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Khanal UP, Yadav S, Koirala B, Khatiwada A, Yadav AK. Metastatic choriocarcinoma presenting as upper gastrointestinal bleeding: A case report. Radiol Case Rep 2024; 19:5877-5881. [PMID: 39314664 PMCID: PMC11419776 DOI: 10.1016/j.radcr.2024.08.073] [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: 06/10/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/25/2024] Open
Abstract
Choriocarcinoma is a type of gestational trophoblastic disease that occurs as a complication of pregnancy-related events. The gestational trophoblastic disease includes both benign and malignant conditions including complete and partial mole, invasive mole, choriocarcinoma, and placental site trophoblastic disease. Choriocarcinoma generally presents with pervaginal bleeding, symptoms of anemia, and symptoms of its metastatic lesion. The common sites of metastasis are the lung, vagina, brain, and liver. The gastrointestinal (GI) tract is an uncommon site of metastasis occurring in <5% of patients. Upper GI bleeding as presenting complaints without pervaginal bleeding is also very rare with only a few reported cases. Here we present a case of 29 years young female who presented in our emergency department with complaints of hematemesis and altered sensorium where clinical suspicion was peptic ulcer disease but imaging modality with computed tomography showed hypervascular lesions in the brain with suspicion of choriocarcinoma. With further imaging and laboratory tests, confirmatory diagnosis of choriocarcinoma was made. This case highlights the importance of imaging in the diagnosis of choriocarcinoma where the history of the patient is misleading.
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Affiliation(s)
- Umesh Prasad Khanal
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Santoshi Yadav
- Department of Pediatrics, Kanti Children's Hospital, Kathmandu, Nepal
| | - Bibek Koirala
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Abhikanta Khatiwada
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Aalok Kumar Yadav
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Aravapalli Y, Mane A, Kathrani N, Chauhan RS. Ruptured large ectopic hydatidiform mole: an infrequent presentation of gestational trophoblastic disease. J Ultrasound 2024; 27:941-945. [PMID: 39102103 PMCID: PMC11496468 DOI: 10.1007/s40477-024-00946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024] Open
Abstract
Gestational trophoblastic disease (GTD) comprises hydatidiform mole, invasive mole, epithelioid trophoblastic tumor, placental site trophoblastic tumor, and choriocarcinoma. Ectopic molar gestation (EMG) is exceedingly rare with similar malignant potential like that of an intrauterine molar pregnancy. We report an uncommon case of EMG diagnosed by ultrasonography (USG) with a brief literature review. A 36-year-multipara presented at 8-weeks gestational age with severe abdominal pain and spotting. She underwent a spontaneous abortion 4 months back. Current transabdominal USG revealed a large right adnexal hydatidiform mole with moderate hemoperitoneum. Right ovary could not be discerned separately. Emergency laparotomy with hysterectomy and right adnexal clearance was done. Histopathology showed complete ectopic hydatidiform mole. USG remains the modality of choice for initial assessment of suspected GTD and it allows reliable evaluation of residual or recurrent disease. This report emphasizes the role of USG in the diagnosis of EMG and also, the importance of including EMG in the differential diagnosis of suspected ectopic pregnancy.
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Affiliation(s)
- Yesuraju Aravapalli
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Raipur, 492001, Chhattisgarh, India
| | - Abhishek Mane
- Asha Sonography and Imaging Centre, Nipani, Belgaum, Karnataka, India
| | - Nihar Kathrani
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Raipur, 492001, Chhattisgarh, India
| | - Richa S Chauhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Raipur, 492001, Chhattisgarh, India.
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3
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Huang M, Ma Y. A case report on renal metastasis as an unusual presentation of choriocarcinoma. BMC Womens Health 2024; 24:568. [PMID: 39434070 PMCID: PMC11492653 DOI: 10.1186/s12905-024-03399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 10/01/2024] [Indexed: 10/23/2024] Open
Abstract
BACKGROUND Choriocarcinoma is an aggressively invasive neoplasm, characterized by its rapid proliferation and propensity for metastasis to distant organs via hematogenous dissemination. Lungs (80%), vagina (30%), pelvis (20%), liver (10%), and brain (10%) are the most frequently metastasized organs. Renal metastases are very rare. The clinical manifestations of choriocarcinoma varies depending on the site of disease, making diagnosis challenging. In this report, we provide a clinical case of choriocarcinoma with metastases to the renal and pulmonary systems, displaying symptoms akin to those observed in ectopic pregnancy. CASE PRESENTATION A 27-year-old female, G2P1, with a previous history of full-term pregnancy in 2018, presented to the hospital with the onset of vaginal bleeding and accompanying abdominal aches. Investigations uncovered a left adnexal mass with a human chorionic gonadotropin (hCG) level of 77,4 mIU/mL and a left pulmonary nodule measuring 31 mm x 21 mm. Laparoscopy was performed due to the high suspicion of an ectopic pregnancy. However, no visible villi were identified during the surgery, and postoperative blood hCG levels continued to rise. A diagnostic curettage also failed to reveal any villi, maintaining the suspicion of a persistent ectopic pregnancy. Following two ineffective courses of methotrexate therapy, the patient was referred to our facility. Prior to her referral, an ultrasound had indicated a mass in the right kidney. However, upon arrival at our hospital, subsequent ultrasonography failed to detect any renal masses. Despite two months of outpatient monitoring, there was a sudden and significant increase in her serum hCG levels. An emergency laparoscopy was performed, revealing no pregnancy-related lesion. After surgery, the patient's hCG levels dropped dramatically to less than one-tenth of the original amount. Multisite enhanced computed tomography(CT)revealed suspicious lesions in both the renal and pulmonary regions. Upon thorough multidisciplinary consultation, a diagnosis of choriocarcinoma was entertained. Consequently, the patient successfully underwent eight cycles of chemotherapy and has remained recurrence-free for the past year. CONCLUSIONS This case underscores the potential for choriocarcinoma in women of reproductive age who exhibit radiological signs of renal masses. Early and accurate diagnosis, followed by prompt intervention, is essential to prevent needless surgery procedures.
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Affiliation(s)
- Meimei Huang
- West China Xiamen hospital of Sichuan University, Xiamen, Fujian, 361000, China
| | - Yu Ma
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.
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Camilleri G, Calleja-Aguis J, Said E. Trophoblastic disease and choriocarcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108727. [PMID: 39370364 DOI: 10.1016/j.ejso.2024.108727] [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: 06/13/2024] [Revised: 08/29/2024] [Accepted: 09/26/2024] [Indexed: 10/08/2024]
Abstract
Gestational trophoblastic disease (GTD) is a group of diseases associated with pregnancies that demonstrate abnormal development of trophoblastic cells. GTD includes hydatidiform moles (HM) that may continue to further develop into gestational trophoblastic neoplasms (GTN), such as choriocarcinoma (CC). Gestational CC is a malignant mass development that may arise from HM, from other (normal) pregnancies or from other gestational events (such as ectopic pregnancies). The aim of this review is to outline current understating of the genetics and epigenetics of GTD and gestational CC and the link between the two diseases.
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Affiliation(s)
- Graziella Camilleri
- Department of Anatomy, Faculty of Medicine and Surgery University of Malta, Malta; Department of Pathology, Mater Dei Hospital, Malta.
| | - Jean Calleja-Aguis
- Department of Anatomy, Faculty of Medicine and Surgery University of Malta, Malta
| | - Edith Said
- Department of Anatomy, Faculty of Medicine and Surgery University of Malta, Malta; Department of Pathology, Mater Dei Hospital, Malta
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Shearer A, Saso S, Stalder C, Jones B. Rare complications of complete hydatidiform molar pregnancy: the 'hook effect' and thyrotoxicosis. BMJ Case Rep 2024; 17:e259812. [PMID: 39353674 DOI: 10.1136/bcr-2024-259812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024] Open
Abstract
A multiparous woman in her 40s presented with a positive pregnancy test, vaginal bleeding, abdominal distention and shortness of breath, 8 weeks after her last menstrual period. A serum human chorionic gonadotrophin (hCG) was reported 900 mIU/ml, and a transvaginal ultrasound (TVUS) diagnosed a pregnancy of unknown location. The patient deteriorated re-presenting 6 days later with features of thyrotoxicosis. TVUS demonstrated a 198×110×165-mm intrauterine mass with features of a complete hydatidiform mole (CHM), and a serum hCG was reported as 440 mIU/ml. Due to the discrepancy between hCG level and suspicion of CHM, the hCG was thought to be falsely low secondary to the 'hook effect'. Following appropriate dilution, the hCG was reported as 4 573 344 mIU/mL. She underwent an uncomplicated surgical evacuation of molar pregnancy and was discharged 3 days postoperatively with resolution of her symptoms and follow-up in a regional gestational trophoblastic disease centre.
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Affiliation(s)
- Amy Shearer
- Imperial College Healthcare NHS Trust, London, UK
| | - Srdjan Saso
- Imperial College London Department of Surgery and Cancer, London, UK
- West London Gynaecological Cancer Center, Imperial College Healthcare NHS Trust, London, UK
| | - Catriona Stalder
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Benjamin Jones
- Imperial College Healthcare NHS Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive & Developmental Biology, Imperial College London Faculty of Medicine, London, UK
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Geisler HC, Safford HC, Mitchell MJ. Rational Design of Nanomedicine for Placental Disorders: Birthing a New Era in Women's Reproductive Health. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2300852. [PMID: 37191231 PMCID: PMC10651803 DOI: 10.1002/smll.202300852] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/16/2023] [Indexed: 05/17/2023]
Abstract
The placenta is a transient organ that forms during pregnancy and acts as a biological barrier, mediating exchange between maternal and fetal circulation. Placental disorders, such as preeclampsia, fetal growth restriction, placenta accreta spectrum, and gestational trophoblastic disease, originate in dysfunctional placental development during pregnancy and can lead to severe complications for both the mother and fetus. Unfortunately, treatment options for these disorders are severely lacking. Challenges in designing therapeutics for use during pregnancy involve selectively delivering payloads to the placenta while protecting the fetus from potential toxic side effects. Nanomedicine holds great promise in overcoming these barriers; the versatile and modular nature of nanocarriers, including prolonged circulation times, intracellular delivery, and organ-specific targeting, can control how therapeutics interact with the placenta. In this review, nanomedicine strategies are discussed to treat and diagnose placental disorders with an emphasis on understanding the unique pathophysiology behind each of these diseases. Finally, prior study of the pathophysiologic mechanisms underlying these placental disorders has revealed novel disease targets. These targets are highlighted here to motivate the rational design of precision nanocarriers to improve therapeutic options for placental disorders.
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Affiliation(s)
- Hannah C. Geisler
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Hannah C. Safford
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Michael J. Mitchell
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
- Penn Institute for RNA Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19014, USA
- Institute for Regenerative Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
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Boonyapipat S, Nanthamongkolkul K, Saeaib N, Liabsuetrakul T. Fertility-sparing surgical interventions for low-risk, non-metastatic gestational trophoblastic neoplasia. Cochrane Database Syst Rev 2024; 9:CD014755. [PMID: 39312299 PMCID: PMC11418970 DOI: 10.1002/14651858.cd014755.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
BACKGROUND The primary treatment approach for addressing low-risk nonmetastatic gestational trophoblastic neoplasia (LR-NMGTN) in women desiring fertility preservation involves chemotherapy. An alternative option for treatment is fertility-sparing surgical interventions, either alone or in combination with adjuvant chemotherapy. The hypothesised advantages of choosing fertility-sparing surgery in cases of LR-NMGTN include potential avoidance of adverse effects associated with chemotherapy, potential reduction in the number of chemotherapy cycles required to achieve complete remission, and potential reduction in time to remission. OBJECTIVES To measure the benefits and harms of fertility-sparing surgical interventions, with or without adjuvant chemotherapy, compared to primary chemotherapy alone, for the treatment of women with low-risk, non-metastatic gestational trophoblastic neoplasia (LR-NMGTN). SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, Web of Science, ClinicalTrials.gov and WHO ICTRP on 31 January 2024. We also searched abstracts of scientific meetings and reference lists of included studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing fertility-sparing surgical interventions, with or without subsequent adjuvant chemotherapy, versus primary chemotherapy as standard care for the treatment of women with LR-NMGTN. DATA COLLECTION AND ANALYSIS We employed standard Cochrane methodological procedures. We used the GRADE approach to assess the certainty of evidence for each outcome, if available. We focused on the following outcomes: treatment success rate, relapse, disease-specific mortality, death due to treatment, pregnancy rate, quality of life, and any adverse events. MAIN RESULTS We included two RCTs, with a total of 151 participants contributing data to our analyses. Both studies used uterine curettage as the fertility-sparing surgical intervention. Fertility-sparing surgical intervention without subsequent adjuvant chemotherapy versus primary chemotherapy alone One RCT involving 62 participants with varying hCG (human chorionic gonadotrophin) levels evaluated this comparison. Most of our outcomes of interest were not measured in this study. The relative risk of experiencing any adverse event could not be estimated as chemotherapy adverse effects were not reported. The study reported that there were no surgical complications. Chemotherapy was administered to 50% of participants in the intervention group after curettage because their hCG levels increased. Fertility-sparing surgical intervention with subsequent adjuvant chemotherapy versus primary chemotherapy alone One RCT involving 89 participants with hCG levels < 5000 IU/L evaluated this comparison. We judged the risk of bias in the study to be high. The evidence was very uncertain about the effect of uterine curettage with subsequent adjuvant chemotherapy on treatment success rate (RR 1.03, 95% CI 0.86 to1.23; 86 participants), relapse (RR 0.5, 95% CI 0.05 to 5.31; 86 participants), pregnancy rate (RR 0.86, 95% CI 0.31 to 2.34; 86 participants), and rate of adverse events (RR 1.15, 95% CI 0.63 to 2.13; 86 participants), all very low certainty evidence. The relative risks of disease-specific mortality and death due to treatment could not be estimated as there were no deaths in either group. There were no results for quality of life as this outcome was not reported. AUTHORS' CONCLUSIONS Uterine curettage is the only fertility-sparing surgical intervention for LR-NMGTN that has been evaluated in a randomised controlled trial. The evidence is very uncertain about the benefits and harms of uterine curettage, with or without subsequent adjuvant chemotherapy, compared to primary chemotherapy alone. The two available studies are small with a high risk of bias, and future research may find substantially different results for all reported outcomes. Larger RCTs, with appropriate clinical outcome measures, would be required to determine the benefits or harms of fertility-sparing surgical interventions for this population.
