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Journal articles on the topic 'Persistent trophoblastic tumor'
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Mangili, Giorgia, Daniele Spagnolo, Luca Valsecchi, and Renato Maggi. "Transvaginal ultrasonography in persistent trophoblastic tumor." American Journal of Obstetrics and Gynecology 169, no. 5 (1993): 1218–23. http://dx.doi.org/10.1016/0002-9378(93)90285-q.
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Abu-Rustum, Nadeem R., Catheryn M. Yashar, Sarah Bean, et al. "Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network 17, no. 11 (2019): 1374–91. http://dx.doi.org/10.6004/jnccn.2019.0053.
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Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor.
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Hui, Pei. "Gestational Trophoblastic Tumors: A Timely Review of Diagnostic Pathology." Archives of Pathology & Laboratory Medicine 143, no. 1 (2018): 65–74. http://dx.doi.org/10.5858/arpa.2018-0234-ra.
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Context.— Gestational trophoblastic tumors include 3 distinct entities: gestational choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Accurate diagnosis is important for clinical management of the patient. Objective.— To review clinical features and pathologic diagnosis of gestational trophoblastic tumors. Data Sources.— Literature and personal experience are the sources for this study. Conclusions.— Trophoblastic tumors are rare encounters in modern medicine, as a result of clinical practice of molar surveillance programs and early chemotherapeutic intervention for persistent gestational trophoblastic neoplasia. Diagnostic recognition of these tumors requires a high index of suspicion, awareness of their histologic characteristics, and appropriate application of immunohistochemical and molecular biomarkers. Recent attention has been given to a few precursor lesions of gestational trophoblastic tumors, including early/in situ choriocarcinoma and atypical placental site nodule.
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Rice, Laurel W., Ross S. Berkowitz, Janice M. Lage, Donald P. Goldstein, and Marilyn R. Bernstein. "Persistent gestational trophoblastic tumor after partial hydatidiform mole." Gynecologic Oncology 36, no. 3 (1990): 358–62. http://dx.doi.org/10.1016/0090-8258(90)90142-8.
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Fénichel, Patrick, Cécile Rouzier, Catherine Butori та ін. "Extragestational βHCG Secretion Due to an Isolated Lung Epithelioid Trophoblastic Tumor: Microsatellite Genotyping of Tumoral Cells Confirmed Their Placental Origin and Oriented Specific Chemotherapy". Journal of Clinical Endocrinology & Metabolism 99, № 10 (2014): 3515–20. http://dx.doi.org/10.1210/jc.2014-1460.
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Abstract Context: Persistent secretion of β-human chorionic gonadotropin (βHCG) in the absence of an ongoing or recent pregnancy and without persistent uterine gestational disease is a rare but challenging situation that requires locating the extrauterine secreting tumor and distinguishing between extragestational choriocarcinoma and gestational trophoblastic neoplasms. Case Presentation: An unexplained, persistent extragestational βHCG secretion occurring in a 29-year-old, nonsmoking woman with abnormal uterine bleeding 4 years after a normal pregnancy and without persistent gestational disease led to the discovery by whole-body computed tomography/positron emission tomography of an isolated pulmonary tumor. Objective: Characterization of paternal alleles in tumoral cells in order to establish their fetal origin, which may be helpful for the diagnosis and treatment of such tumors. Methods and Results: After the surgical procedure, clinical, histological, and immunocytochemical analysis ruled out primary or metastatic bronchopulmonary carcinoma or choriocarcinoma and supported the diagnosis of an isolated, primary, epithelioid trophoblastic tumor. Microsatellite genotyping of tumoral cells identifying paternal alleles confirmed their placental origin and their migration to the lungs, with likely secondary malignant transformation, and guided the choice of postsurgical chemotherapy needed to completely eradicate βHCG secretion. Conclusion: Persistent extragestational secretion of βHCG in a young nonsmoking woman with a precedent pregnancy and an isolated lung tumor suggests the diagnosis of epithelioid trophoblastic tumor, a very rare malignant tumor for which placental origin needs to be confirmed, especially when occurring several years after the patient's last pregnancy. Simple microsatellite genotyping of tumoral cells will allow this confirmation of diagnosis and help in personalizing chemotherapy.
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Varga, Gino, Ulrich Honemeyer, and Kazuo Maeda. "Trophoblastic Diseases." Donald School Journal of Ultrasound in Obstetrics and Gynecology 6, no. 1 (2012): 27–42. http://dx.doi.org/10.5005/jp-journals-10009-1224.
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ABSTRACT Trophoblastic diseases are mainly hydatidiform mole and choriocarcinoma, where the latter is usually the sequela of molar pregnancy and malignant systemic disease with general metastases destructing various tissues and organs till she die. High level urinary hCG, real-time B-mode and color Doppler imaging detect hydatidiform mole in early gestation, postmolar persistent trophoblastic disease is diagnosed by urinary hCG, and treated by prophylactic chemotherapy against choriocarcinoma. Uterine choriocarcinoma and its metastases are diagnosed by hCG and B-mode, color and power Doppler and 3D images detecting rich tumor blood flow. Most choriocarcinoma was effectively treated by primary chemotherapy with methotrexate, etoposide, etc. Until complete remission where hCG is lower than the cut-off level. Placental site trophoblastic tumor (PSTT) and epitheloid trophoblastic tumor (ETT) were low in hCG level and high in human placental lactogen (hPL), and show rich tumor blood flow in color Doppler ultrsound. Nongestational choriocarcinoma is rare and usually chemotherapy resistant. How to cite this article Maeda K, Kurjak A, Varga G, Honemeyer U. Trophoblastic Diseases. Donald School J Ultrasound Obstet Gynecol 2012;6(1):27-42.
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Akakpo, Patrick K., Kofi Ulzen-Appiah, Evans Agbeno, and Leonard Derkyi-Kwarteng. "Diagnosing and treating rare lesions in a low resource setting: lessons from a hybrid epithelioid trophoblastic tumor and choriocarcinoma." Ghana Medical Journal 51, no. 4 (2018): 196–99. http://dx.doi.org/10.4314/gmj.v51i4.9.
