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To retrospectively analyze the fertility outcomes and prognosis of gestational trophoblastic disease (GTD) patients, providing a basis for targeted fertility guidance and counseling. 82 GTD patients of childbearing age who received treatment at the Obstetrics and Gynecology Department of Lanzhou University First Hospital from January 2016 to January 2023 were stratified into re-pregnancy (n = 20) and non-re-pregnancy (n = 33) cohorts based on their pregnancy outcomes. The impacts of various factors on pregnancy outcomes were subsequently evaluated, encompassing the rates of subsequent pregnancies, live births, miscarriages, ectopic pregnancies, and ongoing pregnancies. Finally, logistics regression model was employed to analyze the risk factors affecting re-pregnancy in GTD patients. The study delineated those patients with different GTD pathologies had varying re-pregnancy rates (mole, erosive mole and choriocarcinoma accounted for 66.04%, 30.19% and 3.77%, respectively). Treatment predominantly involved uterine curettage, with fewer cases receiving chemotherapy alone or in conjunction with curettage accounted for 67.92%, 5.66%, and 26.42%, respectively. The average chemotherapy frequency was 4.59 ± 2.43 sessions, and a majority sought reproductive counseling. Re-pregnancy occurred in 37.74% of patients. The live birth rate was 65.00%, with miscarriage and ectopic pregnancy rates at 25.00% and 5.00% respectively. Logistic regression analysis pinpointed the absence of pre-pregnancy counseling as a significant independent risk factor for re-pregnancy in GTD patients (p < 0.05). While chemotherapy may influence ovarian function, with the majority of patients desiring children post-recovery, pregnancy rates remain high. Fertility counseling significantly enhances re-pregnancy success rates in GTD survivors, emphasizing its recommendation for those aiming to conceive post-recovery. [ABSTRACT FROM AUTHOR]

Copyright of Forensic Science & Technology is the property of Institute of Forensic Science, Ministry of Public Security and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Gestational trophoblastic diseases (GTDs) encompass a spectrum of conditions characterized by abnormal trophoblastic cell growth, ranging from benign molar pregnancies to malignant trophoblastic neoplasms. This systematic review explores the molecular underpinnings of GTDs, focusing on genetic and epigenetic factors that influence disease progression and clinical outcomes. Based on 71 studies identified through systematic search and selection criteria, key findings include dysregulations in tumor suppressor genes such as p53, aberrant apoptotic pathways involving BCL-2 (B-cell lymphoma), and altered expression of growth factor receptors and microRNAs (micro-ribose nucleic acid). These molecular alterations not only differentiate molar pregnancies from normal placental development but also contribute to their clinical behavior, from benign moles to potentially malignant forms. The review synthesizes insights from immunohistochemical studies and molecular analyses to provide a comprehensive understanding of GTD pathogenesis and implications for personalized care strategies. [ABSTRACT FROM AUTHOR]

Introduction: Hydatidiform mole with a normally developing fetus is a rare case associated with an increased risk of bleeding, preterm birth, preeclampsia, congenital anomalies, and intrauterine fetal death.Case report: We report a case of a twin pregnancy with a hydatidiform mole and a normal fetus. The pregnancy was conceived via in vitro fertilization. The complete hydatidiform mole was diagnosed during the first screening. We extended the pregnancy until 38 weeks’ gestation. Thanks to the control of beta-human chorionic gonadotropin levels and dynamic ultrasound monitoring, the woman successfully gave birth.

