1
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Saloni, Potdar J, Dahiphale SM. A Complete Hydatidiform Mole Complicated by Theca Lutein Cysts in a Teenager: A Rare Case. Cureus 2024; 16:e52240. [PMID: 38357086 PMCID: PMC10866567 DOI: 10.7759/cureus.52240] [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: 10/17/2023] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
A hydatidiform mole (HM), often known as molar pregnancy, is a type of prenatal trophoblastic illness that develops in the placenta and has the potential to spread. HMs are caused by genetic issues with either the egg or the sperm. They are typically discovered in the first trimester of pregnancy. Abnormal bleeding is one of the initial symptoms, which can seldom be accompanied by the passage of hydropic villi. Theca lutein cysts, absent fetal heart tones, enlarged uterus more than anticipated for gestational age, pregnancy-induced hypertension in the first trimester, hyperemesis, and increased levels of human chorionic gonadotropin (HCG) for gestational dates are other characteristic symptoms and signs. A rare type of follicular cyst known as a theca lutein cyst is a benign ovarian disease caused by natural overstimulation of follicles, also known as hyperreactio lutealis (HL). This is linked to choriocarcinomas, multiple gestations, and prenatal trophoblastic illness (molar pregnancy). Unless exacerbated by torsion, rupture, or bleeding, the majority of theca lutein cysts are treated conservatively. Theca lutein cysts do not impact the course of pregnancy and spontaneously recede following delivery. However, HL may mistakenly be diagnosed by doctors as a cancer during pregnancy if it has the potential to look like one. Frequently, inappropriate surgical intervention is caused by the fear of failing to diagnose malignancy. These treatments may therefore result in decreased fertility in the future. Here we present a case of a young unmarried female with an HM and cysts.
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Affiliation(s)
- Saloni
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jyotsna Potdar
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swati M Dahiphale
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Wanchu R, Rebik J, Macauley E, Elbadri S, Leon L, Jones T, Ganti L. Molar pregnancy presenting in the emergency department. Radiol Case Rep 2023; 18:2063-2065. [PMID: 37064079 PMCID: PMC10102805 DOI: 10.1016/j.radcr.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 04/07/2023] Open
Abstract
A 27-year-old female grava1 para 0 presented to the emergency department with complaints of intractable nausea and vomiting associated with fatigue and shortness of breath for the past 2 weeks with concerns for pregnancy. Physical exam was benign. Labs were significant for a β-hcg level of 348,260 mIU/mL. Ultrasonography showed a 12.4 pelvic mass possibly arriving from the anterior uterus concerning for fibroid. US also showed an anechoic focus suggestive of a gestational sac measuring 2.09 cm. The presentation was concerning for hyperemesis gravidarum due to molar pregnancy.
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3
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Zhong L, Song L, Yin R, Li Q, Wang D. Risk factors for gestational trophoblastic neoplasia development of singleton normal fetus with partial hydatidiform mole pregnancy: A retrospective cohort and literature review. J Obstet Gynaecol Res 2023; 49:479-486. [PMID: 36328803 DOI: 10.1111/jog.15488] [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: 02/10/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Singleton normal fetus with partial hydatidiform mole (PHM) pregnancy is a rare phenomenon. No previous reports have investigated the risk factors of gestational trophoblastic neoplasia (GTN) progression following this condition. METHODS We retrospectively enrolled cases of singleton normal fetuses with PHM pregnancies at West China Second University Hospital, Sichuan University, from 2005 to 2017. Other cases were identified from PubMed databases during 1975 to 2021 for the cohort study. Cox proportional hazards models were applied to evaluate risk factors for GTN progression based on the patient's clinical characteristics. RESULTS Overall, 36 cases of singleton normal fetuses with PHM pregnancies were enrolled. After a median follow-up of 4.0 (0.8-12.0) months, nine (25.0%) patients progressed to GTN. Gestational age at pregnancy termination (hazard ratio [HR] 0.88; 95% confidence interval [CI] 0.78-0.99, p = 0.032), hyperthyroidism (HR 5.75; 95% CI, 1.16-28.50, p = 0.032), and reasons for pregnancy termination (medical indications vs. patients' choice; HR 0.25; 95% CI, 0.06-0.99, p = 0.049) were significantly correlated with GTN progression. Area under the receiver operating characteristic curve (AUC) of gestational age at pregnancy termination to predict non-progression to GTN was 0.784 (95% CI, 0.615-0.903, p < 0.001). A clinically significant cutoff value, that is, gestational age of 24 weeks, was determined by comprehensively considering the cutoff values of AUC and clinical significance of gestational age. CONCLUSIONS Compared to gestational age of pregnancy termination <24 weeks, ≥24 weeks was a protective factor for GTN. Therefore, there is enough evidence to continue pregnancy, except for uncontrolled severe complications, without increasing the risk of GTN progression.
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Affiliation(s)
- Lan Zhong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Liang Song
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Rutie Yin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qingli Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Danqing Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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4
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Al Ghadeer HA, Al Kishi N, Algurini KH, Albesher AB, AlGhadeer MR, Alsalman AA, Bubshait AA, Alkishi BM. Partial Molar Pregnancy With Normal Karyotype. Cureus 2022; 14:e30934. [DOI: 10.7759/cureus.30934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
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5
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Abstract
Pathologic diagnosis of gestational trophoblastic disease (GTD)-hydatidiform moles and gestational trophoblastic neoplasms-underwent a major shift in the past decade from morphology-based recognition to precise molecular genetic classification of entities, which also allows for prognostic stratification of molar gestations. This article highlights these recent advances and their integration into the routine pathology practice. The traditional gross and histomorphologic features of each entity are also reviewed with special focus on differential diagnoses and their clinical implications.
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Affiliation(s)
- Natalia Buza
- Department of Pathology, Yale School of Medicine, 310 Cedar Street LH 108, PO Box 208023, New Haven, CT 06520-8023, USA.
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6
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Borella F, Cosma S, Ferraioli D, Preti M, Gallio N, Valabrega G, Scotto G, Rolfo A, Castellano I, Cassoni P, Bertero L, Benedetto C. From Uterus to Brain: An Update on Epidemiology, Clinical Features, and Treatment of Brain Metastases From Gestational Trophoblastic Neoplasia. Front Oncol 2022; 12:859071. [PMID: 35493999 PMCID: PMC9045690 DOI: 10.3389/fonc.2022.859071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
In this review, we provide the state of the art about brain metastases (BMs) from gestational trophoblastic neoplasia (GTN), a rare condition. Data concerning the epidemiology, clinical presentation, innovations in therapeutic modalities, and outcomes of GTN BMs are comprehensively presented with particular attention to the role of radiotherapy, neurosurgery, and the most recent chemotherapy regimens. Good response rates have been achieved thanks to multi-agent chemotherapy, but brain involvement by GTNs entails significant risks for patients’ health since sudden and extensive intracranial hemorrhages are possible. Moreover, despite the evolution of treatment protocols, a small proportion of these patients ultimately develops a resistant disease. To tackle this unmet clinical need, immunotherapy has been recently proposed. The role of this novel option for this subset of patients as well as the achieved results so far are also discussed.
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Affiliation(s)
- Fulvio Borella
- Division of Gynecology and Obstetrics 1, "City of Health and Science University Hospital", University of Turin, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Stefano Cosma
- Division of Gynecology and Obstetrics 1, "City of Health and Science University Hospital", University of Turin, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Mario Preti
- Division of Gynecology and Obstetrics 1, "City of Health and Science University Hospital", University of Turin, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Niccolò Gallio
- Division of Gynecology and Obstetrics 1, "City of Health and Science University Hospital", University of Turin, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Giulia Scotto
- Department of Oncology, University of Torino, Torino, Italy
| | - Alessandro Rolfo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, "City of Health and Science University Hospital", University of Turin, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, "City of Health and Science University Hospital", University of Turin, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, "City of Health and Science University Hospital", University of Turin, Turin, Italy
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, "City of Health and Science University Hospital", University of Turin, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
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7
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Strickland AL, Gwin K. Gestational Trophoblastic Disease- Rare, Sometimes Dramatic, and What We Know So Far. Semin Diagn Pathol 2022; 39:228-237. [DOI: 10.1053/j.semdp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 11/11/2022]
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8
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Das A, Banik BK. Advances in heterocycles as DNA intercalating cancer drugs. PHYSICAL SCIENCES REVIEWS 2022. [DOI: 10.1515/psr-2021-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The insertion of a molecule between the bases of DNA is known as intercalation. A molecule is able to interact with DNA in different ways. DNA intercalators are generally aromatic, planar, and polycyclic. In chemotherapeutic treatment, to suppress DNA replication in cancer cells, intercalators are used. In this article, we discuss the anticancer activity of 10 intensively studied DNA intercalators as drugs. The list includes proflavine, ethidium bromide, doxorubicin, dactinomycin, bleomycin, epirubicin, mitoxantrone, ellipticine, elinafide, and echinomycin. Considerable structural diversities are seen in these molecules. Besides, some examples of the metallo-intercalators are presented at the end of the chapter. These molecules have other crucial properties that are also useful in the treatment of cancers. The successes and limitations of these molecules are also presented.