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Affiliation(s)
- Sathana Boonyapipat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kulisara Nanthamongkolkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Nungrutai Saeaib
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tippawan Liabsuetrakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Braga A, Paiva G, Barcellos M, Elias KM, Horowitz NS, Berkowitz RS. Diagnosis and Management of Molar Pregnancies. Hematol Oncol Clin North Am 2024:S0889-8588(24)00078-9. [PMID: 39242292 DOI: 10.1016/j.hoc.2024.07.001] [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: 09/09/2024]
Abstract
Complete and partial molar pregnancies arise from abnormal fertilization with marked proliferation of syncytiotrophoblasts. Earlier diagnosis has reduced the frequency of severe medical complications at presentation; however, the risk of progression to gestational trophoblastic neoplasia (GTN) has remained unchanged. Initial assessment should include serum hCG measurement after physical examination, laboratory testing for organ dysfunction, and Doppler ultrasound. Following uterine evacuation, pathologic assessment can distinguish complete from partial moles or non-molar gestations. Close surveillance is essential for the timely diagnosis of GTN. Cure rates and subsequent obstetrics outcomes are excellent, but all patients should be referred for psychologic support and expert level care.
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Affiliation(s)
- Antonio Braga
- Faculty of Medicine, Postgraduate Program in Medical Sciences, Fluminense Federal University, Rua Ataíde Parreiras, 100, Bairro de Fátima, Niterói, RJ 24070-090, Brazil; Department of Obstetrics and Gynecology, Rio de Janeiro Trophoblastic Disease Center, Maternity School of Rio de Janeiro Federal University, Rua Laranjeiras, 180, Laranjeiras, Rio de Janeiro, RJ 22240-003, Brazil; Postgraduate Program in Applied Health Sciences, Vassouras University, Av. Expedicionário Osvaldo de Almeida Ramos, 250, Bloco 03, 2 andar, Centro, Vassouras, RJ 27700-000, Brazil.
| | - Gabriela Paiva
- Faculty of Medicine, Postgraduate Program in Medical Sciences, Fluminense Federal University, Rua Ataíde Parreiras, 100, Bairro de Fátima, Niterói, RJ 24070-090, Brazil
| | - Marcio Barcellos
- Faculty of Medicine, Postgraduate Program in Medical Sciences, Fluminense Federal University, Rua Ataíde Parreiras, 100, Bairro de Fátima, Niterói, RJ 24070-090, Brazil
| | - Kevin M Elias
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Neil S Horowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Ross S Berkowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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9
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Hagey JM, Drury KE, Kaplan S, Davidson BA, Morse JE. Contraceptive use following gestational trophoblastic disease: A systematic review. Contraception 2024; 137:110488. [PMID: 38763274 DOI: 10.1016/j.contraception.2024.110488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To systematically review the effect of contraceptive methods following gestational trophoblastic disease (GTD) on timing of beta-human chorionic gonadotropin (hCG) remission, risk of post-molar gestational trophoblastic neoplasia (GTN), risk of unintended incident pregnancy, and interactions between contraceptive methods and disease treatment. STUDY DESIGN We conducted a search of primary literature with search terms related to GTD and contraception through April 2023 in PubMed and extrapolated our search to other platforms. Randomized controlled trials, observational studies and case reports were eligible for inclusion if they reported on patients with known GTD who received a contraceptive method for pregnancy prevention. Data was abstracted on our main outcomes of interest: timing of beta-hCG remission, risk of post-molar GTN, risk of unintended incident pregnancy, and interactions between contraceptive methods and cancer-directed systemic disease treatment (e.g., chemotherapy). At least two authors reviewed manuscripts at each screening stage with consensus reached before data extraction. Quality assessment checklists were used to assess risk of bias for the different study types. RESULTS Five thousand one hundred and five studies were identified in the database search, of which 42 were included for analysis. Eight thousand two hundred and ninety four participants were evaluated. Over half of the studies were case reports and only two were randomized controlled trials. While there was sparse data on all outcomes, no differences were noted in beta-hCG monitoring, risk of post-molar GTN or incident pregnancies between different contraceptive types. Interactions between contraceptive methods and cancer-directed systemic disease treatment (e.g., chemotherapy) or specific adverse events of contraceptive methods were not identified. CONCLUSIONS Data on contraceptive use following GTD is limited, but use of both hormonal and non-hormonal modern contraceptive methods appears safe. Counseling patients on the full range of contraceptive methods is important to help patients achieve their reproductive health goals and minimize the risk of disease progression through incomplete beta-hCG monitoring prior to future pregnancy. IMPLICATIONS Hormonal and non-hormonal contraceptive options may be used by patients following gestational trophoblastic disease without apparent changes in beta-hCG regression or risk of post-molar gestational trophoblastic neoplasia.
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Affiliation(s)
- Jill M Hagey
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States.
| | - Kerry E Drury
- Duke Women's Health Wake County North, Department of Obstetrics and Gynecology, Duke University, Wake Forest, NC, United States.
| | - Samantha Kaplan
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, United States.
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States.
| | - Jessica E Morse
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States.
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Gu Y, Liu Y, Cheng H, Wang W, Xue X, Wan X, Feng F, Yang J, Ren T, Zhao J, Jiang F, Li Y, Xiang Y. Clinicopathological characteristics and oncologic outcomes of patients with gestational trophoblastic neoplasia manifesting as isolated pulmonary lesions. Gynecol Oncol 2024; 190:28-34. [PMID: 39128338 DOI: 10.1016/j.ygyno.2024.07.686] [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: 05/23/2024] [Revised: 07/13/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE To elucidate the clinicopathological characteristics and oncological outcomes of a special group of patients with gestational trophoblastic neoplasia (GTN) initially presenting with isolated lung lesions, elevated human chorionic gonadotropin (hCG) levels, and unobserved pelvic lesions. METHODS Overall, 2358 patients with GTN treated at our hospital between 2000 and 2023 were retrospectively reviewed, and 40 patients were evaluated. The demographic characteristics, clinicopathological features, treatment data, and follow-up information of each patient were collected. The primary outcome was progression free survival. Kaplan-Meier analysis and univariate and multivariate Cox proportional hazard analyses were used to identify the risk factors. RESULTS Among the 40 patients, 95.0 % had solitary lung lesions, with a median size of 1.9 cm. Moreover, 72.5 % of patients were pathologically confirmed as epithelioid trophoblastic tumors (ETT). During a median follow-up period of 53.5 months (range, 2-143), 11 patients experienced recurrence, including all patients who received chemotherapy alone as the initial treatment, and no death was observed. Relapse treatment involved lung segmentectomy and lobectomy combined with chemotherapy and immunotherapy. Univariate and multivariate Cox analyses identified comparing with surgery±chemotherapy, chemotherapy alone as the initial treatment (hazard ratio [HR] =7.738, 95 % confidence interval [CI] 1.698-35.269, P = 0.008) as independent risk factor for recurrence. CONCLUSIONS In patients with a history of pregnancy exhibiting isolated pulmonary lesions, elevated hCG levels (mostly <1000 mIU/mL), and unobserved pelvic lesions, ETT should be considered first. Surgical resection of lung lesion is crucial for optimal management. When chemotherapy is considered, multidrug regimen is recommended.
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Affiliation(s)
- Yu Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Yang Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Hongyan Cheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Wenze Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaowei Xue
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xirun Wan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Tong Ren
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Jun Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Fang Jiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Yuan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China.
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11
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Bahutair SNM, Dube R, Kuruba MGB, Salama RAA, Patni MAMF, Kar SS, Kar R. Molecular Basis of Hydatidiform Moles-A Systematic Review. Int J Mol Sci 2024; 25:8739. [PMID: 39201425 PMCID: PMC11354253 DOI: 10.3390/ijms25168739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Gestational trophoblastic diseases (GTDs) encompass a spectrum of conditions characterized by abnormal trophoblastic cell growth, ranging from benign molar pregnancies to malignant trophoblastic neoplasms. This systematic review explores the molecular underpinnings of GTDs, focusing on genetic and epigenetic factors that influence disease progression and clinical outcomes. Based on 71 studies identified through systematic search and selection criteria, key findings include dysregulations in tumor suppressor genes such as p53, aberrant apoptotic pathways involving BCL-2 (B-cell lymphoma), and altered expression of growth factor receptors and microRNAs (micro-ribose nucleic acid). These molecular alterations not only differentiate molar pregnancies from normal placental development but also contribute to their clinical behavior, from benign moles to potentially malignant forms. The review synthesizes insights from immunohistochemical studies and molecular analyses to provide a comprehensive understanding of GTD pathogenesis and implications for personalized care strategies.
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Affiliation(s)
- Shadha Nasser Mohammed Bahutair
- Department of Obstetrics and Gynecology, RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras al Khaimah P.O. Box 11172, United Arab Emirates;
| | - Rajani Dube
- Department of Obstetrics and Gynecology, RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras al Khaimah P.O. Box 11172, United Arab Emirates;
| | - Manjunatha Goud Bellary Kuruba
- Department of Biochemistry, RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras al Khaimah P.O. Box 11172, United Arab Emirates;
| | - Rasha Aziz Attia Salama
- Department of Community Medicine, RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras al Khaimah P.O. Box 11172, United Arab Emirates; (R.A.A.S.); (M.A.M.F.P.)
- Department of Public Health and Community Medicine, Kasr El Ainy Faculty of Medicine, Cairo University, Cairo 12613, Egypt
| | - Mohamed Anas Mohamed Faruk Patni
- Department of Community Medicine, RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras al Khaimah P.O. Box 11172, United Arab Emirates; (R.A.A.S.); (M.A.M.F.P.)
| | - Subhranshu Sekhar Kar
- Department of Pediatrics, RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras al Khaimah P.O. Box 11172, United Arab Emirates;
| | - Rakhee Kar
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605006, India;
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Kara SS, Keles E, Yeni Erdem B, Api M. Endometrial Clear Cell Carcinoma with Non-Gestational Uterine Choriocarcinoma Differentiation. Int J Surg Pathol 2024:10668969241265022. [PMID: 39090978 DOI: 10.1177/10668969241265022] [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: 08/04/2024]
Abstract
Choriocarcinoma is a rare and highly malignant tumor that primarily occurs in women of reproductive age. Choriocarcinoma can be classified as gestational or nongestational, based on its pathogenetic origin. Although primary nongestational choriocarcinoma has been described in the ovaries, it is very rare in the uterus, especially in postmenopausal women. It is crucial to differentiate between gestational and non-gestational choriocarcinoma, as it affects the choice of treatment and prognosis. Endometrial clear cell carcinoma is an aggressive subtype of endometrial cancer, accounting for less than 10% of all uterine carcinomas. Trophoblastic differentiation in uterine cancer is unusual and very rare, with only three examples of the subtype of clear cell endometrial cancer with gestational choriocarcinoma reported in the literature, including only one with nongestational choriocarcinoma. Here, we present an example of clear cell carcinoma with nongestational uterine choriocarcinoma differentiation in a postmenopausal woman.
