1
|
Lopes RN, Pacheco EO, Torres LR, Torres US, D'Ippolito G. Common and Uncommon Gestational Complications in Radiological Practice: An Overview. Semin Ultrasound CT MR 2024:S0887-2171(24)00051-9. [PMID: 39069274 DOI: 10.1053/j.sult.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Gestational complications are common in radiological practice and can be identified and evaluated using various imaging methods. Each complication typically presents with specific imaging features; however, there is a lack of comprehensive literature that consolidates this information to facilitate a diagnostic algorithm and focused study. In this context, this review aims to revisit the theoretical basis of differentials in pregnancy-related complications, discussing classic imaging features and providing examples of key features for each diagnosis. The focus is on essential information for accurate diagnosis, emphasizing the role of radiologists in contributing to better outcomes.
Collapse
Affiliation(s)
- Raquel N Lopes
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Eduardo O Pacheco
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Grupo Fleury, São Paulo, Brazil
| | - Lucas R Torres
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Grupo Fleury, São Paulo, Brazil
| | - Ulysses S Torres
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Grupo Fleury, São Paulo, Brazil.
| | - Giuseppe D'Ippolito
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Grupo Fleury, São Paulo, Brazil
| |
Collapse
|
2
|
Sankhe DD, Somalwar S, Jiandani F, Jain S, Shetty A. Invasive Mole Mimicking Abnormal Uterine Bleeding: A Case Report. Cureus 2023; 15:e35195. [PMID: 36968909 PMCID: PMC10032175 DOI: 10.7759/cureus.35195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
Invasive mole (IM) is a very uncommon subtype of gestational trophoblastic disease (GTD), which is the invasion of molar tissue into the uterine or myometrial vasculature. However, this report presents a rare case of a 41-year-old female multiparous P7 with five full-term normal vaginal deliveries and two preterm normal vaginal deliveries. As the patient was not using contraception, her urine pregnancy test (UPT) was done, which demonstrated positive results. A speculum examination revealed a healthy cervix with just mild bleeding, whereas a vaginal examination revealed a firm cervix and an anteverted and mobile eight-week-old uterus along with a free fornix. Pelvic ultrasound and magnetic resonance imaging (MRI) demonstrated the diagnosis of GTD, for which consultation from an oncology physician was taken and the treatment proceeded with a total abdominal hysterectomy. Histological examination of the uterus showed a circumscribed nodule showing a large area of hemorrhage with few chorionic villi lined with trophoblastic cells and occasional villi invading the myometrium and endometrial cavity suggesting hydatidiform mole showing early invasion that confirmed the diagnosis of IM. In conclusion, reproductive-age women who experience abnormal uterine bleeding (AUB) should suspect pregnancy with several possible complications, for which a pregnancy test should be done to rule out complications.
Collapse
|
3
|
Gestational trophoblastic disease: an update. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1793-1815. [PMID: 36763119 DOI: 10.1007/s00261-023-03820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/11/2023]
Abstract
Gestational trophoblastic diseases (GTD) encompass a spectrum of rare pre-malignant and malignant entities originating from trophoblastic tissue. This updated review will highlight important radiological features, pathology and classification, and provide insight into the clinical management of these uncommon disorders. There is a wide geographic variation with the incidence of hydatidiform mole varying between 0.57 and 2 per 1000 pregnancies. The use of ultrasound (US) in the management of early pregnancy symptoms and complications has positively impacted the earlier detection of these diseases and resulted in diminished morbidity. Additional imaging modalities are reserved for problem solving or assessment of pulmonary manifestations of molar pregnancy. Having an awareness of their pleomorphic sonographic presentation and additional pathology that can mimic GTD is critical to avoiding pitfalls. Histologic and molecular analysis further aids in differential diagnosis. Gestational trophoblastic neoplasia (GTN) is inclusive of all malignant GTDs, and arises after 20% of molar pregnancies but can also be seen with non-molar gestations. Biochemical monitoring with human chorionic gonadotrophin is imperative for ongoing monitoring and surveillance and allows early detection of this entity. Doppler US is used for confirmation of diagnosis with magnetic resonance imaging (MRI) reserved for problem solving or assessment of myometrial invasion. This is of heightened relevance in patients undergoing surgical management. Cross sectional imaging is reserved for patients in the setting of GTN for the purposes of staging, prognostication and in the setting of recurrent disease. This may require a combination of computed tomography, MRI and positron emission tomography. Doppler US can provide insight into chemotherapeutic response/predict resistance in patients with GTN. As our understanding of these disorders evolves, there has been maturation in management options with a shift from traditional chemotherapy to innovative immunotherapy, particularly in the setting of resistant or high-risk disease.
