistic regression analysis, time-averaged mean velocity in UtA (UtA-TAmean) and the International Federation of Gynecology and Obstetrics (FIGO) score were identified as independent predictors (P = 0.009 and P = 0.043, respectively) of MTX resistance. The Doppler-based predictive model, developed based on the 90 cases with myometrial invasion, was y = -2.95332 + 0.41696 × FIGO score + 0.03551 × UtA-TAmean. The model showed an area under the curve of 0.757 (95% CI, 0.653-0.862) and the optimal cut-off value was 0.50622, which had 45.2% sensitivity and 96.6% specificity. The model stratified patients with low-risk GTN into low (< 10%), intermediate (10-90%) and high (> 90%) probability of MTX resistance, based on the threshold values of -1.59544 and 0.10046. The model had an accuracy of 74.4% (95% CI, 64.5-82.3%) in the cross-validation and 72.7% (95% CI, 55.8-84.9%) in the internal validation. CONCLUSIONS The Doppler-based predictive model, combining a non-invasive marker of tumor vascularity with the FIGO scoring system, can differentiate cases with low from those with high probability of developing MTX resistance and therefore has the potential to guide treatment options in patients with low-risk GTN and myometrial invasion. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. Qin
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang ProvinceHangzhouZhejiangChina
| | - S. Zhang
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang ProvinceHangzhouZhejiangChina
| | - L. Poon
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong Kong SAR
| | - Z. Pan
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang ProvinceHangzhouZhejiangChina
| | - J. Luo
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - N. Yu
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - L. Wang
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - X. Wu
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - X. Cheng
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang ProvinceHangzhouZhejiangChina
| | - X. Xie
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang ProvinceHangzhouZhejiangChina
| | - Y. Lu
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang ProvinceHangzhouZhejiangChina
- Institute of Translational MedicineZhejiang University School of MedicineHangzhouChina
| | - W. LU
- Women's Reproductive Health Key Laboratory of Zhejiang Province, Women's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang ProvinceHangzhouZhejiangChina
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Xing D, Adams E, Huang J, Ronnett BM. Refined diagnosis of hydatidiform moles with p57 immunohistochemistry and molecular genotyping: updated analysis of a prospective series of 2217 cases. Mod Pathol 2021; 34:961-982. [PMID: 33024305 DOI: 10.1038/s41379-020-00691-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
Immunohistochemical analysis of p57 expression and molecular genotyping accurately subclassify molar specimens into complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM) and distinguish these from nonmolar specimens. Characteristics of a prospective series of potentially molar specimens analyzed in a large gynecologic pathology practice are summarized. Of 2217 cases (2160 uterine, 57 ectopic), 2080 (94%) were successfully classified: 571 CHMs (570 uterine, 1 ectopic), 498 PHMs (497 uterine, 1 ectopic), 900 nonmolar (including 147 trisomies, 19 digynic triploids, and 4 donor egg conceptions), and 56 androgenetic/biparental mosaics; 137 were complex or unsatisfactory and not definitively classified. CHMs dominated in patients aged < 21 and >45 years and were the only kind of molar conception found in the latter group. Of 564 successfully immunostained CHMs, 563 (99.8%) were p57-negative (1 p57-positive [retained maternal chromosome 11] androgenetic by genotyping). Of 153 genotyped CHMs, 148 (96.7%) were androgenetic (85% monospermic) and 5 were biparental, the latter likely familial biparental hydatidiform moles. Of 486 successfully immunostained PHMs, 481 (99%) were p57-positive (3 p57-negative [loss of maternal chromosome 11], 2 unknown mechanism). Of 497 genotyped PHMs, 484 (97%) were diandric triploid (99% dispermic) and 13 were triandric tetraploid (all at least dispermic). Of 56 androgenetic/biparental mosaics, 37 had a p57-negative complete molar component (16 confirmed as androgenetic by genotyping). p57 expression is highly correlated with genotyping, serving as a reliable marker for CHMs, and identifies molar components and androgenetic cell lines in mosaic conceptions. Correlation of morphology, p57 expression, genotyping data, and history are required to recognize familial biparental hydatidiform moles and donor egg conceptions, as the former can be misclassified as nonmolar and the latter can be misclassified as dispermic CHM on the basis of isolated genotyping results.