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Affiliation(s)
- Sahra Sultan Kara
- Department of Obstetrics and Gynecology, University of Health Sciences, Kartal Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Esra Keles
- Department of Gynecologic Oncology, University of Health Sciences, Kartal Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Begum Yeni Erdem
- Department of Pathology, University of Health Sciences, Kartal Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Murat Api
- Department of Gynecologic Oncology, University of Health Sciences, Kartal Lütfi Kırdar City Hospital, Istanbul, Turkey
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13
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Avers E, Langley DM, Karalic K, Snitowsky R. Point-Of-Care Ultrasound to Diagnose Molar Pregnancy in the Emergency Department: A Case Report and Topic Review. Cureus 2024; 16:e68223. [PMID: 39347196 PMCID: PMC11439479 DOI: 10.7759/cureus.68223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/30/2024] [Indexed: 10/01/2024] Open
Abstract
Molar pregnancy is a topic in emergency medicine frequently tested and regularly discussed but is perhaps overshadowed by other conditions such as ectopic pregnancy. It is a rare diagnosis encountered in the emergency department (ED) and is part of a broad spectrum of pathological conditions that fall into the category of gestational trophoblastic disease (GTD). Diagnosis of this potentially malignant condition requires the emergency physician to bear this condition in mind when treating any woman while considering obstetric-related conditions in the first trimester, vaginal bleeding, pelvic pain or pressure, and excessive nausea and vomiting. We present the case of a 20-year-old primigravida 12-week pregnant female who presented to the ED sent in by the midwifery clinic for evaluation with concerns for absent fetal heart tones and abnormal uterine appearance. Point-of-care ultrasound (POCUS) performed upon arrival demonstrated an irregular complex echogenic uterine mass with anechoic areas and cystic structures suspicious for a molar pregnancy. Obstetrics-gynecology (OB-GYN) admitted the patient promptly for definitive surgical care, and tissue analysis confirmed a complete molar gestation. This case highlights the effectiveness of POCUS for prompt diagnosis and treatment of molar pregnancy in the ED.
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Affiliation(s)
- Erin Avers
- Emergency Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - David M Langley
- Emergency Medicine, Florida State University College of Medicine, Sarasota, USA
| | - Katelyn Karalic
- Emergency Medicine, Florida State University College of Medicine, Sarasota, USA
| | - Ryan Snitowsky
- Emergency Medicine, Florida State University College of Medicine, Sarasota, USA
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Bartusevicius A, Bartuseviciene E, Maseviciene M, Sukovas A, Birbalaite I, Karpaviciute M. Heterotopic Tubal Choriocarcinoma Coexistent with a Viable Intrauterine Pregnancy: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1226. [PMID: 39202507 PMCID: PMC11356048 DOI: 10.3390/medicina60081226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/10/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Choriocarcinoma is an aggressive oncological disease that manifests as trophoblast tissue proliferation. The vast majority of primary lesions affect the uterus, with primarily extrauterine lesions being a rarity. Choriocarcinoma with an ongoing pregnancy is extremely rare because fetuses usually do not survive the third trimester. Case Report: We present a case of heterotopic tubal choriocarcinoma coexisting with a viable intrauterine pregnancy. A 30-year-old, 39-week pregnant woman (gravida 2, para 2) came to our hospital complaining of acute upper abdominal pain. During routine prenatal screening in the first trimester, no pathological ultrasound findings were detected. Similar abdominal pain episodes had been recorded at 18, 27, and 32 weeks of gestation, when patient was hospitalized for examination and observation, but the cause of symptoms at that time of gestation remained unclear. The patient underwent an emergency caesarean section due to severe abdominal pain and fetal compromise. She delivered a live male infant. During the surgery, around 1000 mL of blood clots were evacuated, and the excision of the right fallopian tube and masses, as well as the control of significant blood loss was performed. Postoperative serum beta-hCG was elevated to 139 482 IU/L, while imaging studies showed no metastasis. The histological examination of the excised tissue samples confirmed a diagnosis of tubal choriocarcinoma. With a FIGO score of 8, the patient received three courses of the EP/EMA regimen. After more than a year, the patient showed no radiographic signs of distant metastasis and is now in complete remission. Conclusions: This case highlights the diagnostic complexity of such extremely rare scenarios. Even though such cases are rare, it demonstrates the necessity for improved diagnostic measures to enhance patient outcomes in similar clinical situations.
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Affiliation(s)
- Arnoldas Bartusevicius
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.B.); (A.S.)
| | - Egle Bartuseviciene
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.B.); (A.S.)
| | - Minginte Maseviciene
- Department of Pathological Anatomy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Arturas Sukovas
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.B.); (A.S.)
| | - Ieva Birbalaite
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (I.B.); (M.K.)
| | - Migle Karpaviciute
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (I.B.); (M.K.)
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15
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Zhao Y, Cai L, Huang B, Yin X, Pan D, Dong J, Zheng L, Chen H, Lin J, Shou H, Zhao Z, Jin L, Zhu X, Cai L, Zhang X, Qian J. Reappraisal and refined diagnosis of ultrasonography and histological findings for hydatidiform moles: a multicentre retrospective study of 821 patients. J Clin Pathol 2024:jcp-2024-209638. [PMID: 39048306 DOI: 10.1136/jcp-2024-209638] [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: 05/10/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
AIMS Specific identification of a hydatidiform mole (HM) and subclassification of a complete hydatidiform mole (CHM) or partial hydatidiform mole (PHM) are critical. This study aimed to reappraise the diagnostic performance of ultrasonography and histology with a refined diagnosis. METHODS This was a retrospective, multicentre cohort study of 821 patients with histologically suspected HM specimens. Refined diagnostic algorithms with p57 immunohistochemistry and short tandem repeat (STR) genotyping were performed and used as the true standard for assessing the diagnostic performance of the original ultrasonography and morphology methods. The diagnostic performance was calculated using accuracy, agreement rate, sensitivity and the positive predictive value (PPV) compared with refined diagnostic results. RESULTS Of the 821 histologically suspected HM cases included, 788 (95.98%) were successfully reclassified into 448 CHMs, 213 PHMs and 127 non-molar (NM) abortuses. Ultrasonography showed an overall accuracy of 44.38%, with a sensitivity of 44.33% for CHM and 37.5% for PHM. The overall classification accuracy of the original morphological diagnosis was 65.97%. After exclusion of the initially untyped HMs, the overall agreement rate was 59.11% (κ=0.364, p<0.0001) between the original and refined diagnoses, with a sensitivity of 40.09% and PPV of 96.05% for diagnosing CHMs and a sensitivity of 84.98% and a PPV of 45.59% for diagnosing PHMs. The interinstitutional variability of morphology in diagnosing HMs was significant among the 15 centres (range, 8.33%-100.00%, p<0.0001). CONCLUSION The current diagnosis of HM based solely on ultrasound or morphology remains problematic, and ancillary techniques, particularly p57 immunohistochemistry and DNA genotyping, should be integrated into routine practice as much as possible.
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Affiliation(s)
- Yating Zhao
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Limeng Cai
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bo Huang
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiangang Yin
- Department of Pathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang, China
| | - Dan Pan
- Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Jie Dong
- Department of Gynecology, Huzhou Maternity and Child Care Hospital, Huzhou, Zhejiang, China
| | - Lei Zheng
- Department of Pathology, Zhoushan Hospital, Zhoushan, Zhejiang Province, China
| | - Hao Chen
- Department of Pathology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Jun Lin
- Department of Pathology, Quzhou People's Hospital, Quzhou, Zhejiang, China
| | - Huafeng Shou
- Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhigang Zhao
- Department of Pathology, People's Hospital of Anji, Huzhou City, Zhejiang Province, China
| | - Lanying Jin
- Department of Gynecology, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang, China
| | - Xiaoxu Zhu
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Luya Cai
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaofei Zhang
- Department of Gynecology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang, China
| | - Jianhua Qian
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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16
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Zhang J, Dong A, Wang Y. FDG PET/CT Findings of Primary Pulmonary Choriocarcinoma in a Postmenopausal Woman. Clin Nucl Med 2024; 49:698-700. [PMID: 38739485 DOI: 10.1097/rlu.0000000000005272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
ABSTRACT Choriocarcinomas usually occur in the genital tracts of reproductive-age women after a gestational event. Primary pulmonary choriocarcinoma is very rare. We describe FDG PET/CT findings of primary pulmonary choriocarcinoma with multiple intrapulmonary metastases in a postmenopausal woman with elevated serum beta human chorionic gonadotropin level. On FDG PET/CT, the large primary lung tumor showed intense FDG uptake (SUV max , 46), and the small intrapulmonary metastases showed variable FDG uptake (SUV max , 27). Primary pulmonary choriocarcinoma should be included in the differential diagnosis of FDG-avid pulmonary lesions with elevated serum beta human chorionic gonadotropin levels, including metastatic choriocarcinoma and lung cancer.
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Affiliation(s)
- Jun Zhang
- From the Department of Cardiothoracic Surgery, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province
| | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University
| | - Yang Wang
- Department of Pathology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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17
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Aliabadi AR, Wilailak S, McNally O, Berek JS, Sridhar A. Contraceptive strategies for reducing the risk of reproductive cancers. Int J Gynaecol Obstet 2024; 166:141-151. [PMID: 38725288 DOI: 10.1002/ijgo.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Reproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low-resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low-cost behavioral interventions to mitigate reproductive cancer risks.
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Affiliation(s)
- A R Aliabadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, The University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orla McNally
- Department of Oncology and Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Jonathan S Berek
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Aparna Sridhar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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18
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Aiob A, Gumin D, Zilberfarb I, Naskovica K, Sgayer I, Mikhail SM, Sharon A, Lowenstein L. Ethnic disparities in complete and partial molar pregnancy incidence: a retrospective analysis of arab and jewish women in single medical center. BMC Public Health 2024; 24:1440. [PMID: 38811887 PMCID: PMC11138058 DOI: 10.1186/s12889-024-18276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/05/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Molar pregnancies, encompassing complete and partial moles, represent a rare and enigmatic gestational disorder with potential ethnic variations in incidence. This study aimed to investigate relations of ethnicity with risks of complete and partial molar pregnancies within an Israeli population while accounting for age differences. METHODS A retrospective study was conducted of data recorded during 2007-2021 in an academic medical center in Israel. The study population comprised 167 women diagnosed with complete or partial moles, for whom data were obtained through histological examination and P57 immunostaining. Maternal age and ethnicity were extracted from electronic medical records. Incidence rates were calculated per 10,000 live births, and a nested case-control study compared demographic characteristics and molar pregnancy incidences between Arab and Jewish women. Statistical analyses included age-adjusted comparisons, relative risk calculations and multivariate logistic regression. RESULTS The overall risk of molar pregnancy was 22 per 10,000 live births (95% confidence interval [CI] 18-25). Among Arab women, the overall risk was 21 (95% CI 17-25), and for PM and CM: 14 (95% CI 11-17) and 7 (95% CI 5-10), respectively. Among Jewish women, the overall risk was 23 (95% CI 18-29), and for PM and CM: 12 (95% CI 8-17) and 11 (95% CI 7-16), respectively. Among Arab women compared to Jewish women, the proportion of all the partial moles was higher: (65.3% vs. 51.6%, p = 0.05). The incidence of partial mole was higher among Arab than Jewish women, aged 35-39 years (26 vs. 8 per 10,000, p = 0.041), and did not differ in other age groups. After adjusting for age, the relative risk of partial moles was lower among Jews than Arabs (0.7, 95% CI 0.4-1.0, p = 0.053). For Arab compared to Jewish women, the mean age at molar pregnancies was younger: 31.0 vs. 35.1 years. However, other factors did not differ significantly between Arab and Jewish women with molar pregnancies. In multivariate analysis, Jewish ethnicity was significantly associated with a higher risk of complete molar pregnancies (OR = 2.19, 95% CI 1.09-4.41, p = 0.028). CONCLUSION This study highlights ethnic differences in molar pregnancy risk within the Israeli population. Jewish ethnicity was associated with a higher risk of complete molar pregnancies, while Arab women had a significantly higher risk of partial moles. These findings underscore the need to consider ethnicity when studying gestational disorders. Further research should seek to elucidate the underlying factors contributing to these differences.
