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Riccio S, Galanti F, Scudo M, Di Troia L, Ferrillo MG, Manzara F, Ianiri P, Battaglia FA. Recurrent Hydatidiform Moles: A Clinical Challenge-A Case Report and an Update on Management and Therapeutical Strategies. Case Rep Obstet Gynecol 2023; 2023:3752274. [PMID: 37383988 PMCID: PMC10299875 DOI: 10.1155/2023/3752274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023] Open
Abstract
Hydatidiform mole, complete or partial (CHM/PHM), is the most common type of gestational trophoblastic disease (GTD), which is characterized by excessive trophoblastic proliferation and abnormal embryonic development. Some patients present with sporadic or familiar recurrent hydatidiform moles (RHMs), which are characterized by two or more episodes of the disease. A healthy 36-year-old woman was admitted to the Obstetrics and Gynecology Unit of Santa Maria Goretti Hospital, Latina, because of RHMs at 6 weeks of amenorrhea, with an obstetrical anamnesis of RHMs. We performed uterine dilatation and curettage with suction evacuation. The histological examination confirmed the diagnosis of PHM. The clinical follow-up was conducted according to recent guidelines on the diagnosis and management of GTD. After the return to the baseline values of the beta-human chorionic gonadotropin hormone, a combined oral contraceptive therapy was proposed, and the patient was invited to undergo in vitro fertilization (IVF) techniques, specifically oocyte donation, to reduce the possibility of similar future cases of RHMs. Although some etiopathogenetic mechanisms involved in RHMs are still unknown, all patients of childbearing age who are affected by this syndrome should be properly treated and directed towards a correct clinical path as IVF, to have a successful and safe pregnancy.
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Affiliation(s)
- S. Riccio
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - F. Galanti
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - M. Scudo
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - L. Di Troia
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - M. G. Ferrillo
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - F. Manzara
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - P. Ianiri
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
| | - F. A. Battaglia
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Via Canova, Latina 04100, Italy
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Solovova OA, Chernykh VB. Genetics of Oocyte Maturation Defects and Early Embryo Development Arrest. Genes (Basel) 2022; 13:1920. [PMID: 36360157 PMCID: PMC9689903 DOI: 10.3390/genes13111920] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 08/08/2023] Open
Abstract
Various pathogenic factors can lead to oogenesis failure and seriously affect both female reproductive health and fertility. Genetic factors play an important role in folliculogenesis and oocyte maturation but still need to be clarified. Oocyte maturation is a well-organized complex process, regulated by a large number of genes. Pathogenic variants in these genes as well as aneuploidy, defects in mitochondrial genome, and other genetic and epigenetic factors can result in unexplained infertility, early pregnancy loss, and recurrent failures of IVF/ICSI programs due to poor ovarian response to stimulation, oocyte maturation arrest, poor gamete quality, fertilization failure, or early embryonic developmental arrest. In this paper, we review the main genes, as well as provide a description of the defects in the mitochondrial genome, associated with female infertility.
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Choltus H, Lavergne M, De Sousa Do Outeiro C, Coste K, Belville C, Blanchon L, Sapin V. Pathophysiological Implication of Pattern Recognition Receptors in Fetal Membranes Rupture: RAGE and NLRP Inflammasome. Biomedicines 2021; 9:biomedicines9091123. [PMID: 34572309 PMCID: PMC8466405 DOI: 10.3390/biomedicines9091123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022] Open
Abstract
Preterm prelabor ruptures of fetal membranes (pPROM) are a pregnancy complication responsible for 30% of all preterm births. This pathology currently appears more as a consequence of early and uncontrolled process runaway activation, which is usually implicated in the physiologic rupture at term: inflammation. This phenomenon can be septic but also sterile. In this latter case, the inflammation depends on some specific molecules called “alarmins” or “damage-associated molecular patterns” (DAMPs) that are recognized by pattern recognition receptors (PRRs), leading to a microbial-free inflammatory response. Recent data clarify how this activation works and which receptor translates this inflammatory signaling into fetal membranes (FM) to manage a successful rupture after 37 weeks of gestation. In this context, this review focused on two PRRs: the receptor for advanced glycation end-products (RAGE) and the NLRP7 inflammasome.
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Affiliation(s)
- Helena Choltus
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Marilyne Lavergne
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Coraline De Sousa Do Outeiro
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Karen Coste
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Corinne Belville
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Loïc Blanchon
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
| | - Vincent Sapin
- CNRS, INSERM, GReD, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (H.C.); (M.L.); (C.D.S.D.O.); (K.C.); (C.B.); (L.B.)
