Choriocarcinoma in the Near East. Consanguinity as a possible etiologic factor

Gestational trophoblastic tumors

Although virtually 100% of women who develop gestational trophoblastic tumors enter a long-term complete remission, there are many aspects of trophoblastic disease that arouse interest. Epidemiological studies have shown a large geographical variation in the percentage of conceptions that result in a hydatidiform mole and have stimulated studies on the immunological differences of the low and high risk populations. Chromosomal analysis is now complementing the pathological differentiation between complete and partial moles. There is still debate as to which factors are positively associated with the progression of a hydatidiform mole through invasive mole to choriocarcinoma. There are also considerable differences in the proportion of molar patients receiving chemotherapy in different centers. In addition to these topics, this article will review several recently introduced treatment regimens which show improved results with reduced toxicity.

Registry and follow-up systems of trophoblastic disease in Japan

With recent progress in chemotherapy, the prognosis of patients with trophoblastic disease has greatly improved, but the remission rate of patients with choriocarcinoma remains unfavorable. To improve the prognosis of these patients, early detection and early treatment are essential. Under the leadership of the Committee of Trophoblastic Disease of the Japan Society of Obstetrics and Gynecology, regional registries of trophoblastic disease were started in 1974. By 1982 14 prefectures with a total population of 46,893,620 were included in the registry. The early detection and treatment and follow-up made possible by the registry in addition to the introduction of advanced chemotherapy may be responsible for a rapidly decreasing trend in the death rate from this disease.

Epidemiology of gestational trophoblastic disease

The epidemiology of gestational trophoblastic disease is not well understood. Methodologic problems with published reports limit the interpretation of incidence data, although the frequency of hydatidiform mole appears to be about one per 1000 pregnancies. No consistent temporal trends in rates of either hydatidiform mole or choriocarcinoma are evident. Hydatidiform mole appears to be caused by abnormal gametogenesis and fertilization. Age, ethnicity, and a history of hydatidiform mole appear to be important risk factors for hydatidiform mole. Age, ethnicity, a history of hydatidiform mole or fetal wastage, and ABO blood group interactions appear to be important risk factors for choriocarcinoma. Future studies should focus on the mechanisms by which these risk factors influence gametogenesis, fertilization, and malignant transformation of trophoblastic tissue.

Epidemiology of trophoblast disease in Africa--Lagos

Trophoblast neoplasm cases at the Lagos University Teaching Hospital in the two-year period, 1980-1981, have been reviewed. An apparent increased incidence of 1 in 184 deliveries for hydatidiform mole and 1 in 299 deliveries for choriocarcinoma has been noted when compared with a previous review. An association of hydatidiform mole with age and parity was observed in this study. Among patients with hydatidiform mole, 27 percent also had pseudotoxemia and in one case this progressed to eclampsia. In the case of choriocarcinoma, increased parity appears to be associated with a higher mortality. The relatively higher mortality of 31 percent from this study could be related to the long duration of symptoms before diagnosis and treatment, and a plea is made to the general medical practitioners for a better referral system, although the need to create an increased awareness of the clinical symptoms of this disease in the community is also very much desirable. A collaborative study of the epidemiology of this disease in Nigeria is advocated.

Trophoblastic tumors in Greenland

From 1950 through 1974, 37 cases of hydatidiform mole not followed by malignancy and 11 cases of invasively growing trophoblastic tumors (IGTT) occurred among indigenous Greenlandic women. The overall incidence of benign mole was 1:850 births, only slightly higher than most incidences in low-risk areas like Western Europe, North America, Australia, and Israel. In contrast, the overall incidence of IGTT, 1:2861 births, and the minimum incidence of histologically confirmed choriocarcinoma, 1:5245 births, are among the highest population-based incidence on record. A marked increase in incidence of both hydatidiform mole and IGTT was found late in reproductive life. A recent high incidence of mole among teenagers increased the incidence with statistical significance during the latest 10 years, whereas maximum incidence of IGTT was found in 1960--64. A strong association existed between hydatidiform mole and IGTT. During the study period Greenlandic women with mole had a 20% risk of developing IGTT and 64% of IGTT cases were preceded by molar pregnancy. Four cases of benign mole, but no case of IGTT, occurred among the small group of Danish women living in Greeland. The incidence, 1 mole:685 births, was higher than among the indigenous population, although the latter had a lower socio-economic status. The reason for the high occurrence of IGTT among indigenous Greenlanders remains unknown. The predominating HL-A 9 antigen could conceivably reflect a genetic predisposition.

High frequency of hydatidiform mole in native Alaskans

The frequency of hydatidiform mole per delivery in the native Alaskan for fiscal years 1969 through 1974 was 1:257. Nutritional studies do not support the suggestion of protein deficiency as an etiologic factor. It is suggested that genetic factors may be involved.

Choriocarcinoma in Ibadan: clinicopathologic studies

The host tissue reaction to choriocarcinoma was studied in 81 Nigerian patients. A mononuclear cellular reaction, observed in about 42 per cent of the patients, was composed mainly of lymphocytes, plasma cells, histiocytes, and eosinophils in varying quantities around tumor deposits. No correlation was found between the survival of the patients and the intensity of the cellular reaction. Late presentation by our patients for medical advice and treatment may partly account for the relatively poor response to chemotherapy. The syncytiotrophoblast appears to play a primary role in vascular invasion by the neoplastic trophoblast.

Cellular reaction in trophoblastic tumours

The presence of a mononuclear cell reaction to 41 gestational choriocarcinomata, 10 invasive moles and 13 malignant trophoblastic teratomata has been investigated. The intensity of the reaction was graded; there was a significantly better response to therapy and survival rate in those with a "severe" cellular reaction than in those with a "mild" reaction to gestational choriocarcinoma. The pathological and clinical features of invasive moles showed no relationship with the cellular reaction to the tumour. The cellular reaction to trophoblastic teratomata was generally poor but there was a marked cellular reaction to the tumour of one patient who has enjoyed a sustained remission.The relationship of cellular reaction and response to treatment with other histological and clinical features was examined. With the exception of a positive correlation between the degree of vascular invasion and response to treatment, none was found.It is suggested that an infiltrate of mononuclear cells in gestational choriocarcinoma is probably a response to the presence of tumour antigens. The infiltrate favourably affects the response to chemotherapeutic agents, suggesting that it contributes to tumour cell death and it may be interpreted as an immunological response directed at tumour rejection.

Practical effects of blood group incompatibility between mother and fetus

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