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Affiliation(s)
- Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, POB 21, 22100, Nahariya, Israel.
- Department of Obstetrics and Gynecology, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Dina Gumin
- Department of Obstetrics and Gynecology, Galilee Medical Center, POB 21, 22100, Nahariya, Israel
| | - Inna Zilberfarb
- Department of Obstetrics and Gynecology, Galilee Medical Center, POB 21, 22100, Nahariya, Israel
| | - Karina Naskovica
- Department of Obstetrics and Gynecology, Galilee Medical Center, POB 21, 22100, Nahariya, Israel
| | - Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, POB 21, 22100, Nahariya, Israel
- Department of Obstetrics and Gynecology, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Susana Mustafa Mikhail
- Department of Obstetrics and Gynecology, Galilee Medical Center, POB 21, 22100, Nahariya, Israel
- Department of Obstetrics and Gynecology, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Avishalom Sharon
- Department of Obstetrics and Gynecology, Galilee Medical Center, POB 21, 22100, Nahariya, Israel
- Department of Obstetrics and Gynecology, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, POB 21, 22100, Nahariya, Israel
- Department of Obstetrics and Gynecology, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Katzman PJ, Hecht JL. Triaging and Evaluation of Products of Conception in Abortions and Post-Partum Hemorrhage. Pediatr Dev Pathol 2024:10935266241255981. [PMID: 38794948 DOI: 10.1177/10935266241255981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The proper evaluation of abortion specimens and placentas from stillbirth and post-partum cases is important for adequate clinical care of post-abortion and post-partum patients. The following topics will be reviewed: (1) the importance of evaluation of both fetal and placental tissue in first trimester abortions to confirm an intrauterine pregnancy versus an ectopic pregnancy; (2) the clinical history associated with an abortion specimen or retained products of conception (POC) influences how the pathologist should triage the specimen; (3) the criteria for diagnosis of a molar pregnancy, which is critical for clinicians to know which patients need follow-up; (4) the utility of genetic studies for both diagnosis and appropriate follow-up of the patient; and (5) the pathologic evaluation of specimens from patients with post-partum hemorrhage for placenta accreta spectrum and subinvolution of maternal vessels.
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20
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Enuset A, Duck L, Petre C, Machiels JP, Goffin F. Case report: Multidrug resistant gestational trophoblastic neoplasia: focus on failure of immunotherapy and success of high-dose chemotherapy. Front Oncol 2024; 14:1391408. [PMID: 38803539 PMCID: PMC11128616 DOI: 10.3389/fonc.2024.1391408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Gestational trophoblastic neoplasia (GTN) is extremely rare, but has a very good prognosis, with a cure rate close to 100%, for low-risk diseases. This article describes the case of a healthy 28-year-old nulliparous patient with GTN resistant to multiple lines of treatment. The era of immunotherapy is revolutionizing oncology, having already proved its worth in the treatment of many cancers. This article will have a specific focus on the emerging role of immunotherapy in the treatment of GTN. Unfortunately, the use of an immune checkpoint inhibitor (ICI) failed in our case, emphasizing on the necessity to clearly define the future role of immune therapy in GTN. Finally, given the rapid progression of the disease after hysterectomy, induction with Paclitaxel- Ifosfamide and then intensification with high-dose Carboplatin and Etoposide with peripheral blood stem cell support was given as a rescue therapy with still curative intent.
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Affiliation(s)
- Anne Enuset
- Department of Gynecology and Obstetrics, Université Catholique de Louvain, Brussels, Belgium
| | - Lionel Duck
- Onco-Hematology and Palliative Care, Clinique Saint-Pierre Ottignies, Ottignies-Louvain-la-Neuve, Belgium
| | - Claudia Petre
- Department of Gynecology and Obstetrics, Clinique Saint-Pierre Ottignies, Ottignies-Louvain-la-Neuve, Belgium
| | - Jean-Pascal Machiels
- Institut Roi Albert II, Service d’Oncologie Médicale, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (IREC, Pole MIRO), Université Catholique de Louvain, Brussels, Belgium
| | - Frédéric Goffin
- Belgian Gestational Trophoblastic Disease Reference Centre, University of Liège, Liège, Belgium
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21
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Sharma A, Gupta T, Rathore R, Chakraborty O. Placental mesenchymal disease masquerading as molar pregnancy with a favourable maternal and fetal outcome. BMJ Case Rep 2024; 17:e258296. [PMID: 38724211 PMCID: PMC11085982 DOI: 10.1136/bcr-2023-258296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Placental mesenchymal dysplasia (PMD) is an exceptionally rare placental anomaly characterised by placentomegaly and grape-like vesicles resembling partial mole on ultrasonography, yet it can coexist with a viable fetus. We present the case of a primigravida who presented at 22 weeks gestation with a suspected partial mole but with a normally growing fetus. The differential diagnoses considered included placental mesenchymal disease, partial mole and twin pregnancy with molar pregnancy. With normal beta HCG levels and prenatal invasive testing reports, a probable diagnosis of PMD was made, and after thorough counselling, the decision was made to continue the pregnancy. The pregnancy progressed until 37 weeks, culminating in the uneventful delivery of a 2.4 kg healthy male infant. Histopathology confirmed PMD. Early recognition and management of PMD pose significant challenges, given its rarity. Prenatal identification of PMD during both early and late gestation could avert unnecessary termination of pregnancy.
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Affiliation(s)
- Aparna Sharma
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanisha Gupta
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchi Rathore
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Oishika Chakraborty
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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22
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Shivarajpur A, Kohen B. Vaginal Bleeding in a Peri-Menopausal Woman. POCUS JOURNAL 2024; 9:9-10. [PMID: 38681151 PMCID: PMC11044943 DOI: 10.24908/pocus.v9i1.16621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Point of care ultrasound (POCUS) is a useful modality to initially identify a molar pregnancy. In this case, we describe a 51-year-old perimenopausal woman who presented to the emergency department (ED) with vaginal bleeding. A transvaginal POCUS was performed, revealing findings concerning for a molar pregnancy. These findings led to prompt diagnosis and treatment.
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Affiliation(s)
- Ambika Shivarajpur
- Department of Emergency Medicine, Memorial Hospital WestPembroke Pines, FLUSA
| | - Brian Kohen
- Department of Emergency Medicine, Memorial Hospital WestPembroke Pines, FLUSA
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23
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Wang Q, Mao K, Si M, Cao X. Thoracoscopic resection of pulmonary alveoli formed by pulmonary metastases of placental site trophoblastic tumors: A case report. Asian J Surg 2024:S1015-9584(24)00684-5. [PMID: 38641527 DOI: 10.1016/j.asjsur.2023.12.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/25/2023] [Indexed: 04/21/2024] Open
Affiliation(s)
- Qin Wang
- Department of Reproductive Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
| | - Kaiyun Mao
- First Clinical Medical College, Gannan Medical University, Ganzhou, China.
| | - Maoyan Si
- Department of Thoracic Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.
| | - Xiying Cao
- Department of Thoracic Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.
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24
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Kar A, Mills KA. Severe methotrexate hypersensitivity during treatment for Gestational trophoblastic Neoplasia: Case Report and considerations for management. Gynecol Oncol Rep 2024; 52:101364. [PMID: 38495802 PMCID: PMC10940130 DOI: 10.1016/j.gore.2024.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
•Methotrexate (MTX) hypersensitivity is rare and has not been widely reported in the setting of treatment of GTN.•Work up of hypersensitivity reactions may include consultation to an allergist, serum tryptase level, and possible skin testing.•In low-risk GTN, dactinomycin should be utilized after a hypersensitivity reaction to MTX.
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Affiliation(s)
- Ayesha Kar
- University of Chicago, Department of Obstetrics & Gynecology, Section of Gynecologic Oncology
| | - Kathryn A. Mills
- University of Chicago, Department of Obstetrics & Gynecology, Section of Gynecologic Oncology
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25
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Garcia JB, Seasely AR, Roland D, Guo H, Boozer M, Cozzi G, Toboni MD. Management of a complete mole and coexisting fetus in post-dobbs world. Gynecol Oncol Rep 2024; 52:101375. [PMID: 38571565 PMCID: PMC10987889 DOI: 10.1016/j.gore.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Twin pregnancies consisting of a complete hydatidiform mole and a coexistent fetus (CMCF) are rare and associated with a high rate of maternal-fetal morbidity and mortality. Management of these pregnancies remains controversial and increasingly challenging following the Dobbs versus Jackson Women's Health decision given the viability of the coexisting twin fetus. CASE This case looks at the diagnosis, management, and maternal-fetal outcomes of a viable fetus coexisting molar pregnancy at a large academic center in an abortion-restricted state. CONCLUSION CMCF pregnancies are associated with a high risk of morbidity and mortality and are increasingly difficult to manage following the Dobbs decision. Testing platforms, which identify genetic abnormalities in the first trimester, are increasingly important as access to abortion care in the United States is restricted.
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Affiliation(s)
- Jordan Barton Garcia
- University of Alabama at Birmingham Department of Obstetrics and Gynecology, United States
| | - Angela R. Seasely
- University of Alabama at Birmingham Division of Maternal Fetal Medicine, United States
| | - Damien Roland
- University of Alabama at Birmingham Department of Pathology, United States
| | - Hua Guo
- University of Alabama at Birmingham Department of Pathology, United States
| | - Margaret Boozer
- University of Alabama at Birmingham Division of Women’s Reproductive Healthcare, United States
| | - Gabriella Cozzi
- University of Alabama at Birmingham Division of Maternal Fetal Medicine, United States
| | - Michael D. Toboni
- University of Alabama at Birmingham Division of Gynecology Oncology, United States
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26
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Li H, Hu X, Ning MS, Fuller GN, Stewart JM, Gilliam JC, Wu J, Le X, Vaporciyan AA, Lee JJ, Gibbons DL, Heymach JV, Futreal A, Zhang J. Case report: Molecular profiling facilitates the diagnosis of a challenging case of lung cancer with choriocarcinoma features. Front Oncol 2024; 14:1324057. [PMID: 38590653 PMCID: PMC10999639 DOI: 10.3389/fonc.2024.1324057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 04/10/2024] Open
Abstract
Accurate diagnoses are crucial in determining the most effective treatment across different cancers. In challenging cases, morphology-based traditional pathology methods have important limitations, while molecular profiling can provide valuable information to guide clinical decisions. We present a 35-year female with lung cancer with choriocarcinoma features. Her disease involved the right lower lung, brain, and thoracic lymph nodes. The pathology from brain metastasis was reported as "metastatic choriocarcinoma" (a germ cell tumor) by local pathologists. She initiated carboplatin and etoposide, a regimen for choriocarcinoma. Subsequently, her case was assessed by pathologists from an academic cancer center, who gave the diagnosis of "adenocarcinoma with aberrant expression of β-hCG" and finally pathologists at our hospital, who gave the diagnosis of "poorly differentiated carcinoma with choriocarcinoma features". Genomic profiling detected a KRAS G13R mutation and transcriptomics profiling was suggestive of lung origin. The patient was treated with carboplatin/paclitaxel/ipilimumab/nivolumab followed by consolidation radiation therapy. She had no evidence of progression to date, 16 months after the initial presentation. The molecular profiling could facilitate diagnosing of challenging cancer cases. In addition, chemoimmunotherapy and local consolidation radiation therapy may provide promising therapeutic options for patients with lung cancer exhibiting choriocarcinoma features.
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Affiliation(s)
- Hui Li
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Xin Hu
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Matthew S. Ning
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gregory N. Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - John M. Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Jia Wu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ara A. Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J. Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Don L. Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - John V. Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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27
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Tian Y, Yu J, Dan X, Chen T, He Y. Case report: Metastatic choriocarcinoma in the second trimester of a viable pregnancy with successful delivery and outcome after chemotherapy. Front Oncol 2024; 14:1345011. [PMID: 38525427 PMCID: PMC10959001 DOI: 10.3389/fonc.2024.1345011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Metastatic choriocarcinoma during viable pregnancy is rare worldwide, and neonate survival following pregnancy termination in the second trimester is uncommon. Here, we report the successful delivery of a pregnancy by a patient with metastatic choriocarcinoma, who received three courses of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) chemotherapy in the second trimester. After multidisciplinary discussions, she was administered paclitaxel and carboplatin (TC) chemotherapy. Regular contractions occurred during her first paclitaxel infusion, and a healthy infant was delivered by cesarean section at 26+4 gestational weeks. Choriocarcinoma was not detected in the placenta. Following delivery of the pregnancy, the patient underwent total treatment comprising one cycle of TC, seven cycles of EMA-CO, and five courses of etoposide, cisplatin, methotrexate, and dactinomycin chemotherapy; her serum level of beta-human chorionic gonadotropin gradually fell after chemotherapy. Uterine and pulmonary metastases shrank, and no distant metastasis or recurrence were found until the eighth course of maintenance treatment with immunotherapy. The patient received periodic chemotherapy for recurrence at the time of publishing this case report. The child was disease-free 15+ months after delivery. Despite serious metastases and complications, metastatic choriocarcinoma diagnosed in the second trimester of pregnancy can be successfully treated with minimal delay by multidisciplinary medical and nursing management.