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Affiliation(s)
- Aparna Das
- Department of Mathematics and Natural Sciences , College of Sciences and Human Studies, Prince Mohammad Bin Fahd University , Al Khobar 31952 , Kingdom of Saudi Arabia
| | - Bimal Krishna Banik
- Department of Mathematics and Natural Sciences , College of Sciences and Human Studies, Prince Mohammad Bin Fahd University , Al Khobar 31952 , Kingdom of Saudi Arabia
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9
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Pervaiz A, Inany M, Nguyen HQ, Jacques SM, Alshabani K. A Pregnant Woman With Hemoptysis and Diffuse Pulmonary Nodules. Chest 2021; 160:e651-e656. [PMID: 34872680 DOI: 10.1016/j.chest.2021.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/19/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022] Open
Abstract
CASE PRESENTATION A 22-year-old woman who was 36 weeks pregnant presented with a 4-day history of cough, hemoptysis, and exertional dyspnea. She had no fever, night sweats, or weight loss. The review of system was otherwise negative. Her medical history was notable for a spontaneous first-trimester abortion a year ago. At that time, she had a transvaginal ultrasound scan that showed a gestational sac with no fetal movement. A post-abortion ultrasound scan revealed no residual fetal parts.
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Affiliation(s)
- Amina Pervaiz
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Mohammed Inany
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Huy Q Nguyen
- Department of Pathology, Hutzel Women's Hospital/ Harper University Hospital, Wayne State University School of Medicine, Detroit, MI
| | - Suzanne M Jacques
- Department of Pathology, Hutzel Women's Hospital/ Harper University Hospital, Wayne State University School of Medicine, Detroit, MI
| | - Khaled Alshabani
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI.
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10
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Blok LJ, Frijstein MM, Eysbouts YK, Custers J, Sweep F, Lok C, Ottevanger PB. The psychological impact of gestational trophoblastic disease: a prospective observational multicentre cohort study. BJOG 2021; 129:444-449. [PMID: 34314567 PMCID: PMC9292450 DOI: 10.1111/1471-0528.16849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the short-term psychological consequences of gestational trophoblastic disease (GTD). DESIGN A prospective observational multicentre cohort study. SETTING Nationwide in the Netherlands. POPULATION GTD patients. METHODS Online questionnaires directly after diagnosis. MAIN OUTCOME MEASURES Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), Impact of Event Scale (IES) and Reproductive Concerns Scale (RCS). RESULTS Sixty GTD patients were included between 2017 and 2020. Anxious feelings (47%) were more commonly expressed than depressive feelings (27%). Patients experienced moderate to severe adaptation problems in 88%. Patients who already had children were less concerned about their reproductivity than were patients without children (mean score 10.4 versus 15.0, P = 0.031), and patients with children experienced lower distress levels (IES mean score 25.7 versus 34.7, P = 0.020). In addition, patients with previous pregnancy loss scored lower for distress compared with patients without pregnancy loss (IES mean score 21.1 versus 34.2, P = 0.002). DISCUSSION We recommend that physicians monitor physical complaints and the course of psychological wellbeing over time in order to provide personalised supportive care in time for patients who have high levels of distress at baseline. CONCLUSIONS GTD patients experience increased levels of distress, anxiety and depression, suggesting the diagnosis has a substantial effect on the psychological wellbeing of patients. The impact of GTD diagnosis on intrusion and avoidance seems to be ameliorated in patients who have children or who have experienced previous pregnancy loss. TWEETABLE ABSTRACT Patients with gestational trophoblastic disease (GTD) experience short-term psychological consequences such as distress, anxiety and depression, suggesting that the diagnosis GTD has a substantial effect on the psychological wellbeing of patients. Various patient characteristics affect the impact of GTD diagnosis.
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Affiliation(s)
- L J Blok
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M M Frijstein
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Y K Eysbouts
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jae Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Fcgj Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Car Lok
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - P B Ottevanger
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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11
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Ramesan CK, Thomas DS, Sebastian A, Thomas V, Thomas A, George R, Peedicayil A. Role of Hysterectomy in Gestational Trophoblastic Neoplasia. Indian J Surg Oncol 2021; 12:386-390. [PMID: 34295083 DOI: 10.1007/s13193-021-01328-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 04/20/2021] [Indexed: 11/28/2022] Open
Abstract
Hysterectomy has a limited role in the management of gestational trophoblastic neoplasia because of the high effectiveness of chemotherapy and the young age of patients. In selected patients, it is believed to help in reducing the number of chemotherapy cycles, overcoming chemo-resistance, and treating acute haemorrhagic events. The present study aimed to evaluate the indications and outcomes of hysterectomy in patients with GTN at a tertiary care centre in India. Between 2012 and 2019, we identified all patients with GTN from the hospital database. Demographic, clinical, and follow-up details of patients who underwent hysterectomy were obtained from the electronic medical records. During the study period, 98 cases of GTN were treated at our centre of which 54% were low-risk and 46% were high-risk cases. Twenty-six patients (26%) underwent hysterectomy as part of their management for GTN. The patients belonging to the high-risk group had more hysterectomies (65%) with an odds ratio of 2.96. The common pathological diagnosis was choriocarcinoma in 44% and an invasive mole in 30% of patients. Bleeding, either intraperitoneal or vaginal, was the most common indication for hysterectomy (48%). The median number of chemotherapy cycles received was 5 in patients who had primary hysterectomy and 6 in patients who did not have hysterectomy. The majority of patients received EMACO (57.7%) chemotherapy. The mean duration of follow-up was 18 months (range 1-67). After treatment, complete remission was achieved in 94 out of 98 (95.9%) and also in all patients (100%) who had undergone hysterectomy as adjuvant procedure. Three patients died during treatment (3.06%), all belonging to the high-risk group, and one patient had a recurrence (0.01%). In selected cases of GTN, hysterectomy may be an effective means to reduce or eliminate tumour bulk, to overcome chemoresistance and manage acute bleeding events.
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Affiliation(s)
- C K Ramesan
- Department of Gynaecologic Oncology, Christian Medical College, CMC Hospital, Vellore, Tamil Nadu 632004 India
| | - Dhanya Susan Thomas
- Department of Gynaecologic Oncology, Christian Medical College, CMC Hospital, Vellore, Tamil Nadu 632004 India
| | - Ajit Sebastian
- Department of Gynaecologic Oncology, Christian Medical College, CMC Hospital, Vellore, Tamil Nadu 632004 India
| | - Vinotha Thomas
- Department of Gynaecologic Oncology, Christian Medical College, CMC Hospital, Vellore, Tamil Nadu 632004 India
| | - Anitha Thomas
- Department of Gynaecologic Oncology, Christian Medical College, CMC Hospital, Vellore, Tamil Nadu 632004 India
| | - Rachel George
- Department of Gynaecologic Oncology, Christian Medical College, CMC Hospital, Vellore, Tamil Nadu 632004 India
| | - Abraham Peedicayil
- Department of Gynaecologic Oncology, Christian Medical College, CMC Hospital, Vellore, Tamil Nadu 632004 India
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12
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Arabi A, Ayoola-Adeola M, Nguyen HQ, Brar H, Walker C. Pulmonary metastasis as a primary manifestation of gestational choriocarcinoma in a third trimester pregnancy. Gynecol Oncol Rep 2021; 36:100762. [PMID: 33869715 PMCID: PMC8042422 DOI: 10.1016/j.gore.2021.100762] [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: 02/23/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022] Open
Abstract
Choriocarcinomas can follow molar, ectopic, or normal pregnancies. The early diagnosis and treatment of choriocarcinomas is imperative. Atypical symptoms in pregnancy should raise suspicion for choriocarcinoma. Choriocarcinoma must always be in the differential in uncomplicated term pregnancies.
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Affiliation(s)
- Ahmad Arabi
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, 3980 John R, 7-Brush N, MB #165, Detroit, MI 48201, USA
| | - Martins Ayoola-Adeola
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, 3980 John R, 7-Brush N, MB #165, Detroit, MI 48201, USA
| | - Huy Q Nguyen
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA
| | | | - Christopher Walker
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, 3980 John R, 7-Brush N, MB #165, Detroit, MI 48201, USA
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13
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de Queiroz Moura D, Rawache R, Garcia MFG, Vasconcelos NF, Santos P, Coelho GR, Luis da Paz Santos T, Reis da Rocha Filho D, Leite da Silva S, Barbosa de Almeida ER, Fernandes PFCBC, Cerqueira JB, Parente Garcia JH, Costa de Oliveira CM. Donor Choriocarcinoma Transmission From Solid Organ Transplantation: A Case Report. Transplant Proc 2020; 53:1345-1349. [PMID: 33384179 DOI: 10.1016/j.transproceed.2020.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022]
Abstract
Transplantation of any organ has some inherent risk of disease transmission, such as infection and malignancy. The present study aims to describe 2 cases of choriocarcinoma transmission after kidney and liver transplantation originating from the same patient. The donor was a 17-year-old woman who died of cerebral hemorrhage. Both organ recipients died of metastatic choriocarcinoma few months after the transplantation, within days after starting chemotherapy. Retrospective hCG (human chorionic gonadotropin hormone) analysis in donor's blood stored at the time of donation had a result of 9324 mIU/mL. Despite its rarity, clinicians should be aware of the risk of transplant-related choriocarcinoma from female donors in childbearing age. In some cases, hCG dosage should be performed before donation.
