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Willy D, Schmitz R, Möllers M, Heitplatz B, Kuntze A, Stratis Y, Bahlke K, Röpke A, Meyer-Wittkopf M, Oelmeier K. Severe, very early onset preeclampsia in a Covid 19-positive woman with a twin pregnancy presenting with a hydatidiform mole and coexisting normal fetus: a case report. Front Med (Lausanne) 2024; 11:1340905. [PMID: 38414622 PMCID: PMC10896921 DOI: 10.3389/fmed.2024.1340905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024] Open
Abstract
Cases of hydatidiform moles with a coexisting fetus are sparse and patients are at high risk for severe complications. Patients and physicians often face the dilemma of the wish to continue pregnancy until viability of the fetus while the risk for maternal complications increases. We present an educational case of a twin pregnancy presenting with a hydatidiform mole and coexisting normal fetus with a placenta praevia. The patient developed severe, early onset preeclampsia with beginning HELLP-syndrome and was tested Covid-19 positive in the further course. Termination of pregnancy was conducted via caesarean section at 18 + 6 weeks of pregnancy. Histopathology and genetic analysis confirmed a complete hydatidiform mole next to a normal placenta. Close follow-up examinations were conducted and showed normal findings including ß HCG levels normalizing within 5 months. This case combines several rare, difficult and severe medical conditions and demonstrates how an individualized therapy by an interdisciplinary team covering a highly sensitive topic was developed in a situation where no guidelines exist.
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Affiliation(s)
- Daniela Willy
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Barbara Heitplatz
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Anna Kuntze
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Yvonne Stratis
- Institute of Human Genetics, University Hospital Münster, Münster, Germany
| | - Katrin Bahlke
- Institute of Human Genetics, University Hospital Münster, Münster, Germany
| | - Albrecht Röpke
- Institute of Human Genetics, University Hospital Münster, Münster, Germany
| | | | - Kathrin Oelmeier
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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Almuradova E, Karimov Z. Uncommon presentation of gestational trophoblastic disease: A case report of invasive mole with gingival metastasis and unique metastatic dissemination. Int J Gynaecol Obstet 2024; 164:799-801. [PMID: 37909845 DOI: 10.1002/ijgo.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/07/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
SynopsisThis report sheds light on the extraordinary presentation of invasive mole with gingival metastasis. There are limited cases on this topic in the literature.
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Affiliation(s)
- Elvina Almuradova
- Department of Oncology, Medicana International Hospital, Izmir, Turkey
- Department of Oncology, Ege University Hospital, Izmir, Turkey
| | - Ziya Karimov
- Medicine Program, Ege University Faculty of Medicine, Izmir, Turkey
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3
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Qian J, Gracious K, Sun L. Rapid progression from complete molar pregnancy to post-molar gestational trophoblastic neoplasia: a rare case report and literature review. Front Oncol 2023; 13:1303249. [PMID: 38162509 PMCID: PMC10757842 DOI: 10.3389/fonc.2023.1303249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
Background Post-molar gestational trophoblastic neoplasia (pGTN) develops in about 15% to 20% of complete hydatidiform mole (CMH). Commonly, pGTN is diagnosed based on hCG monitoring following the molar evacuation. To date, no detailed information is available on how fast can pGTN develop from CHM. However, the concurrence of CHM and pGTN is extremely rare. Case presentation A 29-year-old woman presented to the gynecology department with irregular vaginal bleeding and an elevated hCG serum level. Both ultrasound and MRI showed heterogeneous mass in uterine cavity and myometrium. Suction evacuation was performed and histologic examination of the evacuated specimen confirmed complete hydatidiform mole. Repeated ultrasound showed significant enlargement of the myometrium mass one week after the evacuation. pGTN with prognostic score of 4 was then diagnosed and multi-agent chemotherapy regimen implemented with a good prognosis. Conclusion In rare cases, CMH can rapidly progress into pGTN. Imaging in combination with hCG surveillance seems to play a vital role guiding timely diagnosis and treatment in the specific condition. Low-risk gestational trophoblastic neoplasia (GTN) should be managed stratified according to the individual situation.
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Affiliation(s)
- Jing Qian
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
| | - Kaoma Gracious
- International Education College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liping Sun
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
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Blok L, Eysbouts Y, Lok CAR, Coppus SFPJ, Sweep FCGJ, Ottevanger P. Psychological impact over time of women with pregnancy loss due to gestational trophoblastic disease compared with miscarriage. Int J Gynecol Cancer 2023; 33:1882-1889. [PMID: 37723103 DOI: 10.1136/ijgc-2023-004639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVES Pregnancy loss, occurring after miscarriage or after gestational trophoblastic disease, has a psychological impact. Besides pregnancy loss, women diagnosed with gestational trophoblastic disease have to deal with a prolonged period of follow-up and potential advice to postpone a future pregnancy. We studied the severity and course of the psychological impact after gestational trophoblastic disease and miscarriage, to identify whether women with gestational trophoblastic disease need different psychological care. METHODS A prospective multicenter study using online questionnaires was performed. Women diagnosed with gestational trophoblastic disease or miscarriage received the following questionnaires directly after diagnosis, and after 6, 6, and 12 months: a self-report questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale, and the Reproductive Concerns Scale. RESULTS 74 women with gestational trophoblastic disease and 76 women with miscarriage were included. At baseline, the proportion of women scoring above the cut-off level for the anxiety subscale of the HADS and for the Impact of Event Scale was significantly higher for women with gestational trophoblastic disease than for women after miscarriage (43.2% vs 28.9%, p=0.02 and 87.8% vs 78.9%, p=0.03, respectively). During follow-up, the differences between both groups vanished and only the Impact of Event Scale after 12 months remained significantly different between women with gestational trophoblastic disease and women after miscarriage (62.7% vs 37.3%, p=0.005). All outcomes, except the Reproductive Concerns Scale, showed a significant decline. However, in women who scored above the cut-off level on the HADS-total or Impact of Event Scale at baseline, and women with psychological or psychiatric history, significant higher scores persisted. CONCLUSION Although women with gestational trophoblastic disease at baseline had more anxiety and distress than women after miscarriage, no significant differences were seen using the HADS-total after 12 months. Using the HADS or Impact of Event Scale directly after pregnancy loss is helpful to identify women at risk of remaining psychological symptoms to provide them with extra psychological support.
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Affiliation(s)
- Laura Blok
- Department of Laboratory Medicine, Radboudumc, Nijmegen, The Netherlands
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Yalcke Eysbouts
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Christianne A R Lok
- Department of Gynaecologic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S F P J Coppus
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Fred C G J Sweep
- Department of Laboratory Medicine, Radboudumc, Nijmegen, The Netherlands
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Piątek S, Szczęsny N, Szymusik I, Karoń K, Piątkowski K, Bornio E, Bidziński M, Gujski M. Fertility-Sparing Treatment in Gestational Choriocarcinoma: Evaluating Oncological and Obstetrical Outcomes in Young Patients. Med Sci Monit 2023; 29:e942078. [PMID: 37957930 PMCID: PMC10656781 DOI: 10.12659/msm.942078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Gestational choriocarcinoma (GC) is an uncommon neoplasia that occurs in women who may not have completed a procreation plan. The aim of this study was to evaluate oncological and obstetrical outcomes in young patients with GC after fertility-sparing treatment. MATERIAL AND METHODS The eligibility criteria for the study were histopathological diagnosis of GC, age ≤40 years, and treatment with systemic chemotherapy. Patients who underwent upfront hysterectomy were excluded. The response to treatment was assessed according to beta-human chorionic gonadotropin (beta-hCG) serum measurement. Complete response and progression were considered if the beta-hCG dropped to a normal range and increased (or reached a plateau), respectively. The birth rate was calculated as the number of women who gave birth after treatment divided by the total number of patients. RESULTS A total of 18 patients fulfilled the study's eligibility criteria. A complete response and progression to first-line chemotherapy were found in 13 (72.22%) and 5 (27.78%) patients, respectively. Salvage treatment was administered to patients with progression. Overall, 16 (88.88%) patients achieved complete response after treatment and 2 (11.12%) died. GC relapse was diagnosed in 1 patient 62 months after treatment. The birth rate was 22.22%, and a total of 6 children were born. All pregnancies ended in term delivery. No congenital abnormalities were detected in the newborns. CONCLUSIONS GC is a life-threatening form of gestational trophoblastic neoplasia, mainly due to its rapid course and resistance to chemotherapy. Most patients with GC will not be able to bear children after treatment.
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Affiliation(s)
- Szymon Piątek
- Department of Gynecologic Oncology, The Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Natalia Szczęsny
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pułaski University of Technology and Humanities, Radom, Poland
| | - Iwona Szymusik
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Karolina Karoń
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pułaski University of Technology and Humanities, Radom, Poland
| | - Krzysztof Piątkowski
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pułaski University of Technology and Humanities, Radom, Poland
| | - Ewelina Bornio
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pułaski University of Technology and Humanities, Radom, Poland
| | - Mariusz Bidziński
- Department of Gynecologic Oncology, The Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Mariusz Gujski
- Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
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McInerney C, McNally O, Cade TJ, Jones A, Neesham D, Naaman Y. Low-risk gestational trophoblastic neoplasia - 20 years experience of a state registry. Aust N Z J Obstet Gynaecol 2023. [PMID: 37964485 DOI: 10.1111/ajo.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/28/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy. AIMS To report the experience of a statewide registry in the treatment of low-risk gestational trophoblastic neoplasia (GTN) over a 20-year period. MATERIALS AND METHODS A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low-risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed. RESULTS The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0-29 days). Seventy-seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi-agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5-6 (odds ratio (OR) 6.56, 95% CI 1.73-24.27, P = 0.005) and those with pre-treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73-24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry. CONCLUSIONS Methotrexate is a highly effective treatment for low-risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5-6 requires further investigation.
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Affiliation(s)
- Carmel McInerney
- Department of Gynaecological Oncology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Orla McNally
- Department of Gynaecological Oncology, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas James Cade
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Antonia Jones
- Department of Gynaecological Oncology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Deborah Neesham
- Department of Gynaecological Oncology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Yael Naaman
- Department of Gynaecological Oncology, The Royal Women's Hospital, Melbourne, Victoria, Australia
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Mitric C, Yang K, Bhat G, Lheureux S, Laframboise S, Li X, Bouchard-Fortier G. Gestational trophoblastic neoplasia: does centralization of care impact clinical management? Int J Gynecol Cancer 2023; 33:1724-1732. [PMID: 37723102 DOI: 10.1136/ijgc-2023-004526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE International societies advocate for gestational trophoblastic neoplasia referral to designated expert centers. This study assessed the impact of centralization of trophoblastic care on clinical outcomes. METHODS A centralized program was implemented in 2018 at two affiliated academic hospitals, Princess Margaret Cancer Center and Mount Sinai Hospital. A retrospective analysis of patients treated between 2000 and 2022 was performed and the clinical outcomes were compared before (2000-2017) and after (2018-2022) centralization. Statistical analyses were performed with significance set as p<0.05. RESULTS A total of 94 patients with trophoblastic neoplasia were included: 60 pre-centralization and 34 post-centralization, 79.8% low-risk and 18.1% high-risk. Centralization led to significant improvement for: (1) accurate score documentation (from 37.9% to 89.3%,); (2) contraception counseling (from 67.2% to 96.7%); (3) median time from diagnosis to chemotherapy (from 9 days to 1 day); and (4) incomplete follow-up (from 20.7% to 3.3%) (all p<0.05). First-line chemotherapy for low-risk neoplasia was dactinomycin in 47.9% and 87.0% pre- and post-centralization, respectively (p=0.005). The median number of chemotherapy cycles decreased from seven to four (p=0.01), and the median number of consolidation cycles increased from two to three (p<0.001). Serum human chorionic gonadotropin (hCG) levels of 10 000-100 000 IU/L were significantly associated with longer time to hCG normalization and higher risk of resistance to first-line chemotherapy compared with hCG levels <1000 IU/L. CONCLUSION Centralization of trophoblastic neoplasia care leads to greater guideline compliance, faster chemotherapy initiation, fewer chemotherapy cycles with optimized consolidation, and enhanced surveillance completion. This supports the establishment of trophoblastic neoplasia expert centers.
