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Joneborg U. Epidemiology of Gestational Trophoblastic Disease. Hematol Oncol Clin North Am 2024:S0889-8588(24)00080-7. [PMID: 39242293 DOI: 10.1016/j.hoc.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
Worldwide incidence rates of gestational trophoblastic disease (GTD) are difficult to estimate and compare due to large methodological differences within and between countries. Asia has generally reported higher incidence rates than Europe and North America, but modern reports have demonstrated a temporal decrease of GTD incidence rates in Asia and an increase in some European countries and North America. The main risk factors for hydatidiform mole are maternal age and previous molar events. Future studies on the epidemiology of GTD should include gestational trophoblastic neoplasia and international collaborative studies on this rare disease should be encouraged.
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Affiliation(s)
- Ulrika Joneborg
- Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, 171 64 Stockholm, Sweden.
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Lund H, Vyberg M, Eriksen HH, Grove A, Jensen AØ, Sunde L. Decreasing incidence of registered hydatidiform moles in Denmark 1999-2014. Sci Rep 2020; 10:17041. [PMID: 33046739 PMCID: PMC7552396 DOI: 10.1038/s41598-020-73921-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 01/09/2023] Open
Abstract
Incidences of hydatidiform mole (HM) registered in European countries varies from 0.98/1000 to 2.17/1000 deliveries, while higher incidences have been reported in other parts of the world. We calculated the incidence by selecting data on HMs classified as ”first”, “second” and “third” from 01.01.1999 to 31.12.2014 registered in the Danish Pathology Registry, which we previously showed to be the most complete data source on the number of HMs in Denmark. In the study period, 1976 first HMs were registered; 1080 (55%) were classified as PHMs (partial HMs) and 896 (45%) as NPHMs (HMs not registered as PHMs). The average incidence of HM was 1.98/1000 deliveries. The incidence of PHM was 1.08/1000 deliveries and the incidence of NPHM was 0.90/1000 deliveries. Forty HMs were registered as second HMs; 85% (34/40) were of the same histopathological type as the first HM. The registered incidence of HM decreased from 2.55/1000 deliveries in 1999 to 1.61/1000 deliveries in 2014 (p < 0.005). The decrease in the incidence of HM was identical with a decrease in the incidence of PHM. New medical practices such as medical abortion and only forwarding selected pregnancy products for histopathologic examination may cause a declining number of HMs registered.
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Affiliation(s)
- Helle Lund
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Mogens Vyberg
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Helle Højmark Eriksen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Anni Grove
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark
| | | | - Lone Sunde
- Department of Biomedicine, Aarhus University, C. F. Møllers Allé 6, 8000, Aarhus C, Denmark.,Department of Clinical Genetics, Aalborg University Hospital, Ladegaardsgade 5, 9000, Aalborg, Denmark
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Gestational Trophoblastic Disease: A Hospital-Based Prospective Study to Characterize Incidence, Risk Factors, Management and Review of Literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Role of Surgery in the Management of Hydatidiform Mole in Elderly Patients: A Single-Center Clinical Experience. Int J Gynecol Cancer 2018; 27:550-553. [PMID: 28129241 DOI: 10.1097/igc.0000000000000903] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Women older than 40 years develop gestational trophoblastic neoplasia (GTN) after a hydatidiform mole (HM) more often than do younger women. Therefore, in elderly women, primary hysterectomy has been advocated as first-line treatment. The aim of the present study was to evaluate whether hysterectomy could reduce the incidence of GTN after a diagnosis of HM. METHODS Seventy-six of 442 patients referred to our unit for an HM between 1994 and 2015 were older than 40 years old. Among these, 12 patients were treated by primary hysterectomy. We compared clinical features, serum human chorionic gonadotrophin (hCG), incidence of GTN, and further treatments in these patients and in those who underwent evacuation and serum hCG monitoring, using univariate and multivariate analyses. RESULTS Patients treated by primary hysterectomy all had a diagnosis of a complete or invasive HM, had more hyperemesis than did control subjects (82% vs 37%, P = 0.008), and had an increased uterine volume (100% vs 41%, P = 0.001). Seven of them developed a subsequent GTN, whereas 5 patients achieved complete remission of disease after surgery (58% vs 30%, P = 0.094). All the patients who developed a GTN after surgery showed lower hCG levels than did control subjects (mean, 671.4 [SD, 1178.4] IU/L vs 23,919.4 [SD, 34,284.9] IU/L; P = 0.005), but there were no significant differences in the amount and type of chemotherapy needed to achieve remission. CONCLUSIONS Primary hysterectomy after 40 years old in women affected by HM does not reduce the incidence of GTN and amount of chemotherapy. Although further studies are needed to confirm these results, a careful hCG monitoring should be recommended in these high-risk patients.