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Affiliation(s)
- Daniela de Queiroz Moura
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil.
| | - Ramon Rawache
- Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil; Liver Transplantation Service at Walter Cantídio University Hospital, Fortaleza, (CE), Brazil
| | | | | | - Priscila Santos
- Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Gustavo Rego Coelho
- Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil; Liver Transplantation Service at Walter Cantídio University Hospital, Fortaleza, (CE), Brazil
| | - Thiago Luis da Paz Santos
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Duílio Reis da Rocha Filho
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Sonia Leite da Silva
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Eliana Regia Barbosa de Almeida
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - Paula F C B C Fernandes
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - João Batista Cerqueira
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
| | - José Huygens Parente Garcia
- Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil; Liver Transplantation Service at Walter Cantídio University Hospital, Fortaleza, (CE), Brazil
| | - Claudia Maria Costa de Oliveira
- Kidney Transplantation Service at Walter Cantídio University Hospital, Fortaleza (CE), Brazil; Federal University of Ceará - Fortaleza (CE), Fortaleza (CE), Brazil
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14
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Dudiak KM, Maturen KE, Akin EA, Bell M, Bhosale PR, Kang SK, Kilcoyne A, Lakhman Y, Nicola R, Pandharipande PV, Paspulati R, Reinhold C, Ricci S, Shinagare AB, Vargas HA, Whitcomb BP, Glanc P. ACR Appropriateness Criteria® Gestational Trophoblastic Disease. J Am Coll Radiol 2020; 16:S348-S363. [PMID: 31685103 DOI: 10.1016/j.jacr.2019.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Abstract
Gestational trophoblastic disease (GTD), a rare complication of pregnancy, includes both benign and malignant forms, the latter collectively referred to as gestational trophoblastic neoplasia (GTN). When metastatic, the lungs are the most common site of initial spread. Beta-human chorionic gonadotropin, elaborated to some extent by all forms of GTD, is useful in facilitating disease detection, diagnosis, monitoring treatment response, and follow-up. Imaging evaluation depends on whether GTD manifests in one of its benign forms or whether it has progressed to GTN. Transabdominal and transvaginal ultrasound with duplex Doppler evaluation of the pelvis are usually appropriate diagnostic procedures in either of these circumstances, and in posttreatment surveillance. The appropriateness of more extensive imaging remains dependent on a diagnosis of GTN and on other factors. The use of imaging to assess complications, typically hemorrhagic, should be guided by the location of clinical signs and symptoms. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Maria Bell
- Sanford Health, Sioux Falls, South Dakota, American College of Obstetricians and Gynecologists
| | | | - Stella K Kang
- New York University Medical Center, New York, New York
| | | | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Refky Nicola
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | | | - Stephanie Ricci
- Cleveland Clinic, Cleveland, Ohio, American College of Obstetricians and Gynecologists
| | - Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Bradford P Whitcomb
- University of Connecticut, Farmington, Connecticut, Society of Gynecologic Oncology
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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15
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Mital R, Forster M, Alloghbi A, Kayyali A. A Case of a False-Positive Urine Pregnancy Test and Delayed Diagnosis of Obstructive Pyelonephritis. Am J Case Rep 2020; 21:e920440. [PMID: 32210220 PMCID: PMC7117853 DOI: 10.12659/ajcr.920440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patient: Female, 28-year-old Final Diagnosis: Obstructive pyelonephritis Symptoms: Dysuria • epigastric pain • flank pain Medication: — Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Rahul Mital
- College of Medicine, University of Toledo College of Medicine, Toledo, OH, USA
| | - Moriah Forster
- College of Medicine, University of Toledo College of Medicine, Toledo, OH, USA
| | | | - Ammar Kayyali
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
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16
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Staples JN, Podwika S, Duska L. The role of pulmonary resection in the management of metastatic gestational trophoblastic neoplasia: Two cases of durable remission following surgery for chemo-resistant disease. Gynecol Oncol Rep 2019; 30:100496. [PMID: 31693720 PMCID: PMC6804952 DOI: 10.1016/j.gore.2019.100496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 11/17/2022] Open
Abstract
GTN is typically a chemo-responsive and highly curative gynecologic malignancy. Surgery may be beneficial in as many as 2/3 of patients with high-risk GTN. In select patients, resection of drug-resistant pulmonary metastases is effective.
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Affiliation(s)
- Jeanine N. Staples
- Corresponding author at: University of Virginia Medical Center, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, P.O. Box 800712, Charlottesville, VA 22908, United States of America.
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17
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Alobaid A, Ahmeed S, Abuzaid M, Aldakhil L, Abu-Zaid A. Low-risk gestational trophoblastic neoplasia: A single-center experience from Saudi Arabia. Avicenna J Med 2019; 9:89-93. [PMID: 31404135 PMCID: PMC6647918 DOI: 10.4103/ajm.ajm_188_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective To report our single-center experience in terms of patient clinical characteristics, treatment outcomes, and chemotherapy-related toxicities in patients with low-risk gestational trophoblastic neoplasia (GTN). Materials and Methods A retrospective cross-sectional study (2008-2013) was conducted at a tertiary health-care hospital in Saudi Arabia. Forty-four (n = 44) patients met the inclusion criteria for low-risk GTN. Methotrexate (MTX) was administered in a 5-day regimen: 0.3-0.5mg/kg intravenously (IV) daily for 5 days every 2 weeks (maximum 25mg per dose). Actinomycin D (ActD) was administered 1.25mg/m2 pulsed IV every 2 weeks. Results The majority of patients had molar pregnancy as the antecedent event (86%), developed GTN within the first 4 months after the initial evacuation (93.2%), had human chorionic gonadotropin levels between 1,000 and 10,000 mIU/dL (36.3%), and had the World Health Organization prognostic scores from 0 to 2 (48.7%). Only 38 patients accepted treatment with chemotherapy. A total of 37 patients received first-line MTX; 34 patients of them achieved complete remission (CR, 92%). The three patients who developed MTX resistance were salvaged with sequential ActD and all achieved CR of 100%. Only one patient received first-line ActD and achieved CR. The overall survival as well as cure rate for all patients with low-risk GTN was 100%. No patient developed MTX-related hepatic toxicity or ActD-related blister formation. No severe adverse effects occurred. Conclusion Our 5-day IV MTX regimen was highly effective in treating patients with low-risk GTN, with CR rate of 92% and no severe toxicity. Primary and sequential ActD therapy appears to be very effective.