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Affiliation(s)
- Deyin Xing
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Emily Adams
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jialing Huang
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Brigitte M Ronnett
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Basida B, Zalavadiya N, Khicher S, York R. Haemoptysis in third trimester-sole manifestation of stage IV gestational choriocarcinoma. BMJ Case Rep 2021; 14:14/4/e241870. [PMID: 33875512 PMCID: PMC8057579 DOI: 10.1136/bcr-2021-241870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gestational choriocarcinoma is a rare neoplasm of pregnancy that is often undiagnosed until the advanced stage manifests with metastatic complications. Herein, we present a case of a 22-year-old young woman with metastatic gestational choriocarcinoma with unidentified primary origin, who presented with haemoptysis as a chief problem in her third trimester. The case emphasises on the rarity of this neoplasm in a viable pregnancy. Prompt diagnosis and treatment is the key for good maternal and fetal prognosis.
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Affiliation(s)
- Brinda Basida
- Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA
| | - Nirav Zalavadiya
- Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA
| | - Suman Khicher
- Department of Rheumatology, Detroit Medical Center, Detroit, Michigan, USA
| | - Russel York
- Department of Rheumatology, Detroit Medical Center, Detroit, Michigan, USA
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Distinct microRNA profiles for complete hydatidiform moles at risk of malignant progression. Am J Obstet Gynecol 2021; 224:372.e1-372.e30. [PMID: 33031755 DOI: 10.1016/j.ajog.2020.09.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND MicroRNAs are small noncoding RNAs with important regulatory functions. Although well-studied in cancer, little is known about the role of microRNAs in premalignant disease. Complete hydatidiform moles are benign forms of gestational trophoblastic disease that progress to gestational trophoblastic neoplasia in up to 20% of cases; however, there is no well-established biomarker that can predict the development of gestational trophoblastic neoplasia. OBJECTIVE This study aimed to investigate possible differences in microRNA expression between complete moles progressing to gestational trophoblastic neoplasia and those regressing after surgical evacuation. STUDY DESIGN Total RNA was extracted from fresh frozen tissues from 39 complete moles collected at the time of uterine evacuation in Brazil. In the study, 39 cases achieved human chorionic gonadotropin normalization without further therapy, and 9 cases developed gestational trophoblastic neoplasia requiring chemotherapy. Total RNA was also extracted from 2 choriocarcinoma cell lines, JEG-3 and JAR, and an immortalized normal placenta cell line, 3A-subE. MicroRNA expression in all samples was quantified using microRNA sequencing. Hits from the sequencing data were validated using a quantitative probe-based assay. Significantly altered microRNAs were then subjected to target prediction and gene ontology analyses to search for alterations in key signaling pathways. Expression of potential microRNA targets was assessed by quantitative real-time polymerase chain reaction and western blot. Finally, potential prognostic protein biomarkers were validated in an independent set of formalin-fixed paraffin-embedded patient samples from the United States (15 complete moles progressing to gestational trophoblastic neoplasia and 12 that spontaneously regressed) using quantitative immunohistochemistry. RESULTS In total, 462 microRNAs were identified in all samples at a threshold of <1 tag per million. MicroRNA sequencing revealed a distinct set of microRNAs associated with gestational trophoblastic neoplasia. Gene ontology analysis of the most altered transcripts showed that the leading pathway was related to response to ischemia (P<.001). Here, 2 of the top 3 most significantly altered microRNAs were mir-181b-5p (1.65-fold; adjusted P=.014) and mir-181d-5p (1.85-fold; adjusted P=.014), both of which have been shown to regulate expression of BCL2. By quantitative real-time polymerase chain reaction, BCL2 messenger RNA expression was significantly lower in the complete moles progressing to gestational trophoblastic neoplasia than the regressing complete moles (-4.69-fold; P=.018). Reduced expression of BCL2 was confirmed in tissue samples by western blot. Immunohistochemistry in the independent patient samples revealed significantly lower cytoplasmic expression of BCL2 in the villous trophoblasts from cases destined for progression to gestational trophoblastic neoplasia compared with those that regressed, both with respect to staining intensity (optic density 0.110±0.102 vs 0.212±0.036; P<.001) and to the percentage of positive cells (16%±28% vs 49.4%±28.05%; P=.003). CONCLUSION Complete moles progressing to gestational trophoblastic neoplasia are associated with a distinct microRNA profile. miR-181 family members and BCL2 may be prognostic biomarkers for predicting gestational trophoblastic neoplasia risk.