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Objective: To raise awareness of the existence of a rare type of malignant trophoblastic tumor and discuss the diagnostic challenges and management of this lesion in a low resource setting.Case report and intervention: A 35 -year -old G6P3 woman was referred to our facility on account of persistent vaginal bleeding due to a suspected incomplete miscarriage with a cervical mass. Her serum β-HCG was elevated (36,900 mIU/ml) and examination showed a bleeding cervical mass. An initial histopathological diagnosis of moderately differentiated squamous cell carcinoma was reviewed to epithelioid trophoblastic tumor resulting in an extra-fascial hysterectomy. A final histopathological diagnosis of hybrid Epithelioid Trophoblastic Tumor and Choriocarcinoma (ETT/CC) was made after external review and immunohistochemistry. She received subsequent chemotherapy.Conclusion: Epithelioid trophoblastic tumor and its hybrids are difficult to diagnose. They may be diagnosed as moderately differentiated squamous cell carcinoma especially in low resource settings where cervical squamous cell carcinoma is relatively more common. A high index of suspicion, a serum β HCG test and close collaborationbetween clinicians and pathologists can help make the diagnosis.Funding: NoneKeywords: Epithelioid trophoblastic tumour, choriocarcinoma, diagnostic challenges, low resource setting
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Zhang, Peilin. "Decidual Vasculopathy and Spiral Artery Remodeling Revisited III: Hypoxia and Re-oxygenation Sequence with Vascular Regeneration." Reproductive Medicine 1, no. 2 (2020): 77–90. http://dx.doi.org/10.3390/reprodmed1020006.
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Aim: Spiral artery remodeling at early pregnancy is characterized by two distinct mechanisms with two morphologic features, namely, trophoblastic-dependent vascular invasion with “plugging”, and trophoblastic-independent mural muscular hypertrophy/hyperplasia, both of which lead to the blocking or narrowing of the arterial lumen with the consequence of reduced maternal blood flow to the developing embryo. Methods: Review of historic literature in light of the new discovery of CD56 (NCAM) expression on endovascular trophoblasts at late gestation, in relation to placental lateral growth with vascular regeneration. Results: Reduced maternal blood flow to the embryo results in a hypoxic condition critical for trophectoderm differentiation and proliferation. Hypoxia is also important for the development of hemangioblasts of vasculogenesis, and hematopoiesis of the placental villi. Up to 13 weeks, both uteroplacental and fetoplacental circulations are established and hypoxic condition relieved for normal fetal/placenta development by ultrasonography. The persistence of trophoblastic plugging and/or mural muscular hypertrophy/hyperplasia leads to persistent reduced maternal blood flow to the placenta, resulting in persistent hypoxia and increased angiogenesis, with a constellation of pathologic features of maternal vascular malperfusion atlate gestation. Wilm’s tumor gene (WT1) expression appears to be central to steroid and peptide hormonal actions in early pregnancy, and vascular regeneration/restoration after pregnancy. Conclusions: Spiral artery remodeling at early pregnancy leads to hypoxia with vascular transformation, and the establishment of uteroplacental circulation results in relief of hypoxia. The hypoxia–re-oxygenation sequence may provide insights into the mechanism of normal fetal/placental development and associated pregnancy complications, such as preeclampsia.
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Moghadam, Maryam Nakhaie, Sonia Nourkhomami, Leila Mousavi Seresht, et al. "B-hCG and H-hCG levels in patients with gestational trophoblastic neoplasia." Current Gynecologic Oncology 18, no. 2 (2020): e34-e38. http://dx.doi.org/10.15557/cgo.2020.0007.
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Objective: Gestational trophoblastic disease is a term that encompasses a spectrum of disorders all arising from the placenta. Human chorionic gonadotropin (hCG) hormone has an essential role in the diagnosis and management of gestational trophoblastic neoplasia. Measuring beta-hCG (B-hCG) levels is the only standard method of monitoring treatment response in patients on chemotherapy. Serial B-hCG levels are also helpful in defining the suitable approach and the dosage of chemotherapeutic drugs. Unfortunately, this marker may not be helpful in some cases. Therefore, the present study was conducted to determine the results of the ratio of B-hCG and hyperglycosylated human chorionic gonadotropin (H-hCG) in patients with gestational trophoblastic neoplasia. Materials and methods: This was a cross-sectional study in 22 patients with gestational trophoblastic neoplasia who were referred to an oncology clinic of an academic hospital of Mashhad University of Medical Sciences in Iran from December 2017 to May 2018. Inclusion criteria were plateau level of B-hCG (during 4 weeks) or persistent low level of hCG. After ruling out other etiologies, H-hCG level was measured and the H-hCG/total hCG ratio was evaluated. If the proportion was more than 20%, active gestational trophoblastic neoplasia was diagnosed, and if it was less than 20%, quiescent gestational trophoblastic neoplasia was diagnosed. In patients with active gestational trophoblastic neoplasia, interventional procedures involved a change in the dose intensity or chemotherapy or proposing a surgery. However, only serial follow-up was recommended in patients with quiescent gestational trophoblastic neoplasia. Then, the patients were followed during the therapy and the condition of patients was followed and recorded. Results: The mean age of patients was 31.36 ± 8.01 years. Hydatidiform mole was the most common diagnosis, accounting for approximately 64% (14) of patients. A total of 81% of patients were undergoing chemotherapy. The interval time between the onset of chemotherapy until plateau or persistent low level of hCG was 11.26 ± 4.03 weeks. The mean B-hCG level was 36.6 mIU/mL and the mean H-hCG/total hCG ratio was 6.24%. This proportion was less than 20% in 82% of patients. Among these patients, 14 patients (77.8%) had spontaneously normalized levels of B-hCG during a 6-month follow-up. Two cases underwent chemotherapy due to increased B-hCG. Other patients are still under follow-up without disease progression. Among 4 patients with a H-hCG/total hCG ratio >20%, hysterectomy was recommended to one patient duo to multiparity and the fact that the tumor was localized in the uterus. In the other patients, an increase in the dose of methotrexate or a change of chemotherapy regimen was performed, which caused a decrease in B-hCG level to normal. All patients are still under follow-up without disease progression. Conclusion: The data in this study suggests the use of H-hCG as a tumor marker in patients with persistent low level of B-hCG, which is useful to distinguish between quiescence gestational trophoblastic neoplasia, which does not need treatment, from active gestational trophoblastic neoplasia. However, further studies with larger sample size are needed to confirm and generalize the above findings. Keywords: gestational trophoblastic
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Begum, Shirin Akter, Md Zillur Rahman Bhuiyan, Rehana Akhter, Romena Afroz, Afroza Khanom, and Kashfia Ahmed Keya. "A review on gestational trophoblastic disease." Bangladesh Medical Journal 44, no. 1 (2016): 51–56. http://dx.doi.org/10.3329/bmj.v44i1.26357.