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Carnelli L, Di Mattei VE, Mazzetti M, Bernardi M, Di Pierro R, Bergamini A, Pella F, Mangili G, Sarno L, Candiani M. Illness Perception in Gestational Trophoblastic Disease Patients: How Mental Representations Affect Anxiety, Depression, and Infertility-Related Stress. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojmp.2017.61001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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Abstract
"The battle of the sexes begins in the zygote" W. Reik and J. Walter. Complete hydatidiform mole (CHM) is a pathology of the placenta with androgenetic diploid origin (chromosomes only from paternal origin). Placental villi present an abnormal hyperproliferation and hydropic degeneration associated with the absence of embryo. Three mechanisms can be envisaged at its origin: (1) destruction/expulsion of the female pronucleus at the time of fertilization by one or two spermatozoa, the former being followed by an endoreplication of the male pronucleus (homozygous mole), (2) a triploid zygote (fertilization by two spermatozoa) leading to a haploid and a diploid clones. The diploid clone may produce a normal fetus while the haploid clone, after endoreplication, generates a complete hydatidiform mole, (3) a nutritional defect during the differentiation of the oocytes of the female embryo that will affect the integrity and maturity of her oocytes during her adult life and lead to hydatidiform mole. In countries with a poor medical health care system, moles can be invasive or, in rare cases, lead to gestational choriocarcinomas.
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Affiliation(s)
- Jean-Jacques Candelier
- Inserm, unité 1197, Interactions cellules souches-niches - physiologie, tumeurs et réparation tissulaire, hôpital Paul Brousse, bâtiment Lavoisier, 14, avenue Paul Vaillant Couturier, 94800 Villejuif, France ; et Université Paris-Saclay
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An investigative study into psychological and fertility sequelae of gestational trophoblastic disease: the impact on patients' perceived fertility, anxiety and depression. PLoS One 2015; 10:e0128354. [PMID: 26030770 PMCID: PMC4452269 DOI: 10.1371/journal.pone.0128354] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/24/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Gestational Trophoblastic Disease (GTD) comprises a group of disorders that derive from the placenta. Even if full recovery is generally expected, women diagnosed with GTD have to confront: the loss of a pregnancy, a potentially life-threatening diagnosis and delays in future pregnancies. The aim of the study is to evaluate the psychological impact of GTD, focusing on perceived fertility, depression and anxiety. METHODS 37 patients treated for GTD at San Raffaele Hospital, Milan, took part in the study. The STAI-Y (State-Trait Anxiety Inventory), the BDI-SF (Beck Depression Scale-Short Form) and the FPI (Fertility Problem Inventory) were used. Patients were grouped on the basis of presence of children (with or without), age (< or ≥35) and type of diagnosis (Hydatidiform Mole, HM, or Gestational Trophoblastic Neoplasia, GTN). Differences in the values between variables were assessed by a t-type test statistic. Three-way ANOVAs were also carried out considering the same block factors. RESULTS The study highlights that women suffering from GTN had higher depression scores compared to women suffering from HM. A significant correlation was found between anxiety (state and trait) and depression. Younger women presented higher Global Stress scores on the FPI, especially tied to Need for Parenthood and Relationship Concern subscales. Need for Parenthood mean scores significantly varied between women with and without children too. CONCLUSIONS We can conclude that fertility perception seems to be negatively affected by GTD diagnosis, particularly in younger women and in those without children. Patients should be followed by a multidisciplinary team so as to be supported in the disease's psychological aspects too.