Collapse
|
4
|
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]
|
5
|
Weng D, Han T, Dong J, Zhang M, Mi Y, He Y, Li X, Zhu X. Angiogenin and MMP-2 as potential biomarkers in the differential diagnosis of gestational trophoblastic diseases. Medicine (Baltimore) 2022; 101:e28768. [PMID: 35119039 PMCID: PMC8812619 DOI: 10.1097/md.0000000000028768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Gestational trophoblastic diseases (GTDs) are characterized by vascular abnormalities of the trophoblast, but their pathogenesis is unknown. Angiogenin (ANG) and matrix metalloproteinase (MMP)-2, which are molecules implicated in the angiogenic process, may play some role in this process. MATERIAL AND METHODS We determined ANG and MMP-2 in the placental tissues of 26 patients who had a benign mole (BM), 12 patients with gestational trophoblast neoplasia (GTN) (1 invasive hydatidiform mole, 10 choriocarcinomas, and 1 placental-site trophoblastic tumor), and 28 normal chorionic villi (NCV) subjects using immunohistochemistry staining. We obtained the serum samples from 20 patients with GTDs and 20 early pregnant women and evaluated them by the enzyme linked immunosorbent assay. RESULTS ANG expression in GTN (66.7%) and BM (100%) samples were both significantly higher (strong/intermediate staining) than in NCV (60.7%) samples (P < .001). Similarly, the immunoreactivities of MMP-2 in the GTN (66.7%) and BM (80.8%) samples were significantly elevated compared to that of the NCV (57.1%) samples (P < .001). The levels of ANG and MMP-2 in the maternal serum of the GTN group were both significantly higher than those of the control group (P < .001). ANG and MMP-2 expressions were associated with gestation age, clinical stage, and FIGO stage. A positive correlation between ANG and MMP-2 expression was observed (rs = 0.725; P < .01). CONCLUSION ANG and MMP-2 levels were significantly elevated in the placental tissues and maternal serum from patients with GTDs. Further studies with more patients may clarify the vascular abnormalities in GTDs and determine potential biomarkers in the differential diagnosis of GTDs.
Collapse
Affiliation(s)
- Dan Weng
- Department of Obstetrics and Gynecology, Hainan Hospital of PLA General Hospital, Sanya, China
- Department of Obstetrics and Gynecology, Shaanxi Provincial Maternal and Child Health's Hospital, Xi’an, China
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Military Medical University, Xi’an, China
| | - Tao Han
- Department of Orthopedics, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Jin Dong
- Department of Obstetrics and Gynecology, Shaanxi Provincial Maternal and Child Health's Hospital, Xi’an, China
| | - Ming Zhang
- Department of Obstetrics and Gynecology, Shaanxi Provincial Maternal and Child Health's Hospital, Xi’an, China
| | - Yang Mi
- Department of Obstetrics and Gynecology, Shaanxi Provincial Maternal and Child Health's Hospital, Xi’an, China
| | - Yiping He
- Department of Obstetrics and Gynecology, Northwestern Women's and Children's Hospital, Xi’an, China
| | - Xiaojuan Li
- Department of Obstetrics and Gynecology, Northwestern Women's and Children's Hospital, Xi’an, China
| | - Xiaoming Zhu
- Department of Obstetrics and Gynecology, Hainan Hospital of PLA General Hospital, Sanya, China
| |
Collapse
|
6
|
Vesicules or placental lakes in ultrasonography, determining the correct etiology. J Gynecol Obstet Hum Reprod 2020; 50:101738. [PMID: 32360634 DOI: 10.1016/j.jogoh.2020.101738] [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: 10/16/2019] [Revised: 02/16/2020] [Accepted: 03/18/2020] [Indexed: 11/20/2022]
Abstract
The prenatal examination of the placenta is often an afterthought to that of the fetus in ultrasonography. Not giving the placenta its due may however result in potentially serious placental pathologies remaining undiscovered, notably in the presence of anechoic zones. These latter have earned numerous names, including "placental lakes", "placental venous lakes", "placental lacunae" or "placental caverns" among others, but they have received little attention in the literature. We thus feel that it is essential to review the various pathologies that placental lakes may signal, since any one of them may greatly affect patient management. The difficulty resides in the diversity of these pathologies, sometimes oncological, other times fetal, and in the potential need for multidisciplinary surgery. Some of these causes of placental lakes may result in maternal or fetal complications and/or necessitate increased and casespecific surveillance. The diagnosis and treatment of such cases requires close collaboration between sonographers, obstetricians, geneticists and pathologists. The work we present here focuses on the different etiologies to consider in the presence of a lacunar placenta and the necessary diagnostic measures. Our objective is to propose a diagnostic flowchart to aid clinicians in this dense differential diagnosis.
Collapse
|
7
|
Abstract
Ultrasound is the imaging study of choice for detection and full characterization of early pregnancies based on its accuracy, low cost, safety profile, and abundant availability. This article reviews the goals and utility of first-trimester ultrasound in gestation localization, viability determination, and abnormal pregnancies, including ectopic implantation, retained products, and molar pregnancy.
Collapse
Affiliation(s)
- Peter S Wang
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA.
| | - Shuchi K Rodgers
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Mindy M Horrow
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| |
Collapse
|
8
|
Lin LH, Polizio R, Fushida K, Francisco RPV. Imaging in Gestational Trophoblastic Disease. Semin Ultrasound CT MR 2019; 40:332-349. [PMID: 31375173 DOI: 10.1053/j.sult.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Gestational trophoblastic disease (GTD) is a spectrum of disorders characterized by abnormal trophoblastic proliferation. GTD includes benign conditions such as hydatidiform moles and malignant diseases that are referred as gestational trophoblastic neoplasia (GTN). Ultrasound plays a central role in the diagnosis of patients with hydatidiform mole. Other imaging modalities are useful in molar pregnancy, mainly for evaluating pulmonary complications and atypical presentation of hydatidiform mole. GTN typically arises after 20% of molar pregnancies but can uncommonly occur after nonmolar gestations. After uterine evacuation, serial human chorionic gonadotropin levels are evaluated in patients for early detection of GTN. Once GTN is suspected, Doppler ultrasound is the primary tool to confirm the diagnosis; however, magnetic resonance imaging can also help in selected cases. Metastatic disease workup can involve various modalities, including ultrasound, X-ray, computed tomography, magnetic resonance imaging and positron emission tomography/computed tomography. In this article, we review the main imaging modalities used to evaluate patients with GTD.