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Molar pregnancy occurs when the fertilization of the egg by the sperm goes wrong and leads to the growth of abnormal cells or clusters of water filled sacs inside the womb. This condition is one of a group of conditions known as gestational trophoblastic tumours (GTTs). Molar pregnancies used to be called hydatidiform mole but now most people call them molar pregnancies. Molar pregnancies are rare but they are the most common type of gestational trophoblastic tumour. In the UK, about 1 in 590 pregnancies is a molar pregnancy. In Asian women, molar pregnancies are about twice as common as in Caucasian women. Most molar pregnancies are benign. They can spread beyond the womb in some women, but are still curable. Molar pregnancies can either be complete or partial. In case of complete mole, no parts of foetal tissue are formed. In case of partial mole there may be some foetal tissue in the womb, alongside the molar tissue. By measuring the levels of ?hCG in blood and urine in high dilution helps to diagnose a molar pregnancy; an ultrasound scan can also diagnose many women with molar pregnancy. The molar tissue needs to be surgically removed. Afterwards, in around 10 to 15 out of 100 women, some molar tissue remains in the deeper tissues of the womb or other parts of the body. This is called a persistent gestational tumour. Invasive mole, choriocarcinoma, and placental site trophoblastic tumor (PSTT) termed as gestational trophoblastic neoplasia (GTN), which can progress, invade, metastasize, and lead to death if left untreated.These women need to have chemotherapy completely get rid of the abnormal cells.Bangladesh Med J. 2015 Jan; 44 (1): 51-56
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Bolis, Giorgio, Nicoletta Colombo, Amalia Epis, et al. "Methotrexate with Citrovorum Factor in Low-Risk Gestational Trophoblastic Tumor." Tumori Journal 73, no. 3 (1987): 309–13. http://dx.doi.org/10.1177/030089168707300317.
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From January 1976 through December 1985, methotrexate (MTX) with citrovorum factor (CF) was administered as primary treatment to 57 patients with low-risk gestational trophoblastic tumor (GTT); 51 patients were non-metastatic and 6 were metastatic GTT. The median number of courses needed to achieve biochemical remission was two (range, 1–7). Complete remission was attained in 95% of non-metastatic GTT patients with postmolar persistent trophoblastic disease, but when choriocarcinoma was histologically confirmed, this fell to 60%. The cure rate of metastatic GTT patients was only 50%. The overall remission rate with the MTX-CF combination was 84.2%. Toxicity was mild, consisting of myelosuppression and mucositis. Fifteen patients were resistant to MTX-CF, or relapsed subsequently, but they all achieved remission with chemotherapy rescue treatment (VP 16 alone, EMA/CO, CHAMOCA). Two patients required a pulmonary lobectomy. They are all still alive in biochemical remission with a median survival of 54 months. Our experience suggests that drug resistance and relapse rate seem related to a β-HCG value higher than 104, an enlarged uterus with myometrial deep involvement, and a histologically confirmed diagnosis of choriocarcinoma. In conclusion, the MTX-CF combination is effective in postmolar GTT, whereas a different therapeutic approach may be considered for a « special » low-risk group of patients, on the basis of prognostic factors.
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Rice, L., J. Lage, R. Berkowitz, D. Goldstein, and M. Bernstein. "Flow cytometric analysis of DNA content in partial hydatidiform moles (PHM) with persistent gestational trophoblastic tumor (GTT)." Gynecologic Oncology 40, no. 2 (1991): 179. http://dx.doi.org/10.1016/0090-8258(91)90160-7.
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Shen, Dan-Hua, Ui Soon Khoo, Hextan Y. S. Ngan, et al. "Coexisting Epithelioid Trophoblastic Tumor and Choriocarcinoma of the Uterus Following a Chemoresistant Hydatidiform Mole." Archives of Pathology & Laboratory Medicine 127, no. 7 (2003): e291-e293. http://dx.doi.org/10.5858/2003-127-e291-cettac.
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Abstract The epithelioid trophoblastic tumor is an unusual type of trophoblastic tumor. Herein, we describe a patient with coexisting epithelioid trophoblastic tumor and choriocarcinoma in the uterus. The patient had a history of hydatidiform mole with recurrent elevation of human chorionic gonadotrophin level that is resistant to chemotherapy. Histopathologic and immunohistochemical examination showed distinctive differences between the 2 trophoblastic tumors. The development of epithelioid trophoblastic tumor may be related to the persistence of locally invasive disease, which was unresponsive to chemotherapy. The patient responded well to surgery. The presence of an epithelioid trophoblastic tumor should be considered in chemoresistant gestational trophoblast tumor.
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Deo, N. D., S. D. Visvanathan, and L. Selvarajah. "OC19.05: Incidence of persistent trophoblastic tumor and the role of ultrasound scanning in the management of gestational trophoblastic disease: our experience in a University Hospital in London." Ultrasound in Obstetrics & Gynecology 44, S1 (2014): 45. http://dx.doi.org/10.1002/uog.13586.
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Tuncer, Z. Selcuk, Marilyn R. Bernstein, Donald P. Goldstein, and Ross S. Berkowitz. "Outcome of Pregnancies Occurring Before Completion of Human Chorionic Gonadotropin Follow-Up in Patients With Persistent Gestational Trophoblastic Tumor." Obstetrical & Gynecological Survey 54, no. 10 (1999): 639–40. http://dx.doi.org/10.1097/00006254-199910000-00016.
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Tuncer, Z. Selcuk, Marilyn R. Bernstein, Donald P. Goldstein, and Ross S. Berkowitz. "Outcome of Pregnancies Occurring before Completion of Human Chorionic Gonadotropin Follow-Up in Patients with Persistent Gestational Trophoblastic Tumor." Gynecologic Oncology 73, no. 3 (1999): 345–47. http://dx.doi.org/10.1006/gyno.1999.5437.
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Koirala, A., P. Khatiwada, A. Giri, P. Kandel, M. Regmi, and D. Upreti. "The Demographics of Molar Pregnancies in BPKIHS." Kathmandu University Medical Journal 9, no. 4 (2012): 298–300. http://dx.doi.org/10.3126/kumj.v9i4.6349.
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This is an analysis of the incidence of molar pregnancies and those of complete and partial molar pregnancies across the reproductive age range for BP Koirala Institute of Health Sciences (BPKIHS) in the period 2010-2011. Patients with molar pregnancies registered with BPKIHS from January 2008 to January 2010 were identified. The overall number of molar pregnancies registered was compared to the number of maternities (live births and still births) and total viable conceptions for this year. A retrospective study of 64 cases of molar pregnancies recorded at BPKIHS during the two year time was done. Medical records were reviewed. Incidence, clinical presentation and methods of diagnosis were studied. During the study period, there were 37 complete moles, 23 partial moles, 1 persistent gestational trophoblastic tumor, 1 choriocarcinoma, and 2 invasive moles. The incidence of molarpregnancy was 3.94 per 1000 deliveries. Median distribution was at 22 years of age, and majority (67%) presented during early second trimester. Twenty one (32.8%) women were of blood group A positive and ten (15.6%) presented with severe form of anemia. This study provides detailed data regarding the incidence of partial and complete molar pregnancies with increasing maternal age. It confirms the relation of molar pregnancy with age, and blood group. Complete mole had the highest incidence, affecting mostly younger age group, and usually in the first half of their pregnancy.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6349 Kathmandu Univ Med J 2011;9(4):298-300
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Brandão, Pedro, Juliana Silva-Rocha, Ana Rita Pinto, and Fernanda Costa. "Distinct gestational trophoblastic neoplasia - different entities, specific management." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 2 (2017): 749. http://dx.doi.org/10.18203/2320-1770.ijrcog20170418.