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Affiliation(s)
- Cristina Mitric
- Sinai Health, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
| | - Kelsey Yang
- Sinai Health, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
| | - Gita Bhat
- Medical Oncology, Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
| | - Stephanie Lheureux
- Medical Oncology, Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
| | - Stephane Laframboise
- Sinai Health, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
| | - Xuan Li
- Department of Biostatistics, Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
| | - Geneviève Bouchard-Fortier
- Sinai Health, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
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8
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Malovrh EP, Lukinovič N, Sobočan M, Knez J. Outcomes of Gestational Trophoblastic Disease Management: A Single Centre Review. Medicina (Kaunas) 2023; 59:1632. [PMID: 37763750 PMCID: PMC10534929 DOI: 10.3390/medicina59091632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Gestational trophoblastic disease (GTD) is a group of pregnancy-related malignant and premalignant diseases. The aim of this study was to assess the prognostic value of clinical characteristics to predict treatment outcomes in women with GTD. Materials and Methods: In this retrospective study, 34 patients treated for GTD at the Division of Gynaecology and Perinatology, University Medical Centre Maribor, between 2008 and 2022 were identified. Clinical and pathological characteristics were obtained by analysing patient data records. Results: Within the cohort of 34 patients with GTD, 29 patients (85.3%) had a partial hydatidiform mole (HM) and five patients545 (14.7%) had a complete HM. Two patients with a complete HM developed a postmolar gestational trophoblastic neoplasia (GTN), which represents 5.8% of all cases. Conclusions: GTD is a rare disease that is frequently asymptomatic. The subsequent consequences of GTD, which can lead to malignant transformation, as well life-threatening disease complications, warrant training for early recognition of HMs and timely treatment and surveillance.
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Affiliation(s)
- Eva Pavla Malovrh
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia; (E.P.M.); (N.L.); (J.K.)
| | - Nuša Lukinovič
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia; (E.P.M.); (N.L.); (J.K.)
| | - Monika Sobočan
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia; (E.P.M.); (N.L.); (J.K.)
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Jure Knez
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia; (E.P.M.); (N.L.); (J.K.)
- Division of Gynaecology and Perinatology, University Medical Centre Maribor, 2000 Maribor, Slovenia
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Kamijo K, Ishida K, Oide S, Anan K, Taito S, Kataoka Y, Chikazawa K. Efficacy and Safety of the Surgery-First Approach Compared to the Chemotherapy-First Approach for Treating Low-Risk Gestational Trophoblastic Neoplasia: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e45726. [PMID: 37868570 PMCID: PMC10590247 DOI: 10.7759/cureus.45726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
For gestational trophoblastic neoplasia (GTN) affecting women of reproductive age, the chemotherapy-first approach is often preferred over the surgery-first approach. Low-risk GTN is treated with a chemotherapy-first approach, but the number of courses required can affect fertility. A surgery-first approach may decrease the number of chemotherapy courses, but its efficacy and safety compared to a chemotherapy-first approach are unclear. Thus, we investigated the efficacy and safety of the surgery-first approach compared to the chemotherapy-first approach in treating low-risk GTN. We searched the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform databases for relevant articles in July 2023. A systematic review and meta-analysis of outcome measures were conducted using a random-effects model. The primary outcomes were remission, the mean number of chemotherapy courses required to cure, and adverse events. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study protocol was registered in the Open Science Framework (https://osf.io/kysvn/). Studies for low-risk GTN included a qualitative synthesis (with 2,192 participants and ten studies, eight of which were about second uterine curettage and two about hysterectomy) and a meta-analysis (with 138 participants and two randomized controlled trials (RCTs) that compared first-line treatments of second uterine curettage and chemotherapy). Second uterine curettage may result in little to no difference in remission (risk ratio: 1.00, 95% confidence interval: 0.96-1.05; low certainty) and a slight reduction in adverse events (risk ratio: 0.87, 95% confidence interval: 0.47-1.60; low certainty). The evidence is very uncertain on the mean number of chemotherapy courses (mean difference: 2.84 lower, 95% confidence interval: 7.31 lower to 1.63 higher; very low certainty). Based on clinical outcomes, second uterine curettage can be comparable to the chemotherapy-first approach as a first-line treatment option for low-risk GTN; however, the overall certainty of the evidence was low or very low.
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Affiliation(s)
- Kyosuke Kamijo
- Obstetrics and Gynecology, Nagano Manicipal Hospital, Nagano, JPN
- Department of Obstetrics and Gynecology, Nagano Prefectural Kiso Hospital, Kiso-gun, JPN
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
| | - Kentaro Ishida
- Department of Obstetrics and Gynaecology, Osaka Red Cross Hospital, Osaka, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, JPN
| | - Shiho Oide
- Urogynecology Center, Kameda Medical Center, Chiba, JPN
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
| | - Keisuke Anan
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, JPN
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JPN
| | - Shunsuke Taito
- Division of Rehabilitation, Hiroshima University Hospital, Hiroshima, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, JPN
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JPN
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, JPN
- Department of Community Medicine, Kyoto University Graduate School of Medicine/Section of Clinical Epidemiology, Kyoto, JPN
| | - Kenro Chikazawa
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, JPN
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10
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Jung H. Complete Hydatidiform Mole with Lung Metastasis and Coexisting Live Fetus: Unexpected Twin Pregnancy Mimicking Placenta Accreta. Diagnostics (Basel) 2023; 13:2249. [PMID: 37443643 DOI: 10.3390/diagnostics13132249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Twin pregnancy with a complete hydatidiform mole and coexisting fetus (CHMCF) is an exceedingly rare condition with an incidence of about 1 in 20,000-100,000 pregnancies. It can be detected by prenatal ultrasonography and an elevated maternal serum beta-human chorionic gonadotropin (BhCG) level. Herein, the author reports a case of CHMCF which was incidentally diagnosed through pathologic examination without preoperative knowledge. The 41-year-old woman, transferred due to preterm labor, delivered a female baby by cesarean section at 28 + 5 weeks of gestation. Clinically, the surgeon suspected placenta accreta on the surgical field, and the placental specimen was sent to the pathology department. On gross examination, focal vesicular and cystic lesions were identified separately from the normal-looking placental tissue. The pathologic diagnosis was CHMCF and considering the fact that placenta accreta was originally suspected, invasive hydatidiform mole was not ruled out. After radiologic work-up, metastatic lung lesions were detected, and methotrexate was administered in six cycles at intervals of every two weeks. The author presents the clinicopathological features of this unexpected CHMCF case accompanied by pulmonary metastasis, compares to literature review findings, and emphasizes the meticulous pathologic examination.
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Affiliation(s)
- Hera Jung
- Department of Pathology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang 10414, Republic of Korea
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11
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Silva VARD, Maestá I, Costa RADA, Campos ADÁ, Braga A, Horowitz N, Elias KM, Berkowitz R. Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease. Rev Bras Ginecol Obstet 2023; 45:e384-e392. [PMID: 37595595 PMCID: PMC10438964 DOI: 10.1055/s-0043-1772179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/12/2023] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE To assess the potential relationship of clinical status upon admission and distance traveled from geographical health district in women with gestational trophoblastic disease (GTD). METHODS This is a cross-sectional study including women with GTD from the 17 health districts from the São Paulo state (I-XVII), Brazil, referred to the Botucatu Trophoblastic Disease Center (specialized center, district VI), between 1990 and 2018. At admission, hydatidiform mole was assessed according to the risk score system of Berkowitz et al. Gestational trophoblastic neoplasia was evaluated using the International Federation of Gynecology and Obstetrics / World Health Organization (FIGO/WHO) staging/risk score. Data on demographics, clinical status and distance traveled were collected. Multiple regression analyses were performed. RESULTS This study included 366 women (335 hydatidiform mole, 31 gestational trophoblastic neoplasia). The clinical status at admission and distance traveled significantly differed between the specialized center district and other districts. Patients referred from health districts IX (β = 2.38 [0.87-3.88], p = 0.002) and XVI (β = 0.78 [0.02-1.55], p = 0.045) had higher hydatidiform mole scores than those from the specialized center district. Gestational trophoblastic neoplasia patients from district XVI showed a 3.32 increase in FIGO risk scores compared with those from the specialized center area (β = 3.32, 95% CI = 0.78-5.87, p = 0.010). Distance traveled by patients from districts IX (200km) and XVI (203.5km) was significantly longer than that traveled by patients from the specialized center district (76km). CONCLUSION Patients from health districts outside the specialized center area had higher risk scores for both hydatidiform mole and gestational trophoblastic neoplasia at admission. Long distances (>80 km) seemed to adversely influence gestational trophoblastic disease clinical status at admission, indicating barriers to accessing specialized centers.
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Affiliation(s)
| | - Izildinha Maestá
- Postgraduation Program in Tocogynecology, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.
- Botucatu Trophoblastic Disease Center, Botucatu Medical School Hospital, São Paulo State University, Botucatu, SP, Brazil.
| | - Roberto Antonio de Araújo Costa
- Postgraduation Program in Tocogynecology, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.
- Scientific Initiation Program by the São Paulo Research Foundation, Botucatu Medical School, São Paulo, SP, Brazil.
| | - Aline de Ávila Campos
- Postgraduation Program in Tocogynecology, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.
- Scientific Initiation Program by the São Paulo Research Foundation, Botucatu Medical School, São Paulo, SP, Brazil.
| | - Antonio Braga
- Rio de Janeiro Trophoblastic Disease Center, Maternity School of the Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.
| | - Neil Horowitz
- Division of Gynaecologic Oncology, Department of Obstetrics, Gynaecology and Reproductive Biology, New England Trophoblastic Disease Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Kevin M. Elias
- Division of Gynaecologic Oncology, Department of Obstetrics, Gynaecology and Reproductive Biology, New England Trophoblastic Disease Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ross Berkowitz
- Division of Gynaecologic Oncology, Department of Obstetrics, Gynaecology and Reproductive Biology, New England Trophoblastic Disease Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA.
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12
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Albright BB, Ellett T, Knochenhaur HE, Goins EC, Monuszko KA, Kaplan SJ, Previs RA, Moss HA, Havrilesky LJ, Davidson BA. Treatments and outcomes in high-risk gestational trophoblastic neoplasia: A systematic review and meta-analysis. BJOG 2023; 130:443-453. [PMID: 36648416 PMCID: PMC10066712 DOI: 10.1111/1471-0528.17374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND High-risk gestational trophoblastic neoplasia (GTN) is rare and treated with diverse approaches. Limited published institutional data has yet to be systematically reviewed. OBJECTIVES To compile global high-risk GTN (prognostic score ≥7) cohorts to summarise treatments and outcomes by disease characteristics and primary chemotherapy. SEARCH STRATEGY MEDLINE, Embase, Scopus, ClinicalTrials.gov and Cochrane were searched through March 2021. SELECTION CRITERIA Full-text manuscripts reporting mortality among ≥10 high-risk GTN patients. DATA COLLECTION AND ANALYSIS Binomial proportions were summed, and random-effects meta-analyses performed. MAIN RESULTS From 1137 records, we included 35 studies, representing 20 countries. Among 2276 unique high-risk GTN patients, 99.7% received chemotherapy, 35.8% surgery and 4.9% radiation. Mortality was 10.9% (243/2236; meta-analysis: 10%, 95% confidence interval [CI] 7-12%) and likelihood of complete response to primary chemotherapy was 79.7% (1506/1890; meta-analysis: 78%, 95% CI: 74-83%). Across 24 reporting studies, modern preferred chemotherapy (EMA/CO or EMA/EP) was associated with lower mortality (overall: 8.8 versus 9.5%; comparative meta-analysis: 8.1 versus 12.4%, OR 0.42, 95% CI: 0.20-0.90%, 14 studies) and higher likelihood of complete response (overall: 76.6 versus 72.8%; comparative meta-analysis: 75.9 versus 60.7%, OR 2.98, 95% CI: 1.06-8.35%, 14 studies), though studies focused on non-preferred regimens reported comparable outcomes. Mortality was increased for ultra-high-risk disease (30 versus 7.5% high-risk; meta-analysis OR 7.44, 95% CI: 4.29-12.9%) and disease following term delivery (20.8 versus 7.3% following molar pregnancy; meta-analysis OR 2.64, 95% CI: 1.10-6.31%). Relapse rate estimates ranged from 3 to 6%. CONCLUSIONS High-risk GTN is responsive to several chemotherapy regimens, with EMA/CO or EMA/EP associated with improved outcomes. Mortality is increased in patients with ultra-high-risk, relapsed and post-term pregnancy disease.