Abstract Background This case describes the youngest patient documented in the literature who presented with a giant hydatidiform mole, effectively addressed through conservative treatment. Case presentation Our department received a 20-year-old Caucasian patient who was admitted due to significant metrorrhagia in an undisclosed pregnancy. During examination, we identified a massive, highly vascularized hydatidiform mole measuring 22 cm (cm). We performed a surgical dilatation and curettage. The anatomopathological findings confirmed the presence of a complete hydatidiform mole (CHM). Following the established guidelines, we conducted weekly monitoring of human chorionic gonadotropin (hCG). Unfortunately, the patient discontinued the follow-up and became pregnant again before achieving hCG negativation. Conclusion This case suggests that conservative treatment is a viable option regardless of the size of gestational trophoblastic disease (GTD), especially when the preservation of fertility is a crucial consideration, as effectively demonstrated in our case.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hydatidiform moles, including both complete and partial moles, constitute a subset of gestational trophoblastic diseases characterized by abnormal fertilization resulting in villous hydrops and trophoblastic hyperplasia with or without embryonic development. This involves chromosomal abnormalities, where one or two sperms fertilize an empty oocyte (complete hydatidiform mole (CHM); mostly 46,XX) or two sperms fertilize one oocyte (partial hydatidiform mole (PHM); mostly 69,XXY). Notably, recurrent occurrences are associated with abnormal genomic imprinting of maternal effect genes such as NLRP7 (chromosome 19q13.4) and KHDC3L (chromosome 6q1). Ongoing efforts to enhance identification methods have led to the identification of growth-specific markers, including p57 (cyclin-dependent kinase inhibitor 1C; CDKN1C), which shows intact nuclear expression in the villous cytotrophoblast and villous stromal cells in PHMs and loss of expression in CHMs. Treatment of hydatidiform moles includes dilation and curettage for uterine evacuation of the molar pregnancy followed by surveillance of human chorionic gonadotropin (HCG) levels to confirm disease resolution and rule out the development of any gestational trophoblastic neoplasia. In this review, we provide a synopsis of the existing literature on hydatidiform moles, their diagnosis, histopathologic features, and management. [ABSTRACT FROM AUTHOR]

Background: This case describes the youngest patient documented in the literature who presented with a giant hydatidiform mole, effectively addressed through conservative treatment. Case presentation: Our department received a 20-year-old Caucasian patient who was admitted due to significant metrorrhagia in an undisclosed pregnancy. During examination, we identified a massive, highly vascularized hydatidiform mole measuring 22 cm (cm). We performed a surgical dilatation and curettage. The anatomopathological findings confirmed the presence of a complete hydatidiform mole (CHM). Following the established guidelines, we conducted weekly monitoring of human chorionic gonadotropin (hCG). Unfortunately, the patient discontinued the follow-up and became pregnant again before achieving hCG negativation. Conclusion: This case suggests that conservative treatment is a viable option regardless of the size of gestational trophoblastic disease (GTD), especially when the preservation of fertility is a crucial consideration, as effectively demonstrated in our case. [ABSTRACT FROM AUTHOR]

Objective: To compare the age-specific clinical features of molar pregnancy and to describe the risk factors associated with this situation. Method: This retrospective case-control study was conducted at the Department of Obstetrics and Gynecology. Tepecik Education and Research Hospital, Izmir, Turkey. The participants included both adolescents (< 19 years) and adults with histologically confirmed hydatidiform moles in our institution between January 2015 and January 2022. The interventions and main outcome measures of this study involved evaluating the clinical and ultrasonographic features, as well as the risk factors, associated with molar pregnancies in adolescents. Results: This study of 137 patients with molar pregnancy found that adults had a higher incidence of partial molar pregnancy (20 patients versus seven patients) and lower beta-hCG levels than adolescents (176.890.71 mIU/ml versus 253.734.47 mIU/ml). Adolescents had a higher likelihood of hyperthyroidism (25.4% versus 9.2%). bleeding on admission (4.2% versus 1.51%),. longer hospital stays (5.44 ± 2.73 days versus 3.59 ± 3.08 days). Higher rates of uterine enlargement and postoperative bleeding (15.5% versus 1.5%). Adolescents also required more analgesia (97% versus 89.4%). Conclusions: Adolescents with Gestational trophoblastic diseases (GTD) may present with more severe symptoms compared to adults, which can lead to delayed diagnosis and treatment. Further research is needed to better understand the underlying mechanisms and risk factors for GTDs in this population. Increased awareness and education can help improve recognition and management of GTDs in adolescents and improve their overall health outcomes. [ABSTRACT FROM AUTHOR]