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Coullin P, Diatta AL, Boufettal H, Feingold J, Leguern E, Candelier JJ. The involvement of the trans-generational effect in the high incidence of the hydatidiform mole in Africa. Placenta 2014; 36:48-51. [PMID: 25468544 DOI: 10.1016/j.placenta.2014.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION While the incidence of various chromosomal anomalies observed, including triploid partial moles is independent of the socio-economic level, higher incidences of complete hydatidiform mole "CHM" is generally associated with under developed areas. Moreover, studies have shown that some nutritional deficiencies are related to the abnormal development of oocytes and placenta. In Senegal and Morocco, the annual seasonal cycle contains one period with food shortages and the incidence of complete moles is significant. Accordingly, accurate statistical analyses have been performed in these two countries. METHODS Each month during a one year period, we investigated the occurrence of normal conceptions, molar conceptions and the conception of the future patients in Senegal and Morocco. The comparisons of the conception dates for these three types of conception were analyzed using the Chi-squared test. RESULTS 94% of the patients were conceived just prior to the period in the year with food shortages. Consequently, the development of the female embryos occurred under nutritional constraints, which negatively affect the recruitment of the vital factors required for the normal synthesis of DNA, proteins and placental differentiation. DISCUSSIONS A nutritional deficiency in the mother at conception of their daughter (future patient) is implicated in the higher incidence of CHM in their daughters' filiation. These nutritional deficiencies during the first weeks of pregnancy will have repercussions on the normal development of the oocytes. Accordingly, these developmental impairments take place during the embryonic life of the future mothers of complete moles and not during the conception of the moles themselves.
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Affiliation(s)
- P Coullin
- INSERM U 972, Hôpital P. Brousse, Bâtiment Lavoisier, 14 Avenue P. V. Couturier, 94800 Villejuif, France; Université Paris XI, Paris Sud, Orsay, France
| | - A L Diatta
- Laboratoire de cytogénétique et service d'obstétrique, CHU Le Dantec, Dakar, Senegal
| | - H Boufettal
- Service de Gynécologie-Obstétrique, CHU Ibn Rochd, Casablanca, Morocco
| | - J Feingold
- AP-HP, Département de génétique et cytogénétique, Fédération de Génétique, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - E Leguern
- AP-HP, Département de génétique et cytogénétique, Fédération de Génétique, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France; INSERM, CRicm (U975), Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France; UPMC Université Paris 06, F-75005 Paris, France
| | - J J Candelier
- INSERM U 972, Hôpital P. Brousse, Bâtiment Lavoisier, 14 Avenue P. V. Couturier, 94800 Villejuif, France; Université Paris XI, Paris Sud, Orsay, France.
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Mangili G, Giorgione V, Gentile C, Bergamini A, Pella F, Almirante G, Candiani M. Hydatidiform mole: age-related clinical presentation and high rate of severe complications in older women. Acta Obstet Gynecol Scand 2014; 93:503-7. [PMID: 24575838 DOI: 10.1111/aogs.12357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 02/07/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to demonstrate differences in clinical presentation of hydatidiform mole between women ≥40 years and younger women. DESIGN Retrospective study. SETTING A tertiary referral unit in northern Italy. POPULATION Three hundred and sixty-five women with hydatidiform mole were divided into group A (<40 years, 318 cases) and group B (≥40 years, 47 cases). METHODS Clinical presentation between groups A and B was analyzed, also considering partial hydatidiform mole and complete hydatidiform mole. MAIN OUTCOME MEASURES Differences in clinical presentation according to woman's age. RESULTS In group B the diagnosis of hydatidiform mole at ≥12 gestational weeks was more frequent (p < 0.001) and the detection of ultrasound features was higher (p < 0.05) than in group A. Vaginal bleeding (p < 0.05), increased uterine volume (p < 0.0001) and hyperemesis (p < 0.05) occurred more frequently in group B. In the women with complete hydatidiform mole, group B women presented with vaginal bleeding (p < 0.001), increased uterine volume (p < 0.05) and hyperemesis (p < 0.05) more frequently than group A women. Complete hydatidiform mole was more commonly diagnosed after 12 weeks of gestation in group B (p < 0.0001). In women ≥50 years, an increased rate of disease-related complications was detected. CONCLUSIONS The clinical features of hydatidiform mole in women ≥40 years are different from those seen in younger women. Failures in the early detection of hydatidiform mole in older women may expose them to a higher rate of severe complications.
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Affiliation(s)
- Giorgia Mangili
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Italy
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