Collapse
Affiliation(s)
- Lawrence Hsu Lin
- University of Sao Paulo Trophoblastic Disease Center, Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Rodrigo Polizio
- Sao Paulo State Cancer Center, Department of Oncology and Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Koji Fushida
- University of Sao Paulo Trophoblastic Disease Center, Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- University of Sao Paulo Trophoblastic Disease Center, Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
9
|
Cesarean section scar choriocarcinoma, an unusual entity with ultrasound, MRI and pathologic correlation. Clin Imaging 2018; 53:43-48. [PMID: 30312854 DOI: 10.1016/j.clinimag.2018.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/14/2018] [Accepted: 09/24/2018] [Indexed: 11/24/2022]
|
10
|
Faure NP, Massardier J, Bolze PA, Hajri T, Devouassoux M, Golfier F, Rousset P. Tumeurs trophoblastiques gestationnelles : éléments clés dans notre pratique radiologique. IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
11
|
Brown DL, Packard A, Maturen KE, Deshmukh SP, Dudiak KM, Henrichsen TL, Meyer BJ, Poder L, Sadowski EA, Shipp TD, Simpson L, Weber TM, Zelop CM, Glanc P. ACR Appropriateness Criteria ® First Trimester Vaginal Bleeding. J Am Coll Radiol 2018; 15:S69-S77. [DOI: 10.1016/j.jacr.2018.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/27/2022]
|
12
|
Clinical and genetic-epigenetic aspects of recurrent hydatidiform mole: A review of literature. Taiwan J Obstet Gynecol 2018; 57:1-6. [DOI: 10.1016/j.tjog.2017.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/19/2022] Open
|
13
|
Shaaban AM, Rezvani M, Haroun RR, Kennedy AM, Elsayes KM, Olpin JD, Salama ME, Foster BR, Menias CO. Gestational Trophoblastic Disease: Clinical and Imaging Features. Radiographics 2017; 37:681-700. [PMID: 28287945 DOI: 10.1148/rg.2017160140] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gestational trophoblastic disease (GTD) is a spectrum of both benign and malignant gestational tumors, including hydatidiform mole (complete and partial), invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. The latter four entities are referred to as gestational trophoblastic neoplasia (GTN). These conditions are aggressive with a propensity to widely metastasize. GTN can result in significant morbidity and mortality if left untreated. Early diagnosis of GTD is essential for prompt and successful management while preserving fertility. Initial diagnosis of GTD is based on a multifactorial approach consisting of clinical features, serial quantitative human chorionic gonadotropin (β-hCG) titers, and imaging findings. Ultrasonography (US) is the modality of choice for initial diagnosis of complete hydatidiform mole and can provide an invaluable means of local surveillance after treatment. The performance of US in diagnosing all molar pregnancies is surprisingly poor, predominantly due to the difficulty in differentiating partial hydatidiform mole from nonmolar abortion and retained products of conception. While GTN after a molar pregnancy is usually diagnosed with serial β-hCG titers, imaging plays an important role in evaluation of local extent of disease and systemic surveillance. Imaging also plays a crucial role in detection and management of complications, such as uterine and pulmonary arteriovenous fistulas. Familiarity with the pathogenesis, classification, imaging features, and treatment of these tumors can aid in radiologic diagnosis and guide appropriate management. ©RSNA, 2017.
Collapse
Affiliation(s)
- Akram M Shaaban
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Maryam Rezvani
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Reham R Haroun
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Anne M Kennedy
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Khaled M Elsayes
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Jeffrey D Olpin
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Mohamed E Salama
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Bryan R Foster
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Department of Radiology and Imaging Sciences (A.M.S., M.R., R.R.H., A.M.K., J.D.O.) and Department of Pathology (M.E.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| |
Collapse
|
14
|
Savage JL, Maturen KE, Mowers EL, Pasque KB, Wasnik AP, Dalton VK, Bell JD. Sonographic diagnosis of partial versus complete molar pregnancy: A reappraisal. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:72-78. [PMID: 27696434 DOI: 10.1002/jcu.22410] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/27/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To assess the prospective sonographic diagnosis of molar pregnancy and compare sonographic features of complete versus partial molar pregnancy. METHODS This institutional review board--approved retrospective chart review conducted between 2001 and 2011 identified 70 women with a histopathologic diagnosis of molar pregnancy and with available sonograms. Clinical data, images, and reports were reviewed, and features enumerated by radiologists blinded to the final diagnosis. RESULTS Mean age of patients was 30.5 ± 7.0 (SD) years (range, 16-49 years) with a mean gravidity of 3.2 ± 2.3 (SD) (range 1-11). Mean gestational age was 74.0 ± 19.1 day (range 39-138) and serum β-human chorionic gonadotropin was 131 ± 156 mIU/ml (range 447-662,000). Pathologic results showed 48 partial and 22 complete molar pregnancies. Sonographically, partial moles more commonly showed a yolk sac (56.3% versus 0%, p < 0.0001), fetal pole (62.5% versus 4.6%, p < 0.0001), fine septa within the sac (25.0% versus 4.6%, p = 0.05), and normal (31.3% versus 0%, p = 0.002) or minimally cystic placenta (27.1% versus 4.6%, p = 0.49), while complete moles had larger gestational sacs (612 versus 44 mm, p = 0.005), were more often avascular on color Doppler imaging (45.5% versus 18.8%, p = 0.02), had more often abnormal tissue in the uterus (82.6% versus 20.8%, p < 0.0001) and placental masses (86.9% versus 16.7%, p < 0.0001), and were more often diagnosed prospectively (86.4% versus 41.7%, p = 0.0005). CONCLUSIONS Complete molar pregnancy is associated with marked cystic changes and mass formation and is often diagnosed sonographically. Partial molar pregnancy often presents with minor cystic changes of the placenta and remains underdiagnosed sonographically. However, correct prospective diagnosis was made more frequently in this study than in older reports, perhaps due to improved spatial resolution of sonographic equipment. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:72-78, 2017.