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Joneborg U, Coopmans L, van Trommel N, Seckl M, Lok CAR. Fertility and pregnancy outcome in gestational trophoblastic disease. Int J Gynecol Cancer 2021; 31:399-411. [PMID: 33649007 DOI: 10.1136/ijgc-2020-001784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of this review is to provide an overview of existing literature and current knowledge on fertility rates and reproductive outcomes after gestational trophoblastic disease. A systematic literature search was performed to retrieve all available studies on fertility rates and reproductive outcomes after hydatidiform mole pregnancy, low-risk gestational trophoblastic neoplasia, high- and ultra-high-risk gestational trophoblastic neoplasia, and the rare placental site trophoblastic tumor and epithelioid trophoblastic tumor forms of gestational trophoblastic neoplasia. The effects of single-agent chemotherapy, multi-agent including high-dose chemotherapy, and immunotherapy on fertility, pregnancy wish, and pregnancy outcomes were evaluated and summarized. After treatment for gestational trophoblastic neoplasia, most, but not all, women want to achieve another pregnancy. Age and extent of therapy determine if there is a risk of loss of fertility. Single-agent treatment does not affect fertility and subsequent pregnancy outcome. Miscarriage occurs more often in women who conceive within 6 months of follow-up after chemotherapy. Multi-agent chemotherapy hastens the natural menopause by three years and commonly induces a temporary amenorrhea, but in young women rarely causes permanent ovarian failure or infertility. Subsequent pregnancies have a high chance of ending with live healthy babies. In contrast, high-dose chemotherapy typically induces permanent amenorrhea, and no pregnancies have been reported after high-dose chemotherapy for gestational trophoblastic neoplasia. Immunotherapy is promising and may give better outcomes than multiple schedules of chemotherapy or even high-dose chemotherapy. The first pregnancy after immunotherapy has recently been described. Data on fertility-sparing treatment in placental site trophoblastic tumor and epithelioid trophoblastic tumor are still scarce, and this option should be offered with caution. In general, patients with gestational trophoblastic neoplasia may be reassured about their future fertility and pregnancy outcome. Detailed registration of high-risk gestational trophoblastic neoplasia is still indispensable to obtain more complete data to better inform patients in the future.
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Affiliation(s)
- Ulrika Joneborg
- Department of Pelvic Cancer, Karolinska University Hospital, Karolinska Institute Department of Women's and Children's Health, Stockholm, Sweden
| | - Leonoor Coopmans
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Nienke van Trommel
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Michael Seckl
- Department of Medical Oncology, Hammersmith Hospitals; Imperial College London, London, Pennsylvania, UK
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
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Bakır MS, Birge Ö, Karadag C, Doğan S, Simsek T. Laparoscopic treatment of recurrent and chemoresistant cesarean scar choriocarcinoma. Clin Case Rep 2021; 9:1457-1461. [PMID: 33768867 PMCID: PMC7981746 DOI: 10.1002/ccr3.3801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022] Open
Abstract
Depending on the developing laparoscopic technique and experience, the treatment of cesarean scar choriocarcinoma can be safely performed laparoscopically by experts.