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Affiliation(s)
- Benjamin B. Albright
- Department of Obstetrics and Gynecology, Duke University Medical Center, 20 Duke Medicine Circle, Durham, NC, USA
| | - Tressa Ellett
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC, USA
| | - Hope E. Knochenhaur
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC, USA
| | - Emily C. Goins
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC, USA
| | - Karen A. Monuszko
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC, USA
| | - Samantha J. Kaplan
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC, USA
| | - Rebecca A. Previs
- Department of Obstetrics and Gynecology, Duke University Medical Center, 20 Duke Medicine Circle, Durham, NC, USA
| | - Haley A. Moss
- Department of Obstetrics and Gynecology, Duke University Medical Center, 20 Duke Medicine Circle, Durham, NC, USA
| | - Laura J. Havrilesky
- Department of Obstetrics and Gynecology, Duke University Medical Center, 20 Duke Medicine Circle, Durham, NC, USA
| | - Brittany A. Davidson
- Department of Obstetrics and Gynecology, Duke University Medical Center, 20 Duke Medicine Circle, Durham, NC, USA
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13
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Zampacorta C, Pasciuto MP, Ferro B, Lucidi A, Maestro AS, Espinosa I, D’Angelo E, Prat J. Placental site trophoblastic tumor (PSTT): a case report and review of the literature. Pathologica 2023; 115:111-116. [PMID: 37114629 PMCID: PMC10462996 DOI: 10.32074/1591-951x-873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Placental site trophoblastic tumor (PSTT), also known as atypical choriocarcinoma, syncytioma, chorioepitheliosis or trophoblastic pseudotumor, is a rare gestational trophoblastic disease (0.25-5% of all trophoblastic tumors) and it is composed by neoplastic proliferation of intermediate trophoblasts at placental implantation site. It consists of aggregates or sheets of large, polyhedral to round, predominantly mononucleated cells with a characteristic vascular and myometrial invasion. Main differential diagnoses are gestational choriocarcinoma (GC) and epitelioid trophoblastic tumor (ETT). We present a case of PSTT in a 25-year-old woman. Neoplastic cells showed moderate/high nuclear pleomorphism, abundant amphophilic, eosinophilic and clear cytoplasm, numerous mitotic figures (10 mitoses/10 HPF), and myometrial invasion. Other features are necrosis, vascular invasion with replacement of myometrial vessels by tumor cells and hemorrhage. The patient showed typical low serum β-hCG levels and high serum humane placental lactogen (hPL) levels.
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Affiliation(s)
- Claudia Zampacorta
- Center for Advanced Studies and Technology (CAST), University Chieti-Pescara, Italy
| | - Maria Paola Pasciuto
- Center for Advanced Studies and Technology (CAST), University Chieti-Pescara, Italy
| | - Benedetta Ferro
- Center for Advanced Studies and Technology (CAST), University Chieti-Pescara, Italy
| | | | | | - Inigo Espinosa
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
| | - Emanuela D’Angelo
- Center for Advanced Studies and Technology (CAST), University Chieti-Pescara, Italy
- Department of Medical, Oral, and Biotechnological Sciences University “G. D’Annunzio” of Chieti-Pescara
| | - Jaime Prat
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
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14
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Malovrh EP, Lukinovič N, Bujas T, Sobočan M, Knez J. Ultra-High-Risk Gestational Choriocarcinoma of the Ovary Associated with Ectopic Pregnancy. Curr Oncol 2023; 30:2217-2226. [PMID: 36826132 PMCID: PMC9955943 DOI: 10.3390/curroncol30020171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
Gestational choriocarcinoma of the ovary is an exceptionally rare and highly aggressive tumor. Preoperative diagnosis of extrauterine choriocarcinoma is difficult due to nonspecific clinical presentation and its resemblance to ectopic pregnancy. Without molecular genetic analysis, it is not possible to reliably differentiate gestational from non-gestational choriocarcinoma. Here, we present a case of a 44-year-old woman who presented to our emergency department with complaints of pelvic pain, vaginal bleeding, and amenorrhea. Because of a recent history of conservatively managed ectopic pregnancy, the patient underwent emergency laparoscopy. Right-sided salpingo-oophorectomy was performed due to intraoperatively suspected ovarian ectopic pregnancy. Histopathology results revealed the diagnosis of ovarian choriocarcinoma of possible gestational origin. It was classified as FIGO stage IV and WHO ultra-high-risk, and she underwent multi-agent chemotherapy without major complications. She has remained in complete remission after a 12-month follow-up. Considering the rarity of this diagnosis, we conducted a literature review including all published cases of suspected gestational choriocarcinomas of the ovary. We conclude that due to the rarity of this entity, preoperative differentiating between ovarian ectopic pregnancy and ovarian choriocarcinoma is extremely challenging, and without molecular genetic analysis, it is not possible to identify the genetic origin of the tumor.
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Affiliation(s)
| | - Nuša Lukinovič
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Tatjana Bujas
- Department of Pathology, University Medical Centre, 2000 Maribor, Slovenia
| | - Monika Sobočan
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
- Clinic for Gynaecology and Perinatology, University Medical Centre, 2000 Maribor, Slovenia
| | - Jure Knez
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
- Clinic for Gynaecology and Perinatology, University Medical Centre, 2000 Maribor, Slovenia
- Correspondence:
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15
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Braga A, Paiva G, Cattai CJ, Elias KM, Horowitz NS, Berkowitz RS. Current chemotherapeutic options for the treatment of gestational trophoblastic disease. Expert Opin Pharmacother 2023; 24:245-258. [PMID: 36399723 DOI: 10.1080/14656566.2022.2150075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Gestational trophoblastic neoplasia (GTN) is a rare tumor that arises from trophoblastic tissues with high remission rates after chemotherapy treatment. GTN can develop from any gestational events, such as miscarriage, ectopic pregnancy, and preterm/term pregnancy, but is more frequent after hydatidiform mole. The sensitivity of this tumor to chemotherapy and the presence of an exceptional tumor marker allow high remission rates, especially when patients are treated in referral centers. AREAS COVERED Observational, retrospective, prospective, systematic reviews, and meta-analysis studies focusing on GTN treatment. We searched PubMed, Medline, and the Library of Congress from January 1965 to May 2022. EXPERT OPINION Early GTN diagnosis allows low-toxic and highly effective treatment. Even multimetastatic disease has high rates of remission with multiagent regimen chemotherapy. Surgery is reserved for uterine disease in patients who have completed childbearing, in cases of chemoresistance to multiagent regimens or in the rare cases of placental site trophoblastic tumor or epithelioid trophoblastic tumor. While resistance is managed by salvage chemotherapy, cases with limited clinical response to sequential regimens have been successfully treated with immunotherapy.
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Affiliation(s)
- Antonio Braga
- Department of Obstetrics and Gynecology, Postgraduate Program in Perinatal Health, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.,, Department of Maternal Child, Postgraduate Program in Medical Sciences, Antonio Pedro University Hospital of Fluminense Federal University, Niterói, RJ, Brazil.,Department of Medicine, Vassouras Medical School, Postgraduate Program in Applied Health Sciences, Vassouras University, Vassouras, RJ, Brazil.,National Academy of Medicine, Young Leadership Physician Program, Rio de Janeiro, RJ, Brazil
| | - Gabriela Paiva
- Department of Obstetrics and Gynecology, Postgraduate Program in Perinatal Health, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.,, Department of Maternal Child, Postgraduate Program in Medical Sciences, Antonio Pedro University Hospital of Fluminense Federal University, Niterói, RJ, Brazil
| | - Cassia Juliana Cattai
- , Department of Maternal Child, Postgraduate Program in Medical Sciences, Antonio Pedro University Hospital of Fluminense Federal University, Niterói, RJ, Brazil
| | - Kevin M Elias
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Neil S Horowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ross S Berkowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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16
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Campos V, Paiva G, Padron L, Freitas F, Pedrotti LG, Sun SY, Viggiano M, Oliveira L, Rohr L, Madi JM, Arrym TP, Oliveira P, Dos Santos Esteves APV, Junior JA, Filho JR, Elias KM, Horowitz NS, Braga A, Berkowitz RS. Influence of COVID-19 pandemic on molar pregnancy and postmolar gestational trophoblastic neoplasia: An observational study. BJOG 2023; 130:292-302. [PMID: 36209485 DOI: 10.1111/1471-0528.17313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/11/2022] [Accepted: 09/23/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess whether the incidence and aggressiveness of molar pregnancy (MP) and postmolar gestational trophoblastic neoplasia (GTN) changed during the COVID-19 pandemic. DESIGN Observational study with two separate designs: retrospective multicentre cohort of patients with MP/postmolar GTN and a cross-sectional analysis, with application of a questionnaire. SETTING Six Brazilian Reference Centres on gestational trophoblastic disease. POPULATION 2662 patients with MP/postmolar GTN treated from March-December/2015-2020 were retrospectively evaluated and 528 of these patients answered a questionnaire. METHODS Longitudinal retrospective multicentre study of patients diagnosed with MP/ postmolar GTN at presentation and a cross-sectional analysis, with application of a questionnaire, exclusive to patients treated during the period of study, to assess living and health conditions during the COVID-19 pandemic compared with previous years. MAIN OUTCOME MEASURES The incidence of MP/postmolar GTN. RESULTS Compared with the last 5 pre-pandemic years, MP/postmolar GTN incidence remained stable during 2020 (COVID-19 pandemic). Multivariable logistic regression, adjusted for the patient age, showed that during 2020, presentation with MP was more likely to be >10 weeks of gestation (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.90-3.29, P < 0.001), have a pre-evacuation hCG level ≥100 000 iu/l (aOR 1.77, 95% CI 1.38-2.28, P < 0.001) and time to the initiation of chemotherapy ≥7 months (aOR 1.86, 95% CI 1.01-3.43, P = 0.047) when compared with 2015-2019. CONCLUSIONS Although the incidence of MP/postmolar GTN remained stable during the COVID-19 pandemic in Brazil, the pandemic was associated with greater gestational age at MP diagnosis and more protracted delays in initiation of chemotherapy for postmolar GTN.
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Affiliation(s)
- Vanessa Campos
- Department of Maternal Child, Postgraduate Program in Medical Sciences, Fluminense Federal University, Niterói, Brazil.,Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Gabriela Paiva
- Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Lilian Padron
- Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Fernanda Freitas
- Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Sue Yazaki Sun
- Department of Obstetrics, Paulista School of Medicine, São Paulo Federal University, São Paulo, Brazil
| | - Maurício Viggiano
- Department of Obstetrics and Gynecology, Goiania Trophoblastic Disease Center (Clinics Hospital of Goias Federal University), Goiania, Brazil
| | - Larissa Oliveira
- Division of Recife Trophoblastic Disease Center (Clinics Hospital of Pernambuco Federal University), Recife, Brazil
| | - Lucia Rohr
- Division of Recife Trophoblastic Disease Center (Clinics Hospital of Pernambuco Federal University), Recife, Brazil
| | - José Mauro Madi
- Division of Caxias do Sul Trophoblastic Disease Center, General Hospital of Caxias do Sul, School of Medicine, Center for Biological and Health Sciences, Caxias do Sul University, Caxias do Sul, Brazil
| | - Tiago Pedromônico Arrym
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Priscila Oliveira
- Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Ana Paula Vieira Dos Santos Esteves
- Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Joffre Amim Junior
- Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Jorge Rezende Filho
- Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Kevin M Elias
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Neil S Horowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Antônio Braga
- Department of Maternal Child, Postgraduate Program in Medical Sciences, Fluminense Federal University, Niterói, Brazil.,Department of Obstetrics and Gynaecology, Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil.,Postgraduate Program in Applied Health Sciences, Vassouras University, Rio de Janeiro, Brazil
| | - Ross S Berkowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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17
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Daumová M, Hadravská Š, Putzová M. Hydatidiform mole. Cesk Patol 2023; 59:50-54. [PMID: 37468322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Hydatidiform mole is the most common form of gestational trophoblastic disease. It is an abnormally formed placental tissue with characteristic changes in karyotype, arising in fertilization disorders. The presence of abundant paternal genetic information plays a key role in the pathogenesis of complete and partial hydatidiform moles. These lesions are characterized by a relatively wide spectrum of morphological changes that may not be fully expressed, especially in the early stages of pregnancy. In addition, some changes can be observed in non-molar gravidities, which, unlike hydatidiform moles, lack any risk of malignant transformation. Although conventional histological examination still plays a key role in the diagnosis, it should be supplemented by other methods that reliably differentiate individual lesions. Accurate diagnosis of molar gravidities is important not only for determining the correct therapeutic approach, but the obtained data may also contribute to further research of these pathological entities.