Background: Gestational trophoblastic disease (GTD), comprising hydatidiform moles and gestational trophoblastic tumours, is extremely rare. Exact diagnosis is crucial to indicate the appropriate treatment and to prevent complications. The scarcity and variability in the number of cases available for reporting, lack of specialised training in GTD, and non-existence of refresher courses implies that the pathologist dealing with these rare and, at times, extremely challenging cases is not completely confident in their diagnosis. Objectives: The objective of this study was to explore the benefits of implementation of an international multidisciplinary conference (virtual) to aid diagnosis of difficult cases and support clinical management of GTD. Methods: A short survey was circulated to all 46 members of the EOTTD pathology and genetics working party and further spread to other colleagues who practice GTD. This showed that the pathologists and geneticists working with GTD patients do not feel adequately supported and equipped with dealing with these rare diseases. Outcome: Virtual cross-border multidisciplinary team meetings (MDTs) were initiated in April 2022, bringing together participants from 11 European countries on a bi-yearly basis. Mean numbers of 3 patients are discussed during the MDTs followed by 3–4 quality assessment cases. A participant survey was conducted at the end of virtual meeting with an average satisfaction rate of 9.5. The pathologists felt supported and benefited from networking and clinical collaboration. Conclusions and Outlook: This international MDT continues to provide support in managing the uncertainty with difficult and rare cases and enhances the pathologists training and experience. The frequency of meetings and the number of cases discussed per meeting will be increased in 2023 given the positive response. This will empower individuals and organisations to work together and improve diagnosis and the prognosis for these young patients. Box 1 Benefits of Expert Pathology Review and MDT Discussion to Patients and Pathologists: ⇨ Benefits to patients • Rare diseases like GTD: centralised expert pathology and genetics review beneficial as only partial diagnostic agreement rates between "non-expert" and "expert" pathologists. • Cross-border MDTs.  ❖ Reach a consensus diagnosis between experts in difficult cases.  ❖ Precision diagnosis and clinical management. ⇨ Benefits to health care professionals  ❖ Networking, collaboration, and diagnostic support.  ❖ Provide education for general pathologists and other "non-expert" pathologists.  ❖ Provide continuing development and experience building for "expert" pathologists.  ❖ Accumulative experience building for the team and re-enforcement. [ABSTRACT FROM AUTHOR]

Background: Gestational trophoblastic disease comprises hydatidiform moles and a rare group of malignancies that derive from trophoblasts. Although there are typical morphological features that may distinguish hydatidiform moles from non-molar products of conception, such features are not always present, especially at early stages of pregnancy. Furthermore, mosaic/chimeric pregnancies and twin pregnancies make pathological diagnosis challenging while trophoblastic tumours can also pose diagnostic problems in terms of their gestational or non-gestational origin. Objectives: The aim of this study was to show that ancillary genetic testing can be used to aid diagnosis and clinical management of GTD. Methods: Each author identified cases where genetic testing, including short tandem repeat (STR) genotyping, ploidy analysis, next-generation sequencing, and immunostaining for p57, the product of the imprinted gene CDKN1C, facilitated accurate diagnosis and improved patient management. Representative cases were chosen to illustrate the value of ancillary genetic testing in different scenarios. Outcome: Genetic analysis of placental tissue can aid in determining the risk of developing gestational trophoblastic neoplasia, facilitating discrimination between low risk triploid (partial) and high risk androgenetic (complete) moles, discriminating between a hydatidiform mole twinned with a normal conceptus and a triploid conception and identification of androgenetic/biparental diploid mosaicism/chimerism. STR genotyping of placental tissue and targeted gene sequencing of patients can identify women with an inherited predisposition to recurrent molar pregnancies. Genotyping can distinguish gestational from non-gestational trophoblastic tumours using tissue or circulating tumour DNA and can also identify the causative pregnancy which is the key prognostic factor for placental site and epithelioid trophoblastic tumours. Conclusions and Outlook: STR genotyping and p57 immunostaining have been invaluable to the management of gestational trophoblastic disease in many situations. The use of next-generation sequencing and of liquid biopsies is opening up new pathways for GTD diagnostics. Development of these techniques has the potential to identify novel biomarkers of GTD and further refine diagnosis. [ABSTRACT FROM AUTHOR]