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Affiliation(s)
- Mehmet Sait Bakır
- Department of Gynecology ObstetricsDivision of Gynecologic OncologyAkdeniz UniversityAntalyaTurkey
| | - Özer Birge
- Department of Gynecology ObstetricsDivision of Gynecologic OncologyAkdeniz UniversityAntalyaTurkey
| | - Ceyda Karadag
- Department of Gynecology ObstetricsDivision of Gynecologic OncologyAkdeniz UniversityAntalyaTurkey
| | - Selen Doğan
- Department of Gynecology ObstetricsDivision of Gynecologic OncologyAkdeniz UniversityAntalyaTurkey
| | - Tayup Simsek
- Department of Gynecology ObstetricsDivision of Gynecologic OncologyAkdeniz UniversityAntalyaTurkey
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Silva ALMD, Monteiro KDN, Sun SY, Borbely AU. Gestational trophoblastic neoplasia: Novelties and challenges. Placenta 2021; 116:38-42. [PMID: 33685753 DOI: 10.1016/j.placenta.2021.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/22/2022]
Abstract
Gestational trophoblastic diseases are a group of pregnancy-related disorders, originated from trophoblast cells. They include benign and aggressive tumors, such as the invasive mole, the choriocarcinoma, the placental site trophoblastic tumor (PSTT), and the epithelioid trophoblastic tumor (ETT). These malignancies are characterized as gestational trophoblastic neoplasm (GTN), rarer, although more dangerous. The diagnosis of GTN is made in most cases by monitoring serum chorionic gonadotropin (hCG) with histological confirmation. The use of specific tissue biomarkers has been increasingly employed as a differential diagnosis, leading to more accurate results and different therapy protocols and prognosis for each GTN. The treatment is based on the International Federation of Gynecology and Obstetrics anatomical staging system and the World Health Organization prognostic score system. If an accurate diagnosis is made and the guidelines followed, the cure for choriocarcinoma and invasive mole cases can reach 98%, whereas PSTT and ETT still present mild success rates. The improved knowledge about GTN and its peculiarities allows physicians to efficiently achieve the differential diagnosis and choose the best available therapy protocol, thus increasing the overall survival of affected women. Nevertheless, obtaining epidemiological data and improving knowledge through basic and translational research are essential to answer open questions on GTN physiopathology, their causes, and cellular behavior.
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Affiliation(s)
- Ana Lucia Mendes da Silva
- Cell Biology Laboratory, Institute of Health and Biological Sciences, Federal University of Alagoas, Av. Lourival Melo Mota S/n, 57072-970, Maceio, Brazil
| | | | - Sue Yazaki Sun
- Department of Obstetrics, Universidade Federal de Sao Paulo - UNIFESP, Escola Paulista de Mediina, Sao Paulo, Brazil
| | - Alexandre Urban Borbely
- Cell Biology Laboratory, Institute of Health and Biological Sciences, Federal University of Alagoas, Av. Lourival Melo Mota S/n, 57072-970, Maceio, Brazil.
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Yuseran H, Hartoyo E, Nurseta T, Kalim H. Genistein inhibits the proliferation of human choriocarcinoma cells via the downregulation of estrogen receptor-α phosphorylation at serine 118. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.yclnex.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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143
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Abstract
PURPOSE OF REVIEW This review demonstrates the evidence for new systemic anticancer treatments and how they integrate within conventional management for gestational trophoblastic neoplasia (GTN). We present the evidence on atypical placental site nodules, and how they incorporate within the GTN spectrum, as well as updates regarding GTN staging and follow-up. RECENT FINDINGS First-line treatment for GTN still lies in conventional chemotherapy, although the introduction of anti-PD1/PD-L1 immune checkpoint inhibitors has shown significant promise in management of relapsed disease, with responses reported in multiple relapsed choriocarcinomas as well as epithelioid trophoblastic tumours and placental site trophoblastic tumours (ETT/PSTT). Following completion of treatment, ETT/PSTT still require life-long surveillance but for other GTN, no recurrences have been detected after 7 years. SUMMARY Checkpoint inhibitors are likely to play an increasing role in the future management of GTN management. Further refinement of prognostic factors to identify those most at risk of GTN recurrence is warranted so that surveillance can be focussed on those most at risk, whilst minimizing unnecessary intervention for those at lower risk.