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18
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Jeremie G, Allias F, Trecourt A, Gaillot-Durand L, Bolze PA, Descotes F, Tondeur G, Perrot J, Hajri T, You B, Golfier F, Lopez J, Devouassoux-Shisheboran M. Molecular Analyses of Chorionic-Type Intermediate Trophoblastic Lesions: Atypical Placental Site Nodules are Closer to Placental Site Nodules Than Epithelioid Trophoblastic Tumors. Mod Pathol 2023; 36:100046. [PMID: 36788063 DOI: 10.1016/j.modpat.2022.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/09/2022] [Accepted: 10/18/2022] [Indexed: 01/19/2023]
Abstract
Gestational trophoblastic diseases derived from the chorionic-type intermediate trophoblast include benign placental site nodule (PSN) and malignant epithelioid trophoblastic tumor (ETT). Among PSNs, the World Health Organization classification introduced a new entity named atypical placental site nodule (APSN), corresponding to an ETT precursor, for which diagnostic criteria remain unclear, leading to a risk of overdiagnosis and difficulties in patient management. We retrospectively studied 8 PSNs, 7 APSNs, and 8 ETTs to better characterize this new entity and performed immunohistochemical analysis (p63, human placental lactogen, Cyclin E, and Ki67), transcriptional analysis using the NanoString method to quantify the expression of 760 genes involved in the main tumorigenesis pathways, and RNA sequencing to identify fusion transcripts. The immunohistochemical analysis did not reveal any significant difference in Cyclin E expression among the 3 groups (P = .476), whereas the Ki67 index was significantly (P < .001) higher in ETT samples than in APSN and PSN samples. None of the APSN samples harbored the LPCAT1::TERT fusion transcripts, in contrast to 1 of 6 ETT samples, as previously described in 2 of 3 ETT samples. The transcriptomic analysis allowed robust clustering of ETTs distinct from the APSN/PSN group but failed to differentiate APSNs from PSNs. Indeed, only 7 genes were differentially expressed between PSN and APSN samples; CCL19 upregulation and EPCAM downregulation were the most distinguishing features of APSNs. In contrast, 80 genes differentiated ETTs from APSNs, establishing a molecular signature for ETT. Gene set analysis identified significant enrichments in the DNA damage repair, immortality and stemness, and cell cycle signaling pathways when comparing ETTs and APSNs. These results suggested that APSN might not represent a distinct entity but rather a transitional stage between PSN and ETT. RNA sequencing and the transcriptional signature of ETT described herein could serve as triage for APSN from curettage or biopsy material, enabling the identification of cases that need further clinical investigations.
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Affiliation(s)
- Gaspard Jeremie
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Fabienne Allias
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Alexis Trecourt
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Lucie Gaillot-Durand
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Pierre Adrien Bolze
- French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Françoise Descotes
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Garance Tondeur
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Jimmy Perrot
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France
| | - Touria Hajri
- French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Benoit You
- French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France; Department of Medical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - François Golfier
- French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Jonathan Lopez
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Mojgan Devouassoux-Shisheboran
- Medical Pole of Biology and Pathology, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, Pierre Bénite, France; French Reference Center for Trophoblastic Disease, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Division Santé, Université Claude Bernard Lyon 1, Villeurbanne, France.
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19
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Yener C, Sayın NC, Keskin FEU, Altan E, Ateş S, Varol F. Quadruplet Pregnancy with Complete Mole and Three Viable Fetuses. Fetal Pediatr Pathol 2022; 41:1035-1040. [PMID: 34807794 DOI: 10.1080/15513815.2021.2006377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: The coexistence of a hydatidiform mole and a fetus can occur in a multiple pregnancy, being less frequent in triplets and quadruplets because of their infrequency. With assisted reproduction, multiple pregnancies are becoming more frequent, and we can expect more frequent coexistence with a molar pregnancy. Case report: This G3, P1 30-year-old mother, after assisted conception, was diagnosed with a quadruplet pregnancy, one of which was a molar conceptus. Due to the potential for malignancy, the pregnancy was electively terminated. Conclusion: Despite the difficulty in conceiving, elective termination of a multiple pregnancy associated with a molar pregnancy may be the most judicious course of action to protect the mother's life.
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Affiliation(s)
- Cem Yener
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Trakya University, Edirne, Turkey
| | - N Cenk Sayın
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Trakya University, Edirne, Turkey
| | | | - Esra Altan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Trakya University, Edirne, Turkey
| | - Sinan Ateş
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Trakya University, Edirne, Turkey
| | - Füsun Varol
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Trakya University, Edirne, Turkey
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20
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Lukinovic N, Malovrh EP, Takac I, Sobocan M, Knez J. Advances in diagnostics and management of gestational trophoblastic disease. Radiol Oncol 2022; 56:430-9. [PMID: 36286620 DOI: 10.2478/raon-2022-0038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) is a heterogeneous group of rare tumours characterised by abnormal proliferation of trophoblastic tissue. It consists of benign or premalignant conditions, such as complete and partial molar pregnancy and variants of malignant diseases. The malignant tumours specifically are commonly referred to as gestational trophoblastic neoplasia (GTN). They consist of invasive mole, choriocarcinoma, placental-site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). CONCLUSIONS Patients with GTD are often asymptomatic, although vaginal bleeding is a common presenting symptom. With the advances in ultrasound imaging in early pregnancy, the diagnosis of molar pregnancy is most commonly made in the first trimester of pregnancy. Sometimes, additional imaging such as chest X-ray, CT or MRI can help detect metastatic disease. Most women can be cured, and their reproductive function can be preserved. In this review, we focus on the advances in management strategies for gestational trophoblastic disease as well as possible future research directions.
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21
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Muacevic A, Adler JR, Delle Marchette M, Bonazzi CM, Gorla S, Moltrasio F, Fruscio R, Vergani P, Landoni F. Gestational Intraplacental Choriocarcinoma in a Term Pregnancy: A Case Report. Cureus 2022; 14:e31243. [PMID: 36505145 PMCID: PMC9731319 DOI: 10.7759/cureus.31243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
Abstract
Intraplacental choriocarcinoma (IC) is a rare type of gestational choriocarcinoma (GC) occurring within the placenta, and only a small number of cases have been reported so far. Intraplacental choriocarcinoma is usually asymptomatic or may present with aspecific symptoms, including unexplained vaginal bleeding during pregnancy. Early diagnosis and treatment are pivotal for ensuring optimal outcomes. However, intraplacental choriocarcinoma is rarely suspected due to limited knowledge and awareness of the condition. Here, we report the case of a 34-year-old woman diagnosed with intraplacental choriocarcinoma by placental histological examination performed after delivery due to unexplained vaginal bleeding at 29 gestational weeks, requiring hospital admission. Two lines of chemotherapy and surgery were necessary to achieve complete remission. Since unexplained vaginal bleeding during pregnancy can be a clinical manifestation of intraplacental choriocarcinoma, we propose to consider placental histological examination in all pregnancies with this complication.
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22
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Lang J, Byars D, Martin C. Hook effect in gestational trophoblastic disease: An emergency department case presentation. J Am Coll Emerg Physicians Open 2022; 3:e12832. [PMID: 36311339 PMCID: PMC9597097 DOI: 10.1002/emp2.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Gestational trophoblastic disease is a process that affects ≈1 of 1000 pregnancies. If left untreated, this can progress to potentially life-threatening complications with malignancy such as choriocarcinoma. The emergency physician must be aware of the presentation and complications of this disease process, including the difficulties in diagnosis. In this case presentation, the authors discuss the presentation and diagnostic process of a patient in the emergency department as well as the phenomenon known as the hook effect, which may complicate the decision-making process.
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Affiliation(s)
- Joseph Lang
- Department of Emergency MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Donald Byars
- Department of Emergency MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Clyde Martin
- Department of Emergency MedicinePortsmouth Naval HospitalPortsmouthVirginiaUSA
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23
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Hoeijmakers YM, Simons M, Bulten J, Gorris MAJ, Ottevanger PB, de Vries IJM, Sweep FCGJ. PD-L1 in gestational trophoblastic disease: an antibody evaluation. Acta Obstet Gynecol Scand 2022; 101:1007-1016. [PMID: 35689468 DOI: 10.1111/aogs.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/19/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Treatment with antibodies directed against programmed-cell death ligand 1 (PD-L1) is a novel therapy for patients with gestational trophoblastic disease. Assessment of PD-L1 expression in tumor tissue is commonly used to identify patients who might benefit from anti-PD-L1 treatment. Multiple antibodies are available to detect PD-L1-expressing cells, and percentages of PD-L1-expressing cells in samples of patients with gestational trophoblastic disease indicated by these antibodies differ substantially. This raises the question which PD-L1 antibody best reflects PD-L1 expression to select patients for treatment. MATERIAL AND METHODS Seven commercially available antibodies for PD-L1 staining (E1L3N, 73-10, 22C3, CAL10, SP142, 28-8, SP263) were validated on Chinese hamster ovarian (CHO) cells transfected with PD-L1, PD-L2, wildtype CHO cells and tonsil tissue. Next, four complete hydatidiform moles and four choriocarcinomas were stained. Samples were independently assessed by two pathologists. RESULTS All seven antibodies showed membranous staining in the PD-L1-transfected CHO cells. E1L3N and 22C3 scored the highest percentages of PD-L1-positive cells (70%-90% and 60%-70%, respectively). E1L3N stained the cytoplasm of non-transfected CHO cells and was excluded from analysis. The remaining six antibodies predominantly stained syncytiotrophoblast cells of both complete hydatidiform moles and choriocarcinomas. The percentage of PD-L1-stained trophoblast cells and staining intensity varied substantially per used PD-L1 antibody and between complete hydatidiform moles and choriocarcinomas. Agreement between pathologists was best with 22C3 (intraclass correlation coefficient 0.94-0.96). CONCLUSIONS Based on staining results of the CHO cells, gestational trophoblastic disease samples and intraclass correlation coefficient, 22C3 seems the most suitable for adequate detection of PD-L1-expressing trophoblast cells. All antibodies detected PD-L1-expressing cells in the gestational trophoblastic disease samples, though with great variability, hampering comparison of results between studies in this rare disease and emphasizing the need for uniformity in detecting PD-L1-expressing cells.
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Affiliation(s)
- Yvonne M Hoeijmakers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel Simons
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A J Gorris
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I Jolanda M de Vries
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fred C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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24
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Wang X, Cheng Y, Li W, Mao R, Zhu T, Lu J, Yue X, Lu X. Management of relapsed gestational trophoblastic neoplasia: What can help to reduce the re-recurrence rate? J Obstet Gynaecol Res 2022; 48:1451-1457. [PMID: 35289459 DOI: 10.1111/jog.15228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/29/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
AIM To explore the risk factors for re-recurrence in relapsed gestational trophoblastic neoplasia (GTN) and therapeutic approaches to reduce the re-recurrence rate. METHODS Data of relapsed GTN treated in the Obstetrics and Gynecology Hospital of Fudan University from January 1, 2015, to December 31, 2020, were reviewed retrospectively. Risk factors associated with re-recurrence were analyzed using Logistic regression analysis. RESULTS A total of 39 relapsed GTN patients were included in our study. At the time of the first relapse, 14 patients received single-agent chemotherapy and 25 patients received multi-agent chemotherapy. Surgery was performed in 19 patients. Complete remission was achieved in all of the patients. Re-recurrence occurred in 21 patients. Univariate analysis suggested that unifocal recurrence was the only factor significantly associated with re-recurrence (OR = 0.25, p = 0.04). Recurrence pattern-based subgroup analysis showed that the proportion of re-recurrence was lower in patients who received both surgery and chemotherapy compared to those who received only chemotherapy in the unifocal recurrence group (3/11 vs. 2/4), but not in the non-unifocal recurrence group (7/8 vs. 9/16). The results of the multivariate analysis showed that there was no significant difference in re-recurrence rates between the surgical approaches and that the non-unifocal recurrence pattern was an independent risk factor for re-recurrence. CONCLUSIONS For relapsed GTN with unifocal recurrence pattern, surgical removal of the lesion can effectively reduce the re-recurrence rate.
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Affiliation(s)
- Xingran Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yu Cheng
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Wenzhi Li
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Runye Mao
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Tingting Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jiaqi Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xiaoni Yue
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xin Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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25
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Abstract
Breast neoplasms are becoming more common in the last few years. Among these masses, metastasis to the breast is rare. Extra-gestational choriocarcinoma is extremely rare among breast neoplasms. We intend to present a case of a 30-year-old female with complaints of breast and axillary lumps. She had a history of a previously treated uterine trophoblastic tumor. Subsequently, she underwent a trucut biopsy of the breast mass and the axillary node, revealing metastatic choriocarcinoma.
