14 results on '"Gestational Trophoblastic Disease surgery"'
Search Results
2. High-intensity focused ultrasound as a pretreatment combined with hysteroscopic resection for gestational trophoblastic neoplasia with chemotherapy intolerance: a case report.
- Author
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Liu Y, Huang J, Du C, Jiang J, Zhou H, and Qu D
- Subjects
- Pregnancy, Female, Humans, Adult, Retrospective Studies, Gestational Trophoblastic Disease diagnostic imaging, Gestational Trophoblastic Disease surgery, Hydatidiform Mole surgery, Uterine Neoplasms diagnostic imaging, Uterine Neoplasms surgery, Uterine Neoplasms pathology
- Abstract
Background: Due to resistance and intolerance to chemotherapy, localized lesion resection may be required in some patients with Gestational trophoblastic neoplasia (GTN), which may lead to massive bleeding. In this case report, we describe the successful use of high-intensity focused ultrasound (HIFU) as an effective pretreatment method for surgical procedure in a patient with GTN to reduce the perioperative risk and the impact on fertility., Case Presentation: A 26-year-old woman was diagnosed with high-risk GTN (FIGO Stage III: 12 prognostic scores) after a hydatidiform mole. The fifth chemotherapy cycle was interrupted due to severe chemotherapy toxicity. However, the uterine lesion was still present and the beta-human chorionic gonadotropin (β-hCG) level was not restored to normal. Therefore, ultrasound-guided HIFU was performed as a pretreatment method to shrink the lesion and prevent massive bleeding during localized lesion resection. The effectiveness of ablation was evaluated immediately using contrast-enhanced ultrasound and Color Flow Doppler ultrasonography. One month after HIFU treatment, the uterine lesion was completely resected under hysteroscopic surgery. During the surgery, HIFU was found to have shrunk the lesion and there was minimal bleeding (5 mL). The uterine cavity morphology and menstruation returned to normal after surgery. The patient has showed no signs of recurrence as of one-year follow-up., Conclusion: Ultrasound-guided HIFU ablation may be a new choice for high-risk GTN patients with chemoresistance or chemo-intolerance. As a noninvasive pretreatment method, HIFU can shrink the uterine lesion, and reduce the risk of bleeding with no obvious effect on fertility.
- Published
- 2023
- Full Text
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3. Surgery including fertility-sparing treatment of GTD.
- Author
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Ngu SF and Ngan HYS
- Subjects
- Female, Humans, Placenta, Pregnancy, Choriocarcinoma, Gestational Trophoblastic Disease drug therapy, Gestational Trophoblastic Disease surgery, Hydatidiform Mole surgery, Uterine Neoplasms surgery
- Abstract
Gestational trophoblastic disease (GTD) consists of a spectrum of diseases, including hydatidiform moles, invasive mole, metastatic mole, choriocarcinoma, placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). GTD is a relatively uncommon disease occurring in women of reproductive age, with high cure rates. Primary treatment of hydatidiform moles includes uterine evacuation, followed by close monitoring of serial hCG levels to detect for post-molar gestational trophoblastic neoplasia (GTN). In patients with GTN, the main therapy consists of chemotherapy, although some surgical procedures are important in selected patients to achieve curing. Hysterectomy is the mainstay treatment for PSTT or ETT and may be considered in selected patients for management of hydatidiform mole and malignant GTN especially in chemoresistant disease. Resection of metastatic lesions such as in the lung or brain can be considered in selected patients with isolated chemoresistant tumour. Surgical treatment of GTD will be discussed in this chapter., Competing Interests: Declaration of competing interest None., (Copyright © 2020. Published by Elsevier Ltd.)
- Published
- 2021
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4. Curative effect of second curettage for treatment of gestational trophoblastic disease - Results of the Belgian registry for gestational trophoblastic disease.