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Gestational trophoblastic diseases are abnormalities of the trophoblastic tissue development. They have Β-hCG as tumour marker, similar clinical manifestations but different pathological features, management and prognosis. Gestational trophoblastic neoplasia includes all forms of gestational trophoblastic disease that are invasive and/or metastasize and correspond to 10% of this group of diseases. The authors performed a retrospective review of all patients referred to our department between 1st January 2011 and 30th June 2016. Presenting symptoms, Β-hCG levels, obstetric and personal history and microscopic features were reviewed. 4 cases were identified - 2 invasive complete and 1 partial hydatidiform moles and 1 placental site trophoblastic tumour. Management and follow-up were individualized. Neither persistence nor recurrences were diagnosed after primary treatment. These case series highlights the importance of an accurate diagnosis and a long-term follow-up considering the risk of persistency or malignancy, as gestational trophoblastic neoplasia usually have good response to the adequate therapy.
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Antaratani, Ramalingappa C., and Shruthi M. "Study of gestational trophoblastic diseases at a tertiary care hospital in India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 4 (2018): 1622. http://dx.doi.org/10.18203/2320-1770.ijrcog20181367.
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Background: Gestational trophoblastic disease refers to the heterogeneous group of interrelated lesions that arises from abnormal proliferation of placental trophoblasts. GTNs are among the rare human tumours that can be cured even in the presence of widespread dissemination. Although GTNs commonly follow a molar pregnancy, they can occur after any gestational event, including induced or spontaneous abortion, ectopic pregnancy, or term pregnancy. The study was conducted to know the incidence of different types of gestational trophoblastic diseases in the local population and the percentage of people ultimately requiring chemotherapy.Methods: The retrospective analysis of case record of 124 women with a diagnosis of GTD admitted to Karnataka Institute of Medical Sciences Hubli between November 2008 to November 2017.Results: A total of 124 cases of GTD were reviewed. Hydatidiform mole was diagnosed in 91 patients; of those experienced spontaneous remission after evacuation. 04 patients had persistent gestational trophoblastic Neoplasia and 13 cases of invasive mole (GTN) 1 case of epitheloid trophoblastic tumors and 15 cases of choriocarcinoma 99 (80%) had low-risk GTN, 25 (20%) had high-risk GTN.Conclusions: Hydatidiform mole was found to be the most common form of gestational trophoblastic diseases. Majority of the cases got cured by simple surgical evacuation. During the course of our study some rare cases of gestational trophoblastic diseases were noted. Patients’ compliance for serial follow up is a highly challenging task in developing countries. Registration of women with GTD represents a minimum standard of care.
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Devasia, Neena, та Tinu Philip. "A study of factors affecting regression of βhCG in gestational trophoblastic disorders". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, № 3 (2019): 955. http://dx.doi.org/10.18203/2320-1770.ijrcog20190864.
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Background: Gestational trophoblastic disorders are among the rare human tumors that can be cured even in the presence of widespread dissemination. Authors can anticipate the development of persistent trophoblastic disease by identifying high risk factors affecting βhCG regression in vesicular mole. The study of this aim was to determine the incidence of gestational trophoblastic disorders and persistent trophoblastic disease in our institution. Factors affecting regression of βhCG and thereby leading to persistent disease are assessed.Methods: The study was conducted for a period of 2 years at a tertiary care centre in central Kerala. The factors affecting progression to persistent disease are assessed by a case control study. Those developing persistent trophoblastic disease were taken as cases and those with normal regression of βhCG were taken as controls. Variables studied were age, sociodemographic factors, obstetric history, histopathological report, βhCG value, post evacuation USG and clinical features.Results: The incidence of gestational trophoblastic diseases was 1 in 178 births and of persistent trophoblastic disease was 18.6%. Fourteen cases with persistent trophoblastic disease were studied and 61 controls were recruited. Incidence increased in older age group (>30) and low socio-economic group. Pre-evacuation βhCG> 40000 and presence of theca lutein cyst are important factors affecting βhCG regression. Strong association with uterine size >poa, post evacuation uterine subinvolution and presence of hyperthyroidism was found.Conclusions: Progression to persistent trophoblastic disease was associated with low socioeconomic status, high pre-evacuation βhCG values, uterine size>poa and presence of theca lutein cysts. Identification of these risk factors helps in proper counseling and meticulous follow up of patients.
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Okamoto, T., K. Matsuo, R. Niu, M. Osawa, and H. Suzuki. "Human chorionic gonadotropin (hCG) beta-core fragment is produced by degradation of hCG or free hCG beta in gestational trophoblastic tumors: a possible marker for early detection of persistent postmolar gestational trophoblastic disease." Journal of Endocrinology 171, no. 3 (2001): 435–43. http://dx.doi.org/10.1677/joe.0.1710435.
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The present study was undertaken to investigate whether human chorionic gonadotropin (hCG) beta-core fragment (hCG beta cf) was directly produced by gestational trophoblastic tumors. Immunoreactivity of hCG beta cf was demonstrated in the extracts as well as in the culture media of hydatidiform mole tissues. It was also present in the extracts of choriocarcinoma tissues, and its molar concentration exceeded that of intact hCG. The presence of hCG beta cf was then confirmed by gel chromatography and Western blot analysis. Immunohistochemistry showed localization of hCG beta cf immunoreactivity to the syncytiotrophoblasts and scattered cells in the stroma of mole tissue, and to syncytiotrophoblastic cells in choriocarcinoma. Immunoreactivity of hCG beta cf was also detected in the sera of the patients with gestational trophoblastic disease, although the hCG beta cf/hCG ratio was less than one hundredth of that in the tissue extracts. Serial measurement of serum hCG beta cf levels after mole evacuation showed that they declined much more rapidly than those of hCG and became undetectable in the patients with subsequent spontaneous resolution, while hCG beta cf remained or became detectable before the rise of hCG was observed in the patients with subsequent persistent trophoblastic disease. Taken together, these results suggest that hCG beta cf is directly produced by gestational trophoblastic tumors, and monitoring of hCG beta cf in the serum after mole evacuation may be useful for early prediction of subsequent development of postmolar persistent trophoblastic disease.
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Petignat, Patrick, Pierre Vassilakos, and Aldo Campana. "Are fertility drugs a risk factor for persistent trophoblastic tumour?" Human Reproduction 17, no. 6 (2002): 1610–15. http://dx.doi.org/10.1093/humrep/17.6.1610.