Collapse
Affiliation(s)
- Julia L Savage
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109
| | - Katherine E Maturen
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109
| | - Erika L Mowers
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109
| | - Katherine B Pasque
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109
| | - Ashish P Wasnik
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109
| | - Jason D Bell
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109
| |
Collapse
|
15
|
AboEllail MAM, Ishimura M, Sajapala S, Yamamoto K, Tanaka T, Nitta E, Kanenishi K, Hata T. Three-Dimensional Color/Power Doppler Sonography and HD live Silhouette Mode for Diagnosis of Molar Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2049-2052. [PMID: 27492394 DOI: 10.7863/ultra.15.11070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/23/2015] [Indexed: 06/06/2023]
Abstract
We present our experience of using new 3-dimensional color/power Doppler sonography (HDliveFlow; GE Healthcare Japan, Tokyo, Japan) with the HD live silhouette mode for diagnosing complete molar pregnancy in the first trimester and differentiating it from missed abortion with hydropic degeneration. In the case of a complete mole, color Doppler sonography showed numerous vesicles without blood vessels, whereas HDliveFlow with the HD live silhouette mode clearly depicted these vesicles forming a mass with the clear demarcation of its edges and showed no blood flow inside the mass. In contrast to the hydropic abortion, which appeared as some vesicles with many blood vessels around them on color Doppler sonography, HDliveFlow with the HD live silhouette mode showed some vesicles embedded within the abundant blood vessels. The spatial relationship between the vesicles and surrounding highly vascularized uterus could be shown on HDliveFlow with the HD live silhouette mode. This technique might be beneficial as an additional diagnostic tool along with conventional color/power Doppler sonography, and it facilitates the early discrimination of these cases in the first trimester of pregnancy.
Collapse
Affiliation(s)
| | | | - Suraphan Sajapala
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Kenta Yamamoto
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Tamaki Tanaka
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Emiko Nitta
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Kenji Kanenishi
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| |
Collapse
|
16
|
Lima LDLA, Parente RCM, Maestá I, Amim Junior J, de Rezende Filho JF, Montenegro CAB, Braga A. Clinical and radiological correlations in patients with gestational trophoblastic disease. Radiol Bras 2016; 49:241-250. [PMID: 27777478 PMCID: PMC5073391 DOI: 10.1590/0100-3984.2015.0073] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Gestational trophoblastic disease is an abnormality of pregnancy that encompasses
a group of diseases that differ from each other in their propensity for
regression, invasion, metastasis, and recurrence. In the past, it was common for
patients with molar pregnancy to present with marked symptoms: copious bleeding;
theca lutein cysts; uterus larger than appropriate for gestational age; early
preeclampsia; hyperemesis gravidarum; and hyperthyroidism. Currently, with early
diagnosis made by ultrasound, most patients are diagnosed while the disease is
still in the asymptomatic phase. In cases of progression to trophoblastic
neoplasia, staging-typically with Doppler flow studies of the pelvis and chest
X-ray, although occasionally with computed tomography or magnetic resonance
imaging-is critical to the choice of an appropriate antineoplastic therapy
regimen. Because it is an unusual and serious disease that affects women of
reproductive age, as well as because its appropriate treatment results in high
cure rates, it is crucial that radiologists be familiar with gestational
trophoblastic disease, in order to facilitate its early diagnosis and to ensure
appropriate follow-up imaging.