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Affiliation(s)
- Abdulaziz Alobaid
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Samer Ahmeed
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Abuzaid
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Latifa Aldakhil
- Department of Obstetrics and Gynecology, King Khaled University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.,College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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18
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De Franciscis P, Schiattarella A, Labriola D, Tammaro C, Messalli EM, La Mantia E, Montella M, Torella M. A partial molar pregnancy associated with a fetus with intrauterine growth restriction delivered at 31 weeks: a case report. J Med Case Rep 2019; 13:204. [PMID: 31269962 PMCID: PMC6610795 DOI: 10.1186/s13256-019-2150-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/05/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Molar pregnancies belong to a group of diseases classified as gestational trophoblastic diseases, which result from an altered fertilization. Partial molar pregnancy with a live fetus is a very rare condition, occurring in 0.005 to 0.01% of all pregnancies; it presents a challenging diagnosis, especially when clinical signs are almost completely absent. CASE PRESENTATION Here we report a rare case of partial molar pregnancy in which a normal-appearing male fetus with diploid karyotype was delivered at 31 weeks gestation by a 37-year-old white woman. The pregnancy was characterized by an episode of threatened abortion in the first trimester and an ultrasonographic diagnosis of intrauterine growth restriction. Our patient did not report any suspicious symptoms for trophoblastic disease. Due to impaired umbilical artery velocimetry with an absence of the diastolic phase, she underwent an emergency caesarean section at 31 weeks and delivered an 880 g male baby. The male baby was normal without any complications at 3-month and 12-month follow-up and the mother had no evidence of recurrence after 3 and 12 months of follow-up. Pathological examination of the placenta showed changes of partial hydatidiform mole. CONCLUSION Partial molar pregnancy with a live fetus is a very rare condition that presents a challenging diagnosis. Recognizing it is of primary importance for patient care and the placenta should always be investigated at birth, especially in a newborn with intrauterine growth restriction.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Domenico Labriola
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Carolina Tammaro
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Enrico Michelino Messalli
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Elvira La Mantia
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy
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19
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Relative Effects of Age, Race, and Stage on Mortality in Gestational Choriocarcinoma. Int J Gynecol Cancer 2019; 28:338-345. [PMID: 29232272 DOI: 10.1097/igc.0000000000001156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Gestational choriocarcinoma is a malignant form of gestational trophoblastic disease that usually arises after a molar pregnancy, but may follow any antecedent pregnancy. Investigations in this rare cancer are limited. We evaluated the prognostic effects of age, race, and stage in choriocarcinomas diagnosed for 4 decades. METHODS Patients diagnosed as having gestational choriocarcinoma between 1973 and 2014 from the Surveillance, Epidemiology, and End Results program were eligible. Relationships with overall survival and cancer-specific survival were evaluated using log-rank testing and Cox modeling. Multivariate analyses included adjustments for age, race, and stage. RESULTS There were 947 patients with choriocarcinoma including 403 non-Hispanic white (NHW) patients, 473 with distant stage, and 142 who died. Median age at diagnosis was 25 years for non-Hispanic black (NHB) patients and 35 years for Asian/Pacific Islanders (API) compared with 29 years for NHW patients (P = 0.0001). Five-year overall survival varied between 82% and 92% when diagnosed at the age of at least 40 years compared with less than 20 years (P < 0.0001), and from 85% to 95% in patients with distant vs local disease (P < 0.0001), respectively. Multivariate analysis demonstrated that age, race, and stage were independent predictors of mortality. Risk of death increased incrementally in patients diagnosed at 20 to 39 years of age (adjusted hazard ratio [aHR], 3.87; 95% confidence interval [CI], 1.69-8.86; P = 0.001) and at least 40 years of age (aHR, 7.18; 95% CI, 2.95-17.49; P < 0.0001) compared with 20 years or younger. Non-Hispanic black patients were the only racial group at higher risk of death compared with NHW patients (aHR, 1.86; 95% CI, 1.22-2.82; P < 0.004). Distant vs local disease added an additional risk of death (aHR, 2.43; 95% CI, 1.57-3.75; P < 0.0001) over that attributable to age at diagnosis and NHB race. Similar relationships to cancer-specific survival were also observed (P < 0.05). CONCLUSIONS Most patients with choriocarcinoma have excellent prognosis. However, NHB patients and patients who are diagnosed at the age of at least 20 years or have distant stage have significantly worse mortality.
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20
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Kim GS, Hwang KA, Choi KC. A promising therapeutic strategy for metastatic gestational trophoblastic disease: Engineered anticancer gene-expressing stem cells to selectively target choriocarcinoma. Oncol Lett 2019; 17:2576-2582. [PMID: 30867726 DOI: 10.3892/ol.2019.9911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022] Open
Abstract
Gestational trophoblastic disease (GTD) is an unusual disease occurring in pregnancy that originates from abnormal trophoblastic cells and comprises a group of diseases with different properties of invasion, metastasis and recurrence. The GTD group includes hydatidiform moles and gestational trophoblastic neoplasms (GTNs), with GTNs being divided into invasive moles, choriocarcinoma, placental site trophoblastic tumors and epithelioid trophoblastic tumors. The present review focuses on current effective treatments for GTD, including conventional and novel promising direct enzyme prodrug therapies (DEPTs). Conventional therapies, such as chemotherapy and hysterectomy, are currently used in a clinical setting; however, the use of diverse DEPTs, including antibody-DEPT and gene-DEPT is also being attempted to cure GTNs. In addition, gene delivery tools using genetically engineered neural stem cells (NSCs) are presently being examined for the treatment of GTNs. The tumor-tropism of NSCs by chemoattractant factors is a unique characteristic of these cells and can serve as a vehicle to deliver anticancer agents. Previous studies have demonstrated that injection with NSC-expressing suicide genes into xenograft animal models has a significant inhibitory effect on tumor growth. Stem cells can be genetically engineered to express anticancer genes, which migrate to the metastatic sites and selectively target cancer cells, and are considered to effectively target metastatic GTNs. However, the safety issue of stem cell therapy, such as tumorigenesis, remains a challenge. Novel therapies comprising a combination of conventional and novel promising treatments are anticipated to be definitive treatments for metastasized and/or recurrent patients with GTNs.
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Affiliation(s)
- Gyu-Sik Kim
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, North Chungcheong 28644, Republic of Korea
| | - Kyung-A Hwang
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, North Chungcheong 28644, Republic of Korea
| | - Kyung-Chul Choi
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, North Chungcheong 28644, Republic of Korea
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21
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Khooei A, Atabaki Pasdar F, Fazel A, Mahmoudi M, Nikravesh MR, Daneshmand Shahbazian S. P53 expression in various types of hydropic placentas (through ploidy analysis as a complementary tool in diagnosis of samples). CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:205-210. [PMID: 31363399 PMCID: PMC6619464 DOI: 10.22088/cjim.10.2.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Placentas characterized by hydropic swelling of chorionic villi occur in a spectrum of pathological conditions including hydropic abortion (HA), partial hydatidiform mole (PHM) and complete hydatidiform mole (CHM). The purpose of this study was to investigate whether the expression of p53 tumour suppressor protein could differentiate these various types of hydropic placentas. METHODS p53 immunohistochemical staining was performed in 19 molar (8 PHM and 11 CHM) and 10 non-molar (HA) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry was performed as a complementary tool in diagnosis of samples. RESULTS DNA histograms obtained from all samples had confirmed diploidy in HAs and CHMs and triploidy in PHMs. p53 immunoreactivity was assessed in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells. The p53 positive reaction was predominantly observed in the nuclei of cytotrophoblastic cells and rarely in stromal cells, no reaction was seen in syncytiotrophoblasts. The mean percentage of p53 positive cells were 6.10±3.75 for HA, 25.87±13.4 for PHM and 39.83±18.76 for CHM. There was a significant difference in P53 immunoreactivity of cytotrophoblastic cells between CHM and HA (P<0.001), and between PHM and HA (P=0.004). There was no significant difference in immunohistochemical reactivity between CHM and PHM (P=0.068). CONCLUSION This study confirms that p53 immunostaining may be helpful in distinguishing complete and partial hydatidiform mole from hydropic abortion, but not complete hydatidiform mole from partial hydatidiform mole.
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Affiliation(s)
- Alireza Khooei
- Department of Pathology, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Atabaki Pasdar
- Department of Anatomical Sciences, Faculty of Medicine, Urmia University of Medical Sciences, Urmia
| | - Alireza Fazel
- Department of Anatomical Sciences, Faculty of Medicine, Urmia University of Medical Sciences, Urmia
| | - Mahmoud Mahmoudi
- Immunology Research Center, Bu Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Nikravesh
- Department of Anatomy and Cell Biology, faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahrzad Daneshmand Shahbazian
- Department of Biomedical Engineering, School of Electrical Engineering, Iran University of Science & Technology (IUST), Tehran, Iran
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22
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Hui P. Gestational Trophoblastic Tumors: A Timely Review of Diagnostic Pathology. Arch Pathol Lab Med 2018; 143:65-74. [PMID: 30407075 DOI: 10.5858/arpa.2018-0234-ra] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT.— Gestational trophoblastic tumors include 3 distinct entities: gestational choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Accurate diagnosis is important for clinical management of the patient. OBJECTIVE.— To review clinical features and pathologic diagnosis of gestational trophoblastic tumors. DATA SOURCES.— Literature and personal experience are the sources for this study. CONCLUSIONS.— Trophoblastic tumors are rare encounters in modern medicine, as a result of clinical practice of molar surveillance programs and early chemotherapeutic intervention for persistent gestational trophoblastic neoplasia. Diagnostic recognition of these tumors requires a high index of suspicion, awareness of their histologic characteristics, and appropriate application of immunohistochemical and molecular biomarkers. Recent attention has been given to a few precursor lesions of gestational trophoblastic tumors, including early/in situ choriocarcinoma and atypical placental site nodule.