- Author
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Vandewal A, Delbecque K, Van Rompuy AS, Noel JC, Marbaix E, Delvenne P, Nisolle M, Van Nieuwenhuysen E, Kridelka F, Vergote I, Goffin F, and Han SN
- Subjects
- Belgium, Chorionic Gonadotropin, Curettage, Female, Humans, Pregnancy, Registries, Gestational Trophoblastic Disease drug therapy, Gestational Trophoblastic Disease surgery, Hydatidiform Mole, Uterine Neoplasms surgery
- Abstract
Objective: We assessed the curative effect of a second curettage in patients with persistent hCG serum levels after first curettage for a gestational trophoblastic disease (GTD)., Study Design: This prospective observational study used the data of the Belgian register for GTD between July 2012 and January 2017. We analysed the data of patients who underwent a second curettage. We included 313 patients in the database. Primary endpoints were need for second curettage and chemotherapy., Results: Thirty-seven patients of the study population (12 %) underwent a second curettage. 20 had persistent human chorionic gonadotropin hormone (hCG) elevation before second curettage. Of them, 9 patients (45 %) needed no further treatment afterwards. Eleven patients (55 %) needed further chemotherapy. Nine (82 %) were cured with single-agent chemotherapy and 2 patients (18 %) needed multi-agent chemotherapy. Of the 37 patients, patients with hCG levels below 5000 IU/L undergoing a second curettage were cured without chemotherapy in 65 % versus 45 % of patients with hCG level more than 5000 IU/L. Of the ten patients with a hCG level below 1000 IU/L, eight were cured without chemotherapy., Conclusions: Patients with post-mole gestational trophoblastic neoplasia can benefit from a second curettage to avoid chemotherapy, especially when the hCG level is lower than 5000 IU/L., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
5. Invasive mole with lung metastasis after an abdominal complete hydatidiform mole treatment.
- Author
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Suzuki S, Takahashi K, Obayashi S, Kitazawa M, Kuroda H, and Fukasawa I
- Subjects
- Adult, Chorionic Gonadotropin, Female, Humans, Pregnancy, Gestational Trophoblastic Disease diagnosis, Gestational Trophoblastic Disease surgery, Hydatidiform Mole diagnosis, Hydatidiform Mole, Invasive, Lung Neoplasms, Uterine Neoplasms diagnosis, Uterine Neoplasms surgery
- 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., (© 2020 Japan Society of Obstetrics and Gynecology.)
- Published
- 2021
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6. The impact of previous cesarean section (C/S) on the risk for post-molar gestational trophoblastic neoplasia (GTN).
- Author
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Cho HW, Ouh YT, Min KJ, Lee NW, Lee S, Song JY, Hong JH, and Lee JK
- Subjects
- Adult, Chorionic Gonadotropin, beta Subunit, Human blood, Female, Gestational Trophoblastic Disease blood, Gestational Trophoblastic Disease drug therapy, Gestational Trophoblastic Disease surgery, Humans, Hydatidiform Mole blood, Hydatidiform Mole drug therapy, Hydatidiform Mole surgery, Multivariate Analysis, Parity, Pregnancy, Risk, Cesarean Section statistics & numerical data, Gestational Trophoblastic Disease epidemiology, Hydatidiform Mole epidemiology
- Abstract
Objective: To investigate the relationship between previous cesarean section (C/S) and risk for post-molar gestational trophoblastic neoplasia (GTN)., Methods: Data from patients who were treated for hydatidiform moles between 1995 and 2016 were retrospectively reviewed. Patient age, gravidity, parity, abortion history, gestational age, pretreatment beta-human chorionic gonadotropin (HCG), previous molar pregnancy, clinical symptoms, enlarged uterus, theca lutein cyst, type of GTN, World Health Organization risk score, chemotherapy, and mode of delivery were recorded. Hazard ratios (HR) and 95% confidence intervals (CI) for variables associated with the occurrence of post-molar GTN and invasive mole were estimated by univariate and multivariate Cox proportional hazards models., Results: From 1995 to 2016, 182 patients were diagnosed with molar pregnancy and underwent treatment. Patients with previous C/S (C/S group) had higher age (37.0 vs 32.8. p = 0.004), gravidity (3.1 vs 2.0, p < 0.001), and parity (1.6 vs 0.9, p < 0.001) than patients without previous C/S (non-C/S group). Post-molar GTN (43.5 vs 26.5%, p < 0.001), invasive mole (21.7 vs 3.7%, p < 0.001), hysterectomy (28.3 vs 6.6%, p < 0.001), and chemotherapy (45.7 vs 28.7%, p = 0.03) were more frequent in the C/S group. In multivariate analysis, independent risk factors for post-molar GTN were previous C/S (HR 5.1, 95% CI 2.1-12.7), abortion history (HR 6.3, 95% CI 2.5-15.6), and pretreatment β-hCG (HR 1.3, 95% CI 1.1-1.6)., Conclusions: In this study, C/S was a strong risk factor for occurrence of post-molar GTN and invasive mole. Aggressive treatment, such as multi-agent chemotherapy or hysterectomy, can be considered for hydatidiform moles in patients with a C/S history., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2020
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7. Incidence and outcome of gestational trophoblastic disease in lower Egypt.