Collapse
Affiliation(s)
- Lana de Lourdes Aguiar Lima
- Master's Student in the Perinatal Health Program at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Izildinha Maestá
- PhD, Adjunct Professor of Obstetrics at the Faculdade de Medicina da Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Botucatu, SP, Brazil
| | - Joffre Amim Junior
- PhD, Associate Professor of Obstetrics at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Director of the Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Jorge Fonte de Rezende Filho
- PhD, Full Professor of Obstetrics at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Carlos Antonio Barbosa Montenegro
- PhD, Full Member Emeritus of the Academia Nacional de Medicina, Full Professor of Obstetrics at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Antônio Braga
- PhD, Adjunct Professor of Obstetrics at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, and at the Faculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| |
Collapse
|
17
|
|
18
|
El-agwany AS, Abdeldayem TM. Invasive mole of the uterus: A description of two cases managed by hysterectomy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
19
|
Lin LH, Bernardes LS, Hase EA, Fushida K, Francisco RPV. Is Doppler ultrasound useful for evaluating gestational trophoblastic disease? Clinics (Sao Paulo) 2015; 70:810-5. [PMID: 26735221 PMCID: PMC4676324 DOI: 10.6061/clinics/2015(12)08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/14/2015] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Doppler ultrasound is a non-invasive method for evaluating vascularization and is widely used in clinical practice. Gestational trophoblastic neoplasia includes a group of highly vascularized malignancies derived from placental cells. This review summarizes data found in the literature regarding the applications of Doppler ultrasound in managing patients with gestational trophoblastic neoplasia. The PubMed/Medline, Web of Science, Cochrane and LILACS databases were searched for articles published in English until 2014 using the following keywords: "Gestational trophoblastic disease AND Ultrasonography, Doppler." Twenty-eight articles met the inclusion criteria and were separated into the 4 following groups according to the aim of the study. (1) Doppler ultrasound does not seem to be capable of differentiating partial from complete moles, but it might be useful when evaluating pregnancies in which a complete mole coexists with a normal fetus. (2) There is controversy in the role of uterine artery Doppler velocimetry in the prediction of development of gestational trophoblastic neoplasia. (3) Doppler ultrasound is a useful tool in the diagnosis of gestational trophoblastic neoplasia because abnormal myometrial vascularization and lower uterine artery Doppler indices seem to be correlated with invasive disease. (4) Lower uterine artery Doppler indices in the diagnosis of gestational trophoblastic neoplasia are associated with methotrexate resistance and might play a role in prognosis. CONCLUSION Several studies support the importance of Doppler ultrasound in the management of patients with gestational trophoblastic neoplasia, particularly the role of Doppler velocimetry in the prediction of trophoblastic neoplasia and the chemoresistance of trophoblastic tumors. Doppler findings should be used as ancillary tools, along with human chorionic gonadotropin assessment, in the diagnosis of gestational trophoblastic neoplasia.
Collapse
Affiliation(s)
- Lawrence H Lin
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Centro de Doenças Trofoblásticas, São Paulo/SP, Brazil
- Corresponding author: E-mail:
| | - Lisandra S Bernardes
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Centro de Doenças Trofoblásticas, São Paulo/SP, Brazil
| | - Eliane A Hase
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Centro de Doenças Trofoblásticas, São Paulo/SP, Brazil
| | - Koji Fushida
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Centro de Doenças Trofoblásticas, São Paulo/SP, Brazil
| | - Rossana P V Francisco
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Centro de Doenças Trofoblásticas, São Paulo/SP, Brazil
| |
Collapse
|
20
|
|
21
|
Characteristics of Three-Dimensional Power Doppler in Gestational Trophoblastic Disease. DISEASE MARKERS 2015; 2015:917687. [PMID: 26257463 PMCID: PMC4519557 DOI: 10.1155/2015/917687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 11/18/2022]
Abstract
Purpose. In the present study, the three-dimensional power Doppler was used as a quantitative method to evaluate its reliability in detecting and assessing of gestational trophoblastic disease (GTD). Methods. 52 GTD patients who received diagnosis and treatment at the first affiliated hospitals of Xi'an Jiaotong University in China between 2011 and 2013 were evaluated using Voluson E8 (GE Medical System). Demographic information, pathological characteristics, clinical history, sonographic images, and related indices (resistance index, vascularization index, and flow and vascularization index) were evaluated. Result. Three-dimension power Doppler indicated that there were significant differences in the resistance index, vascularization index, flow index, and vascularization-flow index between the healthy individuals and each subgroup of patients (P < 0.01). Further, in combining invasive hydatidiform mole and choriocarcinoma groups, there was a significant difference between hydatidiform mole and the combined malignant group (P < 0.01). And the abnormal sonographic and power Doppler findings in GTD were resolved when chemotherapy was done successfully. Conclusion. Combined with the clinical features, sonography and three-dimension power Doppler imaging were helpful in diagnosing GTD as a noninvasive method, distinguishing the invasive nature of disease, detecting the recurrence of the disease, and assessing the effectiveness of the chemotherapy.
Collapse
|
22
|
Dasari P. Missing choriocarcinoma may be easy but not suspecting it in a high-risk case can be potentially fatal. BMJ Case Rep 2015; 2015:bcr-2014-208526. [PMID: 25883254 DOI: 10.1136/bcr-2014-208526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 27-year-old woman, fourth gravida, with three prior consecutive vesicular moles was diagnosed with a recurrent vesicular mole on ultrasonography (USG) and had very low β-human chorionic gonadotropin (HCG) values. During suction evacuation no vesicles were seen and on repeat USG the patient was diagnosed to have fibroid uterus. She was discharged at request and advised to undergo MRI to rule out choriocarcinoma. The MRI was interpreted as fibroid uterus with degeneration. After 3 weeks of suction evacuation, the patient presented with acute abdomen. She underwent emergency laparotomy for haemoperitoneum and was diagnosed as invasive mole with perforation; total hysterectomy was performed. Her β-HCG after laparotomy was more than 200,000 mIU/L, and the histopathological examination revealed choriocarcinoma. When methotrxate, adriamycin and cyclophosphamide (MAC) therapy was advised, the patient initially received methotrexate monotherapy; after three cycles her β-HCG started rising after an initial drop, and the patient required four cycles of EMACO to achieve remission.