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Affiliation(s)
- Pei Hui
- From the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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23
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McGregor K, Myat Min A, Karunkonkowit N, Keereechareon S, Tyrosvoutis ME, Tun NW, Rijken MJ, Hoogenboom G, Boel M, Chotivanich K, Nosten F, McGready R. Obstetric ultrasound aids prompt referral of gestational trophoblastic disease in marginalized populations on the Thailand-Myanmar border. Glob Health Action 2018; 10:1296727. [PMID: 28571514 PMCID: PMC5496045 DOI: 10.1080/16549716.2017.1296727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The use of obstetric ultrasound in the diagnosis of gestational trophoblastic disease (GTD) in high-income settings is well established, leading to prompt management and high survival rates. Evidence from low-income settings suggests ultrasound is essential in identifying complicated pregnancies, but with limited studies reviewing specific conditions including GTD. Objective: The aim of this study is to review the role of ultrasound in diagnosis and management of GTD in a marginalized population on the Thailand–Myanmar border. Antenatal ultrasound became available in this rural setting in 2001 and care for women with GTD has been provided by Thailand public hospitals for 20 years. Design: Retrospective record review. Results: The incidence of GTD was 103 of 57,004 pregnancies in Karen and Burmese women on the Thailand–Myanmar border from 1993–2013. This equates to a rate of 1.8 (95% CI 1.5–2.2) per 1000 or 1 in 553 pregnancies. Of the 102 women with known outcomes, one (1.0%) died of haemorrhage at home. The median number of days between first antenatal clinic attendance and referral to hospital was reduced from 20 (IQR 5–35; range 1–155) to 2 (IQR 2–6; range 1–179) days (p = 0.002) after the introduction of ultrasound. The proportion of severe outcomes (death and total abdominal hysterectomy) was 25% (3/12) before ultrasound compared to 8.9% (8/90) with ultrasound (p = 0.119). A recurrence rate of 2.5% (2/80) was observed in the assessable population. The presence of malaria parasites in maternal blood was not associated with GTD. Conclusions: The rate of GTD in pregnancy in this population is comparable to rates previously reported within South-East Asia. Referral time for uterine evacuation was significantly shorter for those women who had an ultrasound. Ultrasound is an effective method to improve diagnosis of GTD in low-income settings and an effort to increase availability in marginalized populations is required.
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Affiliation(s)
- Kathryn McGregor
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Aung Myat Min
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Noaeni Karunkonkowit
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Suporn Keereechareon
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Mary Ellen Tyrosvoutis
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Nay Win Tun
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Marcus J Rijken
- b Julius Centrum Global Health , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Gabie Hoogenboom
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Machteld Boel
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Kesinee Chotivanich
- c Mahidol-Oxford Tropical Medicine Research Unit, Department of Tropical Medicine, Faculty of Tropical Medicine , Mahidol University , Bangkok , Thailand
| | - François Nosten
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand.,d Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine , University of Oxford , Oxford , UK
| | - Rose McGready
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand.,d Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine , University of Oxford , Oxford , UK
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24
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Moussa RA, Eesa AN, Abdallah ZF, Abdelmeged A, Mahran A, Bahaa H. Diagnostic Utility of Twist1, Ki-67, and E-Cadherin in Diagnosing Molar Gestations and Hydropic Abortions. Am J Clin Pathol 2018; 149:442-455. [PMID: 29562309 DOI: 10.1093/ajcp/aqy012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This study aims to assess whether the expression of Twist1, Ki-67, and E-cadherin can guide the differential diagnosis of complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), and hydropic abortion (HA). METHODS Differential expression of Twist1, Ki-67, and E-cadherin was analyzed in gestational products from 55 cases of CHM, PHM, and HA using immunohistochemistry. Prior to analysis, the studied cases were confirmed for their diagnosis by flow cytometric assessment of DNA ploidy and p57 immunostaining. RESULTS Twist1 expression can distinguish CHM from PHM and HA with 100% sensitivity, 100%, specificity, 100% positive predictive value (PPV), and 100% negative predictive value (NPV). Furthermore, combined Ki-67 and E-cadherin expression could differentiate PHM and HA with 100% sensitivity, 93.3% specificity, 92.3% PPV, and 100% NPV. CONCLUSIONS Twist1 expression is a highly reliable marker for the diagnosis of CHM, where combined Ki-67 and E-cadherin immunoreactivity can distinguish PHM from nonmolar pregnancies.
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Affiliation(s)
- Rabab A Moussa
- Department of Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed N Eesa
- Department of Pathology, Faculty of Medicine, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Zeinab F Abdallah
- Virology & Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ayman Abdelmeged
- Department of Obstetrics & Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Mahran
- Department of Obstetrics & Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Haitham Bahaa
- Department of Obstetrics & Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
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25
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Lim W, Yang C, Jeong M, Bazer FW, Song G. Coumestrol induces mitochondrial dysfunction by stimulating ROS production and calcium ion influx into mitochondria in human placental choriocarcinoma cells. Mol Hum Reprod 2017; 23:786-802. [DOI: 10.1093/molehr/gax052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/06/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Whasun Lim
- Department of Biomedical Sciences, Catholic Kwandong University, Gangneung 25601, Republic of Korea
| | - Changwon Yang
- Department of Biotechnology, Institute of Animal Molecular Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - Muhah Jeong
- Department of Biotechnology, Institute of Animal Molecular Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - Fuller W Bazer
- Department of Animal Science, Center for Animal Biotechnology and Genomics, Texas A&M University, College Station, 77843–2471, TX, USA
| | - Gwonhwa Song
- Department of Biotechnology, Institute of Animal Molecular Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
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18F-FDG PET/CT Demonstrating Chorioadenoma Destruens After Evacuation of Complete Hydatidiform Mole. Clin Nucl Med 2017; 42:766-767. [PMID: 28759528 DOI: 10.1097/rlu.0000000000001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gestational trophoblastic neoplasias (GTNs) are a group of pregnancy-related neoplasms, which include chorioadenoma destruens (invasive mole), placental site trophoblastic tumor, and choriocarcinoma. Although the role of F-FDG PET/CT is still undefined in GTN, in selected cases, it can have significant impact on patient management. Here, we present the case of a 29-year-old woman with hydatidiform mole suggestive of GTN 3 months after evacuation. F-FDG PET/CT demonstrated chorioadenoma destruens (invasive mole) and ruled out metastasis in this case.
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27
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Hong T, Hills E, Aguinaga MDP. Radiographically occult pulmonary metastases from gestational trophoblastic neoplasia. Radiol Case Rep 2017; 12:292-294. [PMID: 28491173 PMCID: PMC5417626 DOI: 10.1016/j.radcr.2017.01.007] [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: 04/25/2016] [Revised: 12/19/2016] [Accepted: 01/02/2017] [Indexed: 11/15/2022] Open
Abstract
Gestational trophoblastic neoplasia (GTN) is a spectrum of diseases including partial and complete hydatidiform moles, placental site trophoblastic tumor, and choriocarcinoma. One of the most important considerations is recognition of the possibility of GTN after molar pregnancy or even normal pregnancy. It is common practice to use chest x-ray for the detection of pulmonary metastasis. Computed tomography imaging of the lungs is ordered if lung lesions are noted on chest x-rays. However, understanding the limitations of chest x-rays is important for detecting smaller pulmonary lesions. We present a patient with GTN and pulmonary metastasis after having received 2 negative chest x-rays.
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Affiliation(s)
- Tina Hong
- Department of Obstetrics and Gynecology, Meharry Medical College, 1005 Dr. D. B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
| | - Edward Hills
- Department of Obstetrics and Gynecology, Meharry Medical College, 1005 Dr. D. B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
| | - Maria Del Pilar Aguinaga
- Department of Obstetrics and Gynecology, Meharry Medical College, 1005 Dr. D. B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
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Eysbouts YK, Massuger LFAG, IntHout J, Lok CAR, Sweep FCGJ, Ottevanger PB. The added value of hysterectomy in the management of gestational trophoblastic neoplasia. Gynecol Oncol 2017; 145:536-542. [PMID: 28390821 DOI: 10.1016/j.ygyno.2017.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the undoubted effectiveness of chemotherapeutic treatment in gestational trophoblastic neoplasia (GTN), problems related to toxicity of chemotherapy and chemo-resistant disease have led to reconsideration of the use of hysterectomy. Aim of the present study was to evaluate indications for and outcome of hysterectomy in patients with GTN in a nation-wide cohort. METHODS Between 1977 and 2012, we identified all patients diagnosed with GTN and treated with hysterectomy from the Dutch national databases. Demographics, clinical characteristics and follow-up were recorded retrospectively. RESULTS One hundred and nine patients (16.5% of all registered patients with GTN) underwent hysterectomy as part of their management for GTN. The majority of patients was classified as low-risk disease (74.3%), post-molar GTN (73.5%) and disease confined to the uterus (65.1%). After hysterectomy, complete remission was achieved in 66.2% of patients with localized disease and in 15.8% of patients with metastatic disease. For patients with localized disease, treated with primary hysterectomy, treatment duration was significantly shorter (mean 3.2weeks and 8.0weeks respectively, p=0.01) with lower number of administered chemotherapy cycles (mean 1.5 and 5.8 respectively, p<0.01) than patients in a matched control group. CONCLUSION In selected cases, a hysterectomy may be an effective means to either reduce or eliminate tumor bulk. Primary hysterectomy should mainly be considered in older patients with localized disease and no desire to preserve fertility, whereas patients with chemotherapy-resistant disease may benefit from additional hysterectomy, especially when disease is localized. For patients with widespread metastatic disease, the benefit of hysterectomy lies in the removal of chemotherapy-resistant tumor bulk with subsequent effect on survival.