- Author
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Zakaria A, Hemida R, Elrefaie W, and Refaie E
- Subjects
- Adolescent, Adult, Egypt epidemiology, Female, Gestational Trophoblastic Disease blood, Gestational Trophoblastic Disease diagnosis, Gestational Trophoblastic Disease surgery, Humans, Hydatidiform Mole epidemiology, Hydatidiform Mole pathology, Hydatidiform Mole surgery, Incidence, Pregnancy, Prospective Studies, Treatment Outcome, Uterine Neoplasms pathology, Vacuum Curettage, Young Adult, Chorionic Gonadotropin blood, Gestational Trophoblastic Disease epidemiology, Hydatidiform Mole blood, Placenta pathology
- Abstract
Background: Gestational trophoblastic disease (GTD) defines a spectrum of proliferative disorders of trophoblastic epithelium of the placenta. Incidence, risk factors, and outcome may differ from one country to another., Objective: To describe incidence, patient characteristics, treatment modalities, and outcome of GTD at Mansoura University which is a referral center of Lower Egypt., Methods: An observational prospective study was conducted at the GTD Clinic of Mansoura University. The patients were recruited for 12 months from September 2015 to August 2016. The patients' characteristics, management, and outcome were reported., Results: We reported 71 clinically diagnosed GTD cases, 62 of them were histologically confirmed, 58 molar (33 CM and 25 PM) in addition to 4 initially presented GTN cases. Mean age of the studied cases was 26.22 years ± 9.30SD. Mean pre-evacuation hCG was 136170 m.i.u/ml ±175880 SD. Most of the cases diagnosed accidentally after abnormal sonographic findings (53.2%). Rate of progression of CM and PM to GTN was 24.2% and 8%, respectively., Conclusion: The incidence of molar pregnancy and GTN in our locality was estimated to be 13.1 and 3.2 per 1000 live births respectively. We found no significance between CM and PM regarding hCG level, time to hCG normalization, and progression rate to GTN., (© 2020 Zakaria A et al.)
- Published
- 2020
- Full Text
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8. Multiple metastatic gestational trophoblastic disease after a twin pregnancy with complete hydatidiform mole and coexisting fetus, following assisted reproductive technology: Case report and literature review.
- Author
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Nobuhara I, Harada N, Haruta N, Higashiura Y, Watanabe H, Watanabe S, Hisanaga H, and Sado T
- Subjects
- Abortion, Induced, Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Chorionic Gonadotropin, beta Subunit, Human blood, Cyclophosphamide therapeutic use, Dactinomycin therapeutic use, Etoposide therapeutic use, Female, Gestational Age, Gestational Trophoblastic Disease drug therapy, Gestational Trophoblastic Disease surgery, Humans, Hysterectomy, Lung Neoplasms drug therapy, Lung Neoplasms pathology, Lung Neoplasms secondary, Methotrexate therapeutic use, Pregnancy, Tomography, X-Ray Computed methods, Uterine Hemorrhage, Uterine Neoplasms diagnostic imaging, Uterine Neoplasms pathology, Uterine Neoplasms surgery, Vincristine therapeutic use, Fertilization in Vitro adverse effects, Gestational Trophoblastic Disease pathology, Hydatidiform Mole pathology, Pregnancy Complications, Neoplastic pathology, Pregnancy, Twin
- Abstract
Objective: Twin pregnancy with complete hydatidiform mole and coexisting fetus (CHMCF) is rare and associated with severe complications during pregnancy and subsequent gestational trophoblastic disease (GTD). We encountered a case of multiple metastatic GTD after a twin pregnancy with CHMCF, following conventional in vitro fertilization (IVF). Only one case of metastatic GTD after CHMCF due to assisted reproductive technology (ART) has been reported. Here, we present the clinical course and reveal the clinical features of CHMCF after ART through a literature review., Case Report: A 42-year-old primigravida woman had an abnormal pregnancy (i.e., CHMCF) by IVF. She had persisting severe vaginal bleeding, which led to termination of her pregnancy at 10 weeks of gestation. Pathohistological examination revealed that this was a case of CHMCF. Five weeks after the termination, the serum β-human chorionic gonadotropin level was still extremely high, and systemic contrast-enhanced computed tomography revealed a tumor in the uterine corpus and more than 30 lung nodules. After 11 cycles of combination chemotherapy with etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine (EMA/CO) to treat high-risk GTD, hysterectomy was needed as radical therapy., Conclusion: Cases of CHMCF following ART may also have higher malignant potential and higher risk of GTD development and become more aggressive biologically. The clinical course of CHMCF after ART seems to be almost the same as that without ART based on the results of literature review., (Copyright © 2018. Published by Elsevier B.V.)