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Affiliation(s)
- Javaria Aleem
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | | - Nida Babar
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Anum Sultan
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Anis Ur Rehman
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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26
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Murphy KM, Carrick K, Gwin K, Rogers V, Koduru P, Ronnett BM, Castrillon DH. Rare Complete Hydatidiform Mole With p57 Expression in Villous Mesenchyme: Case Report and Review of Discordant p57 Expression in Hydatidiform Moles. Int J Gynecol Pathol 2022; 41:45-50. [PMID: 33900230 PMCID: PMC8663530 DOI: 10.1097/pgp.0000000000000773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Complete hydatidiform mole (CHM) is a premalignant proliferative disease of the placenta characterized by misexpression of imprinted gene products, most notably p57. The majority of CHM exhibit immunohistochemical absence of p57 protein in villous mesenchyme (VM) and cytotrophoblast (CT) and are thus p57 VM/CT concordant. However, some gestations show loss of p57 in only VM or CT, either in all chorionic villi or a subset thereof (VM/CT discordant). Here, we present a rare case of a p57 VM/CT-discordant CHM with diffuse retention of p57 expression in VM but complete absence in CT. Histologically, the case exhibited typical features of CHM including trophoblast hyperplasia and severe nuclear atypia, but was unusual in the presence of gestational membranes identified ultrasonographically and histologically. Ploidy determination by FISH and genotyping by short tandem repeat analyses showed that this was a diploid gestation with variable allelic ratios and with an androgenetic lineage, similar to previously reported p57 VM/CT-discordant cases.
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27
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Grzechocinska B, Gajewska M, Kedzierski M, Gajda S, Jedrzejak P, Wielgos M. Hyperthyroidism secondary to a hydatidiform mole. Ginekol Pol 2021; 92:741-742. [PMID: 34747003 DOI: 10.5603/gp.a2021.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/31/2021] [Accepted: 08/22/2021] [Indexed: 11/25/2022] Open
Abstract
The case presented in the article is that of a 47-year-old female patient with hyperthyroidism induced by a hydatidiform mole. Attention was drawn to the necessity of preparing the patient for a procedure with drugs that stabilize the hormonal activity of the thyroid. The removal of the hydatidiform mole resulted in gradual normalization of thyroid hormone levels. The trophoblast has a hormonal activity, secrete hCG (human chorionic gonadotropin).The hCG partial structural homology causes affinity to the TSH (thyroid stimulating hormone) receptor. The higher the weight of the trophoblast, the higher the production and concentration of hCG in the blood. Therefore, gestational trophoblastic disease may be accompanied by hyperthyroidism. The problem is frequently described, however, due to the risk of developing thyroid storm, it cannot be overlooked [1].
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Affiliation(s)
| | - Malgorzata Gajewska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
| | - Maciej Kedzierski
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Sylwia Gajda
- Endocrine Oncology and Nuclear Medicine Clinic, M. Skłodowska-Curie Memorial Institute - Cancer Centre, Warsaw, Poland, Warsaw, Poland
| | - Piotr Jedrzejak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
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28
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Clark M, Tchrakian N, Clarke B, Metser U, Bouchard-Fortier G. Placenta increta mimicking placental site trophoblastic tumor. Int J Gynecol Cancer 2021; 31:1481-1485. [PMID: 34725244 DOI: 10.1136/ijgc-2021-002988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Mitchell Clark
- Gynecologic Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Blaise Clarke
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ur Metser
- Medical Imaging, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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29
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Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, Lurain JR, Massuger L. Diagnosis and management of gestational trophoblastic disease: 2021 update. Int J Gynaecol Obstet 2021; 155 Suppl 1:86-93. [PMID: 34669197 PMCID: PMC9298230 DOI: 10.1002/ijgo.13877] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Gestational trophoblastic disease (GTD) arises from abnormal placenta and is composed of a spectrum of premalignant to malignant disorders. Changes in epidemiology of GTD have been noted in various countries. In addition to histology, molecular genetic studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by ultrasound has resulted in changes in clinical presentation and decreased morbidity from uterine evacuation. Follow-up with human chorionic gonadotropin (hCG) is essential for early diagnosis of gestational trophoblastic neoplasia (GTN). The duration of hCG monitoring varies depending on histological type and regression rate. Low-risk GTN (FIGO Stages I-III: score <7) is treated with single-agent chemotherapy but may require additional agents; although scores 5-6 are associated with more drug resistance, overall survival approaches 100%. High-risk GTN (FIGO Stages II-III: score ≥7 and Stage IV) is treated with multiagent chemotherapy, with or without adjuvant surgery for excision of resistant foci of disease or radiotherapy for brain metastases, achieving a survival rate of approximately 90%. Gentle induction chemotherapy helps reduce early deaths in patients with extensive tumor burden, but late mortality still occurs from recurrent treatment-resistant tumors.
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Affiliation(s)
- Hextan Y S Ngan
- Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Michael J Seckl
- Department of Medical Oncology, Charing Cross Trophoblastic Disease Center, Charing Cross Campus of Imperial College London, London, UK
| | - Ross S Berkowitz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - François Golfier
- Department of Obstetrics and Gynecology, French Trophoblastic Disease Reference Centre, Lyon University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Paradan K Sekharan
- Department of Obstetrics and Gynecology, Institute of Maternal and Child Health, Medical College, Calicut, India
| | - John R Lurain
- John I. Brewer Trophoblastic Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leon Massuger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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30
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Collet C, Lopez J, Battail C, Allias F, Devouassoux-Shisheboran M, Patrier S, Lemaitre N, Hajri T, Massardier J, You B, Mallet F, Golfier F, Alfaidy N, Bolze PA. Transcriptomic Characterization of Postmolar Gestational Choriocarcinoma. Biomedicines 2021; 9:biomedicines9101474. [PMID: 34680590 PMCID: PMC8533618 DOI: 10.3390/biomedicines9101474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 01/13/2023] Open
Abstract
The human placenta shares properties with solid tumors, such as rapid growth, tissue invasion, cell migration, angiogenesis, and immune evasion. However, the mechanisms that drive the evolution from premalignant proliferative placental diseases—called hydatidiform moles—to their malignant counterparts, gestational choriocarcinoma, as well as the factors underlying the increased aggressiveness of choriocarcinoma arising after term delivery compared to those developing from hydatidiform moles, are unknown. Using a 730-gene panel covering 13 cancer-associated canonical pathways, we compared the transcriptomic profiles of complete moles to those of postmolar choriocarcinoma samples and those of postmolar to post-term delivery choriocarcinoma. We identified 33 genes differentially expressed between complete moles and postmolar choriocarcinoma, which revealed TGF-β pathway dysregulation. We found the strong expression of SALL4, an upstream regulator of TGF-β, in postmolar choriocarcinoma, compared to moles, in which its expression was almost null. Finally, there were no differentially expressed genes between postmolar and post-term delivery choriocarcinoma samples. To conclude, the TGF-β pathway appears to be a crucial step in the progression of placental malignancies. Further studies should investigate the value of TGF- β family members as biomarkers and new therapeutic targets.
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Affiliation(s)
- Constance Collet
- Institut National de la Santé et de la Recherche Médicale U1292, Biologie et Biotechnologie pour la Santé, 38043 Grenoble, France; (C.C.); (C.B.); (N.L.); (N.A.)
- Commissariat à l’Energie Atomique et aux Energies Alternatives (CEA), Interdisciplinary Research Institute of Grenoble, CEDEX, 38054 Grenoble, France
- Service Obstétrique, Centre Hospitalo-Universitaire Grenoble Alpes, University Grenoble-Alpes, CS 10217, CEDEX 9, 38043 Grenoble, France
| | - Jonathan Lopez
- Department of Biochemistry and Molecular Biology, Plateforme de Recherche de Transfert en Oncologie, University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France;
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052, CNRS UMR5286, Faculté de Médecine Lyon Est, 69008 Lyon, France
| | - Christophe Battail
- Institut National de la Santé et de la Recherche Médicale U1292, Biologie et Biotechnologie pour la Santé, 38043 Grenoble, France; (C.C.); (C.B.); (N.L.); (N.A.)
- Commissariat à l’Energie Atomique et aux Energies Alternatives (CEA), Interdisciplinary Research Institute of Grenoble, CEDEX, 38054 Grenoble, France
- Service Obstétrique, Centre Hospitalo-Universitaire Grenoble Alpes, University Grenoble-Alpes, CS 10217, CEDEX 9, 38043 Grenoble, France
| | - Fabienne Allias
- Department of Pathology, University Hospital Lyon, Sud University of Lyon 1, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (F.A.); (M.D.-S.)
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (S.P.); (T.H.); (J.M.); (B.Y.); (F.G.)
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, University Hospital Lyon, Sud University of Lyon 1, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (F.A.); (M.D.-S.)
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (S.P.); (T.H.); (J.M.); (B.Y.); (F.G.)
| | - Sophie Patrier
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (S.P.); (T.H.); (J.M.); (B.Y.); (F.G.)
- Department of Pathology, University Hospital of Rouen, CEDEX, 76031 Rouen, France
| | - Nicolas Lemaitre
- Institut National de la Santé et de la Recherche Médicale U1292, Biologie et Biotechnologie pour la Santé, 38043 Grenoble, France; (C.C.); (C.B.); (N.L.); (N.A.)
- Commissariat à l’Energie Atomique et aux Energies Alternatives (CEA), Interdisciplinary Research Institute of Grenoble, CEDEX, 38054 Grenoble, France
- Service Obstétrique, Centre Hospitalo-Universitaire Grenoble Alpes, University Grenoble-Alpes, CS 10217, CEDEX 9, 38043 Grenoble, France
| | - Touria Hajri
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (S.P.); (T.H.); (J.M.); (B.Y.); (F.G.)
| | - Jérôme Massardier
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (S.P.); (T.H.); (J.M.); (B.Y.); (F.G.)
- Department of Obstetrics and Gynecology, University Hospital Femme Mere Enfant, University of Lyon 1, 51, Boulevard Pinel, 69500 Bron, France
| | - Benoit You
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (S.P.); (T.H.); (J.M.); (B.Y.); (F.G.)
- Investigational Center for Treatments in Oncology and Hematology of Lyon (CITOHL), Medical Oncology Department, University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
| | - François Mallet
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France;
- Medical Diagnostic Discovery Department (MD3), bioMérieux S.A., 69280 Marcy l’Etoile, France
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, EA 7426 Patho-Physiology of Injury-Induced Immunosuppression, PI3, Claude Bernard Lyon 1 University, Edouard Herriot Hospital, 69437 Lyon, France
| | - François Golfier
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (S.P.); (T.H.); (J.M.); (B.Y.); (F.G.)
- Department of Gynecological Surgery and Oncology, Hospices Civils de Lyon, University Hospital Lyon Sud, University of Lyon 1, Obstetrics, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
| | - Nadia Alfaidy
- Institut National de la Santé et de la Recherche Médicale U1292, Biologie et Biotechnologie pour la Santé, 38043 Grenoble, France; (C.C.); (C.B.); (N.L.); (N.A.)
- Commissariat à l’Energie Atomique et aux Energies Alternatives (CEA), Interdisciplinary Research Institute of Grenoble, CEDEX, 38054 Grenoble, France
- Service Obstétrique, Centre Hospitalo-Universitaire Grenoble Alpes, University Grenoble-Alpes, CS 10217, CEDEX 9, 38043 Grenoble, France
| | - Pierre-Adrien Bolze
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France; (S.P.); (T.H.); (J.M.); (B.Y.); (F.G.)
- Department of Gynecological Surgery and Oncology, Hospices Civils de Lyon, University Hospital Lyon Sud, University of Lyon 1, Obstetrics, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
- Correspondence: ; Tel.: +33-(0)4-78-86-66-78
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Yamamoto E, Kanal K, Soeung SC, Fujita N, Krang S, Long-Hay P, Nishino K, Niimi K, Hamajima N. The current situation of health services for hydatidiform mole in Cambodia. J Obstet Gynaecol Res 2021; 47:3652-3660. [PMID: 34342367 DOI: 10.1111/jog.14955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/17/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
AIM Management of hydatidiform mole is important to reduce the mortality and morbidity of choriocarcinoma. This study aims to understand the existing health services for hydatidiform mole and to estimate the incidence of gestational trophoblastic disease (GTD) in Cambodia. METHODS A questionnaire was used to collect information on the existing health services for pregnancy and hydatidiform mole at health facilities from attendants of the 16th Annual Conference of the Cambodian Society of Gynecology and Obstetrics in 2017. The incidence of GTD in 2014-2017 was estimated using Health Information System data. RESULTS A total of 126 attendants, who were from all provinces except three provinces, answered the questionnaire. The work places were national hospitals (n = 29), provincial hospitals (n = 42), district hospitals (n = 20), health centers (n = 6), and others (n = 29). The answers of participants from the public sector suggested the following: Ultrasonography is available at all hospitals but not health centers; Human chorionic gonadotropin (hCG) measurement is only available at national hospitals; Treatment of hydatidiform mole is performed at national hospitals and provincial hospitals; and Treatment of gestational trophoblastic neoplasia (GTN) is provided at national hospitals. The incidence of hydatidiform mole and GTN at health facilities in the public sector in 2014-2017 was 0.95 per 1000 deliveries and 6.58 per 100 000 deliveries, respectively. CONCLUSIONS The results suggest that provincial hospitals are important to detect suspected invasive mole and refer to national hospitals for diagnosis and treatment. Further studies on the management of GTD and development of the guidelines of GTD are needed.