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Affiliation(s)
- Y K Eysbouts
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - L F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J IntHout
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C A R Lok
- Department of Gynecologic Oncology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute Amsterdam, The Netherlands
| | - F C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - P B Ottevanger
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Sekiya Y, Yamamoto E, Niimi K, Nishino K, Nakamura K, Kotani T, Kajiyama H, Shibata K, Kikkawa F. c-Rel Promotes Invasion of Choriocarcinoma Cells via PI3K/AKT Signaling. Oncology 2017; 92:299-310. [DOI: 10.1159/000458529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/30/2017] [Indexed: 01/04/2023]
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Ishihara T, Kanasaki H, Oride A, Hara T, Kyo S. Differential diagnosis and management of placental polyp and uterine arteriovenous malformation: Case reports and review of the literature. ACTA ACUST UNITED AC 2017; 12:538-543. [PMID: 29334028 PMCID: PMC5373263 DOI: 10.1177/1745505717692590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Postpartum uterine bleeding is not uncommon and is caused by a variety of obstetrical and gynecological disorders, such as retained placenta, dysfunctional bleeding, and endometrial polyps. Placental polyps and uterine arteriovenous malformation are disorders often encountered in cases of abnormal uterine bleeding in the late puerperal period. These patients may experience life-threatening bleeding and require prompt intervention based on the correct differential diagnosis. The optimal treatments for both diseases differ as follows: intrauterine curettage or transcervical resection are chosen for placental polyps, while total abdominal hysterectomy or uterine artery embolization is preferred for uterine arteriovenous malformation since intrauterine curettage or transcervical resection has the risk of massive bleeding. However, since placental polyp and uterine arteriovenous malformation have similar clinical characteristics, it is important to accurately identify and differentiate between them to ensure optimal therapy. We report here cases that were suggestive of placental polyp or uterine arteriovenous malformation. We discuss the differential diagnoses and treatments for both diseases based on a literature review and propose a novel algorithm for managing such patients.
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Affiliation(s)
- Tomoko Ishihara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Haruhiko Kanasaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Aki Oride
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tomomi Hara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo, Japan
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Dutch Risk Classification and FIGO 2000 for Gestational Trophoblastic Neoplasia Compared. Int J Gynecol Cancer 2016; 26:1712-1716. [DOI: 10.1097/igc.0000000000000812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
ObjectiveOver the years, there has been a wide variety of classification systems in use worldwide to stratify patients between single-agent versus multi-agent chemotherapy, hindering comparison of international research results. The study presents a retrospective comparison of the International Federation of Gynecology and Obstetrics 2000 and Dutch risk classification system for gestational trophoblastic neoplasia.Methods and MaterialsAll patients diagnosed with gestational trophoblastic neoplasia between January 2003 and December 2012 at the trophoblastic disease centre in London were retrospectively scored according to the Dutch classification system (N = 813).ResultsAn extensive overlap between both scoring systems was seen, even though items and relative value of items were quite distinct. The Dutch system seems to be simpler and easier to apply in all situation; a degree of overtreatment can however be presumed with the use of either system.ConclusionsAlthough it is likely that outcome is indeed affected by the individual factors used in both systems, many factors relate to tumor bulk and may not be independently prognostic. We therefore believe that further refinement of the classification systems and their underlying prognostic items plus any new items that seem promising would be useful.
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Hasanzadeh M, Sharifi N, Farazestanian M, Nazemian SS, Madani Sani F. Immunohistochemistry Study of P53 and C-erbB-2 Expression in Trophoblastic Tissue and Their Predictive Values in Diagnosing Malignant Progression of Simple Molar Pregnancy. IRANIAN JOURNAL OF CANCER PREVENTION 2016; 9:e4115. [PMID: 27703642 PMCID: PMC5038832 DOI: 10.17795/ijcp-4115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/09/2015] [Accepted: 06/05/2016] [Indexed: 11/26/2022]
Abstract
Background Finding a tumor marker to predict the aggressive behavior of molar pregnancy in early stages has yet been a topic for studies. Objectives In this survey we planned to study patients with molar pregnancy to 1) assess the p53 and c-erbB-2 expression in trophoblastic tissue, 2) to study the relationship between their expression intensity and progression of a molar pregnancy to gestational trophoblastic neoplasia, and 3) to determine a cut off value for the amount of p53 and c-erbB-2 expression which might correlate with aggressive behavior of molar pregnancy. Patients and Methods In a prospective cross sectional study by using a high accuracy technique EnVision Tm system for immunohistochemistry staining of molar pregnancy samples, we evaluated p53 and c-erbB-2 expression in cytotrophoblast and syncytiotrophoblast and the correlation of their expression with progression of molar pregnancy to gestational trophoblastic neoplasia (GTN). Normal prostatic tissue and Breast cancer tissue were used as positive controls. Results We studied 28 patients with simple molar pregnancy (SMP) and 30 with GTN. Cytotrophobalst had significantly higher expression of p53 and c-erbB-2 and syncytiotrophoblast had greater expression of p53 in GTN group as compared to SMP group. The cut off values for percentage of p53 positive immunostained cytotrophoblast and syncytiotrophoblast were 5.5% and 2.5%. In c-erbB-2 positive membranous stained cytotrophoblast the cut off was 12.5%. Conclusions Our data suggests that over expression of p53 and c-erbB-2 is associated with malignant progression of molar pregnancy. We encountered that high expression of p53 and c-erbB-2 in trophoblastic cells could predict gestational trophoblastic neoplasia during the early stages.
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Affiliation(s)
- Malihe Hasanzadeh
- Department of Obstetrics and Gynecology, Women Health Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Norrie Sharifi
- Department of Pathology, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Marjaneh Farazestanian
- Women Health Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Di Mattei VE, Carnelli L, Mazzetti M, Bernardi M, Di Pierro R, Bergamini A, Mangili G, Candiani M, Sarno L. Mental Representations of Illness in Patients with Gestational Trophoblastic Disease: How Do Patients Perceive Their Condition? PLoS One 2016; 11:e0153869. [PMID: 27101144 PMCID: PMC4839755 DOI: 10.1371/journal.pone.0153869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/05/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Gestational Trophoblastic Disease comprises a group of benign and malignant disorders that derive from the placenta. Using Leventhal's Common-Sense Model as a theoretical framework, this paper examines illness perception in women who have been diagnosed with this disease. METHODS Thirty-one women diagnosed with Gestational Trophoblastic Disease in a hospital in Italy were asked to complete the Illness Perception Questionnaire-Revised to measure the following: illness Identity, illness opinions and causes of Gestational Trophoblastic Disease. RESULTS High mean scores were observed in the Emotional representations and Treatment control subscales. A significant difference emerged between hydatidiform mole patients and those with gestational trophoblastic neoplasia on the Identity subscale. A significant correlation emerged between "time since diagnosis" and the Treatment control subscale. DISCUSSION This study is the first to investigate illness perception in Gestational Trophoblastic Disease. From a clinical perspective the results highlight the need for multidisciplinary support programs to promote a more realistic illness perception.
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Affiliation(s)
- Valentina E. Di Mattei
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Letizia Carnelli
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | | | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Candiani
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lucio Sarno
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Burny C, Rabilloud M, Golfier F, Massardier J, Hajri T, Schott AM, Subtil F. Early diagnosis of gestational trophoblastic neoplasia based on trajectory classification with compartment modeling. BMC Med Res Methodol 2016; 16:3. [PMID: 26732086 PMCID: PMC4702411 DOI: 10.1186/s12874-015-0106-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In randomized clinical trials or observational studies, it is common to collect biomarker values longitudinally on a cohort of individuals. The investigators may be interested in grouping individuals that share similar changes of biomarker values and use these groups for diagnosis or therapeutic purposes. However, most classical model-based classification methods rely mainly on empirical models such as splines or polynomials and do not reflect the physiological processes. METHODS A model-based classification method was developed for longitudinal biomarker measurements through a pharmacokinetic model that describes biomarker changes over time. The method is illustrated using data on human Chorionic Gonadotrophic Hormone measurements after curettage of hydatidiform moles. RESULTS The resulting classification was linked to the evolution toward gestational trophoblastic neoplasia and may be used as a tool for early diagnosis. The diagnostic accuracy of the pharmacokinetic model was more reproducible than the one of a purely mathematical model that did not take into account the biological processes. CONCLUSION The use of pharmacokinetic models in model-based classification approaches can lead to clinically useful classifications.