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Chaves, Mariana M., Tiago Maia, Teresa Margarida Cunha, and Vera Furtado Veiga. "Placental site trophoblastic tumour: the rarest subtype of gestational trophoblastic disease." BMJ Case Reports 13, no. 10 (2020): e235756. http://dx.doi.org/10.1136/bcr-2020-235756.
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Placental site trophoblastic tumour (PSTT) is a very rare form of gestational trophoblastic disease that grows slowly, secretes low levels of beta-subunit of human chorionic gonadotropin (β-hCG), presents late-onset metastatic potential and is resistant to several chemotherapy regimens. Here, we report a case of PSTT in a 36-year-old woman who presented with amenorrhea and persistently elevated serum level of β-hCG after a miscarriage. Transvaginal ultrasound revealed a hypovascular ill-defined solid lesion of the uterine fundus and MRI showed a tumour infiltrating the external myometrium with discrete early enhancement and signal restriction on diffusion-weighted imaging. PSTT was suspected, and after endometrial biopsy by hysteroscopy and posterior hysterectomy, microscopic examination allowed the final diagnosis. The level of β-hCG dropped significantly in about a month after surgical treatment. Due to the rarity of PSTT, reporting new cases is crucial to improve the diagnosis and managing of these patients.
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Matsui, H. "Outcome of subsequent pregnancy after treatment for persistent gestational trophoblastic tumour." Human Reproduction 17, no. 2 (2002): 469–72. http://dx.doi.org/10.1093/humrep/17.2.469.
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Habib, Asma, Md Mofazzel Hossain, and Fauzia Jahan. "Successful Pregnancy Outcome Within Short Period of Remission From Choriocarcinoma Treated with Single Agent Chemotherapy - A Case Report." Bangladesh Medical Journal 40, no. 3 (2014): 29–32. http://dx.doi.org/10.3329/bmj.v40i3.18671.
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Gestational trophoblastic tumour/disease (GTT/GTD) is unique it cancer biology in that they result from aberrations of either a normal or an abnormal pregnancy. The most common antecedent pregnancy event to GTT is a complete or partial hydatidiform mole (HM). However, persistent trophoblastic disease or choriocarcinoma can follow a complete hydatidiform mole with an incident of approximately 8%, and after a partial hydatidiform mole with an incidence of approximately 0.5%. The exact proportion of cases of hydatidiform mole transforming to choriocarcinoma cannot be clearly estimated, approximately 3% to 5% of cases of complete hydatidiform mole. 1-3 Therefore, all patients with GTT need to be monitored so that the small proportion of persistent mole or choriocarcinoma can receive prompt treatment and elimination of their' disease. The recommendation stands as strict avoidance of pregnancy for at least one year after treatment of molar pregnancy or low risk non-metastatic gestational trophoblastic tumour. Pregnancy during this period of surveillance interferes with the sequential monitoring of abnormal trophoblastic activity by serum beta-human chorionic gonadotrophin levels and relapses become difficult to detect. The effect of single agent or combination chemotherapy on the totipotent oocytes usually wavers away during the recommended period of contraception. But in cases of pregnancy during the period of surveillance certain factors have been found to be associated with increased risk of relapse and teratogenic effects of the offspring. High risk/score (according to the FIGO scoring system ) and advanced stage Gestational trophoblastic tumour (GTT), short interval between pregnancy and remission from combination chemotherapy, poor compliance during the antenatal follow-up are linked with detrimental maternal and foetal outcome. Here we report a case of successful pregnancy outcome in a patient who conceived within 3 months of remission from choriocarcinoma treated by methotrexate as evidenced by 2 consecutive negative ?-human chorionic gonadotropin (?-hCG) values. DOI: http://dx.doi.org/10.3329/bmj.v40i3.18671 Bangladesh Medical Journal 2011 Vol.40(3):29-32
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Korbeľ, Miroslav, Jozef Šufliarsky, Ľudovít Danihel, and Zuzana Nižňanská. "Results of treatment of gestational trophoblastic neoplasia in the Slovak Republic in the years 1993–2017." Česká gynekologie 86, no. 2 (2021): 94–101. http://dx.doi.org/10.48095/cccg202194.
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Overview Objective: Gestational trophoblastic neoplasia epidemiology and treatment results in the Slovak Republic in the years 1993–2017. Methods: Retrospective analysis results of gestational trophoblastic neoplasia treatment in the Centre for gestational trophoblastic disease in the Slovak Republic in Bratislava in the years 1993–2017 according to prognostic scoring and staging system FIGO/WHO (International Federation of Gynecology and Obstetrics/World Health Organization). Results: The Centre for Gestational Trophoblastic Disease was created in the Slovak Republic in the year 1993, after the split of former Czechoslovakia. A total of 100 patients with gestational trophoblastic neoplasia were treated in this Centre in the years 1993–2017. According to prognostic scoring and staging system FIGO/ WHO, 74% patients were at a low risk and 26% of patients were at a high-risk of gestational trophoblastic neoplasia. There were 56, 2, 32 and 10% patients in stages I, II, III, and IV, respectively. The total curability and mortality rates were 96 and 4%, respectively. The curability rate 100% was achieved in stages I–III and in all placental site trophoblastic tumours, and the curability rate 60% was achieved in stage IV. In the years 1993 –2017, the incidences were 1 in 59,315 pregnancies and 1 in 42,299 deliveries for choriocarcinoma, 1 in 489,348 pregnancies and 1 in 348,965 deliveries for placental site trophoblastic tumours, 1 in 139,814 pregnancies and 1 in 99,704 deliveries for invasive mole, and 1 in 39,947 pregnancies and 1 in 28,487 deliveries for persistent gestational trophoblastic neoplasia. In the Czech Republic in the same period of time, there were treated 281 (301) patients with the curability rate 98.6% (98.7%). Conclusion: The results of the treatment of gestational trophoblastic neoplasia in the Slovak Republic are comparable with those achieved by leading centers specialized for the treatment of this disease in Europe and in the world. Early detection and centralisation of the treatment are crucial points for successful treatment, as the high curability rate of gestational trophoblastic neoplasia is achieved by effective therapy. Keywords: gestational trophoblastic neoplasia – choriocarcinoma – placental site trophoblastic tumour – epithelioid trophoblastic tumour – invasive mole – curability – mortality – reproductive outcomes
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Chen, Ruey-Jien, Su-Cheng Huang, Song-Nan Chow, Chang-Yao Hsieh, and Hey-Chi Hsu. "Persistent gestational trophoblastic tumour with partial hydatidiform mole as the antecedent pregnancy." BJOG: An International Journal of Obstetrics and Gynaecology 101, no. 4 (1994): 330–34. http://dx.doi.org/10.1111/j.1471-0528.1994.tb13620.x.