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Affiliation(s)
- Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koum Kanal
- Cambodian Society of Gynecology and Obstetrics, Phnom Penh, Cambodia
| | - Sann Chan Soeung
- Cambodian Society of Gynecology and Obstetrics, Phnom Penh, Cambodia
| | - Noriko Fujita
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sidonn Krang
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Puthik Long-Hay
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Blok LJ, Frijstein MM, Eysbouts YK, Custers J, Sweep F, Lok C, Ottevanger PB. The psychological impact of gestational trophoblastic disease: a prospective observational multicentre cohort study. BJOG 2021; 129:444-449. [PMID: 34314567 PMCID: PMC9292450 DOI: 10.1111/1471-0528.16849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the short-term psychological consequences of gestational trophoblastic disease (GTD). DESIGN A prospective observational multicentre cohort study. SETTING Nationwide in the Netherlands. POPULATION GTD patients. METHODS Online questionnaires directly after diagnosis. MAIN OUTCOME MEASURES Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), Impact of Event Scale (IES) and Reproductive Concerns Scale (RCS). RESULTS Sixty GTD patients were included between 2017 and 2020. Anxious feelings (47%) were more commonly expressed than depressive feelings (27%). Patients experienced moderate to severe adaptation problems in 88%. Patients who already had children were less concerned about their reproductivity than were patients without children (mean score 10.4 versus 15.0, P = 0.031), and patients with children experienced lower distress levels (IES mean score 25.7 versus 34.7, P = 0.020). In addition, patients with previous pregnancy loss scored lower for distress compared with patients without pregnancy loss (IES mean score 21.1 versus 34.2, P = 0.002). DISCUSSION We recommend that physicians monitor physical complaints and the course of psychological wellbeing over time in order to provide personalised supportive care in time for patients who have high levels of distress at baseline. CONCLUSIONS GTD patients experience increased levels of distress, anxiety and depression, suggesting the diagnosis has a substantial effect on the psychological wellbeing of patients. The impact of GTD diagnosis on intrusion and avoidance seems to be ameliorated in patients who have children or who have experienced previous pregnancy loss. TWEETABLE ABSTRACT Patients with gestational trophoblastic disease (GTD) experience short-term psychological consequences such as distress, anxiety and depression, suggesting that the diagnosis GTD has a substantial effect on the psychological wellbeing of patients. Various patient characteristics affect the impact of GTD diagnosis.
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Affiliation(s)
- L J Blok
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M M Frijstein
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Y K Eysbouts
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jae Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Fcgj Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Car Lok
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - P B Ottevanger
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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33
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Eiriksson L, Dean E, Sebastianelli A, Salvador S, Comeau R, Jang JH, Bouchard-Fortier G, Osborne R, Sauthier P. Guideline No. 408: Management of Gestational Trophoblastic Diseases. J Obstet Gynaecol Can 2021; 43:91-105.e1. [PMID: 33384141 DOI: 10.1016/j.jogc.2020.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This guideline reviews the clinical evaluation and management of gestational trophoblastic diseases, including surgical and medical management of benign, premalignant, and malignant entities. The objective of this guideline is to assist health care providers in promptly diagnosing gestational trophoblastic diseases, to standardize treatment and follow-up, and to ensure early specialized care of patients with malignant or metastatic disease. INTENDED USERS General gynaecologists, obstetricians, family physicians, midwives, emergency department physicians, anaesthesiologists, radiologists, pathologists, registered nurses, nurse practitioners, residents, gynaecologic oncologists, medical oncologists, radiation oncologists, surgeons, general practitioners in oncology, oncology nurses, pharmacists, physician assistants, and other health care providers who treat patients with gestational trophoblastic diseases. This guideline is also intended to provide information for interested parties who provide follow-up care for these patients following treatment. TARGET POPULATION Women of reproductive age with gestational trophoblastic diseases. OPTIONS Women diagnosed with a gestational trophoblastic disease should be referred to a gynaecologist for initial evaluation and consideration for primary surgery (uterine evacuation or hysterectomy) and follow-up. Women diagnosed with gestational trophoblastic neoplasia should be referred to a gynaecologic oncologist for staging, risk scoring, and consideration for primary surgery or systemic therapy (single- or multi-agent chemotherapy) with the potential need for additional therapies. All cases of gestational trophoblastic neoplasia should be discussed at a multidisciplinary cancer case conference and registered in a centralized (regional and/or national) database. EVIDENCE Relevant studies from 2002 onwards were searched in Embase, MEDLINE, the Cochrane Central Register of Controlled Trials, and Cochrane Systematic Reviews using the following terms, either alone or in combination: trophoblastic neoplasms, choriocarcinoma, trophoblastic tumor, placental site, gestational trophoblastic disease, hydatidiform mole, drug therapy, surgical therapy, radiotherapy, cure, complications, recurrence, survival, prognosis, pregnancy outcome, disease outcome, treatment outcome, and remission. The initial search was performed in April 2017 and updated in May 2019. Relevant evidence was selected for inclusion in the following order: meta-analyses, systematic reviews, guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional significant articles were identified through cross-referencing the identified reviews. The total number of studies identified was 673, with 79 studies cited in this review. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. The Executive and Board of Directors of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration, and the Board of Directors for the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. See the online appendix tables for key to grading and interpretation of recommendations. BENEFITS These guidelines will assist physicians in promptly diagnosing gestational trophoblastic diseases and urgently referring patients diagnosed with gestational trophoblastic neoplasia to gynaecologic oncology for specialized management. Treating gestational trophoblastic neoplasia in specialized centres with the use of centralized databases allows for capturing and comparing data on treatment outcomes of patients with these rare tumours and for optimizing patient care. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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34
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Harsono AB, Hidayat YM, Winarno GNA, Nisa AS, Alkaff FF. A Case of Rapid Transformation from Hydatidiform Mole to Invasive Mole: The Importance of β-hCG (Human Chorionic Gonadotropin) Serum Levels in Follow-Up Evaluation. Am J Case Rep 2021; 22:e931156. [PMID: 34127641 PMCID: PMC8216494 DOI: 10.12659/ajcr.931156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/11/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) is a spectrum of disorders consisting of premalignant (ie, complete [CHM] and partial hydatidiform moles [PHM]) and malignant conditions (ie, invasive moles, choriocarcinoma, placental site trophoblastic tumors, and epithelioid trophoblastic tumor). If GTD persists after initial treatment and has persistent elevated beta human chorionic gonadotropin (ß-hCG), it is referred to as post-molar gestational trophoblastic neoplasia (pGTN). To date, there is no detailed information regarding how fast invasive moles can develop from CHM. However, the risk of developing any pGTN from CHM is rare within 1 month and is greatest in the first 12 months after evacuation, with most cases presenting within 6 months. CASE REPORT We present a case of a 46-year-old primigravida woman with rapid transformation of an invasive mole. In the beginning, the patient had a chief concern of a uterus size greater than the gestational dates. Laboratory evaluation showed high ß-hCG serum level (>300 000 mIU/mL), and ultrasonography evaluation revealed a hydatidiform mole. Suction evacuation and curettage procedures were then performed. Pathology evaluation afterwards revealed a complete hydatidiform mole without any sign of malignancy. Twenty-two days afterwards, the patient came to the emergency room with vaginal bleeding. ß-hCG serum level was high (53 969 mIU/mL), and ultrasonography examination showed the presence of fluid filling the uterine cavity. The patient was then diagnosed with GTN, and hysterectomy was chosen as the treatment of choice. After the surgery, her ß-hCG serum level gradually reverted back to normal. CONCLUSIONS Invasive moles can develop less than 1 month after suction evacuation and curettage procedure for CHM. Serial ß-hCG serum level evaluation according to the guideline should be performed to prevent late diagnosis, which could lead to the development of metastasis and worsen the prognosis.
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Affiliation(s)
- Ali Budi Harsono
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yudi Mulyana Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Gatot Nyarumenteng A. Winarno
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Aisyah Shofiatun Nisa
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Firas Farisi Alkaff
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
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Oyatogun O, Sandhu M, Barata-Kirby S, Tuller E, Schust DJ. A rational diagnostic approach to the "phantom hCG" and other clinical scenarios in which a patient is thought to be pregnant but is not. Ther Adv Reprod Health 2021; 15:26334941211016412. [PMID: 34179786 PMCID: PMC8207263 DOI: 10.1177/26334941211016412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
The scenario in which a patient tests positive for human chorionic gonadotropin (hCG) in the absence of pregnancy can pose a diagnostic dilemma for clinicians. The term “phantom hCG” refers to persistently positive hCG levels on diagnostic testing in a nonpregnant patient and such results often lead to a false diagnosis of malignancy and subsequent inappropriate treatment with chemotherapy or hysterectomy. There remains a need for a consistent and rational diagnostic approach to the “phantom hCG.” This article aims to review the different etiologies of positive serum hCG testing in nonpregnant subjects and concludes with a practical, stepwise diagnostic approach to assist clinicians encountering this clinical dilemma.
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Affiliation(s)
- Oluwafunmilayo Oyatogun
- Institute for Women's Health Research and Department of Obstetrics, Gynecology and Women's Health, University of Missouri, 500 North Keene St Suite 203, Columbia, MO 65201, USA
| | - Mandeep Sandhu
- Institute for Women's Health Research and Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | - Stephanie Barata-Kirby
- Institute for Women's Health Research and Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | - Erin Tuller
- Institute for Women's Health Research and Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | - Danny J Schust
- Institute for Women's Health Research and Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
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36
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Hung LY, Leung MT, Chan TCH, Cheung HN, Li WH, Cheung YS, Wong ASM, Shek CC, Chen SPL. Case Report: The first familial hCG syndrome in a Chinese family. F1000Res 2021; 10:458. [PMID: 34249343 PMCID: PMC8240598 DOI: 10.12688/f1000research.53636.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/27/2022] Open
Abstract
Familial hCG syndrome is a rare and benign cause of elevated serum beta human chorionic gonadotropin (hCG). We present here a case of familial hCG syndrome diagnosed in a Hong Kong Chinese family, which we believe to be the first reported in Chinese. A 38-year-old woman presented with incidental finding of persistently elevated hCG, analytically confirmed both in urine and blood. Extensive radiological and biochemical work-up were performed but were negative for pregnancy and malignancy. Testing of another asymptomatic family member revealed unexplained elevation of serum hCG, confirming the diagnosis of familial hCG syndrome. Knowledge and awareness of this entity among clinicians are important to avoid unnecessary investigations and treatment in affected families.
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Affiliation(s)
- Ling-Yin Hung
- Chemical Pathology Laboratory, Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong.,Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong
| | - Mei-Tik Leung
- Chemical Pathology Laboratory, Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Toby Chun-Hei Chan
- Chemical Pathology Laboratory, Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Hoi-Ning Cheung
- Chemical Pathology Laboratory, Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Wai-Hon Li
- Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Yui-Shing Cheung
- Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Assumpta Sze-Man Wong
- Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Chi-Chung Shek
- Chemical Pathology Laboratory, Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Sammy Pak-Lam Chen
- Chemical Pathology Laboratory, Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
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Braga A, Padrón L, Rezende-Filho J, Elias K, Horowitz N, Berkowitz R. Treatment of hydatidiform mole using manual vacuum aspiration: technical and tactical aspects. Int J Gynecol Cancer 2021; 31:1299-1300. [PMID: 34049976 DOI: 10.1136/ijgc-2021-002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Antonio Braga
- Department of Obstetrics and Gynecology, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil .,Department Maternal Child, Federal Fluminense University, Niteroi, Rio de Janeiro, Brazil
| | - Lilian Padrón
- Gynecology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Rezende-Filho
- Department of Obstetrics and Gynecology, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kevin Elias
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Horowitz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross Berkowitz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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38
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Dagdeviren G, Cevher F, Cendek B, Erkaya S. Histopathological examination of the curettage material in nonviable pregnancies and evaluation of the frequency of hydatidiform mole. J Obstet Gynaecol Res 2021; 47:2745-2751. [PMID: 34038979 DOI: 10.1111/jog.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/03/2021] [Accepted: 05/16/2021] [Indexed: 12/01/2022]
Abstract
AIM The study aimed to determine the frequency of possible missed diagnosis of gestational trophoblastic disease in nonviable pregnancies and to evaluate the importance of histopathological examination. METHODS In this retrospective study, the results of the histopathological assessment of patients undergoing uterine surgery with a diagnosis of nonviable pregnancy were analyzed before 14 weeks of gestation. Nonviable pregnancy was defined as anembryonic pregnancy and intrauterine exitus (IU-ex) based on ultrasound findings. The frequency and sonographic characteristics of molar pregnancy in nonviable pregnancy were analyzed. RESULTS Molar pregnancy was detected in 24 (1.62%) of 1481 patients diagnosed with nonviable pregnancy on ultrasound. One thousand one hundred and twenty-one of the cases were IU-ex (75.69%) and the remaining were anembryonic pregnancy (24.31%). The mean crown-rump length of pregnancies in the IU-ex group was 16.7 mm and the mean gestational age was 8 weeks. The average gestational sac diameter was found to be 26 mm in anembryonic pregnancy patients. The hydatidiform mole ratio was significantly higher in anembryonic pregnancy patients (3.06%) than in IU-ex patients (1.16%) (p = 0.013). CONCLUSIONS The appearance of early molar pregnancy on ultrasound evaluation may mimic anembryonic pregnancies. Therefore, histopathological examination of anembryonic pregnancies may be useful in early diagnosis and for the treatment of gestational trophoblastic neoplasia.