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Affiliation(s)
- Claire Burny
- Service de Biostatistique, Hospices Civils de Lyon, 162 avenue Lacassagne, F-69003, Lyon, France. .,Université de Lyon, F-69000, Lyon, France. .,Université Lyon 1, F-69100, Villeurbanne, France. .,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France.
| | - Muriel Rabilloud
- Service de Biostatistique, Hospices Civils de Lyon, 162 avenue Lacassagne, F-69003, Lyon, France. .,Université de Lyon, F-69000, Lyon, France. .,Université Lyon 1, F-69100, Villeurbanne, France. .,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France.
| | - François Golfier
- Université de Lyon, F-69000, Lyon, France. .,Université Lyon 1, F-69100, Villeurbanne, France. .,Department of Gynaecological and Oncological Surgery-Obstetrics, Lyon Sud University Hospital, Lyon, France. .,French Trophoblastic Disease Reference Centre, Lyon Sud University Hospital, Lyon, France.
| | - Jérôme Massardier
- French Trophoblastic Disease Reference Centre, Lyon Sud University Hospital, Lyon, France. .,Department of Obstetrics, University Hospital Femme-Mère-Enfant, Lyon, France.
| | - Touria Hajri
- Université de Lyon, F-69000, Lyon, France. .,Université Lyon 1, F-69100, Villeurbanne, France. .,French Trophoblastic Disease Reference Centre, Lyon Sud University Hospital, Lyon, France. .,Pôle Information Médicale Evaluation Recherche, Equipe d'Accueil 4129, Hospices Civils de Lyon, Lyon, France.
| | - Anne-Marie Schott
- Université de Lyon, F-69000, Lyon, France. .,Université Lyon 1, F-69100, Villeurbanne, France. .,Pôle Information Médicale Evaluation Recherche, Equipe d'Accueil 4129, Hospices Civils de Lyon, Lyon, France.
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, 162 avenue Lacassagne, F-69003, Lyon, France. .,Université de Lyon, F-69000, Lyon, France. .,Université Lyon 1, F-69100, Villeurbanne, France. .,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France.
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Erol O, Süren D, Tutuş B, Toptaş T, Gökay AA, Derbent AU, Özel MK, Sezer C. Immunohistochemical Analysis of E-Cadherin, p53 and Inhibin-α Expression in Hydatidiform Mole and Hydropic Abortion. Pathol Oncol Res 2015; 22:515-21. [DOI: 10.1007/s12253-015-0031-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/14/2015] [Indexed: 11/24/2022]
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40-year-old female with menorrhagia and abdominal pain: A case of metastatic gestational trophoblastic neoplasia. Radiol Case Rep 2015; 10:1057. [PMID: 27408664 PMCID: PMC4921190 DOI: 10.2484/rcr.v10i1.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Choriocarcinoma is part of a rare spectrum of placental abnormalities known as gestational trophoblastic disease (GTD). It is the most invasive form of GTD, with a mortality rate approaching 100% if left untreated. It spreads predominantly hematogenously to multiple target sites, most commonly the lungs. Due to its hypervascular nature, it is often complicated by bleeding. We describe a case of choriocarcinoma in a 40-year-old female with metastases to the lungs, brain, and bilateral kidneys resulting in large retroperitoneal hematomas.
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Rodríguez-Gutiérrez R, Villarreal-Pérez JZ, Morales-Martinez FA, Rodríguez-Guajardo R, González-Saldivar G, Mancillas-Adame LG, Alvarez-Villalobos NA, Lavalle-Gonzalez FJ, González-González JG. Ovarian and adrenal androgens and their link to high human chorionic gonadotropin levels: a prospective controlled study. Int J Endocrinol 2014; 2014:191247. [PMID: 25505909 PMCID: PMC4258315 DOI: 10.1155/2014/191247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/02/2014] [Accepted: 11/03/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Although the association between human chorionic gonadotropin (hCG) and hyperandrogenism was identified more than 40 years ago, relevant questions remain unanswered. Design and Methods. We conducted a prospective, longitudinal, and controlled study in 23 women with a diagnosis of a complete hydatidiform mole (HM). Results. All participants completed the study. Before HM evacuation mean hCG was markedly higher in the cases than in the control group (P ≤ 0.001). Free testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) were found to be higher in the cases (2.78 ± 1.24 pg/mL and 231.50 ± 127.20 μ/dL) when compared to the control group (1.50 ± 0.75 pg/mL and 133.59 ± 60.69 μ/dL) (P = 0.0001 and 0.001), respectively. There was a strong correlation between hCG and free T/total T/DHEA-S concentrations (r = 0.78; P ≤ 0.001, r = 0.74; P ≤ 0.001, and r = 0.71; P ≤ 0.001), respectively. In the cases group 48 hours after HM evacuation, hCG levels were found to be significantly lower when compared to initial levels (P = 0.001) and free T and DHEA-S declined significantly (P = 0.0002 and 0.009). Conclusion. Before uterus evacuation, hCG, free T, and DHEA-S levels were significantly higher when compared with controls finding a strong correlation between hCG and free T/DHEA-S levels. Forty-eight hours after HM treatment hCG levels declined and the difference was lost. A novel finding of our study is that in cases, besides free T, DHEA-S was also found to be significantly higher and both the ovaries and adrenal glands appear to be the sites of this androgen overproduction.
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Affiliation(s)
- René Rodríguez-Gutiérrez
- Endocrinology Division, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
| | - Jesús Zacarías Villarreal-Pérez
- Endocrinology Division, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
| | - Felipe Arturo Morales-Martinez
- Obstetrics and Gynecology Department, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
| | - René Rodríguez-Guajardo
- Obstetrics and Gynecology Department, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
| | - Gloria González-Saldivar
- Endocrinology Division, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
| | - Leonardo G. Mancillas-Adame
- Endocrinology Division, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
| | - Neri Alejandro Alvarez-Villalobos
- Clinical Research Unit, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
| | - Fernando Javier Lavalle-Gonzalez
- Endocrinology Division, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
| | - José Gerardo González-González
- Endocrinology Division, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
- Clinical Research Unit, University Hospital “Dr. José E. González”, School of Medicine, Autonomous University of Nuevo León, Francisco I. Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico
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Al-Husaini H, Soudy H, Darwish A, Ahmed M, Eltigani A, Edesa W, Elhassan T, Omar A, Elghamry W, Al-Hashem H, Al-Hayli S, Madkhali I, Ahmad S, Al-Badawi IA. Gestational trophoblastic neoplasia: treatment outcomes from a single institutional experience. Clin Transl Oncol 2014; 17:409-15. [PMID: 25398721 DOI: 10.1007/s12094-014-1251-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/17/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the outcomes of gestational trophoblastic neoplasia (GTN) at a single institution and to determine the factors affecting response to chemotherapy and survival. METHODS/PATIENTS From 1979-2010, we retrospectively reviewed the data of 221 patients treated at our center. GTN Patients were assigned to low-risk (score ≤6) or high-risk (score ≥7) based on the WHO risk factor scoring system. Overall survival (OS) probabilities were estimated using Kaplan-Meier method. Logistic regression was applied to study the impact of different factors on the response to initial therapy. RESULTS Patients' OS rate was 97 %. Median age at diagnosis was 37 year. 131 (59 %) patients had low-risk and 88 (40 %) cases had high-risk GTN. Complete remission rates to initial chemotherapy in low-risk group were 53 % and 87 % for single-agent methotrexate or dactinomycin, respectively. In high-risk group, 94 % achieved complete remission to initial chemotherapy with etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). Etoposide, cisplatin, and dactinomycin as primary therapy in high-risk patients was successful in 70 %, while bleomycin, etoposide, and cisplatin (BEP) was successful in 53 % of cases. Salvage chemotherapy, surgical intervention or radiation therapy resulted in overall complete remission of 90 % in low-risk and 73 % in high-risk groups. Factors associated with resistance to initial chemotherapy were advanced-stage III/IV (p = 0.005), metastatic site other than lung or vagina (p = 0.005) and high-risk prognostic score (p = 0.05). OS was significantly influenced by the type of antecedent pregnancy (molar 98 % vs. others 93 %; p = 0.04), FIGO stage (I, II 100 % vs. III, IV 94 %; p = 0.02), score (low-risk 100 % vs. high-risk 92 %; p = 0.01), and site of metastasis (lung/vagina 98 % vs. others 85 %; p = 0.002). CONCLUSIONS GTNs have excellent prognosis if properly treated at experienced centers. Single-agent dactinomycin seems more effective for low-risk GTN. EMA-CO remains the preferred primary treatment regimen for high-risk group. The excellent outcome reflects the success of salvage therapy.
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Affiliation(s)
- H Al-Husaini
- Medical Oncology Consultant, King Faisal Cancer Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC 64, Riyadh, 11211, Saudi Arabia,
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Dhanda S, Ramani S, Thakur M. Gestational trophoblastic disease: a multimodality imaging approach with impact on diagnosis and management. Radiol Res Pract 2014; 2014:842751. [PMID: 25126425 PMCID: PMC4122023 DOI: 10.1155/2014/842751] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/28/2014] [Indexed: 11/20/2022] Open
Abstract
Gestational trophoblastic disease is a condition of uncertain etiology, comprised of hydatiform mole (complete and partial), invasive mole, choriocarcinoma, and placental site trophoblastic tumor. It arises from abnormal proliferation of trophoblastic tissue. Early diagnosis of gestational trophoblastic disease and its potential complications is important for timely and successful management of the condition with preservation of fertility. Initial diagnosis is based on a multimodality approach: encompassing clinical features, serial quantitative β-hCG titers, and pelvic ultrasonography. Pelvic magnetic resonance imaging (MRI) is sometimes used as a problem-solving tool to assess the depth of myometrial invasion and extrauterine disease spread in equivocal and complicated cases. Chest radiography, body computed tomography (CT), and brain MRI have been recommended as investigative tools for overall disease staging. Angiography has a role in management of disease complications and metastases. Efficacy of PET (positron emission tomography) and PET/CT in the evaluation of recurrent or metastatic disease has not been adequately investigated yet. This paper discusses the imaging features of gestational trophoblastic disease on various imaging modalities and the role of different imaging techniques in the diagnosis and management of this entity.