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De Vos, M., M. Leunen, C. Fontaine, and Ph De Sutter. "Successful Primary Treatment of a Hydatidiform Mole with Methotrexate and EMA/CO." Case Reports in Medicine 2009 (2009): 1–3. http://dx.doi.org/10.1155/2009/454161.
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Background. The preferred treatment method of most hydatidiform moles is suction aspiration. In rare circumstances uterine abnormalities may preclude surgical treatment.Case. We report a case of complete molar pregnancy successfully treated with methotrexate followed by EMA/CO. A 38-year-old woman with a complete hydatidiform mole and multiple uterine fibroids underwent a failed attempt at suction aspiration. Following treatment with methotrexate, a nonmetastatic persistent trophoblastic tumour developed. Six cycles of EMA/CO led to complete remission.Conclusion. We propose that primary treatment of molar pregnancies with chemotherapy is a useful treatment option in cases where uterine abnormalities interfere with suction aspiration.
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Kaiser, Franziska, Julia Hartweg, Selina Jansky, et al. "Persistent Human KIT Receptor Signaling Disposes Murine Placenta to Premature Differentiation Resulting in Severely Disrupted Placental Structure and Functionality." International Journal of Molecular Sciences 21, no. 15 (2020): 5503. http://dx.doi.org/10.3390/ijms21155503.
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Activating mutations in the human KIT receptor is known to drive severe hematopoietic disorders and tumor formation spanning various entities. The most common mutation is the substitution of aspartic acid at position 816 to valine (D816V), rendering the receptor constitutively active independent of ligand binding. As the role of the KIT receptor in placental signaling cascades is poorly understood, we analyzed the impact of KITD816V expression on placental development using a humanized mouse model. Placentas from KITD816V animals present with a grossly changed morphology, displaying a reduction in labyrinth and spongiotrophoblast layer and an increase in the Parietal Trophoblast Giant Cell (P-TGC) layer. Elevated differentiation to P-TGCs was accompanied with reduced differentiation to other Trophoblast Giant Cell (TGC) subtypes and by severe decrease in proliferation. The embryos display growth retardation and die in utero. KITD816V-trophoblast stem cells (TSC) differentiate much faster compared to wild type (WT) controls. In undifferentiated KITD816V-TSCs, levels of Phosphorylated Extracellular-signal Regulated Kinase (P-ERK) and Phosphorylated Protein Kinase B (P-AKT) are comparable to wildtype cultures differentiating for 3–6 days. Accordingly, P-TGC markers Placental Lactogen 1 (PL1) and Proliferin (PLF) are upregulated as well. The results reveal that KIT signaling orchestrates the fine-tuned differentiation of the placenta, with special emphasis on P-TGC differentiation. Appropriate control of KIT receptor action is therefore essential for placental development and nourishment of the embryo.
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Shakya, Beemba, and Gehanath Baral. "Trends of Gestational Trophoblastic Disease at a Tertiary Care Hospital." Nepal Journal of Obstetrics and Gynaecology 12, no. 1 (2018): 26–31. http://dx.doi.org/10.3126/njog.v12i1.18977.
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Aims: The objective of this study was to determine the clinical presentation of GTD and response of GTN to single and multiple agent chemotherapy on the basis of WHO Prognostic risk scoring system.Methods: This was a cross-sectional retrospective study undertaken at Paropakar Maternity and Women’s Hospital. The medical records of 102 GTD cases were reviewed from January 25, 2015 to January 24, 2016. Data pertaining patient characteristics, histopathology types of GTD, management, prognostic risk scores, chemotherapy, follow up and remissions were retrieved and were analyzed using SPSS version 16.0.Results: Among 102 GTD cases, the most common presentation was vaginal bleeding 69(67.6%) followed by ultrasound diagnosed cases 30(29.4%). Primary management of all cases were suction evacuation, 68 completed and 12 are under follow-up. GTN was diagnosed in 14/90 (15.5%) of complete mole and 5/90 (5.5%) of partial mole. Twenty-two cases received chemotherapy for persistent gestational trophoblastic tumour(19) and invasive mole(3). Twenty cases were low risk score group and two cases under high risk group. Out of 20 low risk cases that received MTX-FA, 13/20 (65%) achieved remission. Due to low response of MTX-FA, five of them were converted to Actinomycin-D and achieved remission (100%). Two high risk cases received EMA-CO regimen and achieved 100% remission. Two low risk GTN, complete and invasive mole (underwent hysterectomy) are undergoing MTX-FA chemotherapy.Conclusions: The most common presentation of GTD was vaginal bleeding. Low risk GTN achieved 65% remission with Methotrexate-Folinic acid, ultimately achieved 100% remission with Actinomycin-D. High risk GTN achieved 100% remission with EMA-CO regimen.
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Said, Tamer H., and Yasser Elkerm. "Repeated ultrasound guided local infiltration of methotrexate in persistent gestational trophoblastic disease with myometrial invasion: case series and review of literature." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 5 (2021): 2045. http://dx.doi.org/10.18203/2320-1770.ijrcog20211535.
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Gestational trophoblastic disease is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. An invasive mole is a hydatidiform mole that has grown into the muscle layer of the uterus. Invasive vesicular moles can develop from either partial or complete moles, but complete moles become invasive much more often than do partial moles. Invasive moles develop in a little less than 20% of women who have had a complete mole evacuated. Treatment of invasive mole is classically by giving systemic chemotherapy. Objectives of current study were to evaluate the effect of repeated local methotrexate injection in treatment of invasive mole. Cases with invasive mole assigned for local injection of 50 mg methotrexate in 10 cm normal saline using local injection in the myometrium under transvaginal ultrasound guidance. Follow up weekly till negative results are obtained. All cases showed rapid decrease of the level of b-hCG level after local injection and showed negative hormone results within 6 weeks after injection. Local methotrexate intra-myometrial local injection therapy has successful results in cases with persistent invasive hydatidiform mole and should be tried before referring them for systemic therapy.
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Pariyar, J. "Gestational trophoblastic disease in Nepalese women managed in B. P. Koirala Memorial Cancer Hospital." Journal of Clinical Oncology 27, no. 15_suppl (2009): e16570-e16570. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e16570.