- Published
- 2018
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9. Human Chorionic Gonadotropin Regression Curves after Partial or Complete Molar Pregnancy in Flanders: Are They Different from Regression Curves from the Eighties?
- Author
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Delattre S, Han S, Moerman P, Billen J, Goffin F, Scharpé K, and Vergote I
- Subjects
- Abortion, Therapeutic, Adult, Belgium, Female, Gestational Trophoblastic Disease surgery, Humans, Hydatidiform Mole surgery, Postoperative Period, Pregnancy, Reference Values, Time Factors, Uterine Neoplasms surgery, Chorionic Gonadotropin blood, Gestational Trophoblastic Disease blood, Hydatidiform Mole blood, Regression Analysis, Uterine Neoplasms blood
- Abstract
Background/aims: We updated human chorionic gonadotropin (hCG) regression curves created in the eighties after evacuation of complete and partial molar (CM and PM, respectively) pregnancies using modern hCG assays. We created similar curves for patients in need of chemotherapy (gestational trophoblastic neoplasia [GTN])., Methods: A total of 126 patients who were diagnosed with gestational trophoblastic disease from 1990 to 2014 were included. We compared curves from 2 groups, CM and PM, with historical ones. The third group was a comparison of GTN patients receiving first-line chemotherapy and patients in need of a switch of chemotherapy., Results: The regression curves were comparable to historical ones. According to the latter, mean time to normalization was 14-15 weeks after evacuation. We observed a normalization within 12 (CM) and 12.7 (PM) weeks. In addition, a remarkable but not statistically significant vertical shift (20 IU/L higher) was observed prior to day 60 compared with historical curves. The comparison in GTN patients showed a statistical significant difference, even at day 7., Conclusion: The presented hCG regression curves in the Flemish region were comparable with the ones of the eighties but with a vertical shift, hypothetically due to more sensitive assays. In addition, regression curves in GTN patients receiving chemotherapy can be used to evaluate response., (© 2017 S. Karger AG, Basel.)
- Published
- 2018
- Full Text
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10. Gestational Trophoblastic Neoplasia and Pregnancy Outcome After Routine Second Curettage for Hydatidiform Mole A Retrospective Observational Study.
- Author
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Kan M, Yamamoto E, Niimi K, Tamakoshi K, Sekiya Y, Nishino K, Ino K, and Kikkawa F
- Subjects
- Chorionic Gonadotropin, Curettage, Female, Humans, Pregnancy, Retrospective Studies, Gestational Trophoblastic Disease surgery, Hydatidiform Mole surgery, Pregnancy Outcome, Uterine Neoplasms surgery
- Abstract
Objective: To investigate gestational trophoblastic neoplasia (GTN), fertility, and pregnancy outcome in molar patients who underwent routine second curettage., Study Design: Eighty-two patients who visited our hospital for hydatidi- form mole between 2002 and 2011 were registered in this study. All patients had sec- ond curettage around the 7th day after first evacuation. We performed retrospective analysis on several factors between a remission group and a GTN group., Results: Fourteen patients (17.1%) had chemotherapy after being diagnosed with GTN. Multivariate analysis revealed that the hCG value before first evac- uation was only one independent prognostic factor for GTN. The median follow-up period was 45.5 months, and 41 patients had 62 pregnancies after remission of hydatidiform mole and GTN. The fertility rate was 80% in 45 patients with desire for a baby, and 39 pregnancies (62.9%) ended in live births without congenital malformation., Conclusion: The incidence of GTN was not lower in hydatidiform mole with routine second curettage. An independent prognostic factor for GTN- was the hCG value before the first evac- uation in molar patients. Our results suggest that rou- tine second curettage does not affect the fertility rate or increase a risk of adverse outcomes in subsequent prej- nancies.