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Affiliation(s)
- Yalin Tian
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jiayi Yu
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xin Dan
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Tanglin Chen
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yalin He
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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28
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Hajri T, Massoud M, Vergne M, Descargues P, Allias F, You B, Lotz JP, Haesebaert J, Bolze PA, Golfier F, Massardier J. Multiple pregnancy with complete hydatidiform mole and coexisting normal fetus in a retrospective cohort of 141 patients. Am J Obstet Gynecol 2024; 230:362.e1-362.e8. [PMID: 37722570 DOI: 10.1016/j.ajog.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Multiple pregnancy with a complete hydatidiform mole and a normal fetus is prone to severe obstetrical complications and malignant transformation after birth. Prognostic information is limited for this rare form of gestational trophoblastic disease. OBJECTIVE This study aimed to determine obstetrical outcomes and the risk of gestational trophoblastic neoplasia in women with multiple pregnancy with complete hydatidiform mole and coexisting normal fetus, and to identify risk factors for poor obstetrical and oncological outcomes to improve patient information and management. STUDY DESIGN This was a retrospective national cohort study of 11,411 records from the French National Center for Trophoblastic Disease registered between January 2001 and January 2022. RESULTS Among 11,411 molar pregnancies, 141 involved histologically confirmed multiple pregnancy with complete hydatidiform mole and coexisting normal fetus. Roughly a quarter of women (23%; 33/141) decided to terminate pregnancy because of presumed poor prognosis or by choice. Among the 77% of women (108/141) who continued their pregnancy, 16% of pregnancies (17/108) were terminated because of maternal complications, and 37% (40/108) ended in spontaneous miscarriage before 24 weeks' gestation. The median gestational age at delivery in the remaining 47% of pregnancies (51/108) was 32 weeks. The overall neonatal survival rate at day 8 was 36% (39/108; 95% confidence interval, 27-46) after excluding elective pregnancy terminations. Patients with free beta human chorionic gonadotropin levels <10 multiples of the median were significantly more likely to reach 24 weeks' gestation compared with those with free beta human chorionic gonadotropin levels >10 multiples of the median (odds ratio, 7.0; 95% confidence interval, 1.3-36.5; P=.022). A lower free beta human chorionic gonadotropin level was also associated with better early neonatal survival (the median free beta human chorionic gonadotropin level was 9.4 multiples of the median in patients whose child was alive at day 8 vs 20.0 multiples of the median in those whose child was deceased; P=.02). The overall rate of gestational trophoblastic neoplasia after a multiple pregnancy with complete hydatidiform mole and a normal fetus was 26% (35/136; 95% confidence interval, 19-34). All 35 patients had low-risk International Federation of Gynecology and Obstetrics scores, and the cure rate was 100%. Termination of pregnancy on patient request was not associated with lower risk of gestational trophoblastic neoplasia. Maternal complications such as preeclampsia and postpartum hemorrhage were not associated with higher risk of gestational trophoblastic neoplasia, and neither were high human chorionic gonadotropin levels or newborn survival at day 8. CONCLUSION Multiple pregnancy with complete hydatidiform mole and coexisting fetus carries a high risk of obstetrical complications. In patients who continued their pregnancy, approximately one-third of neonates were alive at day 8, and roughly 1 in 4 patients developed gestational trophoblastic neoplasia. Therefore, the risk of malignant transformation appears to be higher compared with singleton complete moles. Low levels of free beta human chorionic gonadotropin may be indicative of better early neonatal survival, and this relationship warrants further study.
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Affiliation(s)
- Touria Hajri
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France
| | - Mona Massoud
- Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Margot Vergne
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France
| | - Pierre Descargues
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Fabienne Allias
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Pathology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Benoit You
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Medical Oncology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Investigation Center for Treatments in Oncology and Hematology of Lyon (CITOHL), Lyon, France
| | - Jean-Pierre Lotz
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Medical Oncology and Cellular Therapy, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Tenon University Hospital, Alliance for Cancer Research (APREC), Paris, France
| | - Julie Haesebaert
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Research on Healthcare Performance (RESHAPE), Inserm U1290, Université Claude Bernard Lyon 1, France
| | - Pierre-Adrien Bolze
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - François Golfier
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Jerome Massardier
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Femme Mere Enfant University Hospital, Lyon, France.
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29
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Mdoe MB, Mselle LT, Kibusi SM. An integrative review of home care recommendations for women after caesarean section. Nurs Open 2024; 11:e2145. [PMID: 38532272 PMCID: PMC10965751 DOI: 10.1002/nop2.2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/25/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
AIM To describe home-based care and practices recommended for mothers after caesarean section (CS), existing in the literature. DESIGN Systematic review. METHODS This integrative literature review was conducted by using Google Scholar, PubMed and Hinari databases from its inception to June 2021. The search included research articles, protocols and guidelines that describe home care practice after CS and assessed for their quality. Synthesis of recommendations from the included literature was classified based on the type of study design, and the review was guided by methodology registered in Prospero (ID CRD42021276905). RESULTS A total of 681 literatures were found, and 12 met the criteria. Recommended home care components were divided into four major categories; wound care practice (wound cleaning, drying and bandage change); nutrition (high-protein diet, vitamin C, fibre and balanced diet); exercise (pelvic floor muscle, walking and breathing exercise) and hygiene (bathing and wearing clean clothes). There was limited literature addressing the components of perineal care and home environment. Varying recommendations were found regarding wound cleaning and dressing in the studies done in low- and high-income countries.
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Affiliation(s)
- Mwajuma Bakari Mdoe
- Department of Clinical Nursing, School of Nursing and Public HealthUniversity of DodomaDodomaTanzania
- Department of Clinical Nursing, School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Lilian Teddy Mselle
- Department of Clinical Nursing, School of NursingMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Stephen Mathew Kibusi
- Department of Public Health, School of Nursing and Public HealthUniversity of DodomaDodomaTanzania
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30
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Bolze P, Schoenen S, Margaillan M, Braga A, Sauthier P, Elias K, Seckl M, Winter M, Coulter J, Lok C, Joneborg U, Undurraga Malinverno M, Hajri T, Massardier J, You B, Golfier F, Goffin F. Chemotherapy is not needed when complete evacuation of gestational choriocarcinoma leads to hCG normalization. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108012. [PMID: 38350264 DOI: 10.1016/j.ejso.2024.108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The standard treatment for gestational choriocarcinoma is chemotherapy. OBJECTIVE To describe the risk of recurrence with expectant management of gestational choriocarcinoma that has reached a normal human chorionic gonadotropin level after tumor removal without adjuvant chemotherapy. METHODS A retrospective multicenter international cohort study was conducted from 1981 to 2017 involving 11 gestational trophoblastic disease reference centers with patient's follow-up extended until 2023. Clinical and biological data of included patients were extracted from each center's database. The inclusion criteria were i) histological diagnosis of gestational choriocarcinoma in any kind of placental tissue retrieved, ii) spontaneous normalization of human chorionic gonadotropin level following choriocarcinoma retrieval, iii) patient did not receive any oncological treatment for the choriocarcinoma, iv) and at least 6 months of follow-up after the first human chorionic gonadotropin level normalization. RESULTS Among 80 patients with retrieved gestational choriocarcinoma and whose human chorionic gonadotropin level normalized without any other oncological therapy, none had a recurrence of choriocarcinoma after a median follow-up of 50 months. The median interval between choriocarcinoma excision and human chorionic gonadotropin level normalization was 48 days. The International Federation of Gynecology and Obstetrics/World Health Organization risk score was ≤6 in 93.7% of the cases. CONCLUSIONS This multicenter international study reports that selected patients with gestational choriocarcinoma managed in gestational trophoblastic disease reference centers did not experience any relapse when the initial tumor evacuation is followed by human chorionic gonadotropin level normalization without any additional treatment. Expectant management may be a safe approach for highly selected patients.
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Affiliation(s)
- Pa Bolze
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France.
| | - S Schoenen
- Centre Belge de Référence des Maladies Trophoblastiques, Liège, Belgium.
| | - M Margaillan
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - A Braga
- Rio de Janeiro Trophoblastic Disease Reference Center, Rio de Janeiro, Brazil
| | - P Sauthier
- Réseau des Maladies Trophoblastiques Du Québec, Montréal, Canada
| | - K Elias
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, USA
| | - M Seckl
- Charing Cross Gestational Trophoblastic Disease Center, London, UK
| | - M Winter
- Sheffield Center for Trophoblastic Diseases, Sheffield, UK
| | - J Coulter
- Department of Gynaecology Obstetrics, Cork University Maternity Hospital, Cork, Ireland
| | - C Lok
- Center of Gynaecologic Oncology, Amsterdam, Netherlands
| | - U Joneborg
- Department of Women's and Children's Health and Department of Pelvic Cancer, Karolinska Institutet/University Hospital, Stockholm, Sweden
| | - M Undurraga Malinverno
- Unité D'oncogynécologie, Département de Gynécologie et Obstétrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - T Hajri
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - J Massardier
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - B You
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - F Golfier
- Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
| | - F Goffin
- Centre Belge de Référence des Maladies Trophoblastiques, Liège, Belgium
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31
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Almuradova E, Karimov Z. Uncommon presentation of gestational trophoblastic disease: A case report of invasive mole with gingival metastasis and unique metastatic dissemination. Int J Gynaecol Obstet 2024; 164:799-801. [PMID: 37909845 DOI: 10.1002/ijgo.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/07/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
SynopsisThis report sheds light on the extraordinary presentation of invasive mole with gingival metastasis. There are limited cases on this topic in the literature.
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Affiliation(s)
- Elvina Almuradova
- Department of Oncology, Medicana International Hospital, Izmir, Turkey
- Department of Oncology, Ege University Hospital, Izmir, Turkey
| | - Ziya Karimov
- Medicine Program, Ege University Faculty of Medicine, Izmir, Turkey
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32
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Kashtiara A, Schoonjans C, Van Looveren C, Jordens N, Van Peer F, Herthogs M, Deman F, Van Rompuy AS. Pneumothorax caused by metastatic gestational trophoblastic neoplasia: a case report. Acta Chir Belg 2024; 124:50-53. [PMID: 36355799 DOI: 10.1080/00015458.2022.2146844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Gestational trophoblastic neoplasia (GTN) is a group of malignant neoplasms that arise from abnormal proliferation of trophoblastic tissue. The metastatic spread rate is depended on the histopathological type, with pulmonary metastases being the most common (80%) in patients with metastases. Pneumothorax as a primary manifestation is extremely rare. We hereby discuss a unique case of spontaneous hemi-pneumothorax due to metastatic GTN in a 30-weeks pregnant woman. CASE PRESENTATION A 25-year-old woman - G2 P0 A1 - was admitted to our maternal intensive care department with atypical respiratory symptoms. A chest x-ray revealed a large right sided pneumothorax. The patient underwent an urgent percutaneous chest tube. Since halting of the suction resulted in residual pneumothorax, a video-assisted thoracoscopic surgery (VATS) with wig resection of a bullous lesion was performed followed by chemical pleurodesis. Histopathological examination identified the lesion as a gestational trophoblastic metastasis with some features of choriocarcinoma. After primary section Caesarea adjuvant chemotherapy (MTX) was instigated with rapid decline of serum HCG values. Six months after surgery she was doing well with no biochemical or radiographic evidence of recurrent metastasis. CONCLUSION Lung metastases are common in patients with metastatic GTN; however, pneumothorax is an extremely rare complication. We report a case of pneumothorax in a 30-week pregnant woman caused by pulmonary spread of GTN from a previous miscarriage. This case illustrates that in patients with pneumothorax and a history of miscarriage, metastatic GTN should be considered as a possible cause.