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Affiliation(s)
- Gulsah Dagdeviren
- Department of Perinatology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Funda Cevher
- Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Busra Cendek
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Salim Erkaya
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Erfiandi F, Mantilidewi KI, Hidayat YM, Harsono AB, Suardi D, Salima S, Kurniadi A, Islami IP, Agustina H, Dewayani BM, Nisa AS, Toriq H. A Rare Case of Early Transformation of Gestational Trophoblastic Neoplasia Following Molar Pregnancy. Am J Case Rep 2021; 22:e930789. [PMID: 33972495 PMCID: PMC8126585 DOI: 10.12659/ajcr.930789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/11/2021] [Accepted: 03/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) encompasses a group of disorders that arise from abnormal growth of trophoblastic tissue. The spectrum of GTD includes 2 major groups: benign and malignant. The benign form is a hydatidiform mole, either complete or partial; the malignant forms, referred to as gestational trophoblastic neoplasia (GTN), consist of invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Most patients who undergo evacuation of a hydatidiform mole by curettage have a disease-free period before a new tumor develops that can be considered malignant. In rare cases, metastasis occurs rapidly and manifests coincidentally before the hydatidiform mole can be evacuated. CASE REPORT A 19-year-old woman in Bandung City, West Java, Indonesia, was diagnosed with a molar pregnancy with early evidence of a mass in her vagina that was suspicious for stage II GTN. The early emergence of a vaginal mass was a rare case of early transformation of a molar pregnancy into GTN. CONCLUSIONS Careful evaluation is warranted of patients with characteristics typical of an intrauterine molar pregnancy who have an early presentation of a vaginal mass because of the possibility that the diagnosis could be GTN.
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Affiliation(s)
- Febia Erfiandi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Kemala Isnainiasih Mantilidewi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yudi Mulyana Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Ali Budi Harsono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Dodi Suardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Siti Salima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Andi Kurniadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Indah P. Islami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hasrayati Agustina
- Department of Anatomical Pathology, Faculty of Medicine, Padjadjaran University– Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Birgitta Maria Dewayani
- Department of Anatomical Pathology, Faculty of Medicine, Padjadjaran University– Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Aisyah Shofiatun Nisa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Huda Toriq
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University – Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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Bas S, Seyfettinoglu S, Narin MA, Ogur M. Loss of Reproductive Ability due to Late Application of Young Refugee with Choriocarcinoma During the COVID-19 Pandemic. J Adolesc Young Adult Oncol 2021; 10:355-358. [PMID: 33835857 DOI: 10.1089/jayao.2020.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Choriocarcinoma is an aggressive malignant trophoblastic neoplasm. The rapid growth of neoplastic tissue and myometrial invasion can cause uterine perforation. It is important to quickly diagnose the disease and plan treatment because these tumors are nearly always curable, and fertility can be preserved in most cases with proper management. The outbreak of novel coronavirus disease has affected the whole world since January 2019 and caused delays in treatment and follow-up of patients all over the world. In this study, we report a case of choriocarcinoma who postponed her admission to the hospital after diagnosis because she was afraid of the pandemic and lost her fertility due to uterine rupture and massive intra-abdominal hemorrhage.
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Affiliation(s)
- Sevda Bas
- Department of Gynecologic Oncology, Adana City Training and Research Hospital, Adana, Turkey
| | - Sevtap Seyfettinoglu
- Department of Gynecologic Oncology, Adana City Training and Research Hospital, Adana, Turkey
| | - Mehmet Ali Narin
- Department of Gynecologic Oncology, Adana City Training and Research Hospital, Adana, Turkey
| | - Merih Ogur
- Department of Gynecologic Oncology, Adana City Training and Research Hospital, Adana, Turkey
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Lin LH, Maestá I, St Laurent JD, Hasselblatt KT, Horowitz NS, Goldstein DP, Quade BJ, Sun SY, Braga A, Fisher RA, Berkowitz RS, Elias KM. Distinct microRNA profiles for complete hydatidiform moles at risk of malignant progression. Am J Obstet Gynecol 2021; 224:372.e1-372.e30. [PMID: 33031755 DOI: 10.1016/j.ajog.2020.09.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND MicroRNAs are small noncoding RNAs with important regulatory functions. Although well-studied in cancer, little is known about the role of microRNAs in premalignant disease. Complete hydatidiform moles are benign forms of gestational trophoblastic disease that progress to gestational trophoblastic neoplasia in up to 20% of cases; however, there is no well-established biomarker that can predict the development of gestational trophoblastic neoplasia. OBJECTIVE This study aimed to investigate possible differences in microRNA expression between complete moles progressing to gestational trophoblastic neoplasia and those regressing after surgical evacuation. STUDY DESIGN Total RNA was extracted from fresh frozen tissues from 39 complete moles collected at the time of uterine evacuation in Brazil. In the study, 39 cases achieved human chorionic gonadotropin normalization without further therapy, and 9 cases developed gestational trophoblastic neoplasia requiring chemotherapy. Total RNA was also extracted from 2 choriocarcinoma cell lines, JEG-3 and JAR, and an immortalized normal placenta cell line, 3A-subE. MicroRNA expression in all samples was quantified using microRNA sequencing. Hits from the sequencing data were validated using a quantitative probe-based assay. Significantly altered microRNAs were then subjected to target prediction and gene ontology analyses to search for alterations in key signaling pathways. Expression of potential microRNA targets was assessed by quantitative real-time polymerase chain reaction and western blot. Finally, potential prognostic protein biomarkers were validated in an independent set of formalin-fixed paraffin-embedded patient samples from the United States (15 complete moles progressing to gestational trophoblastic neoplasia and 12 that spontaneously regressed) using quantitative immunohistochemistry. RESULTS In total, 462 microRNAs were identified in all samples at a threshold of <1 tag per million. MicroRNA sequencing revealed a distinct set of microRNAs associated with gestational trophoblastic neoplasia. Gene ontology analysis of the most altered transcripts showed that the leading pathway was related to response to ischemia (P<.001). Here, 2 of the top 3 most significantly altered microRNAs were mir-181b-5p (1.65-fold; adjusted P=.014) and mir-181d-5p (1.85-fold; adjusted P=.014), both of which have been shown to regulate expression of BCL2. By quantitative real-time polymerase chain reaction, BCL2 messenger RNA expression was significantly lower in the complete moles progressing to gestational trophoblastic neoplasia than the regressing complete moles (-4.69-fold; P=.018). Reduced expression of BCL2 was confirmed in tissue samples by western blot. Immunohistochemistry in the independent patient samples revealed significantly lower cytoplasmic expression of BCL2 in the villous trophoblasts from cases destined for progression to gestational trophoblastic neoplasia compared with those that regressed, both with respect to staining intensity (optic density 0.110±0.102 vs 0.212±0.036; P<.001) and to the percentage of positive cells (16%±28% vs 49.4%±28.05%; P=.003). CONCLUSION Complete moles progressing to gestational trophoblastic neoplasia are associated with a distinct microRNA profile. miR-181 family members and BCL2 may be prognostic biomarkers for predicting gestational trophoblastic neoplasia risk.
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Joneborg U, Coopmans L, van Trommel N, Seckl M, Lok CAR. Fertility and pregnancy outcome in gestational trophoblastic disease. Int J Gynecol Cancer 2021; 31:399-411. [PMID: 33649007 DOI: 10.1136/ijgc-2020-001784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of this review is to provide an overview of existing literature and current knowledge on fertility rates and reproductive outcomes after gestational trophoblastic disease. A systematic literature search was performed to retrieve all available studies on fertility rates and reproductive outcomes after hydatidiform mole pregnancy, low-risk gestational trophoblastic neoplasia, high- and ultra-high-risk gestational trophoblastic neoplasia, and the rare placental site trophoblastic tumor and epithelioid trophoblastic tumor forms of gestational trophoblastic neoplasia. The effects of single-agent chemotherapy, multi-agent including high-dose chemotherapy, and immunotherapy on fertility, pregnancy wish, and pregnancy outcomes were evaluated and summarized. After treatment for gestational trophoblastic neoplasia, most, but not all, women want to achieve another pregnancy. Age and extent of therapy determine if there is a risk of loss of fertility. Single-agent treatment does not affect fertility and subsequent pregnancy outcome. Miscarriage occurs more often in women who conceive within 6 months of follow-up after chemotherapy. Multi-agent chemotherapy hastens the natural menopause by three years and commonly induces a temporary amenorrhea, but in young women rarely causes permanent ovarian failure or infertility. Subsequent pregnancies have a high chance of ending with live healthy babies. In contrast, high-dose chemotherapy typically induces permanent amenorrhea, and no pregnancies have been reported after high-dose chemotherapy for gestational trophoblastic neoplasia. Immunotherapy is promising and may give better outcomes than multiple schedules of chemotherapy or even high-dose chemotherapy. The first pregnancy after immunotherapy has recently been described. Data on fertility-sparing treatment in placental site trophoblastic tumor and epithelioid trophoblastic tumor are still scarce, and this option should be offered with caution. In general, patients with gestational trophoblastic neoplasia may be reassured about their future fertility and pregnancy outcome. Detailed registration of high-risk gestational trophoblastic neoplasia is still indispensable to obtain more complete data to better inform patients in the future.
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Affiliation(s)
- Ulrika Joneborg
- Department of Pelvic Cancer, Karolinska University Hospital, Karolinska Institute Department of Women's and Children's Health, Stockholm, Sweden
| | - Leonoor Coopmans
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Nienke van Trommel
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Michael Seckl
- Department of Medical Oncology, Hammersmith Hospitals; Imperial College London, London, Pennsylvania, UK
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
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Rzanny-Owczarzak M, Sawicka-Metkowska J, Jończyk-Potoczna K, Gowin E, Sosnowska-Sienkiewicz P, Mańkowski P, Januszkiewicz-Lewandowska D. Simultaneous Occurrence of Choriocarcinoma in an Infant and Mother. Int J Environ Res Public Health 2021; 18:1934. [PMID: 33671231 DOI: 10.3390/ijerph18041934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
Infantile choriocarcinoma is an extremely rare disease. We present a case study of a 1-month-old male with choriocarcinoma diagnosed simultaneously with his mother. On admission to hospital, the disease was very advanced and massive progression and multi-organ failure caused the death of the patient despite the implemented treatment. It was too late to save the child’s life, but early enough to save his mother. The authors believe that the serum levels of hCG should be determined in every newborn with anemia and liver tumor, especially when the mother has a positive history of miscarriage.
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Lepore A, Conran RM. Educational Case: Hydatidiform Molar Pregnancy. Acad Pathol 2021; 8:2374289520987256. [PMID: 33598531 PMCID: PMC7863141 DOI: 10.1177/2374289520987256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/26/2020] [Accepted: 11/25/2020] [Indexed: 11/20/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Anna Lepore
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Richard M. Conran
- Eastern Virginia Medical School, Norfolk, VA, USA
- Richard M. Conran, Eastern Virginia Medical School, Pathology & Anatomy, 700 West Olney Road, Norfolk, VA 23507, USA.