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Affiliation(s)
- James Clark
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, Fulham Palace Road, London W68RF UK
| | - Susanna Slater
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, Fulham Palace Road, London W68RF UK
| | - Michael J Seckl
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, Fulham Palace Road, London W68RF UK
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Capozzi VA, Butera D, Armano G, Monfardini L, Gaiano M, Gambino G, Sozzi G, Merisio C, Berretta R. Obstetrics outcomes after complete and partial molar pregnancy: Review of the literature and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 259:18-25. [PMID: 33550107 DOI: 10.1016/j.ejogrb.2021.01.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 01/25/2023]
Abstract
The hydatidiform mole is a rare gynecological disease rising from the trophoblastic. Post-molar pregnancies have an extremely variable course, varying from repeated abortions, stillbirths, preterm births, live births, or recurring in further molar pregnancies. Literature on obstetric outcomes following molar pregnancy is poor, often including monocentric studies, and with data collected from national databases. This review and meta-analysis aim to analyze the obstetric outcomes after conservative management of complete (CHM) and partial (PHM) molar pregnancies. The meta-analysis was performed following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). Six studies met the inclusion. Of the total 25,222 patients, 13,129 complete (52.1 %) and 12,093 partial (47.9 %) molar pregnancies were included. Live births rate after CHM was statistically higher (p = 0.002) compared to the live births after PHM (53.6 % vs. 51.0 %, 3266 vs. 1807 cases, respectively). Studies showed heterogeneity I2 = 57.7 %, pooled proportion = 0.2 %, and 95 % Confidence Interval (CI) 0.6 to 0.9. No statistically significant difference was demonstrated for ectopic pregnancies (p = 0.633), miscarriage (p = 0.637), preterm birth (p = 0.865), stillbirth (p = 0.911), termination of pregnancy (p = 0.572), and complete molar recurrence (p = 0.580) after CHM and PHM. Partial molar recurrence occurred more frequently after PHM than CHM (0.4 % vs. 0.3 %, 52 vs. 37 cases, respectively, p = 0.002). Careful counseling on the obstetric subsequent pregnancies outcomes should be provided to patients eager for further pregnancy and further studies are needed to confirm these results.
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Affiliation(s)
- Vito Andrea Capozzi
- Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 43125, Parma, Italy.
| | - Diana Butera
- Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 43125, Parma, Italy
| | - Giulia Armano
- Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 43125, Parma, Italy
| | - Luciano Monfardini
- Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 43125, Parma, Italy
| | - Michela Gaiano
- Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 43125, Parma, Italy
| | - Giulia Gambino
- Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 43125, Parma, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Piazzale N. Leotta, 90139, Palermo, Italy
| | - Carla Merisio
- Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 43125, Parma, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 43125, Parma, Italy
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Pereira JVB, Lim T. Hyperthyroidism in gestational trophoblastic disease - a literature review. Thyroid Res 2021; 14:1. [PMID: 33446242 PMCID: PMC7807451 DOI: 10.1186/s13044-021-00092-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/04/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Gestational trophoblastic disease (GTD) is a group of pregnancy-related disorders that arise from abnormal proliferation of placental trophoblast. Some patients with GTD develop hyperthyroidism, a rare but potentially life-threatening complication requiring early detection and management. Existing literature on hyperthyroidism in GTD is scant. This review aims to analyse the epidemiology, pathophysiology and management of this phenomenon. METHODS A comprehensive search of MEDLINE, EMBASE and Cochrane Library was performed to obtain articles that explored hyperthyroidism in GTD. A total of 405 articles were screened and 228 articles were considered for full-text review. We selected articles that explored epidemiology, pathophysiology and outcomes/management of hyperthyroidism in GTD. RESULTS The pathophysiology of hyperthyroidism in GTD is well-investigated. Placental trophoblastic tissue secretes excessive hCG, which is structurally similar to thyroid stimulating hormone and also has enhanced thyrotropic activity compared to normal hCG. The incidence and prevalence of hyperthyroidism in GTD varies worldwide, with lower rates associated with high uptake of early antenatal screening and early GTD detection. No clear risk factors for hyperthyroidism in GTD were identified. While hyperthyroidism can be definitively managed with surgical evacuation of the uterus, severe complications associated with hyperthyroidism in GTD have been reported, including thyroid storm-induced multi-organ failure, ARDS, and pulmonary hypertension. CONCLUSION Early detection of GTD is critical to prevent development of hyperthyroidism and its associated complications. Hyperthyroidism should be recognised as an important perioperative consideration for women undergoing surgery for GTD, and requires appropriate management. Future studies should explore risk factors for hyperthyroidism in GTD, which may facilitate earlier identification of high-risk women.