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Affiliation(s)
- Ardavan Kashtiara
- Department of Thoracic and Vascular Surgery, GZA Hospitals, Antwerp, Belgium
| | - Carmen Schoonjans
- Department of Thoracic and Vascular Surgery, GZA Hospitals, Antwerp, Belgium
| | | | - Nathalie Jordens
- Department of Obstetrics and Gynecology, GZA Hospitals, Antwerp, Belgium
| | - Fleur Van Peer
- Department of Obstetrics and Gynecology, GZA Hospitals, Antwerp, Belgium
| | | | - Frederik Deman
- Department of Pathology, GZA Hospitals, Antwerp, Belgium
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Gu Y, Zheng H, Xue X, Wang D, Cheng H, Zong L, Xiang Y. Intracardiac metastasis of gestational choriocarcinoma: a case report and literature review. BMC Pregnancy Childbirth 2024; 24:19. [PMID: 38166849 PMCID: PMC10759681 DOI: 10.1186/s12884-023-06144-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Gestational trophoblastic neoplasia (GTN) with intracardiac metastasis is rare, and here we reported a patient with intracardiac metastasis of high-risk and refractory gestational choriocarcinoma and reviewed relevant literatures. CASE PRESENTATION A 37-year-old woman presented with vaginal bleeding and high level of β-human chorionic gonadotropin (β-hCG) at 199,060 (mIU/mL). It was clinically diagnosed with gestational choriocarcinoma. The patient initially received eight cycles of chemotherapy but unsatisfactory response was observed, and the level of β-hCG still ranged between 5000 and 10,000. Then there was found intracardiac masses in the right atrium (2.6*1.7 cm), anterior chordae tendineae of the tricuspid valve (1.4*0.7 cm) and the right ventricle (4.1*2.9 cm) by ultrasonic cardiogram (UCG). PET/CT highly suspected the intracardiac metastasis of choriocarcinoma (SUVmax = 9.3) and no disease was found in the lung and pelvis. The patient undertook complete intracardiac masses resection. The pathology confirmed the intracardiac metastasis of disease. After a week of operation, the UCG found a 5.4*4.2 cm mass in the right atrium again. Considering the poor prognosis, the patient received palliative care and eventually died of disease progression. CONCLUSION Intracardiac metastasis of GTN is an aggressive sign of disease. Patients can benefit from chemotherapy and surgery. Future investigation of PD-1 immunotherapy combines with chemotherapy are expected to improve the prognosis in this group of patients.
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Affiliation(s)
- Yu Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Haoran Zheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Xiaowei Xue
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China, No. 1 Shuaifuyuan Road, Dongcheng District, 100730
| | - Dan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Hongyan Cheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Liju Zong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China, No. 1 Shuaifuyuan Road, Dongcheng District, 100730.
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
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Gergely L, Repiska V, Petrovic R, Korbel M, Danihel L, Sufliarsky J, Kubickova M, Gbelcova H, Priscakova P. Short tandem repeats genotyping of gestational choriocarcinoma - our experiences. Taiwan J Obstet Gynecol 2024; 63:73-76. [PMID: 38216273 DOI: 10.1016/j.tjog.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE This short communication demonstrates how short tandem repeat genotyping can identify the origin of gestational choriocarcinoma. MATERIALS AND METHODS The origin of gestational choriocarcinoma in our three cases was determined using the short tandem repeats genotyping technique, which involved quantitative fluorescent PCR and fragmentation analysis. RESULTS In Case 1 despite no medical history of molar pregnancy, DNA analysis indicated that the choriocarcinoma originated from a homozygous complete hydatidiform mole. We conclude, that the patient's complete abortion 10 years prior to the choriocarcinoma diagnosis was an undiagnosed complete hydatidiform mole. In Case 2 and Case 3 the clinically presumed origin of choriocarcinoma was confirmed. CONCLUSION Determining the origin of choriocarcinoma is essential for clinical application, as it affects the FIGO scoring system for gestational trophoblastic neoplasia, which determines the patient's prognosis and treatment approach.
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Affiliation(s)
- Lajos Gergely
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia; Centre for Gestational Trophoblastic Disease of Slovak Republic, Bratislava, Slovakia.
| | - Vanda Repiska
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia; Centre for Gestational Trophoblastic Disease of Slovak Republic, Bratislava, Slovakia.
| | - Robert Petrovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia.
| | - Miroslav Korbel
- 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia; Centre for Gestational Trophoblastic Disease of Slovak Republic, Bratislava, Slovakia.
| | - Ludovit Danihel
- Institute of Pathological Anatomy, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia; Centre for Gestational Trophoblastic Disease of Slovak Republic, Bratislava, Slovakia.
| | - Jozef Sufliarsky
- Centre for Gestational Trophoblastic Disease of Slovak Republic, Bratislava, Slovakia; Department of Oncology, Faculty of Medicine, Comenius University Bratislava, National Cancer Institute, Bratislava, Slovakia.
| | - Michaela Kubickova
- Centre for Gestational Trophoblastic Disease of Slovak Republic, Bratislava, Slovakia; Department of Oncology, Faculty of Medicine, Comenius University Bratislava, National Cancer Institute, Bratislava, Slovakia.
| | - Helena Gbelcova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia.
| | - Petra Priscakova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia; Centre for Gestational Trophoblastic Disease of Slovak Republic, Bratislava, Slovakia.
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Florea A, Caba L, Grigore AM, Antoci LM, Grigore M, Gramescu MI, Gorduza EV. Hydatidiform Mole-Between Chromosomal Abnormality, Uniparental Disomy and Monogenic Variants: A Narrative Review. Life (Basel) 2023; 13:2314. [PMID: 38137915 PMCID: PMC10744706 DOI: 10.3390/life13122314] [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: 09/28/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
A hydatidiform mole (HM) or molar pregnancy is the most common benign form of gestational trophoblastic disease characterized by a proliferation of the trophoblastic epithelium and villous edema. Hydatidiform moles are classified into two forms: complete and partial hydatidiform moles. These two types of HM present morphologic, histopathologic and cytogenetic differences. Usually, hydatidiform moles are a unique event, but some women present a recurrent form of complete hydatidiform moles that can be sporadic or familial. The appearance of hydatidiform moles is correlated with some genetic events (like uniparental disomy, triploidy or diandry) specific to meiosis and is the first step of embryo development. The familial forms are determined by variants in some genes, with NLRP7 and KHDC3L being the most important ones. The identification of different types of hydatidiform moles and their subsequent mechanisms is important to calculate the recurrence risk and estimate the method of progression to a malign form. This review synthesizes the heterogeneous mechanisms and their implications in genetic counseling.
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Affiliation(s)
- Andreea Florea
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.F.); (A.-M.G.); (L.-M.A.); (M.I.G.); (E.V.G.)
| | - Lavinia Caba
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.F.); (A.-M.G.); (L.-M.A.); (M.I.G.); (E.V.G.)
| | - Ana-Maria Grigore
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.F.); (A.-M.G.); (L.-M.A.); (M.I.G.); (E.V.G.)
| | - Lucian-Mihai Antoci
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.F.); (A.-M.G.); (L.-M.A.); (M.I.G.); (E.V.G.)
| | - Mihaela Grigore
- Department of Obstetrics and Gynecology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Mihaela I. Gramescu
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.F.); (A.-M.G.); (L.-M.A.); (M.I.G.); (E.V.G.)
| | - Eusebiu Vlad Gorduza
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.F.); (A.-M.G.); (L.-M.A.); (M.I.G.); (E.V.G.)
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Porragas-Paseiro HS, Johnson S, Brubaker L, Sanders BE. Pneumocystis jirovecii pneumonia complicating methotrexate treatment in a patient with low-risk post-molar gestational trophoblastic neoplasia: A case report and review of the literature. Gynecol Oncol Rep 2023; 50:101286. [PMID: 37860081 PMCID: PMC10582284 DOI: 10.1016/j.gore.2023.101286] [Citation(s) in RCA: 1] [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: 08/18/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
Low-risk gestational trophoblastic neoplasia (GTN) is generally treated with single agent chemotherapy, including methotrexate (MTX) or dactinomycin. We present a case of a patient with low-risk GTN who underwent single agent MTX therapy, developed Pneumocystis jirovecii pneumonia (PJP), recovered, and ultimately completed consolidation treatment for GTN on single agent MTX. While MTX administration is associated with an increased risk of PJP, this association is best described in rheumatology literature. This is the first case of PJP complicating MTX therapy within the gynecologic oncology literature.
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Affiliation(s)
- Hector S Porragas-Paseiro
- University of Colorado, Department of Obstetrics and Gynecology; Division of Gynecologic Oncology, USA
| | - Steven Johnson
- University of Colorado, Department of Infectious Diseases, USA
| | - Lindsay Brubaker
- University of Colorado, Department of Obstetrics and Gynecology; Division of Gynecologic Oncology, USA
| | - Brooke E Sanders
- University of Colorado, Department of Obstetrics and Gynecology; Division of Gynecologic Oncology, USA
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37
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Tanaka Y, Furuya K, Sumi M, Yamashita S, Chang Y, Shikado K, Tsubouchi H, Ogita K. Multidisciplinary perioperative management in dilatation and evacuation for a giant hydatidiform mole: A case report. Case Rep Womens Health 2023; 40:e00556. [PMID: 37954516 PMCID: PMC10637891 DOI: 10.1016/j.crwh.2023.e00556] [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: 10/02/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Gestational trophoblastic disease (GTD) is an abnormal pregnancy caused by the placenta, which can potentially metastasise. Suction evacuation is recommended for diagnosis and treatment, and dilatation and evacuation (D&E) is usually performed under intravenous anaesthesia due to the short operation time and minimal blood loss. We refer to the guidelines produced by the Japan Society of Obstetrics and Gynaecology (JSOG), and acknowledge that practices vary globally. However, to the best of our knowledge, there is no evidence on perioperative management and arrangements in D&E required for managing giant hydatidiform moles, such as preventing massive haemorrhage, respiratory dysfunction with a pathogenesis like ovarian hyperstimulation syndrome (OHSS), or intensive care needs. This case report describes perioperative considerations for managing a giant hydatidiform mole using D&E in a uterus enlarged to the third-trimester pregnancy size. A 28-year-old multiparous woman was clinically diagnosed with a hydatidiform mole after a spontaneous miscarriage due to abnormal genital bleeding, systemic oedema, and abdominal distention. Ultrasound and computed tomography showed a ballooning uterus with a third-trimester pregnancy size, a robust intrauterine mass, and ascites. Serum hCG levels were extremely high (>3,000,000 mIU/mL), confirming the clinical diagnosis of a hydatidiform mole. Emergency D&E was safely performed under multidisciplinary perioperative management, with careful preparation and support. This is a rare experience-based case report and valuable documentation detailing multidisciplinary perioperative management under general anaesthesia. To the best of our knowledge, this is the first report describing the considerations, details, and innovations required in the perioperative management of giant hydatidiform moles using D&E.
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Affiliation(s)
| | - Kiichiro Furuya
- Corresponding author at: Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23 Rinku Ourai-Kita, Izumisano, Osaka 598-8577, Japan.
| | - Masanori Sumi
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, Osaka, Japan
| | - Saya Yamashita
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, Osaka, Japan
| | - Yangsil Chang
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, Osaka, Japan
| | - Kayoko Shikado
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, Osaka, Japan
| | - Hiroaki Tsubouchi
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, Osaka, Japan
| | - Kazuhide Ogita
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, Osaka, Japan
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38
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Wang T, Guo W, Ren X, Lang F, Ma Y, Qiu C, Jiang J. Progress of immunotherapies in gestational trophoblastic neoplasms. J Cancer Res Clin Oncol 2023; 149:15275-15285. [PMID: 37594534 DOI: 10.1007/s00432-023-05010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/18/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Different from other malignant gynecologic tumors, gestational trophoblastic neoplasms (GTNs) exhibit an exceptionally high cure rate primarily through chemotherapeutic interventions. However, there exists a small subset of refractory GTNs that do not respond to conventional chemotherapies. In such cases, the emergence of immunotherapies has demonstrated significant benefits in managing various challenging GTNs. PURPOSE This article aims to provide a comprehensive and systematic review of the immune microenvironment and immunotherapeutic approaches for GTNs. The purpose is to identify potential biomarkers that could enhance disease management and summarize the available immunotherapies for ease of reference. METHODS We reviewed the relevant literatures toward immunotherapies of GTNs from PubMed. CONCLUSION Current immunotherapeutic strategies for GTNs mainly revolve around immune checkpoint inhibitors (ICIs) targeting programmed death receptor 1 (PD-1) and programmed cell death ligand 1 (PD-L1). Prominent examples include avelumab, pembrolizumab, and camrelizumab. However, existing researches into the underlying mechanisms are still limited.
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Affiliation(s)
- Tong Wang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Wenxiu Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Xiaochen Ren
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Fangfang Lang
- Maternal and Child Health Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Ying Ma
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Chunping Qiu
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China.
| | - Jie Jiang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, Shandong, People's Republic of China.