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Affiliation(s)
- Sunita Dhanda
- Department of Diagnostic Imaging, National University Hospital, Level 2, Main Building, 5 Lower Kent Ridge Road, Singapore 119074
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
| | - Subhash Ramani
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
| | - Meenkashi Thakur
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
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Moghazy D, Al-Hendy O, Al-Hendy A. Krukenberg tumor presenting as back pain and a positive urine pregnancy test: a case report and literature review. J Ovarian Res 2014; 7:36. [PMID: 24708577 PMCID: PMC4234994 DOI: 10.1186/1757-2215-7-36] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/27/2014] [Indexed: 12/28/2022] Open
Abstract
A Krukenberg tumor is a rare and potentially deadly cause of elevated serum β-hCG as part of a paraneoplastic syndrome. This study aims to describe the unusual case of a 36-year-old woman that presented to the Emergency Department (ED) with back pain and a positive urine pregnancy test. Assessment revealed no intrauterine pregnancy and a small left ovarian cyst. Further investigation showed moderately differentiated gastric adenocarcinoma with distant metastases to the spine. The patient died less than 3 months after her first presentation to the ED. Paraneoplastic syndrome, albeit rare, should be considered in the differential diagnosis of elevated β-hCG due to the high mortality associated with Krukenberg tumors.
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Affiliation(s)
- Dalia Moghazy
- Center for Women Health Research, Meharry Medical College, Nashville, Tennessee, USA.
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Chen KH, Hsu SC, Chen HY, Ng KF, Chen TC. Utility of fluorescence in situ hybridization for ploidy and p57 immunostaining in discriminating hydatidiform moles. Biochem Biophys Res Commun 2014; 446:555-60. [DOI: 10.1016/j.bbrc.2014.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/02/2014] [Indexed: 11/28/2022]
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Okumura M, Fushida K, Francisco RPV, Schultz R, Zugaib M. Massive necrosis of a complete hydatidiform mole in a twin pregnancy with a surviving coexistent fetus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:177-179. [PMID: 24371114 DOI: 10.7863/ultra.33.1.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Development of a silver in situ hybridisation based assay for the determination of ploidy status in molar pregnancy diagnosis. Pathology 2013; 46:15-20. [PMID: 24300715 DOI: 10.1097/pat.0000000000000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to establish a scoring method for ploidy analysis using silver in situ hybridisation (SISH) with a chromosome 17 centromere probe. SISH was performed using the Ventana chromosome 17 centromere probe on sections from formalin fixed, paraffin embedded archival cases of complete hydatidiform moles, partial hydatidiform moles and hydropic products of conception with previously established ploidy status (determined by flow cytometry or karyotyping). In order to determine ploidy status, a scoring method was developed based on both the average number of signals per nucleus (ASN) and the percentage of nuclei with three signals (N3S), enumerated in 50 villous cytotrophoblastic and/or stromal cells. The results of four independent observers were compared individually and collectively with previously established ploidy status. There was a highly statistically significant difference between diploid and triploid gestations for ASN (1.86 ± 0.13 and 2.70 ± 0.16 respectively, Student t-test, p < 0.0001) and for N3S (1.14 ± 1.65 and 71.59 ± 14.25 respectively, Student t-test, p < 0.0001). The sensitivity and specificity of the SISH-based assay was 99.1% and 100% respectively for ASN, and 100% and 100% respectively for N3S. A chromosome 17 centromere probe SISH-based assay can reliably distinguish between diploid and triploid gestations. This test has diagnostic utility in distinguishing partial hydatidiform moles from histological mimics.
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Atabaki Pasdar F, Khooei A, Fazel A, Mahmoudi M, Tavassoli F. Detection of sugar chain expression in hydatidiform mole using lectin histochemistry. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:376-80. [PMID: 24349722 PMCID: PMC3838644 DOI: 10.5812/ircmj.3997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/11/2012] [Accepted: 04/18/2012] [Indexed: 11/20/2022]
Abstract
Background Hydatidiform moles carry a significant risk for developing persistent gestational trophoblastic disease. Lectins are useful tools to identify cellular glycosylation pattern and changes in glycosylation that occur during growth, development, differentiation and also, during disease states. Objectives Considering the changes in glycosylation that occur during cell proliferation, differentiation and transformation, the aim of the present study was to evaluate the sugar chain expression in hydatidiform mole by using HRP-conjugated lectins. Materials and Methods Lectin histochemistry with a panel of HRP-conjugated lectins comprising SBA, PNA, VVA, UEA-1, LTA, GS-І (B4) and WGA were performed in 20 molar (partial & complete moles) formalin-fixed, paraffin-embedded tissue samples. Results The partial and complete moles generally showed similar reactivity with all used lectins. None of lectins reacted with villous cytotrophoblasts, whereas 4 of 7 lectins comprising WGA, LTA, UEA-І and PNA (after pretreatment with neuraminidase) showed a moderate to strong reactivity with villous syncytiotrophoblasts in both partial and complete hydatidiform moles. The villous stroma reacted with all used lectins except VVA. Conclusions Our histochemical findings showed a relatively heavy glycosylation of syncytiotrophoblasts of both partial and complete molar tissues, which was prominent in apical portion. This may play a role in their capacity to increase trophoblastic proliferation.
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Affiliation(s)
- Fatemeh Atabaki Pasdar
- Department of Anatomy & Cell Biology, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Alireza Khooei
- Department of Pathology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Alireza Khooei, Department of Pathology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118022242, Fax: +98-5118022242, E-mail:
| | - Alireza Fazel
- Department of Anatomy & Cell Biology, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Fatemeh Tavassoli
- Department of Obstetrics & Gynecology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Niimi K, Yamamoto E, Fujiwara S, Shinjo K, Kotani T, Umezu T, Kajiyama H, Shibata K, Ino K, Kikkawa F. High expression of N-acetylglucosaminyltransferase IVa promotes invasion of choriocarcinoma. Br J Cancer 2012; 107:1969-77. [PMID: 23169300 PMCID: PMC3516685 DOI: 10.1038/bjc.2012.496] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: Gestational trophoblastic diseases (GTDs) are related to trophoblasts, and human chorionic gonadotropin (hCG) is secreted by GTDs as well as normal placentas. However, the asparagine-linked sugar chains on hCG contain abnormal biantennary structures in invasive mole and choriocarcinoma, but not normal pregnancy or hydatidiform mole. N-acetylglucosaminyltransferase-IV (GnT-IV) catalyses β1,4-N-acetylglucosamine branching on asparagine-linked oligosaccharides, which are consistent with the abnormal sugar chain structures on hCG. Methods: We investigated GnT-IVa expression in GTDs and placentas by immunohistochemistry, western blot, and RT–PCR. We assessed the effects of GnT-IVa knockdown in choriocarcinoma cells in vitro and in vivo. Results: The GnT-IVa was highly expressed in trophoblasts of invasive mole and choriocarcinoma, and moderately in extravillous trophoblasts during the first trimester, but not in hydatidiform mole or other normal trophoblasts. The GnT-IVa knockdown in choriocarcinoma cells significantly reduced migration and invasive capacities, and suppressed cellular adhesion to extracellular matrix proteins. The extent of β1,4-N-acetylglucosamine branching on β1 integrin was greatly reduced by GnT-IVa knockdown, although the expression of β1 integrin was not changed. In vivo studies further demonstrated that GnT-IVa knockdown suppressed tumour engraftment and growth. Conclusion: These findings suggest that GnT-IVa is involved in regulating invasion of choriocarcinoma through modifications of the oligosaccharide chains of β1 integrin.
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Affiliation(s)
- K Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Abstract
This article reviews the different disease entities that fall under the classification of gestational trophoblastic disease (GTD). The conditions included range from molar pregnancy to the malignant forms of gestational trophoblastic neoplasm (GTN). These disorders all arise from abnormal placental trophoblastic development. The different types of GTD, symptomatology, and diagnostic modalities are examined. The various methods of treatment are reviewed. Although the management of GTD and GTN falls outside the scope of midwifery practice, midwives need to be aware of the incidence, risk factors, and symptoms for specific types of GTD in order to be able to diagnose and refer for treatment in a timely manner. Psychosocial aspects that affect the woman who has not only had a pregnancy loss but also may be faced with a life-threatening illness are examined. The role of the midwife in the management, counseling, and follow-up of GTD and GTN is discussed.
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Affiliation(s)
- Ruth Monchek
- University of Dentistry and Medicine of New Jersey, USA
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