- Published
- 2016
11. [Histopathology of gestational trophoblastic disease. An update].
- Author
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Horn LC, Einenkel J, and Vogel M
- Subjects
- Abortion, Induced statistics & numerical data, Adult, Cell Division, Diagnosis, Differential, Female, Gestational Trophoblastic Disease classification, Gestational Trophoblastic Disease surgery, Humans, Hydatidiform Mole classification, Ki-67 Antigen analysis, Mitotic Index, Myometrium pathology, Necrosis, Neoplasm Invasiveness, Placenta Diseases classification, Pregnancy, Gestational Trophoblastic Disease pathology, Hydatidiform Mole pathology, Placenta Diseases pathology
- Abstract
The differential diagnosis of villous forms of gestational trophoblastic disease (GTD) includes hydropic abortion, complete and partial hytatidiform mole and placental mesenchymal dysplasia. In addition to histologic criteria, p57(KIP2) immunohistochemistry might be helpful. Choriocarcinoma represents the most immature form of GTD. This and downregulation of HSP-27 might contribute to the high chemosensitivity, compared to placental site (PSTT) and epitheloid trophoblastic tumor (ETT). Within the differential diagnosis of the non-villous forms of GTD an algorithmic approach of immunohistochemistry is very helpful. With an incidence of 1.6% of all abortions within the first trimester the exaggerated placental site reaction (EPS) is rare. There is no molecular indication that the EPS represents a precursor lesion of PSTT. The morphologic prediction of the behaviour of PSTT is not well established. Factors which might be associated with adverse outcome are age >35 years, interval since last pregnancy >2 years, growth outside the uterus, deep myometrial invasion, destructive growth, extensive coagulative necrosis, presence of cells with clear cytoplasm, high mitotic rate and a Ki-67 labeling index >50%. Recent molecular data suggest a neoplastic transformation of (cyto-) trophoblastic stem cells, within the pathogenesis of (non-villous) GTD. The detection of target molecules for a targeted therapy is currently irrelevant.
- Published
- 2009
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12. Anesthetic management of a patient with hyperthyroidism due to hydatidiform mole.
- Author
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Matsumoto S, Shingu C, Hidaka S, Goto K, Hagiwara S, Iwasaka H, and Noguchi T
- Subjects
- Atrial Fibrillation etiology, Atrial Fibrillation therapy, Chorionic Gonadotropin blood, Electrocardiography, Female, Gestational Trophoblastic Disease pathology, Gestational Trophoblastic Disease surgery, Humans, Hydatidiform Mole pathology, Hydatidiform Mole surgery, Hysterectomy, Middle Aged, Monitoring, Intraoperative, Ovariectomy, Pregnancy, Thyroid Hormones blood, Tomography, X-Ray Computed, Anesthesia, Gestational Trophoblastic Disease complications, Hydatidiform Mole complications, Hyperthyroidism etiology, Hyperthyroidism therapy, Intraoperative Complications therapy
- Abstract
Secondary hyperthyroidism can often complicate gestational trophoblastic disease, a malignant uterine cancer. We report here the perioperative management of hyperthyroidism due to hydatidiform mole. A 53-year-old woman underwent emergency surgery due to suspicion of hydatidiform mole. Tachycardiac atrial fibrillation was detected by electrocardiography at the preoperative examination. No abnormalities were found in blood count, coagulation, biochemical tests, chest radiographs, or respiratory function. General anesthesia with nitrous oxide, oxygen, and sevoflurane, combined with fentanyl and 1% mepivacaine, was administered intermittently from an epidural catheter. Intraoperative events included hypotension and tachycardia, although in general, tachycardia was prevented with antiarrhythmic agents and transfusion with a plasma expander and crystalloid fluid. Hyperthyroidism was highly suspected from the patient's clinical course and was confirmed by high levels of preoperative serum free triiodothyronine (T3) and thyroxine (T4). The patient became euthyroid within a few days after mole evacuation and did not require an antiarrhythmic agent after her return to the inpatient ward.