Collapse
Affiliation(s)
- Papa Dasari
- Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India
| |
Collapse
|
23
|
Mousavi AS, Zamani A, Khorasanizadeh F, Gilani MM, Zendehdel K. Resistance to single-agent chemotherapy and its risk factors in low-risk gestational trophoblastic neoplasms. J Obstet Gynaecol Res 2014; 41:776-83. [DOI: 10.1111/jog.12613] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Azam Sadat Mousavi
- Gynecology Oncology Department; Valiasr Hospital, Faculty of Medicine; Imam Khomeini Hospital Complex; Tehran University of Medical Sciences; Tehran I.R of Iran
| | - Ashraf Zamani
- Gynecology Oncology Department; Valiasr Hospital, Faculty of Medicine; Imam Khomeini Hospital Complex; Tehran University of Medical Sciences; Tehran I.R of Iran
- Gynecology Oncology Department; Taleghani Hospital; Faculty of Medicine; Arak University of Medical Sciences; Arak I.R of Iran
| | - Faezeh Khorasanizadeh
- Students’ Scientific Research Center; Tehran I.R of Iran
- Cancer Research Center; Cancer Institute of Iran; Tehran University of Medical Sciences; Tehran I.R of Iran
| | - Mitra Modarres Gilani
- Gynecology Oncology Department; Valiasr Hospital, Faculty of Medicine; Imam Khomeini Hospital Complex; Tehran University of Medical Sciences; Tehran I.R of Iran
| | - Kazem Zendehdel
- Cancer Research Center; Cancer Institute of Iran; Tehran University of Medical Sciences; Tehran I.R of Iran
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Plavsic SK, Sarmiento J, Stewart K, Aguila J, Bagherpour A. Pelvic Ultrasound Simulation Training Models and Case Scenarios. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10009-1330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Pelvic ultrasound simulation training using high-fidelity mannequins can provide a safe and controlled learning environment to foster the ultrasound education of medical students, residents and faculty. The instruction can be tailored to the specific needs of the learners. Topics for instruction range from teaching basic anatomy and ultrasound scanning techniques to common and advanced obstetrics and gynecology disease presentations and pathological processes. Simulation can closely approximate patient encounters using case based scenarios which will aid in developing knowledge and skills that can be transferred to the clinical environment. The goal of simulation is to help the learners to become more confident and competent to care for their patients.
How to cite this article
Sarmiento J, Stewart K, Aguila J, Bagherpour A, Kupesic Plavsic S. Pelvic Ultrasound Simulation Training Models and Case Scenarios. Donald School J Ultrasound Obstet Gynecol 2014;8(1):22-30.
Collapse
|
26
|
|
27
|
Zhou Y, Lu H, Yu C, Tian Q, Lu W. Sonographic characteristics of placental site trophoblastic tumor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:679-684. [PMID: 22807194 DOI: 10.1002/uog.12269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate clinical features and ultrasound findings in cases of placental site trophoblastic tumor (PSTT). METHODS Fourteen cases of PSTT treated at our institution between May 2004 and October 2010 were identified and the clinical features and findings on transvaginal sonography (TVS) were investigated. Pathological confirmation of PSTT was obtained in all cases. RESULTS The most frequent symptoms associated with PSTT were abnormal vaginal bleeding, which was present in 11 cases, and amenorrhea, which was present in five cases. The interval from antecedent pregnancy to diagnosis was 4-36 (median, 12.5) months. Blood serum was positive for beta-human chorionic gonadotropin (β-hCG) at the time of ultrasound examination, although the level was generally low, with a median of 166.2 IU/L (range, 4.5-3480.2). Sonographic presentation of PSTT was classified into one of three types according to the characteristics observed on TVS: Type I, heterogeneous solid mass in the uterine cavity (four cases), with minimal to a moderate degree of vascularization on color Doppler imaging; Type II, heterogeneous solid mass in the myometrium (six cases), with minimal to a high degree of vascularization (only one case was highly vascularized); and Type III, cystic lesions in the myometrium (four cases) with a high degree of vascularization (lacunar-type lesions). CONCLUSIONS Combined with clinical features, characteristics demonstrated by TVS provide evidence for the suspicion of PSTT and could contribute to clinical decision making.
Collapse
Affiliation(s)
- Y Zhou
- Ultrasound Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | | | | |
Collapse
|
28
|
Okumura M, Fushida K, Pulcineli Vieira Francisco R, Schultz R, Zugaib M. Sonographic appearance of an advanced invasive mole and associated metastatic thrombus in the inferior vena cava. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:113-115. [PMID: 22238139 DOI: 10.1002/jcu.21875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 11/14/2011] [Indexed: 05/31/2023]
Abstract
We present a case of an advanced invasive mole with a metastatic thrombus in the inferior vena cava in which sonography clearly showed vesicles in the myometrium, ovaries, and metastatic thrombus leading to a diagnosis of invasive mole rather than choriocarcinoma.