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Affiliation(s)
- Jarett Vanz-Brian Pereira
- Faculty of Medicine, University of New South Wales, Wallace Wurth Building - UNSW Sydney, 18 High St, Kensington NSW, Sydney, 2052, Australia.
| | - Taylor Lim
- Faculty of Medicine, University of New South Wales, Wallace Wurth Building - UNSW Sydney, 18 High St, Kensington NSW, Sydney, 2052, Australia
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Abstract
Ultrasound is a readily available, safe and portable imaging modality that is widely applied in gynecology. However, there is limited guidance for its use intra-operatively especially with complex gynecological procedures. This narrative review examines the existing literature published on the use of intraoperative ultrasound (IOUS) in benign gynecology and in gynecological oncology. We searched for the following terms: ‘intraoperative,’ ‘ultrasonography,’ ‘gynecology’ and ‘oncology’ using Pubmed/Medline. IOUS can minimize complications and facilitate difficult benign gynecological procedures. There is also a role for its use in gynecological oncology surgery and fertility-sparing surgery. The use of IOUS in gynecological surgery is an emerging field which improves visualization in the surgical field and aids completion of minimally invasive techniques. Ultrasound (US) is a portable and safe imaging method that uses high frequency sound waves to visualize structures within the body. While most US examinations are done outside the body there is an emerging field which uses US devices within the body during surgery to aid complex procedures. This review examines the published literature on this technique in benign gynecology and in gynecological oncology. This review demonstrates the use of intraoperative US improves visualization and minimizes surgical complications.
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147
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Maheut C, Rollin I, Baissas P, Panel P, Niro J. Management of uterine rupture during molar pregnancy. J Gynecol Obstet Hum Reprod 2021; 50:102058. [PMID: 33401026 DOI: 10.1016/j.jogoh.2020.102058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
Gestational trophoblastic disease (GTD) is rare and encompasses several clinicopathologic forms from pre-malignant to malignant disorders. Clinical presentation is most of the time dominated by vaginal bleeding. Only few cases of uterine rupture during GTD have been reported in literature. We present the case of a female patient admitted to the hospital for hemorrhagic shock secondary to a uterine rupture due to an undiagnosed GTD. After an emergency laparoscopy, the patient underwent total hysterectomy with bilateral salpingectomy and bilateral ovarian cystectomy. Pulmonary metastasis were discovered on imaging after stagnation of the beta-hCG level. The surgical treatment was completed by 6 cycles of Methotrexate followed by 7 cycles of Actinomycine D with a good response.
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Affiliation(s)
- Celia Maheut
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay-Rocquencourt, France.
| | - Isabelle Rollin
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay-Rocquencourt, France.
| | - Pauline Baissas
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay-Rocquencourt, France.
| | - Pierre Panel
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay-Rocquencourt, France.
| | - Julien Niro
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay-Rocquencourt, France.
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148
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Chen J, Guan L, Fan P, Liu X, Liu R, Liu Y, Bai H. In vitro study of the effects of DC electric fields on cell activities and gene expression in human choriocarcinoma cells. Electromagn Biol Med 2021; 40:49-64. [PMID: 33179558 DOI: 10.1080/15368378.2020.1846555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/01/2020] [Indexed: 02/08/2023]
Abstract
Physiological electric fields (EFs), as one of the environmental cues influencing both normal and tumor cells, have profound effects on tumor cell malignancy potential. The cellular responses to EFs by choriocarcinoma cells and their underlying mechanisms are unknown. In this study, the migration/motility, cell cycle progression and proliferation of choriocarcinoma cells in electric field culture showed that choriocarcinoma cells migrated cathodally in an applied EF, and EF stimulation influenced cell cycle progression through G2/M arrest and therefore induced a reduction in cellular proliferation. The transcriptome of choriocarcinoma cells subjected to EF stimulation (150 mV/mm) was analyzed using RNA sequencing (RNA-Seq), and the results were verified by reverse transcription quantitative polymerase chain reaction. A Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that ErbB and HIF-1 signaling pathways that are involved in cell migration/motility, cell cycle progression and proliferation were significantly altered in cells treated with an EF of 150 mV/mm compared with control cells, and in addition, the downstream pathways of these signaling pathways such as AKT and P42/P44 MAPK (ERK1/2) showed primary activation by Western blotting. This study's results suggest that an applied EF is an effective cue in regulating cellular phenotypes of choriocarcinoma cells and that transcriptional analysis contributes to the understanding of the mechanism of EF-guided cell functions.