- CHU de Clermont-Ferrand, Biochemistry and Molecular Genetic Department, 63000 Clermont-Ferrand, France
- Correspondence: ; Tel.: +33-473-178-174
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Kopelman ZA, Hope ER. High-Risk Gestational Trophoblastic Neoplasia from a Homozygous NLRP7 Mutation. Gynecol Oncol Rep 2021; 37:100803. [PMID: 34189227 PMCID: PMC8215180 DOI: 10.1016/j.gore.2021.100803] [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: 04/01/2021] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022] Open
Abstract
NLRP7 germline mutation can result in high risk gestational trophoblastic neoplasia. No successful reproductive outcomes have been reported with homozygous NLRP7 mutation. Germline testing should be considered for patients presenting with recurrent gestational trophoblastic disease. Once an NLRP7 mutation is diagnosed, consultation with reproductive endocrinology is necessary to discuss future fertility. Further research is needed in rare cases regarding gestational trophoblastic neoplasia recurrence and reproductive outcomes.
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Affiliation(s)
- Zachary A Kopelman
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
| | - Erica R Hope
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
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The genetics of recurrent hydatidiform moles in Mexico: further evidence of a strong founder effect for one mutation in NLRP7 and its widespread. J Assist Reprod Genet 2021; 38:1879-1886. [PMID: 33751332 DOI: 10.1007/s10815-021-02132-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To investigate the frequency of a founder mutation in NLRP7, L750V, in independent cohorts of Mexican patients with recurrent hydatidiform moles (RHMs). METHODS Mutation analysis was performed by Sanger sequencing on DNA from 44 unrelated Mexican patients with RHMs and seven molar tissues from seven additional unrelated patients. RESULTS L750V was present in homozygous or heterozygous state in 37 (86%) patients and was transmitted on the same haplotype to patients from different states of Mexico. We also identified a second founder mutation, c.2810+2T>G in eight (18.1%) patients, and a novel premature stop-codon mutation W653*. CONCLUSION Our data confirm the strong founder effect for L750V, which appears to be the most common mutation in NLRP7. We also report on six healthy live births to five patients with biallelic NLRP7 mutations, two from spontaneous conceptions and four from donated ovum and discuss our recommendations for DNA testing and genetic counseling.
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Aiob A, Naskovica K, Sharon A, Bornstein J. A possible association between hydatidiform mole and the COVID-19 pandemic: A retrospective cohort study. Gynecol Oncol 2021; 161:454-457. [PMID: 33712273 PMCID: PMC7934616 DOI: 10.1016/j.ygyno.2021.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/27/2021] [Indexed: 11/25/2022]
Abstract
Objective To confirm an increase in the number of women with molar pregnancy during the COVID-19 pandemic. Methods In this retrospective cohort study, all patients with complete or partial mole diagnosed at our institution between January 1, 2010 and October 31, 2020, were included. To verify whether there was an increase in the incidence of hydatidiform mole (HM) and deliveries in 2020, the incidences for each year from January 2010 to October 2020 were recorded. In addition, we identified all women who were diagnosed with HM from January to October 2020, and compared them with a control group who underwent uterine evacuation for missed abortion of a singleton pregnancy during the same period. We also documented the time taken to diagnose missed abortion or molar pregnancy to check if a delay in diagnosis can explain the increase in HM incidence. Results Between 2016 and 2019, there was a statistically significant increase in the incidence of molar pregnancy. A further increase occurred in 2020 (odds ratio = 2.071). The mean gestational age of the embryo at the time of diagnosis was smaller in the HM group than in the missed abortion group (6.3 ± 1.67–7.4 ± 2.4, one-sided P = 0.034), meaning that it took more time (days) to diagnose molar pregnancy than missed abortion (22.38 ± 10.32 vs. 15.83 ± 7.83 days, P = 0.012). Conclusion There was a significant increase in the incidence of molar pregnancy during the COVID-19 pandemic, possibly because of the delay in receiving medical care. We recommend providing gynecological primary care services during a crisis, such as a pandemic.