Collapse
Affiliation(s)
- Maria Okumura
- Department of Obstetrics, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
29
|
Cavoretto P, Gentile C, Mangili G, Garavaglia E, Valsecchi L, Spagnolo D, Montoli S, Candiani M. Transvaginal ultrasound predicts delayed response to chemotherapy and drug resistance in stage I low-risk trophoblastic neoplasia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:99-105. [PMID: 22262502 DOI: 10.1002/uog.11097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Methotrexate (MTX) resistance is defined on the basis of the human chorionic gonadotropin (hCG) curve. The aim of this study was to identify low-risk non-metastatic patients with gestational trophoblastic neoplasia (GTN) who can achieve resolution by continuing MTX treatment despite a transient hCG plateau. METHODS Before starting chemotherapy, 24 patients with FIGO Stage I GTN underwent transvaginal ultrasonography with power Doppler in order to identify myometrial lesions (areas of increased echogenicity and increased power Doppler signal). Ultrasound response to chemotherapy was defined when myometrial lesions decreased in echogenicity, Doppler signal or size. When ultrasound response occurred, despite chemoresistance defined by hCG values, MTX treatment was continued. RESULTS MTX was continued in three out of seven chemoresistant patients because ultrasound suggested response to MTX. All three of these patients achieved a complete response, thus nearly halving the MTX-resistance rate. CONCLUSION Among patients who are candidates for second-line treatment on the basis of hCG, ultrasound may identify those in whom further MTX administration can induce a delayed complete response.
Collapse
Affiliation(s)
- P Cavoretto
- IRCCS San Raffaele Hospital, Obstetrics and Gynecology Department, Vita-Salute University, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Kurdziel KA, Lindenberg L, Choyke PL. Oncologic Angiogenesis Imaging in the clinic---how and why. IMAGING IN MEDICINE 2011; 3:445-457. [PMID: 22132017 PMCID: PMC3224985 DOI: 10.2217/iim.11.31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The ability to control the growth of new blood vessels would be an extraordinary therapeutic tool for many disease processes. Too often, the promises of discoveries in the basic science arena fail to translate to clinical success. While several anti angiogenic therapeutics are now FDA approved, the envisioned clinical benefits have yet to be seen. The ability to clinically non-invasively image angiogenesis would potentially be used to identify patients who may benefit from anti-angiogenic treatments, prognostication/risk stratification and therapy monitoring. This article reviews the current and future prospects of implementing angiogenesis imaging in the clinic.
Collapse
|
31
|
|
32
|
Cosgrove D, Lassau N. Imaging of perfusion using ultrasound. Eur J Nucl Med Mol Imaging 2010; 37 Suppl 1:S65-85. [PMID: 20640418 DOI: 10.1007/s00259-010-1537-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ultrasound can be used to image perfusion in two ways: the traditional one using Doppler and the more recent using microbubble contrast agents. Doppler is simple to use and inexpensive but is limited to larger vessels with faster flow rates. It cannot interrogate the microvasculature because bulk tissue movement is faster than capillary flow. It has been used for liver and tumour flow. Contrast studies are much richer and can assess both the macro- and microcirculation. One approach analyses the time-intensity curves in a region of interest, e.g. a tumour, myocardium, brain, following bolus i.v. injection. Another approach measures the time taken for the microbubbles to cross a vascular bed of interest. These arrival times can be useful for the liver in both diffuse and focal diseases and for the kidney. Features derived from time-intensity curves following bolus i.v. injections of microbubbles form sensitive early indicators of the vascular response of tumours to antivascular drugs. This approach, known as dynamic contrast-enhanced ultrasound (DCE-US), has been accepted as a valid technique for monitoring tumour response by several authorities.
Collapse
Affiliation(s)
- David Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, UK.
| | | |
Collapse
|
33
|
Abstract
The intrauterine environment has a strong influence on pregnancy outcome. The placenta and the umbilical cord together form the main supply line of the fetus. Amniotic fluid also serves important functions. These three main components decide whether there will be an uneventful pregnancy and the successful birth of a healthy baby. An insult to the intrauterine environment has an impact on the programming of the fetus, which can become evident in later life, mainly in the form of cardiovascular diseases, diabetes, and certain learning disabilities. The past two decades have witnessed major contributions from researchers in this field, who have included ultrasonologists, epidemiologists, neonatologists, and pediatricians. Besides being responsible for these delayed postnatal effects, abnormalities of the placenta, umbilical cord, and amniotic fluid also have associations with structural and chromosomal disorders. Population and race also influence pregnancy outcomes to some extent in certain situations. USG is the most sensitive imaging tool currently available for evaluation of these factors and can offer considerable information in this area. This article aims at reviewing the USG-related developments in this area and the anatomy, physiology, and various pathologies of the placenta, umbilical cord, and the amniotic fluid.
Collapse
Affiliation(s)
- Arun Kinare
- Department of Ultrasound, K.E.M. Hospital, Jehangir Hospital, Pune, India
| |
Collapse
|
34
|
Falkert A, Yildiz A, Seelbach-Goebel B. Partial mole with fetal triploidy as a cause for imminent HELLP-syndrome at 16 weeks of gestation. Arch Gynecol Obstet 2008; 279:423-5. [PMID: 18648829 DOI: 10.1007/s00404-008-0732-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
A woman at 16 weeks of gestation was admitted to our perinatal center with unspecific abdominal pain. The results from blood samples 12 h after admission revealed a fulminant HELLP-syndrome. After starting i.v. corticosteroid therapy, the woman recovered quickly. CVS was performed because of abnormal findings by ultrasound and a fetal triploidy (69, XXX) was diagnosed. Pregnancy was terminated and histopathological examination of the placental tissue confirmed a partial mole.