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Affiliation(s)
- Jinxin Chen
- Laboratory of Genetic Disease and Perinatal Medicine and Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University , Chengdu, P. R. China
- Department of Biochemistry, North Sichuan Medical College , Nanchong, P. R. China
| | - Linbo Guan
- Laboratory of Genetic Disease and Perinatal Medicine and Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University , Chengdu, P. R. China
| | - Ping Fan
- Laboratory of Genetic Disease and Perinatal Medicine and Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University , Chengdu, P. R. China
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University , Chengdu, P. R. China
| | - Rui Liu
- Division of Peptides Related with Human Disease, West China Hospital, Sichuan University , Chengdu, P. R. China
| | - Yu Liu
- Department of Biochemistry and Molecular Biology, West China School of Preclinical and Forensic Medicine, Sichuan University , Chengdu, P. R. China
| | - Huai Bai
- Laboratory of Genetic Disease and Perinatal Medicine and Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University , Chengdu, P. R. China
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149
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Todosijević J, Scherbakov A, Volkova Y, Jurišić V. Investigation of the effect of steroidal imidazoheterocycles hormone derivatives on JEG-3 trophoblast cells of choriocarcinoma. KRAGUJEVAC JOURNAL OF SCIENCE 2021. [DOI: 10.5937/kgjsci2143099t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This study aimed to examine the biological activities of unique steroid hormone derivatives-steroidal imidazoheterocycles. The activity synthesized steroidal compounds were tested for the viability of JEG-3 trophoblast cells of choriocarcinoma. The results of the MTT cytotoxicity test showed that most of the examined steroidal imidazoheterocycles act proliferatively on the JEG-3 cell line, except (E, F, and J). Antiproliferative activity of these derivates is probably influenced by different substituents at position 17-C atom in the chemical structure of the hormone and by different substituents on the oxygen atom of acetamide group in the hormone molecule. In order to better confirm the antiproliferative activity of these derivatives, it is necessary to performed complex research on a large panel of cancer cell lines and by different assay.
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150
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Oyatogun O, Sandhu M, Barata-Kirby S, Tuller E, Schust DJ. A rational diagnostic approach to the "phantom hCG" and other clinical scenarios in which a patient is thought to be pregnant but is not. Ther Adv Reprod Health 2021; 15:26334941211016412. [PMID: 34179786 PMCID: PMC8207263 DOI: 10.1177/26334941211016412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
The scenario in which a patient tests positive for human chorionic gonadotropin (hCG) in the absence of pregnancy can pose a diagnostic dilemma for clinicians. The term "phantom hCG" refers to persistently positive hCG levels on diagnostic testing in a nonpregnant patient and such results often lead to a false diagnosis of malignancy and subsequent inappropriate treatment with chemotherapy or hysterectomy. There remains a need for a consistent and rational diagnostic approach to the "phantom hCG." This article aims to review the different etiologies of positive serum hCG testing in nonpregnant subjects and concludes with a practical, stepwise diagnostic approach to assist clinicians encountering this clinical dilemma.
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Affiliation(s)
- Oluwafunmilayo Oyatogun
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, 500 North Keene St Suite 203, Columbia, MO 65201, USA
| | - Mandeep Sandhu
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA
| | - Stephanie Barata-Kirby
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA
| | - Erin Tuller
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA
| | - Danny J. Schust
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA
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