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Affiliation(s)
- Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Centre, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Karina Naskovica
- Department of Obstetrics and Gynecology, Galilee Medical Centre, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Avishalom Sharon
- Department of Obstetrics and Gynecology, Galilee Medical Centre, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Centre, Nahariya, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
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Abbas AM, Ahmed L, Salem AS, Elsamman SH, Refai A, Fathy SK, Ahmed OA, Shalotut AS, AbdelWahab RA. COVID-19 and hydatidiform mole. Am J Reprod Immunol 2020; 84:e13310. [PMID: 32698238 PMCID: PMC7404502 DOI: 10.1111/aji.13310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 07/16/2020] [Indexed: 12/22/2022] Open
Abstract
The emergence of coronavirus disease 2019 (COVID‐19) as a pandemic threatens the entire world resulting in severe consequences for people's health. Pregnant patients with COVID‐19 had immune dysregulation that could result in abnormal pregnancy outcomes such as hydatidiform mole (HM), recurrent pregnancy loss, and early‐onset preeclampsia. In this article, we tried to summarize the possible association between COVID‐19 and the HM's development by reviewing the role of NOD‐Like Receptor (NLR) Family Pyrin Domain Containing 7 (NLRP7), cytokines, zinc, and leukocytes in the pathogenesis of HM.
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Affiliation(s)
- Ahmed M Abbas
- Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.,COvid-19 Research of Assiut UNiversity Association (CORAUNA) group, Assiut, Egypt
| | - Lobna Ahmed
- COvid-19 Research of Assiut UNiversity Association (CORAUNA) group, Assiut, Egypt.,Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amera S Salem
- COvid-19 Research of Assiut UNiversity Association (CORAUNA) group, Assiut, Egypt.,Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shimaa H Elsamman
- COvid-19 Research of Assiut UNiversity Association (CORAUNA) group, Assiut, Egypt.,Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Alshaima Refai
- COvid-19 Research of Assiut UNiversity Association (CORAUNA) group, Assiut, Egypt.,Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Safaa K Fathy
- COvid-19 Research of Assiut UNiversity Association (CORAUNA) group, Assiut, Egypt.,Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Omar A Ahmed
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Asmaa S Shalotut
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Radwa A AbdelWahab
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
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8
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Pregnancy after oocyte donation in a patient with NLRP7 gene mutations and recurrent molar hydatidiform pregnancies. J Assist Reprod Genet 2020; 37:2273-2277. [PMID: 32592075 DOI: 10.1007/s10815-020-01861-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/16/2020] [Indexed: 01/26/2023] Open
Abstract
Molar pregnancies are benign trophoblastic diseases associated with a risk of malignant transformation. If aetiology remains mostly unknown, the risk of recurrent molar pregnancy is around 1.5% after one molar pregnancy and around 25% after 2 molar pregnancies. In the later situation, genetic mutations have been described, increasing hugely this risk. In case of mutations, probability to obtain a normal pregnancy is estimated around 1.8%. We report the case of a Caucasian 30-year-old woman whose previous five spontaneous pregnancies had a negative outcome: a spontaneous miscarriage and then 4 complete hydatidiform moles. Genetic testing revealed that the patient carried two heterozygous mutations in the NLRP7 gene (c.2982-2A > G and Y318CfsX7). According to this, counselling was conducted to advocate for oocyte donation in order to obtain a normal pregnancy. This technique enabled a complication-free, singleton pregnancy that resulted in a healthy term live birth of a 2900 g female. Few months after delivery, the patient presented a new complete hydatidiform mole. Women presented with mutations in the NLRP7, KHDC3L or PADI6 genes are unlikely to obtain normal pregnancies, with a major risk of reproductive failure. In such a context, oocyte donation may be the best option. Only 4 normal pregnancies and deliveries have been published in this situation through this technique to our knowledge.
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Abbas AM, Ahmed OA, Shaltout AS. Hydatidiform mole in the era of COVID-19 pandemic. Is there an association? Am J Reprod Immunol 2020; 84:e13253. [PMID: 32320102 PMCID: PMC7235493 DOI: 10.1111/aji.13253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID‐19) is considered a worldwide pandemic. COVID‐19 patients had profound immune dysregulation so they could be susceptible for adverse pregnancy outcomes as hydatidiform mole. In this article, we tried to explain the link between hydatidiform mole and COVID‐19.
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Affiliation(s)
- Ahmed M Abbas
- Faculty of Medicine, Department of Obstetrics & Gynecology, Assiut University, Assiut, Egypt
| | - Omar A Ahmed
- Faculty of Medicine, Department of Pathology, Assiut University, Assiut, Egypt
| | - Asmaa S Shaltout
- Faculty of Medicine, Department of Medical Microbiology & Immunology, Assiut University, Assiut, Egypt
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