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Di Mattei V, Mazzetti M, Perego G, Cugnata F, Brombin C, Bergamini A, Cioffi R, Vasta F, Pella F, Rabaiotti E, Mangili G, Candiani M. Psychological factors influencing emotional reactions to gestational trophoblastic disease: The role of coping mechanisms and illness perception. Eur J Cancer Care (Engl) 2021; 30:e13404. [PMID: 33459425 DOI: 10.1111/ecc.13404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/30/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Referring to Leventhal's common-sense model, this observational cross-sectional study aimed at investigating the relationship between illness mental representations, coping mechanisms and psychological distress in a sample of women with gestational trophoblastic disease (GTD). METHODS Thirty-eight women diagnosed with GTD (18 with hydatidiform mole; 20 with gestational trophoblastic neoplasia) were asked to complete the Illness Perception Questionnaire-Revised, the Coping Orientation to the Problems Experienced, the State-Trait Anxiety Inventory-Form Y and the Beck Depression Inventory-Short Form. Demographic and clinical information was collected through a self-report questionnaire. RESULTS The sample did not report significant symptomatic distress in relation to GTD. Correlation analysis showed that the Emotional representations subscale of the Illness Perception Questionnaire-Revised was significantly associated with both state anxiety and depression; avoidant coping significantly and positively correlated with anxiety and depression, as well as with illness emotional representations. Mediation analysis revealed significant indirect effects of avoidant coping on both anxiety and depression through the mediation of emotional representations. CONCLUSION Avoidant coping could lead women to develop emotional representations of illness characterised by negative affects, which in turn enhance distress levels. Results underline the importance to promote adaptive coping strategies, along with accurate illness perceptions, to foster better psychological adjustment to GTD.
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Affiliation(s)
- Valentina Di Mattei
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Martina Mazzetti
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Perego
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Federica Cugnata
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Brombin
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Vasta
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Pella
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Rabaiotti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Gockley AA, Lin LH, Davis M, Melamed A, Rizzo A, Sun SY, Elias K, Goldstein DP, Berkowitz RS, Horowitz NS. Impact of clinical characteristics on human chorionic gonadotropin regression after molar pregnancy. Clinics (Sao Paulo) 2021; 76:e2830. [PMID: 34468539 PMCID: PMC8366901 DOI: 10.6061/clinics/2021/e2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to determine the effects of age, race/ethnicity, body mass index, and contraception on human chorionic gonadotropin (hCG) regression following the evacuation of a molar pregnancy. METHODS This was a retrospective cohort study of 277 patients with molar pregnancies between January 1, 1994 and December 31, 2015. The rate of hCG regression was estimated using mixed-effects linear regression models on daily log-transformed serum hCG levels after evacuation. RESULTS There were no differences in hCG half-lives among age (p=0.13) or race/ethnicity (p=0.16) groups. Women with obesity and hormonal contraceptive use demonstrated faster hCG regression than their counterparts (3.2 versus. 3.7 days, p=0.02 and 3.4 versus. 4.0 days, p=0.002, respectively). CONCLUSION Age and race/ethnicity were not associated with hCG regression rates. Hormonal contraceptive use and obesity were associated with shorter hCG half-lives, but with unlikely clinical significance. It is important to understand whether the clinical characteristics of patients may influence the hCG regression curve, as it has been proposed as a way to predict the risk of gestational trophoblastic neoplasia.
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Affiliation(s)
- Allison A. Gockley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA
- Corresponding author. E-mail:
| | - Lawrence H. Lin
- Department of Pathology, NYU School of Medicine, New York, USA
- Centro de Doencas Trofoblasticas, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Michelle Davis
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA
| | - Alexander Melamed
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Massachusetts, USA
| | - Anthony Rizzo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA
| | - Sue Yazaki Sun
- Centro de Doencas Trofoblasticas, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Kevin Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA
- Gynecologic Oncology Program, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, USA
- Trophoblastic Tumor Registry, New England Trophoblastic Disease Center, Boston, USA
| | - Donald P. Goldstein
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA
- Gynecologic Oncology Program, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, USA
- Trophoblastic Tumor Registry, New England Trophoblastic Disease Center, Boston, USA
| | - Ross S. Berkowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA
- Gynecologic Oncology Program, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, USA
- Trophoblastic Tumor Registry, New England Trophoblastic Disease Center, Boston, USA
| | - Neil S. Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA
- Gynecologic Oncology Program, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, USA
- Trophoblastic Tumor Registry, New England Trophoblastic Disease Center, Boston, USA
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Diver E, Richardson M, Liao CI, Mann AK, Darcy KM, Tian C, Kapp DS, Chan JK. Age and racial differences in the presentation of gestational trophoblastic neoplasia. Int J Gynecol Cancer 2020; 31:194-202. [PMID: 33310882 DOI: 10.1136/ijgc-2020-002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Gestational trophoblastic neoplasia are a group of diseases with few data given their rarity. The aim of this study was to determine the age and racial differences in the presentation and survival of patients with gestational trophoblastic neoplasia in the United States. METHODS Data were collected from the National Cancer Database from January 2004 to December 2014. Chi-square tests, Cox regression, and Kaplan-Meier models were performed. Demographic characteristics included age at diagnosis, race, insurance status, facility location and type, community median income, high school dropout rate, education, income, and population density data. RESULTS There were 1004 eligible patients including 64% white (n=645), 23% black (n=233), and 8.3% Asian patients (n=83). Median age was 30.8 (range 14-59) years. Stage I, II, III, IV, and unknown were diagnosed in 32%, 5.4%, 30%, 18%, and 15% of patients, respectively, with 5-year survival of 99%, 93%, 94%, 72%, and 95%, respectively (p<0.001). Compared with national birth rates, those with gestational trophoblastic neoplasia were overrepresented at younger (age 10-19 years: 8.2% vs 4.8%) and older ages (age 40-54 years: 17% vs 3.3%). The extremes of age at presentation were more pronounced in black patients with gestational trophoblastic neoplasia (age 10-19 years: 11% vs 6.9%, 40-54 years: 18% vs 3.2%), and black patients constituted 23% of patients compared with 15% of births nationwide. Some 59% of patients were treated at Academic/Research Programs. Only 6/448 (1.3%) facilities treated more than one patient per year, and only 9% (n=92) of patients were treated at one of these high-volume facilities. On multivariable analysis, older age, higher Charlson/Deyo co-morbidity score, and higher stage disease were independently associated with worse survival (all p<0.001). CONCLUSIONS Gestational trophoblastic neoplasia was disproportionately higher in those at extremes of age and in black women as compared with United States national data. The lack of centralization of care justifies the need to develop regional centers of excellence for this rare malignancy.
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Affiliation(s)
- Elisabeth Diver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Michael Richardson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Cheng-I Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Amandeep K Mann
- Department of Obstetrics and Gynecology, California Pacific & Palo Alto Medical Foundation/Sutter Cancer Research Institute, San Francisco, California, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Daniel S Kapp
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - John K Chan
- Department of Obstetrics and Gynecology, California Pacific & Palo Alto Medical Foundation/Sutter Cancer Research Institute, San Francisco, California, USA
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Riahi R, Rahimiforoushani A, Nourijelyani K, Akbari Sharak N, Bakhtiyari M. Early Detection of Gestational Trophoblastic Neoplasia Based on Serial Measurement of Human Chorionic Gonadotrophin Hormone in Women with Molar Pregnancy. Int J Prev Med 2020; 11:187. [PMID: 33815711 PMCID: PMC8000164 DOI: 10.4103/ijpvm.ijpvm_288_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/26/2019] [Indexed: 11/09/2022] Open
Abstract
Background: The majority of studies which investigate the predicted power of Human chorionic gonadotropin (hCG) levels to the occurrence of Gestational trophoblastic neoplasia (GTN) considered the effect of a single measurement of hCG or used classical statistical methods without considering the endogenous marker. The aim of this study is to investigate the association between weekly measurements of β-hCG with time to GTN occurring, using a robust Bayesian joint modeling. Methods: Data of 201 women with a molar pregnancy were considered for this retrospective cohort study. After the first measurement of β-hCG in 48 hours post evacuation of mole, the other titration was performed on a weekly basis until three consecutive normal titers. The association between serial measurements of β-hCG and risk of GTN occurring were assessed by the classic and Bayesian joint modeling and in separate analysis the mixed linear effect and Cox-PH model were used. Results: The mean age (SD) of participants was 26.6 (6.55) year. The GTN was occurred among 14.9% of patients. The association parameter using Bayesian approach was estimated as 1.30 (95% CI: 0.44 to 2.20) which showed one unit increase in the log β-hCG corresponds to the 2.80-times increase in the hazard for the occurrence of GTN (Hazard Ratio: 2.80, 95% CI: 1.55 to 8.98). Conclusions: Findings of this study revealed that weekly measurements of β-hCG are an important and reliable biomarker to early detection of developing of molar pregnancy to persistent GTN.
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Affiliation(s)
- Roya Riahi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimiforoushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Keramat Nourijelyani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Akbari Sharak
- Student Research Committee, Department of Biostatistics and Epidemiology, School of Public Health Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmood Bakhtiyari
- Non-Communicable Diseases Research Center, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.,Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Sunde L, Singh R, Ravn K, Schelde P, Hansen ES, Uldbjerg N, Niemann I, Hatt L. Hydatidiform mole diagnostics using circulating gestational trophoblasts isolated from maternal blood. Mol Genet Genomic Med 2020; 9:e1565. [PMID: 33306861 PMCID: PMC7963416 DOI: 10.1002/mgg3.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022] Open
Abstract
Background In gestational trophoblastic disease, the prognosis is related to the genetic constitution. In some cases, taking a biopsy is contraindicated. Methods In a pregnant woman, ultrasound scanning suggested hydatidiform mole. To explore if the genetic constitution can be established without taking a biopsy (or terminating the pregnancy), cell‐free DNA and circulating gestational trophoblasts were isolated from maternal blood before evacuation of the uterus. The evacuated tissue showed the morphology of a complete hydatidiform mole. Without prior whole‐genome amplification, short tandem repeat analysis of 24 DNA markers was performed on the samples, and on DNA isolated from evacuated tissue, and from the blood of the patient and her partner. Results Identical genetic results were obtained in each of three circulating gestational trophoblasts and the evacuated tissue, showing that this conceptus had a diploid androgenetic nuclear genome. In contrast, analysis of cell‐free DNA was less informative and less specific due to the inherent presence of cell‐free DNA from the patient. Conclusion Our results show that it is possible to isolate and analyze circulating gestational trophoblasts originating in a pregnancy without maternal nuclear genome. For diagnosing gestational trophoblastic diseases, genotyping circulating gestational trophoblasts appears to be superior to analysis of cell‐free DNA.
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Affiliation(s)
- Lone Sunde
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | | | | | | | - Niels Uldbjerg
- Department of Women's Disease and Birth, Aarhus University Hospital, Aarhus, Denmark
| | - Isa Niemann
- Department of Women's Disease and Birth, Aarhus University Hospital, Aarhus, Denmark
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Suzuki S, Takahashi K, Obayashi S, Kitazawa M, Kuroda H, Fukasawa I. Invasive mole with lung metastasis after an abdominal complete hydatidiform mole treatment. J Obstet Gynaecol Res 2020; 47:420-424. [PMID: 33078868 DOI: 10.1111/jog.14537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/29/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
A 27-year-old woman, gravida 1, para 0, was transferred to our hospital with acute abdominal pain. Her serum human chorionic gonadotropin level was 60 231 mIU/mL. Transabdominal ultrasound revealed an echo-free space, and emergency laparoscopy-assisted surgery was performed with a preoperative diagnosis of ruptured ectopic pregnancy. The pelvic cavity was filled with clots, and the peritoneal surface of the uterine fundus was swollen and showed continuous bleeding. The lesion was located on peritoneum and not connected with the uterine cavity. Histological examination of the conceptus showed features of a complete hydatidiform mole. After a mild decrease, hCG levels adversely increased 3 weeks later with multiple lung nodules. With a diagnosis of invasive moles, the patient was administered chemotherapy. This case demonstrates that it is important to recognize the potential of ectopic hydatidiform moles through abdominal pregnancy. This is the first report of an invasive abdominal hydatidiform mole, and hCG monitoring seemed to be essential for gestational trophoblastic neoplasia detection.
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Affiliation(s)
- Shiho Suzuki
- Department of Obstetrics and Gynecology, Dokkyo Medical University Hospital, Mibu, Japan
| | - Kenta Takahashi
- Department of Obstetrics and Gynecology, Dokkyo Medical University Hospital, Mibu, Japan
| | - Satoshi Obayashi
- Department of Obstetrics and Gynecology, Dokkyo Medical University Hospital, Mibu, Japan
| | - Masafumi Kitazawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University Hospital, Mibu, Japan
| | - Hajime Kuroda
- Department of Pathology, Dokkyo Medical University Hospital, Mibu, Japan
| | - Ichio Fukasawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University Hospital, Mibu, Japan
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