Collapse
Affiliation(s)
- Andreas Falkert
- Department of Obstetrics and Gynecology, University of Regensburg, Frauenklinik St. Hedwig, Steinmetzstrasse 1-3, 93049 Regensburg, Germany.
| | | | | |
Collapse
|
35
|
Abramowicz JS, Sheiner E. Ultrasound of the placenta: a systematic approach. Part I: Imaging. Placenta 2008; 29:225-40. [PMID: 18262643 DOI: 10.1016/j.placenta.2007.12.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/17/2007] [Accepted: 12/20/2007] [Indexed: 11/28/2022]
Abstract
Diagnostic ultrasound has been in use in clinical obstetrics for close to half-a-century. However, in the literature, examination of the placenta appears to be treated with less attention than the fetus or the pregnant uterus. This is somewhat unexpected, given the obvious major functions this organ performs during the entire pregnancy. Examination of the placenta plays a foremost role in the assessment of normal and abnormal pregnancies. A methodical sonographic evaluation of the placenta should include: location, visual estimation of the size (and, if appearing abnormal, measurement of thickness and/or volume), implantation, morphology, anatomy, as well as a search for anomalies, such as additional lobes and tumors. Additional assessment for multiple gestations consists of examining the intervening membranes (if present). The current review considers the various placental characteristics, as they can be evaluated by ultrasound, and the clinical significance of abnormalities of these features. Numerous and varied pathologies of the placenta can be detected by routine ultrasound. It is incumbent on the clinician performing obstetrical ultrasound to examine the placenta in details and in a methodical fashion because of the far reaching clinical significance and potentially avoidable severe consequences of many of these abnormalities.
Collapse
Affiliation(s)
- J S Abramowicz
- Department of Obstetrics and Gynecology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
| | | |
Collapse
|
36
|
Bensimon D, de la Roque AD, De Laveaucoupet J, Boué F, Musset D. [What is your diagnosis? Lung metastasis of a gestational trophoblastic tumor]. ACTA ACUST UNITED AC 2007; 88:984-6. [PMID: 17878859 DOI: 10.1016/s0221-0363(07)89909-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Bensimon
- Service de Radiologie, Hopital Antoine Béclère, 157 Rue de la Porte de Triavaux, 92140 Clamart, France
| | | | | | | | | |
Collapse
|
37
|
Sherer DM, Stimphil R, Hellmann M, Gorelick C, Serur E, Zigalo A, Jain M, Abulafia O. Transvaginal sonographic findings of isolated intramural uterine choriocarcinoma mimicking an interstitial pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:791-4. [PMID: 16731898 DOI: 10.7863/jum.2006.25.6.791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- David M Sherer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, NY 11203-2098, USA.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Allen SD, Lim AK, Seckl MJ, Blunt DM, Mitchell AW. Radiology of gestational trophoblastic neoplasia. Clin Radiol 2006; 61:301-13. [PMID: 16546459 DOI: 10.1016/j.crad.2005.12.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Revised: 10/26/2005] [Accepted: 12/05/2005] [Indexed: 12/20/2022]
Abstract
Gestational trophoblastic neoplasia (GTN) encompasses a broad spectrum of placental lesions from the pre-malignant hydatidiform mole (complete and partial) through to the malignant invasive mole, choriocarcinoma and rare placental site trophoblastic tumour (PSTT). Ultrasound remains the radiological investigation of choice for initial diagnosis, and it can also predict invasive and recurrent disease. Magnetic resonance imaging is of invaluable use in assessing extra-uterine tumour spread, tumour vascularity, and overall staging. Positron emission tomography and computed tomography undoubtedly have a role in recurrent and metastatic disease, while angiography has a place in disease and complication management. This review will describe the relevant pathophysiology and natural history of GTN, and the use of imaging techniques in the diagnosis and management of these conditions.
Collapse
Affiliation(s)
- S D Allen
- Department of Radiology, Charing Cross Hospital, Hammersmith Hospitals NHS Trust, London, UK
| | | | | | | | | |
Collapse
|
39
|
Abstract
Ultrasound is the modality of choice for evaluating normal or abnormal first trimester pregnancy. Sonography can usually provide a specific diagnosis in abnormal first trimester bleeding. When the sonographic appearance is correlated with the clinical presentation, accurate diagnosis is possible in most cases of gestational trophoblastic disease (GTD). Partial or complete hydatidiform moles can be diagnosed in early gestation. However certain cases will be missed if the curettage material is not sent for pathologic examination. Sometimes molar pregnancies have very unusual sonographic appearances. Sonography and Doppler imaging are helpful in diagnosing gestational trophoblastic disease, in determining whether invasive disease is present, in detecting recurrent disease, and in following the effectiveness of chemotherapy. This pictorial essay describes the pathogenesis, epidemiology, and sonographic spectrum of gestational trophoblastic disease.
Collapse
Affiliation(s)
- Kiran A Jain
- UC Davis Medical Center, Sacramento, CA 95817, USA.
| |
Collapse
|
40
|
|
41
|
Current awareness in prenatal diagnosis. Prenat Diagn 2005; 25:529-34. [PMID: 16032805 DOI: 10.1002/pd.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|