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e16570 Background: Gestational trophoblastic disease (GTD) is potentially curable disease. Its incidence varies in different countries with high incidence reported in Japan (2/1000 pregnancies) and Mexico (2.5/1000 pregnancies). No studies have been reported regarding epidemiology, management and outcome of GTD in Nepal. Methods: The study was a descriptive case series. Case records of GTD patients attending B.P. Koirala Memorial Cancer Hospital, Nepal from 2001 to 2007 were analyzed. The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and follow-up. Results: A total of 45 cases of gestational trophoblastic disease (GTD) were received from 26 districts of Nepal. The age of the patients ranged from 16 to 50 years with a mean age of 29.1 years (SD 9.4 years). Out of 45 cases 19 (43%) were of Tibeto-Burmese ethnic group and 15 (33%) belonged to Indo-Aryan ethnic group. There were 17 cases (37.8%) of hydatidiform mole, 6 were invasive mole (13.35%), 4 of persistent gestational trophoblastic tumour (8.8%) and 22 patients (48.8%) of choriocarcinoma. In 7 cases (15.5%) molar pregnancy had occurred in the first conception, another 7 cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. The most common presenting symptom was vaginal bleeding and 26 (57.8%) patients had anaemia. Theca Leuteal cyst was present in 11 (24.5%), 17 (37.8%) cases had lung metastasis, 4 (8.9%) had brain metastasis and another 4 (8.9%) had disseminated disease detecteted radiologically. Among the 45 cases 6 (13.3%) were treated with suction evacuation only; 9 (20%) underwent hysterectomy for uterine perforation, excessive hemorrhage and invasive mole. 28 (62.2%) cases underwent adjuvant chemotherapy among which 12 (26.6%) received single agent chemotherapy and 15 (33.3%) received EMA-CO regimen. Brain irradiation was required in a case with brain metastasis. Five (11.1%) cases with disseminated disease and high WHO risk score left the hospital against medical advice. There were 3 (6.7%) mortalities. 37 (82.1%) cases are in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. No significant financial relationships to disclose.
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Balduit, Andrea, Alessandro Mangogna, Chiara Agostinis, et al. "Zinc Oxide Exerts Anti-Inflammatory Properties on Human Placental Cells." Nutrients 12, no. 6 (2020): 1822. http://dx.doi.org/10.3390/nu12061822.
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Background: An aberrant and persistent inflammatory state at the fetal-maternal interface is considered as a key contributor in compromised pregnancies. Decidual endothelial cells (DECs) play a pivotal role in the control of the local decidual inflammation. The aim of the current study was to determine whether dietary supplement with zinc oxide (ZnO), due to its very low adverse effects, may be useful for modulating the inflammatory response in the first trimester of pregnancy. Methods: The anti-inflammatory properties of ZnO in pregnancy were evaluated by in vitro tests on endothelial cells isolated from normal deciduas and on a trophoblast cell line (HTR8/Svneo). The effects of this treatment were analyzed in terms of adhesion molecule expression and inflammatory cytokine secretion, by real time-quantitative PCR (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA). Results: Our data showed that ZnO was able to reduce the inflammatory response of DECs, in terms of vascular cell adhesion molecule-1 (VCAM-1), interleukin (IL)-8, IL-6, tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCP-1) expression induced by TNF-α stimulation. This compound exerted no effect on intracellular adhesion molecule-1 (ICAM-1) exocytosis induced by TNF-α on stimulated trophoblast cells, but significantly reduced their IL-6 expression. Conclusion: According to these results, it can be suggested that the ZnO supplement, through its modulation of the pro-inflammatory response of DECs, can be used in pregnancy for the prevention of local decidual inflammation.
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Rubin, Mishaela R., John P. Bilezikian, Steven Birken, and Shonni J. Silverberg. "Human chorionic gonadotropin measurements in parathyroid carcinoma." European Journal of Endocrinology 159, no. 4 (2008): 469–74. http://dx.doi.org/10.1530/eje-08-0169.
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ObjectivePreoperatively, it is difficult to differentiate between parathyroid cancer (PtCa) and severe primary hyperparathyroidism (PHPT) due to a benign tumor. Human chorionic gonadotropin (hCG) is a tumor marker in trophoblastic and nontrophoblastic cancers and hyperglycosylated hCG is increased in hCG-secreting malignancies. We investigated whether hCG can distinguish PtCa cancer from benign disease and add prognostic information.DesignObservational study.MethodsMeasurement of urinary hCG (total and malignant isoforms) and serum malignant hCG in 8 subjects with PtCa and in 18 subjects with PHPT (measurement of urine in ten and serum in eight).ResultsTotal urinary hCG was normal in the benign PHPT control subjects (range: 0–17 fmol/mg Cr; nl<50). In the PtCa subjects, three had normal total urinary hCG levels and survived complication free for at least 2 years; three had persistently elevated total urinary hCG levels (range: 217–1986 fmol/mg Cr) and sustained hip fracture (n=3) and died (n=2) within 3 and 6 months respectively; two had a rise in total urinary hCG and had hip fracture (n=1) and died (n=2) within 4 and 10 months respectively. Elevated urinary hCG was of the malignant hyperglycosylated isoform. Serum malignant hyperglycosylated hCG values in all of the cancer patients exceeded the maximal serum malignant hCG level of the PHPT subjects with benign disease (3.77 pmol/l).ConclusionhCG, especially its hyperglycosylated isoform, might add diagnostic and prognostic information in PtCa. Further studies would help to elucidate the role of hCG as a potential tumor marker in this disease.
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McNeish, I. A., S. Strickland, L. Holden, et al. "Low-Risk Persistent Gestational Trophoblastic Disease: Outcome After Initial Treatment With Low-Dose Methotrexate and Folinic Acid From 1992 to 2000." Journal of Clinical Oncology 20, no. 7 (2002): 1838–44. http://dx.doi.org/10.1200/jco.2002.07.166.
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PURPOSE: We have simplified the treatment of gestational trophoblastic disease (GTD) in order to reduce the number of patients exposed to potentially carcinogenic chemotherapy. Patients who score 0 to 8 on the Charing Cross scoring system are classified as low-risk and receive methotrexate (MTX) and folinic acid (FA), whereas those who score higher than 8 are classified as high-risk and receive the etoposide, methotrexate, and dactinomycin (EMA)/cyclophosphamide and vincristine (CO) regimen. PATIENTS AND METHODS: Between 1992 and 2000, 485 women with GTD were commenced on MTX/FA at Charing Cross Hospital, London, United Kingdom. If patients developed MTX resistance or toxicity, treatment was altered according to the level of beta human chorionic gonadotropin (hCG). If serum hCG was ≤ 100 IU/L, patients received dactinomycin; if hCG was greater than 100 IU/L, patients received EMA/CO. RESULTS: The median duration of follow-up was 4.7 years. Overall survival was 100% and the relapse rate was 3.3% (16 of 485 patients). hCG values normalized in 324 (66.8%) of 485 patients with MTX alone, whereas 161 (33.2%) of 485 patients required a change in treatment, 11 because of MTX toxicity and 150 because of MTX resistance. Sixty-seven patients changed to dactinomycin, of whom 58 achieved normal hCG values, and nine required third-line chemotherapy with EMA/CO. hCG values normalized in 93 (98.9%) of 94 patients who changed directly to EMA/CO from MTX. CONCLUSION: Single-agent dactinomycin has activity in patients with low-risk GTD who develop MTX resistance and whose hCG is low. Simplifying the stratification of GTD into two classes (low- and high-risk) does not compromise overall outcome and may reduce the risk of second tumors.