Background: Ectopic molar pregnancy (EMP) is a rare form of gestational trophoblastic disease that occurs when a hydatidiform mole implants outside the uterus. Case Presentation: We describe a 35-yr-old woman with mild abdominal pain, delayed menstruation for 2 months, and high beta-human chorionic gonadotropin levels. Sonography revealed a heterogeneous hyperechoic mass in the left adnexa and fluid in the endometrial cavity, suggestive of a tubal EMP. She underwent endometrial curettage and left salpingectomy. Pathology confirmed the diagnosis of invasive hydatidiform mole/left tubal EMP. The case recovered well and had no complications. Conclusion: This case highlights the need for early diagnosis and multidisciplinary treatment of EMP to avoid serious consequences from persistent trophoblastic tumors. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Our study aims to determine the frequency and types of GTD (Gestational Trophoblastic Disease) in our clinic, to evaluate its relationship with clinical parameters, and the consistency of clinical prediagnosis and pathological definitive diagnosis. PATIENTS AND METHODS: In the present study, hospital records of 120 patients with gestational trophoblastic disease between January 2019 and August 2022 were obtained and evaluated retrospectively. Demographic, hematological, biochemical, and clinical data were collected in detail, and the data were analyzed statistically. RESULTS: Our study included a total of 120 female patients, with an average age of 31.16±9.70. The average number of patients was 3. The average time for women to receive the diagnosis was 9.80±2.45 weeks, with the most frequent complaint on our part being bleeding (85.8%). When the pathology outcomes of the patients we included in our study were examined, it was found that the number of patients diagnosed with incomplete abortion was 34, the number of patients diagnosed with complete abortion was 82, the number of invasive moles diagnosed was 3, and the number of patient diagnosed with choriocarcinoma was 1. Kappa ratio was calculated as 0.419 (p<0.001) when the compliance of the clinical diagnosis was assessed. This value was consistent with median level alignment. In a study that examined the three years of our calism in our bulk, 1.8 per 1,000 births were followed frequently. CONCLUSIONS: We should inform patients in detail about gestational trophoblastic diseases and warn patients not to delay their consequences. We should recommend that pregnancy be avoided for 12 months for low-risk patients and 18 months for high-risk patients after GTD. [ABSTRACT FROM AUTHOR]

A pregnant woman with hydatidiform mole in one twin was misdiagnosed as one of the twins with embryonic arrest. She chose to terminate the pregnancy and developed distant lung metastasis. After chemotherapy, she eventually recovered. This article systematically analyzes the diagnosis and treatment of hydatidiform mole in one twin to increase the awareness and reduce misdiagnosis of the disease. [ABSTRACT FROM AUTHOR]

Gestational choriocarcinoma, a rare variant of gestational trophoblastic disease, typically arises from abnormal trophoblastic cell proliferation post-pregnancy, often associated with a hydatidiform mole. While most choriocarcinoma cases develop within the uterine cavity, an exceedingly rare manifestation occurs within a previous cesarean section scar. In our study, a 31-year-old woman with a history of hydatidiform mole presented with amenorrhea and spotting. Initial assessments revealed elevated beta-human chorionic gonadotropin (βhCG) levels and a heteroechoic mass at her prior cesarean section scar in sonographic examination. Histopathologic findings and the metastatic workup categorized the patient as FIGO stage I, indicating no metastasis. Due to the absence of metastasis, adjuvant chemotherapy was omitted. Total abdominal hysterectomy confirmed choriocarcinoma. Post-surgery, βhCG levels notably decreased, remaining negative during the two-year follow-up with no reported symptoms. Our findings suggest that surgical resection and meticulous βhCG monitoring may be a promising treatment strategy for non-metastatic choriocarcinoma.