- Published
- 2009
- Full Text
- View/download PDF
13. Inappropriate management of women with persistent low hCG results.
- Author
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Cole LA and Khanlian SA
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, False Positive Reactions, Female, Gestational Trophoblastic Disease drug therapy, Humans, Hydatidiform Mole drug therapy, Hysterectomy, Ovariectomy, Pregnancy, Reference Values, Retrospective Studies, Chorionic Gonadotropin analysis, Diagnostic Errors, Gestational Trophoblastic Disease diagnosis, Gestational Trophoblastic Disease surgery, Hydatidiform Mole diagnosis, Hydatidiform Mole surgery
- Abstract
The USA hCG Reference Service is a consulting service with a specialized clinical laboratory aiding physicians in the interpretation of conflicting or nonrepresentative human chorionic gonadotropin (hCG) results. We have consulted on 189 cases with persistent low levels of hCG but no evidence of pregnancy or tumor. Quiescent gestational trophoblastic disease (GTD) was identified in 121 cases by the absence of invasive trophoblast antigen and nonresponse to chemotherapy (64 cases with a history of hydatidiform mole or gestational trophoblastic neoplasia (GTN) and 57 cases following antecedent pregnancy). Another 61 Reference Service cases hadfalse positive hCG, and we observed 7 cases with low levels of hCG of pituitary origin (hCG subsequently suppressed by estrogen-progesterone medication). Most disturbing is that the majority of these cases (68%) received needless therapy for assumed GTN/choriocarcinoma/placental site trophoblastic tumor before consultation with the Reference Service. One hundred twenty-eight of the 189 patients (77 of 121 with quiescent GTD, 48 of 61 withfalse positive hCG and 3 of 7 with pituitary hCG) underwent therapy ranging from single-agent chemotherapy (117 cases), to EMA-CO combination chemotherapy (etoposide, methotrexate, actinomycin D alternating with cyclophosphamide and vincristine) (16 cases), to hysterectomy and/or bilateral salpingo-oophorectomy (31 cases). False positive hCG and pituitary hCG would obviously not respond to these treatments, and no treated cases of quiescent GTD responded to chemotherapy orfully responded to hysterectomy. The continued needless treatment of patients with quiescent GTD, even after multiple publications, is entirely avoidable. Unfortunately, the number of needlessly treated cases referred to the Reference Service is increasing.
- Published
- 2004
14. Criteria for initiating chemotherapy in patients after evacuation of hydatidiform mole.
- Author
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Matsui H, Iitsuka Y, Yamazawa K, Tanaka N, Mitsuhashi A, Seki K, and Sekiya S
- Subjects
- Female, Humans, Immunoenzyme Techniques, Pregnancy, Radioimmunoassay, Time Factors, Chorionic Gonadotropin blood, Gestational Trophoblastic Disease drug therapy, Gestational Trophoblastic Disease surgery, Hydatidiform Mole drug therapy, Hydatidiform Mole surgery
- Abstract
Objectives: To evaluate the spontaneous regression curve of serum human chorionic gonadotropin (hCG) in patients with an uneventful course after evacuation of hydatidiform mole and to compare the criteria for initiating chemotherapy in patients after evacuation of mole., Methods: From 1986 to 2001, 608 patients were followed at our department after evacuation of mole. The spontaneous regression curves of serum hCG in 432 patients with an uneventful course were established., Results: After evacuation of mole, the titers of serum hCG decreased constantly, and 90% of patients with an uneventful course were within normal range within 16 weeks. In 432 patients with an uneventful course, the upper 95% confidence limit of serum hCG at 5, 8 and 20 weeks was 753.7, 422.9 and 14.8 mIU/ml, respectively. Moreover, 39 (9.0%) and 15 patients (3.5%) with an uneventful course might have been diagnosed with gestational trophoblastic tumor and received needless chemotherapy based on the normal regression curve established by the Japan Society of Obstetrics and Gynecology or the US criteria of 4 consecutive plateauing or rising hCG values, respectively., Conclusions: Our more selective criteria for initiating chemotherapy in patients after evacuation of mole, i.e. hCG of 10,000 mIU/ml at 5 weeks, 1,000 mIU/ml at 8 weeks and nondetectable levels at 24 weeks after evacuation of mole, may be safe and acceptable in the management of patients after evacuation of mole., (Copyright 2003 S. Karger AG, Basel)
- Published
- 2003
- Full Text
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