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Tîrnovanu MC, Tîrnovanu VG, Toma B, Toma L, Țarcă E, Stătescu L, Tîrnovanu ȘD, Ungureanu C, Trandafirescu MF, Bernic J, Cojocaru E. Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review. J Pers Med 2023; 13:1563. [PMID: 38003877 PMCID: PMC10671948 DOI: 10.3390/jpm13111563] [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: 09/16/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Placental morbid adherence is a known risk factor for postpartum hemorrhage. The incidence of abnormal placental attachment has been increasing over the past few decades, mainly due to rising rates of cesarean deliveries, advanced maternal age, and the use of assisted reproductive technologies. Cesarean section is a significant risk factor for placenta increta, as it disrupts the normal architecture of the uterine wall, making it more difficult for the placenta to detach after delivery. We present the case of a woman who underwent a cesarean section at 28 weeks due to anterior placenta previa, accompanied by hemorrhage and rupture of membranes. Following the delivery, she experienced normal postoperative bleeding and was discharged home after five days. However, six weeks later, she presented with heavy bleeding, leading to the decision to perform a total hysterectomy. The levels of HCG were found to be low. The pathological examination of the specimens confirmed a diagnosis of placenta increta, as it revealed notable placental proliferation, necrotic villi, and placental invasion near the uterine serosa. Notably, we did not find any similar cases documented in the literature. Patients experiencing prolonged vaginal bleeding after childbirth and diagnosed with placenta accreta should be closely monitored through ultrasound examinations; abnormal proliferation of the placenta can occur, and prompt detection is crucial for appropriate management.
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Affiliation(s)
- Mihaela Camelia Tîrnovanu
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (L.T.)
- “Cuza Voda” Obstetrics-Gynecology Clinic Hospital, 700038 Iasi, Romania;
| | - Vlad Gabriel Tîrnovanu
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (L.T.)
| | - Bogdan Toma
- “Cuza Voda” Obstetrics-Gynecology Clinic Hospital, 700038 Iasi, Romania;
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.U.); (M.F.T.); (E.C.)
| | - Loredana Toma
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (L.T.)
- “Cuza Voda” Obstetrics-Gynecology Clinic Hospital, 700038 Iasi, Romania;
| | - Elena Țarcă
- Department of Surgery II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Laura Stătescu
- Department of Dermatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ștefan Dragoș Tîrnovanu
- Department of Surgery II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Carmen Ungureanu
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.U.); (M.F.T.); (E.C.)
| | - Mioara Florentina Trandafirescu
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.U.); (M.F.T.); (E.C.)
| | - Jana Bernic
- Discipline of Pediatric Surgery, “Nicolae Testemițanu” State University of Medicine and Pharmacy, 2025 Chisinau, Moldova;
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.U.); (M.F.T.); (E.C.)
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40
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Coopmans L, Larsson A, Joneborg U, Lok C, van Trommel N. Surgical Management of Gestational Trophoblastic Disease. Gynecol Obstet Invest 2023; 89:214-229. [PMID: 37788661 DOI: 10.1159/000534065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) is a rare pregnancy-related condition consisting of premalignant and malignant forms arising from proliferation of trophoblastic cells. The malignant forms are collectively referred to as gestational trophoblastic neoplasia (GTN) and are highly sensitive to chemotherapy. However, surgical procedures remain indispensable in the diagnosis and treatment of GTD. OBJECTIVES The aim of this review was to summarize surgical interventions in the treatment of GTD and GTN. We reviewed indications, efficacy, possible complications, and oncological outcomes of surgery. METHODS Three searches were performed in the databases of PubMed, Embase, and the Cochrane Library to create an up-to-date overview of existing literature on the following subjects: (1) the role of primary hysterectomy in GTD and GTN; (2) the role of second curettage in GTD and GTN; (3) fertility sparing surgery in GTN; (4) surgical management of metastases. Included articles originated from the time period 1952-2022. Articles written in English, Spanish, and French were included. OUTCOMES Thirty-eight articles were found and selected. Surgical evacuation through suction curettage is most used and advised in the treatment of GTD. A second curettage could be beneficial in patients with low hCG levels and low FIGO scores. In women who have completed their families, primary hysterectomy might be considered as the risk of subsequent GTN is lower than after suction curettage. In case of the rare forms of GTN (epithelioid trophoblastic tumor or placental site trophoblastic tumor) surgical tumor resection remains the most important step in treatment. Data on fertility sparing surgery in GTN are scarce and this treatment should be considered experimental. CONCLUSION AND OUTLOOK Surgery remains an important part of treatment of GTD and is sometimes indispensable to achieve curation. Further collection of evidence is needed to determine treatment steps.
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Affiliation(s)
- Leonoor Coopmans
- Gynecological Oncology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands,
| | - Agnes Larsson
- Department of Gynecologic Cancer Surgery, Karolinska University Hospital and Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Joneborg
- Department of Gynecologic Cancer Surgery, Karolinska University Hospital and Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Christianne Lok
- Gynecological Oncology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nienke van Trommel
- Gynecological Oncology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Bogani G, Ray-Coquard I, Mutch D, Vergote I, Ramirez PT, Prat J, Concin N, Ngoi NYL, Coleman RL, Enomoto T, Takehara K, Denys H, Lorusso D, Takano M, Sagae S, Wimberger P, Segev Y, Kim SI, Kim JW, Herrera F, Mariani A, Brooks RA, Tan D, Paolini B, Chiappa V, Longo M, Raspagliesi F, Benedetti Panici P, Di Donato V, Caruso G, Colombo N, Pignata S, Zannoni G, Scambia G, Monk BJ. Gestational choriocarcinoma. Int J Gynecol Cancer 2023; 33:1504-1514. [PMID: 37758451 DOI: 10.1136/ijgc-2023-004704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Gestational choriocarcinoma accounts for 5% of gestational trophoblastic neoplasms. Approximately 50%, 25%, and 25% of gestational choriocarcinoma occur after molar pregnancies, term pregnancies, and other gestational events, respectively. The FIGO scoring system categorizes patients into low (score 0 to 6) and high risk (score 7 or more) choriocarcinoma. Single-agent and multi-agent chemotherapy are used in low- and high-risk patients, respectively. Chemotherapy for localized disease has a goal of eradication of disease without surgery and is associated with favorable prognosis and fertility preservation. Most patients with gestational choriocarcinoma are cured with chemotherapy; however, some (<5.0%) will die as a result of multi-drug resistance, underscoring the need for novel approaches in this group of patients. Although there are limited data due to its rarity, the treatment response with immunotherapy is high, ranging between 50-70%. Novel combinations of immune checkpoint inhibitors with targeted therapies (including VEGFR-2 inhibitors) are under evaluation. PD-L1 inhibitors are considered a potential important opportunity for chemo-resistant patients, and to replace or de-escalate chemotherapy to avoid or minimize chemotherapy toxicity. In this review, the Rare Tumor Working Group and the European Organization for Research and Treatment of Cancer evaluated the current landscape and further perspective in the management of patients diagnosed with gestational choriocarcinoma.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Isabelle Ray-Coquard
- Centre Leon Berard, LYON CEDEX 08, France
- Hesper lab, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - David Mutch
- Washington University in Saint Louis, St Louis, Missouri, USA
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
| | - Jaime Prat
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria
| | | | | | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Belgium
| | - Kazuhiro Takehara
- Department of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | | | | | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Satoru Sagae
- Gynecologic Oncology, Tokeidai Kinen Byoin, Sapporo, Japan
| | - Pauline Wimberger
- Gyncology and Obstetrics, Technische Universitat Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | - Yakir Segev
- Obstetrics and Gynecology, Carmel Hospital, Haifa, Israel
| | - Se Ik Kim
- Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Jae-Weon Kim
- Obstetrics and gynecology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Fernanda Herrera
- Centre Hospitalier Universitaire Vaudois Departement doncologie CHUV-UNIL, Lausanne, Switzerland
| | - Andrea Mariani
- Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Rebecca A Brooks
- Section of Gynecologic Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - David Tan
- National University Cancer Institute, Singapore
| | - Biagio Paolini
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | | | | | | | | | - Nicoletta Colombo
- Medical Gynecologic Oncology Unit; University of Milan Bicocca; Milan; Italy, European Institute of Oncology, Milano, Italy
| | - Sandro Pignata
- Gynaecological Oncology, National Cancer Institute Napels, Naples, Italy
| | - Gianfranco Zannoni
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Bradley J Monk
- Virginia G Piper Cancer Center - Biltmore Cancer Center, Phoenix, Arizona, USA
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Helbig M, Steinmann M, Jaschinski S, Seckl M, Meier W, Fehm T, Volkmer A. Primary hepatic metastatic epitheloid trophoblastic tumor of the uterus treated with multimodal therapy including pembrolizumab and thermoablation. Case report of an extremely rare disease and review of the literature. Gynecol Oncol Rep 2023; 49:101281. [PMID: 37822711 PMCID: PMC10562736 DOI: 10.1016/j.gore.2023.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
Epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic tumor, first described by Shih and Kurman in 1998. ETT often present as abnormal vaginal bleeding in women of reproductive age, but unlike more common forms of GTN tend to produce much less human chorionic gonadotropin (hCG) for the volume of disease present. ETT can occur after any gestational event and can occur in both intrauterine and extrauterine sites. We present a case of a 46-year-old female patient incidentally diagnosed with ETT and hepatic metastasis. Therapy was multimodal and involved chemotherapy, operation, thermoablation of liver metastases and immunocheckpoint inhibitor. The patient remains disease free for almost four years now. ETT presents a diagnostic challenge due to their rarity and histologic resemblance to other pathologies. ETT can be relatively chemo resistant and are therefore often treated surgically. Misdiagnosis might delay effective treatment and affects survival.
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Affiliation(s)
- M. Helbig
- University Hospital of Düsseldorf, Department of Gynecology and Obstetrics, Germany
| | - M. Steinmann
- Medical Practice for Gynecology and Obstetrics, Düsseldorf, Germany
| | - S. Jaschinski
- University Hospital of Düsseldorf, Institute of Pathology, Germany
| | - M.J. Seckl
- Gestational Trophoblastic Disease and Malignant Ovarian Germ Cell Tumor Services, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - W. Meier
- University Hospital of Düsseldorf, Department of Gynecology and Obstetrics, Germany
| | - T. Fehm
- University Hospital of Düsseldorf, Department of Gynecology and Obstetrics, Germany
| | - A.K. Volkmer
- University Hospital of Düsseldorf, Department of Gynecology and Obstetrics, Germany
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Khoromi S. Secondary headaches in pregnancy and the puerperium. Front Neurol 2023; 14:1239078. [PMID: 37840942 PMCID: PMC10569305 DOI: 10.3389/fneur.2023.1239078] [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: 06/12/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
Headache during pregnancy can be due to primary causes such as migraine but can also be a presenting symptom of secondary causes including life threatening conditions. This is a minireview of secondary causes of headache during pregnancy and the puerperium. Unique alterations in physiological and vascular functions as well as in the coagulation pathway which occur during pregnancy increase the risk of most of these secondary conditions which include preeclampsia, eclampsia, hemorrhagic stroke, cerebral venous, sinus thrombosis, reversible cerebral vascular syndrome, and posterior reversible encephalopathy. Marked increase in progesterone level in pregnancy is also associated with the growth of tumors such as meningiomas, as 70% of these tumors are positive for progesterone receptors and increase in size can lead to headache along with other neurological symptoms. Hemodynamic changes can lead to the growth of meningiomas as well. Although hormone producing pituitary tumors are usually not conducing to pregnancy, women with known pituitary tumors who do get pregnant may become symptomatic during pregnancy and develop secondary headache. Another rare cause of secondary headache during pregnancy is pituitary apoplexy. Although its occurrence is uncommon, it needs to be properly recognized and treated to avoid endocrine and visual complications. Other rare entities with increased incidence during the puerperium such postdural puncture headache will be also discussed. In summary, new onset headache during pregnancy deserves special attention because in the absence of proper recognition and treatment, secondary headache disorders can endanger the life of the mother and the fetus.