المخلص: أهداف البحث: لدى مستقبلات فيتامين د أدوار كمضاد للسرطان لأنواع مختلفة من السرطانات. الهدف من هذه الدراسة هو تحديد الفروق في مستويات مستقبلات فيتامين د بين الورم الحويصلي المائي وورم النسيج الترويفي الحملي. طرق البحث: هذه دراسة مقارنة شملت ستة وستين نسيجا تم جمعها من الورم الحويصلي المائي وورم النسيج الترويفي الحملي. تم إجراء اختبار ''تي'' واختبار ''مان ويتني'' لمقارنة التعبير المناعي لمستقبلات فيتامين د، بما في ذلك شدة مستقبلات فيتامين د، توزيع مستقبلات فيتامين د، والتقدير التاريخي بين الورم الحويصلي المائي وورم النسيج الترويفي الحملي. النتائج: تم تضمين ما مجموعه ستة وستين عينة من الأنسجة في هذه الدراسة، تتألف من سبعة وثلاثين نسيجا تم تشخيصها بالورم الحويصلي المائي وأربعة وعشرين نسيجا تم تشخيصها بورم النسيج الترويفي الحملي. تمت المقارنة بين العمر والأعداد بين المرضى الذين يعانون من الورم الحويصلي المائي والمرضى الذين يعانون من ورم النسيج الترويفي الحملي، ولم يلاحظ وجود فروقات كبيرة في كلا المجموعتين. بالنسبة لحالات ورم النسيج الترويفي الحملي، كانت شدة مستقبلات فيتامين د أقل بشكل ملحوظ من شدة مستقبلات فيتامين د في نسيج الورم الحويصلي المائي. بالإضافة إلى ذلك، كان التقدير التاريخي في نسيج ورم النسيج الترويفي الحملي أقل بشكل ملحوظ من التقدير التاريخي في نسيج الورم الحويصلي المائي. ومع ذلك، لم يكن هناك فروقات كبيرة في توزيع مستقبلات فيتامين د بين نسيج ورم النسيج الترويفي الحملي ونسيج الورم الحويصلي المائي. الاستنتاجات: كان التعبير المنخفض لمستقبلات فيتامين د مرتبطا بورم النسيج الترويفي الحملي. بالمقابل، كان التعبيرالعالي لمستقبلات فيتامين د مرتبطا بالورم الحويصلي المائي. تشير هذه النتائج إلى أن مستويات مستقبلات فيتامين د قد تلعب دورا في شدة مرض النسيج الترويفي الحملي. Abstract: Objective: Vitamin D receptor (VDR) exerts anti-cancer properties in a variety of cancers. The purpose of this study was to investigate the expression of VDR in patients with hydatidiform mole (HM) and gestational trophoblastic neoplasia (GTN). Methods: This is a cross-sectional study involved 61 specimens of HM (n = 37, 60.7%) and GTN (n = 24, 39.3%) was collected from the biopsy. An immunohistochemistry was used to asses the VDR expression. Student's t-test and Mann–Whitney test were used to compare the expression of VDR, including VDR staining intensity, VDR distribution, and histoscore, between HM and GTN tissue specimens. Results: No significant differences in age and parity were noted between patients with HM or GTN (p > 0.05). The VDR staining intensity of GTN tissue specimens was significantly lower than that of HM tissue specimens (2.3 ± 0.8 vs. 2.8 ± 0.5, p = 0.008). In addition, the histoscore for GTN tissues was significantly lower than that for HM tissues (7.3 ± 3.2 vs. 9.4 ± 28, p = 0.016). However, no significant differences in VDR distribution between GTN and HM tissues were observed (3.3 ± 0.8 vs. 3.3 ± 1.0, p = 0.525). Conclusion: Low VDR expression is associated with GTN, whereas high VDR expression is associated with HM, suggesting that the expression of VDR may regulate the severity of gestational trophoblastic disease.

Intraplacental choriocarcinoma is a rare tumour, with approximately 62 reported cases. It may manifest as a spectrum of disease ranging from an incidental lesion diagnosed on routine placental examination to disseminated maternal and/or neonatal disease. In this case series, we presented two rare cases of intraplacental choriocarcinoma with extremely varied clinical presentations. The extremely varied clinical presentations of both patients described in the case series complicated the process of arriving at the diagnosis. In both cases, subsequent investigations showed no maternal or neonatal metastasis, and maternal serum beta-hCG levels downtrended with conservative management. We aim to highlight the importance of performing a detailed physical examination and evaluation of the patient and multidisciplinary management with oncology opinion. A detailed examination of the placenta should also be considered when faced with obstetric complications so that early diagnosis and the required management can be executed in a prompt fashion. [ABSTRACT FROM AUTHOR]