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Albonici, Loredana, Monica Benvenuto, Chiara Focaccetti, et al. "PlGF Immunological Impact during Pregnancy." International Journal of Molecular Sciences 21, no. 22 (2020): 8714. http://dx.doi.org/10.3390/ijms21228714.
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During pregnancy, the mother’s immune system has to tolerate the persistence of paternal alloantigens without affecting the anti-infectious immune response. Consequently, several mechanisms aimed at preventing allograft rejection, occur during a pregnancy. In fact, the early stages of pregnancy are characterized by the correct balance between inflammation and immune tolerance, in which proinflammatory cytokines contribute to both the remodeling of tissues and to neo-angiogenesis, thus, favoring the correct embryo implantation. In addition to the creation of a microenvironment able to support both immunological privilege and angiogenesis, the trophoblast invades normal tissues by sharing the same behavior of invasive tumors. Next, the activation of an immunosuppressive phase, characterized by an increase in the number of regulatory T (Treg) cells prevents excessive inflammation and avoids fetal immuno-mediated rejection. When these changes do not occur or occur incompletely, early pregnancy failure follows. All these events are characterized by an increase in different growth factors and cytokines, among which one of the most important is the angiogenic growth factor, namely placental growth factor (PlGF). PlGF is initially isolated from the human placenta. It is upregulated during both pregnancy and inflammation. In this review, we summarize current knowledge on the immunomodulatory effects of PlGF during pregnancy, warranting that both innate and adaptive immune cells properly support the early events of implantation and placental development. Furthermore, we highlight how an alteration of the immune response, associated with PlGF imbalance, can induce a hypertensive state and lead to the pre-eclampsia (PE).
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Yang, Chunfeng, Jianqi Li, Yuanyuan Zhang, Hanzhen Xiong, and Xiujie Sheng. "Epithelioid trophoblastic tumor coexisting with choriocarcinoma around an abdominal wall cesarean scar: a case report and review of the literature." Journal of Medical Case Reports 14, no. 1 (2020). http://dx.doi.org/10.1186/s13256-020-02485-8.
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Abstract Background Mixed gestational trophoblastic neoplasms are extremely rare and comprise a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors, and placental site trophoblastic tumors. We present a case of a patient with extrauterine mixed gestational trophoblastic neoplasm adjacent to the abdominal wall cesarean scar. On the basis of a literature review, this type of case has never been reported before due to the unique lesion location and low incidence. Case presentation Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum β-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar. Conclusions It is worth noting whether epithelioid trophoblastic tumor exists in the setting of persistent positive low-level β-human chorionic gonadotropin. More studies are required to provide mechanistic insights into these mixed gestational trophoblastic neoplasms.
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Bakhat, M. A. H., S. T. Fayed, A. M. Ibrahim, A. H. Naguib, and M. A. Faris. "The Value of Hysteroscopy in Women with Persistently Elevated Post-Evacuation Serum Human Chorionic Gonadotropin (hCG) Level Following Evacuation of Molar Disease." QJM: An International Journal of Medicine 113, Supplement_1 (2020). http://dx.doi.org/10.1093/qjmed/hcaa056.
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Abstract Background and rational Gestational trophoblastic disease (GTD) is a spectrum of trophoblastic diseases that encompass the hydatidiform mole (both complete and partial), as well as the potentially-malignant and malignant forms: invasive mole, choriocarcinoma and placental site trophoblastic tumor. Gestational trophoblastic neoplasia (GTN) refers to persistent elevation of serum levels of human chorionic gonadotropin (hCG). The subsequentmanagement of GTD after evacuation of the uterus relies on serial surveillance of serum hCG levels. When serum hCG levels plateau or rise, chemotherapy should promptly be initiated. Patients and Methods This study for accuracy of a diagnostic test. The current study was conducted at Gynecologic Oncology Unit and Early Cancer Detection Unit at Ain Shams University Maternity Hospital during the period between January 2016 and June 2018. Results In the present study, the case who had a vascular mass, the patient was 44 years old and she was para 4, so board decision was for TAH. Postoperative serum hCG surveillance for this case showed adequately declining levels. She, accordingly, did not receive chemotherapy. For the 19/44 (43.2%) cases who had a hysteroscopic finding of ‘an empty cavity’ were diagnosed as persistent GTN and received chemotherapy according to the protocol. The remaining 25/44 (56.8%) cases, who had a hysteroscopic finding of ‘remnants’, underwent re-evacuation. Postoperative serum hCG surveillance showed persistently elevated levels in 9/44 (20.5%) cases, who, therefore, received chemotherapy according to the protocol; and adequately declining levels in 16/44 (36.4%) cases, who, accordingly, did not receive chemotherapy. Conclusion The hysteroscopy significantly reduced the risk of chemotherapy in women with hydatidiform mole and have persistent post-evacuation elevated serum hCG level and sonographic criteria of invasive disease.
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Rehman, Tejhmal, Ali Hameed, Nigel Beharry, J. Du Parcq, and Gul Bano. "An unusual cause of gynaecomastia in a male." Endocrinology, Diabetes & Metabolism Case Reports 2019 (July 3, 2019). http://dx.doi.org/10.1530/edm-19-0060.
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Summary Beta-human chorionic gonadotropin (βhCG) is normally produced by syncytiotrophoblasts of the placenta during pregnancy and aids embryo implantation. However, it is also secreted in varying amounts in non-pregnant conditions commonly heralding a neoplastic process. We present a case of 50-year-old man, who presented with bilateral gynaecomastia with elevated testosterone, oestradiol, suppressed gonadotropins with progressively increasing levels of human chorionic gonadotropin (hCG). Biochemical and radiological investigations including ultrasonography of testes, breast tissue, MRI pituitary and CT scan full body did not identify the source of hCG. FDG PET scan revealed a large mediastinal mass with lung metastasis. Immunostaining and histological analysis confirmed the diagnosis of primary choriocarcinoma of the mediastinum. It is highly aggressive and malignant tumor with poor prognosis. Early diagnosis and management are essential for the best outcome. Learning points: High βhCG in a male patient or a non-pregnant female suggests a paraneoplastic syndrome. In the case of persistently positive serum hCG, exclude immunoassay interference by doing the urine hCG as heterophilic antibodies are not present in the urine. Non-gestational choriocarcinoma is an extremely rare trophoblastic tumor and should be considered in young men presenting with gynaecomastia and high concentration of hCG with normal gonads. A high index of suspicion and extensive investigations are required to establish an early diagnosis of extra-gonadal choriocarcinoma. Early diagnosis is crucial to formulate optimal management strategy and to minimize widespread metastasis for best clinical outcome.