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Affiliation(s)
- Suzan Khoromi
- University of California, San Diego, La Jolla, CA, United States
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Bencherifi Y, Abbassi IE, Karoini DE, Ennachit M, Benhessou M, Kerroumi ME. The value of surgery in the treatment of gestational choriocarcinoma: A case report. Int J Surg Case Rep 2023; 110:108634. [PMID: 37591194 PMCID: PMC10436163 DOI: 10.1016/j.ijscr.2023.108634] [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: 06/14/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gestational choriocarcinoma is a rare malignant trophoblastic tumor; it is characterized by its high metastatic potential and chemosensitivity. Hysterectomy also has a role in the management of this tumor. CASE PRESENTATION We report a rare case of gestational choriocarcinoma in a young woman initially classified as low risk (FIGO2), treated by surgery after chemoresistance to different chemotherapy protocols, marked by an excellent clinical and biochemical improvement. CLINICAL DISCUSSION Gestational choriocarcinoma is a malignant tumor of the villous trophoblast, devoid of placental villi and vesicles.Despite the excellence of chemotherapy, surgery has a significant place in the treatment of gestational trophoblastic tumors. The most common modality of surgical treatment is total hysterectomy. Ovarian metastases are rare; the ovaries may be preserved depending on the age of the patients. CONCLUSION The progress of recent years lies in the clarification of the therapeutic strategies used in the treatment of gestational trophoblastic tumors, in particular choriocarcinoma.
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Affiliation(s)
- Younes Bencherifi
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, 1 rue des hôpitaux, Casablanca, Morocco
| | - Imane El Abbassi
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, 1 rue des hôpitaux, Casablanca, Morocco.
| | - Douha El Karoini
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, 1 rue des hôpitaux, Casablanca, Morocco
| | - Mohammed Ennachit
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, 1 rue des hôpitaux, Casablanca, Morocco
| | - Mustapha Benhessou
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, 1 rue des hôpitaux, Casablanca, Morocco
| | - Mohammed El Kerroumi
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, 1 rue des hôpitaux, Casablanca, Morocco
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45
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Salima S, Wibowo MH, Dewayani BM, Nisa AS, Alkaff FF. Recurrent Partial Hydatidiform Mole: A Case Report of Seven Consecutive Molar Pregnancies. Int J Womens Health 2023; 15:1239-1244. [PMID: 37554967 PMCID: PMC10406109 DOI: 10.2147/ijwh.s421386] [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: 05/26/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
Hydatidiform mole (HM) is an aberrant pregnancy characterized by atypical trophoblastic hyperplasia, hydropic chorionic villi, and deprived fetal development. There are two types of HM, ie, complete (CHM) and partial (PHM). Both CHM and PHM can recur; however, the recurrence of PHM is very scarce compared to CHM. In this report, we present a case of a 33-year-old woman with recurrent PHM for 7 times without any normal pregnancy in-between. PHM was determined by histology examination. The patient underwent suction curettage and was followed up with serial β-hCG levels. Recurrent PHM, although rare, is associated with an increased incidence of malignancy. A series of clinical and β-hCG evaluation should be warranted because of the possibility of gestational trophoblastic neoplasia development.
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Affiliation(s)
- Siti Salima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Mulyohadi Hadi Wibowo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Birgitta M Dewayani
- Department of Pathology of Anatomy, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Aisyah Shofiatun Nisa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran-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
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
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Song S, Kim M, Koh JH, Kang OJ, Oh D, Lee SH, Lee SJ, Ahn JW, Roh HJ, Kim KR, Kim JS. Chimeric Singleton Placenta Comprising Placental Mesenchymal Dysplasia and Complete Hydatidiform Mole with Live Birth and Postpartum Diagnosis of Gestational Trophoblastic Neoplasia. Gynecol Obstet Invest 2023; 88:314-321. [PMID: 37442099 DOI: 10.1159/000531864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Placental mesenchymal dysplasia (PMD) is a benign lesion that is often misdiagnosed as complete (CHM) or partial hydatidiform mole. PMD usually results in live birth but can be associated with several fetal defects. Herein, we report PMD with CHM in a singleton placenta with live birth. CASE PRESENTATION A 34-year-old gravida 2, para 1, living 1 (G2P1L1) woman was referred on suspicion of a molar pregnancy in the first trimester. Maternal serum human chorionic gonadotrophin levels were increased during early pregnancy, with multicystic lesions and placentomegaly observed on ultrasonography. Levels decreased to normal with no fetal structural abnormalities observed. A healthy male infant was delivered at 34 gestational weeks. Placental p57KIP2 immunostaining and short tandem repeat analysis revealed three distinct histologies and genetic features: normal infant and placenta, PMD, and CHM. Gestational trophoblastic neoplasia was diagnosed and up to fourth-line chemotherapy administered. CONCLUSION Distinguishing PMD from hydatidiform moles is critical for avoiding unnecessary termination of pregnancy. CHM coexisting with a live fetus rarely occurs. This case is unique in that a healthy male infant was born from a singleton placenta with PMD and CHM.
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Affiliation(s)
- Seungyeon Song
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Misung Kim
- Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ji Hye Koh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ok Ju Kang
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - DaSol Oh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Sang-Hun Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Soo-Jeong Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Jun-Woo Ahn
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hyun-Jin Roh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Kyu-Rae Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Sook Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
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Deleuze A, Massard C, Le Du F, You B, Lefeuvre-Plesse C, Bolze PA, de la Motte Rouge T. Management of trophoblastic tumors : review of evidence, current practice, and future directions. Expert Rev Anticancer Ther 2023; 23:699-708. [PMID: 37198729 DOI: 10.1080/14737140.2023.2215438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Gestational trophoblastic neoplasia (GTN) is a group of rare tumors characterized by abnormal trophoblastic proliferation following pregnancy including invasive moles, choriocarcinomas, and intermediate trophoblastic tumors (ITT). Although the treatment and follow-up of GTN has been heterogeneous, globally the emergence of expert networks has helped to harmonize its management. AREAS COVERED We provide an overview of the current knowledge, diagnosis, and management strategies in GTN and discuss innovative therapeutic options under investigation. While chemotherapy has been the historical backbone of GTN treatment, promising drugs such as immune checkpoint inhibitors targeting the PD-1/PD-L1 pathway and anti-angiogenic tyrosine kinase inhibitors are currently being investigated remodeling the therapeutical landscape of trophoblastic tumors. EXPERT OPINION Chemotherapy regimens for GTN have potential long-term effects on fertility and quality of life, making innovative and less toxic therapeutic approaches necessary. Immune checkpoint inhibitors have shown promise in reversing immune tolerance in GTN and have been evaluated in several trials. However, immunotherapy is associated with rare but life-threatening adverse events and evidence of immune-related infertility in mice, highlighting the need for further research and careful consideration of its use. Innovative biomarkers could help personalize GTN treatments and reduce chemotherapy burden in some patients.
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Affiliation(s)
- Antoine Deleuze
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | | | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Benoit You
- Department of Gynecological Oncological, and Obstetrics Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
- French Reference Center for Trophoblastic Diseases, University Hospital Lyon Sud, Lyon, France
- Institute of Cancerology, Hospices Civils de Lyon, CITOHL, Lyon, UR, France
| | | | - Pierre-Adrien Bolze
- Department of Gynecological Oncological, and Obstetrics Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
- Institute of Cancerology, Hospices Civils de Lyon, CITOHL, Lyon, UR, France
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Riccio S, Galanti F, Scudo M, Di Troia L, Ferrillo MG, Manzara F, Ianiri P, Battaglia FA. Recurrent Hydatidiform Moles: A Clinical Challenge-A Case Report and an Update on Management and Therapeutical Strategies. Case Rep Obstet Gynecol 2023; 2023:3752274. [PMID: 37383988 PMCID: PMC10299875 DOI: 10.1155/2023/3752274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023] Open
Abstract
Hydatidiform mole, complete or partial (CHM/PHM), is the most common type of gestational trophoblastic disease (GTD), which is characterized by excessive trophoblastic proliferation and abnormal embryonic development. Some patients present with sporadic or familiar recurrent hydatidiform moles (RHMs), which are characterized by two or more episodes of the disease. A healthy 36-year-old woman was admitted to the Obstetrics and Gynecology Unit of Santa Maria Goretti Hospital, Latina, because of RHMs at 6 weeks of amenorrhea, with an obstetrical anamnesis of RHMs. We performed uterine dilatation and curettage with suction evacuation. The histological examination confirmed the diagnosis of PHM. The clinical follow-up was conducted according to recent guidelines on the diagnosis and management of GTD. After the return to the baseline values of the beta-human chorionic gonadotropin hormone, a combined oral contraceptive therapy was proposed, and the patient was invited to undergo in vitro fertilization (IVF) techniques, specifically oocyte donation, to reduce the possibility of similar future cases of RHMs. Although some etiopathogenetic mechanisms involved in RHMs are still unknown, all patients of childbearing age who are affected by this syndrome should be properly treated and directed towards a correct clinical path as IVF, to have a successful and safe pregnancy.
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Affiliation(s)
- S. Riccio
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - F. Galanti
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - M. Scudo
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - L. Di Troia
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - M. G. Ferrillo
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - F. Manzara
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - P. Ianiri
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - F. A. Battaglia
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
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Pérez‐Nieto OR, Herrera‐Venegas CA, Pozos‐Cortés KP, Flores‐Ramírez R, Ugalde‐Real JS, Argüello‐Bolaños J, Puente MEP, Zamarrón‐López ÉI, Deloya‐Tomas E. A case report of atypical preeclampsia with severity criteria for hydatidiform complete mole. Clin Case Rep 2023; 11:e7470. [PMID: 37305892 PMCID: PMC10248192 DOI: 10.1002/ccr3.7470] [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: 04/16/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
Preeclampsia is defined as elevation of blood pressure and any of the following severity criteria: proteinuria, thrombocytopenia, elevation of creatinine in the absence of another renal pathology, elevation of transaminases, pulmonary edema, or neurological symptoms. However, after 20 weeks of gestation in a previously normotensive patient, cases of preeclampsia associated with molar pregnancy have been described in patients at less than 20 weeks of gestation. A 26-year-old woman, at 14.1 weeks of gestation was admitted to the lower extremities with facial edema, holocranial headache, nausea, epigastralgia, phosphenes, and photophobia, with a double-length uterine fundus for gestational age and ultrasonography. Obstetricians who showed images of snowflakes without fetuses and annexes had multiple thecal-lutein cysts. Atypical preeclampsia was identified using the severity data for complete hydatidiform moles. Given the possibility of serious complications that may endanger the life of the maternal-fetal binomial, atypical forms of preeclampsia should be suspected.
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Mekni K, Mejri O, Ayadi A, ElFekif C. Unexpected association between breast cancer and molar pregnancy in a 52-year-old woman: A case report. Int J Surg Case Rep 2023; 107:108253. [PMID: 37201361 DOI: 10.1016/j.ijscr.2023.108253] [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: 03/10/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION There was no prior discussion about the association between breast cancer and molar pregnancy, particularly at an advanced age. Through our case and a systematic review, we will discuss the relevance of ovarian castration in hormone-receptor-positive breast cancer. CASE PRESENTATION We reported the case of a 52-year-old woman, not yet menopausal, who was diagnosed with a right breast tumor classified as BI-RADS category 4. The anatomopathological analysis of mammary biopsy revealed an invasive ductal carcinoma of no special type (grade 2). Hormone receptors were positive. It was a HER2-negative Breast cancer. It was then decided to treat the patient with radical surgery followed by chemotherapy, radiotherapy, and hormonotherapy. The patient had a "Patey operation". The postoperative course was without significant complications. No medical or surgical castration was indicated in the expectation that chemotherapy would cause ovarian failure. Unlikely, during chemotherapy course our patient developed a molar pregnancy. CLINICAL DISCUSSION Our case illustrates the possibility of pregnancy in non-menopausal women with estrogen-receptor-positive breast cancer. The combination of tamoxifen or aromatase inhibitors with ovarian suppression as standard adjuvant therapy may be recommended in such cases. CONCLUSIONS Ovarian function suppression in non-menopausal women with hormone receptor-positive breast cancer seems to be necessary. So that, we can avoid unexpected manifestations like molar pregnancy.
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Affiliation(s)
- Karima Mekni
- Gynecological and Obstetric Department, Mahmoud El Matri Hospital; Faculty of Medicine, Tunis El Manar University, Tunisia; The LR18SP05 Research Laboratory.
| | - Oumayma Mejri
- Gynecological and Obstetric Department, Mahmoud El Matri Hospital; Faculty of Medicine, Tunis El Manar University, Tunisia
| | - Aida Ayadi
- Pathology Department, Abd Errahmene Mami Hospital, Ariana, Tunisia; Faculty of Medicine, Tunis El Manar University, Tunisia
| | - Chiraz ElFekif
- Gynecological and Obstetric Department, Mahmoud El Matri Hospital; Pathology Department, Abd Errahmene Mami Hospital, Ariana, Tunisia
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