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to play a diagnostic and predictive role in gestational trophoblastic disease. However, the conclusions are still ambiguous. This meta-analysis aimed to evaluate the combined predictive value of NLR and PLR in the malignant progression of gestational trophoblastic disease. Method: Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, Wanfang and China Biomedical Literature Database were searched for the relevant literature published up to 1 October 2022. Study selection and data extraction were performed independently by two reviewers. All analyses were performed using Revman, MetaDisc and STATA software. Results: A total of 858 patients from five studies were included in this meta-analysis. The pooled sensitivity and specificity of NLR were 0.8 (95% CI: 0.71–0.88) and 0.73 (95% CI: 0.69–0.76), respectively, and the area under curve of the summary receiver operating curve was 0.81. The pooled sensitivity and specificity of PLR were 0.87 (95% CI: 0.75–0.95) and 0.49 (95% CI: 0.44–0.54), respectively, and the area under curve of the summary receiver operating curve was 0.88. I2 statistic and Deek's funnel plot showed no heterogeneity and publication bias. Conclusion: NLR can accurately predict the progression from hydatidiform mole to gestational trophoblastic neoplasia and is a promising biomarker in further follow-up. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The clinical course and sequelae of molar pregnancy pose several diagnostic and management challenges, especially conceiving after assisted reproductive technology. A review of the literature was conducted on molar pregnancy with a coexistent fetus following assisted reproductive techniques, its clinical course, and sequelae. The literature review was conducted using search terms “coexistent fetus,” “hydatidiform mole,” “twin,” “assisted conception” AND “persistent gestational trophoblastic disease (PGTD)” OR “chemotherapy” in PubMed. A literature search identified 26 reported cases conceived following assisted conception. Management guidelines for hydatidiform mole with live fetuses are very vague and do not give specificity due to the fact that it is often associated with complications and bad obstetric outcomes. It also requires continuous monitoring and follow-up in a tertiary care center anticipating disease progression to postnatal PGTD. To assess the risk of continuation of pregnancy, multicentric studies with larger sample sizes are required to have a valid finding.

Accurately interpreting persistent, low human chorionic gonadotropin (hCG) levels is essential for managing gestational trophoblastic disease. Erroneous interpretation can lead to inappropriate interventions, including unnecessary chemotherapy or hysterectomy, or unjustified changes in chemotherapeutic regimens due to misidentification of a false-positive hCG as a true positive. The predominant etiology of phantom hCG is the presence of heterophilic antibodies. Consequently, screening for urine hCG is indispensable for its diagnosis because immunoglobulin is not generally present in urine. Here, we report about phantom hCG after a complete hydatidiform mole. Initial urine hCG evaluations were negative, although the serum hCG levels remained positive, leading to the diagnosis of phantom hCG. After subsequent delivery, urine hCG levels persisted at diminished levels. However, a different assay yielded negative hCG results for both serum and urine samples. The patient subsequently gave birth. The absence of hCG was consistently confirmed over five years. [ABSTRACT FROM AUTHOR]

Gestational trophoblastic diseases (GTDs) encompass a spectrum of conditions characterized by abnormal trophoblastic cell growth, ranging from benign molar pregnancies to malignant trophoblastic neoplasms. This systematic review explores the molecular underpinnings of GTDs, focusing on genetic and epigenetic factors that influence disease progression and clinical outcomes. Based on 71 studies identified through systematic search and selection criteria, key findings include dysregulations in tumor suppressor genes such as p53, aberrant apoptotic pathways involving BCL-2 (B-cell lymphoma), and altered expression of growth factor receptors and microRNAs (micro-ribose nucleic acid). These molecular alterations not only differentiate molar pregnancies from normal placental development but also contribute to their clinical behavior, from benign moles to potentially malignant forms. The review synthesizes insights from immunohistochemical studies and molecular analyses to provide a comprehensive understanding of GTD pathogenesis and implications for personalized care strategies.

Background: The incidence of molar pregnancy has demonstrated marked geographic and ethnic differences. This difference in the prevalence across various countries perhaps may depend upon the socioeconomic, genetic, nutritional and other cultural factors. In spite of having a higher prevalence among Asians, still epidemiological characteristics of Gestational Trophoblastic Disease (GTD) or Gestational Trophoblastic Neoplasia (GTN) are difficult to determine secondary to inconsistencies in case definitions and lack of centralised databases. Hence, this study was undertaken to determine the proportion and the clinical profile of women with hydatidiform mole from a South Indian population, where as of now there is limited data to enable us to detect and provide the standard of care for patients with GTN. Materials and Methods: A prospective cohort study between August 2014 to December 2015 and a retrospective review of medical records for the preceding 2 years from the year 2012 to 2014 was conducted in JIPMER to determine the proportion of women with molar pregnancy as well as to study the clinico-epidemiologic profile of hydatidiform mole. The study population comprised of a total of 116 cases, of which, 68 cases belonged to the prospective group and 48 cases to the retrospective group. The patients belonging to the prospective group (68) were followed up for a period of 6 months to note the trend of the β HCG and to detect the occurrence of GTN. The patients in the retrospective group (48) were considered only for analysing the clinical profile of hydatidiform mole, as follow up was not possible for this group of patients. Results: The proportion of molar pregnancy was calculated to be 2.07 per 1000 live births. Majority (59%) of the study population belonged to the age group of 18-23 years. Almost all the patients (98%) belonged to lower socioeconomic group. More than one-third (48%) of the patients were nulliparous. It was observed that, greater than half of the patients (56%) presented between 11-15 weeks of amenorrhoea. Majority (76%) of the patients had no previous abortions in their obstetric history. Only 4 (3.45%) patients had previous history of molar pregnancy. Abnormal uterine bleeding was the most common complaint noted in 79% of patients. Nausea and vomiting were noted in 62 patients, out of which 25 (40%) presented with hyperemesis requiring fluid and electrolyte correction. Anaemia was the most common medical complication noted in 55% of patients, followed by hyperthyroidism in 33% and hypertension in 2% patients. Among the 116 patients, 74(64%) had preevacuation HCG level more than 2,00,000mIU/ml. Suction evacuation was done in all the cases and 9 (8%) patients required re-evacuation in view of residual vesicular mole on a check scan. Among the 116 patients, histopathology revealed complete mole in 88% patients and partial mole in 12%. In the prospective group, following suction evacuation, 79% of the patients attained remission by the end of 6 months whereas in 13 patients (21%), hCG continued to either plateau or increase following the primary evacuation and they further developed GTN requiring chemotherapy. Out of the 13 cases of GTN, 7 patients attained remission with chemotherapy, whereas 6 patients failed to achieve remission during the 6 months' study period. Conclusion: Young, nulliparous women belonging to low socio-economic status had a higher proportion of hydatidiform mole. Improving the literacy rates, creating awareness among the women, early registration of pregnancy, prompt referral to higher centres and early administration of appropriate treatment, with a vigilant follow up would help in early detection of GTN.There is also a need for studies at country level which will give us a national figure on molar pregnancies. Thus, a standardized clinicoepidemiological profile of molar pregnancy in India can be created. [ABSTRACT FROM AUTHOR]

Tubal ectopic pregnancy with hydatidiform mole is extremely rare in clinical practice, and preoperative diagnosis is often difficult. The diagnosis is mainly based on the postoperative histopathology results. This article reports a 38 -year -old woman whom underwent laparoscopic right fallopian tube resection in an emergency due to rupture of right fallopian tube pregnancy. The postoperative pathology revealed completeness hydatidiform mole. The patient recovered well after surgery, with a satisfactory decrease in serum human chorionic gonadotropin (hCG) during the follow-up period. There were no symptoms of vaginal bleeding, coughing, hemoptysis, or related lesion metastasis. Tubal pregnancy with hydatidiform mole often manifests as acute abdominal disease. Therefore, for patients with acute abdominal disease, the possibility of hydatidiform mole should be paid to. The treatment is mainly based on surgery, and chemotherapy should be performed if necessary. After surgery, close follow -up is required, and doctors should be noting the possibility of lesion erosion and malignancy too. [ABSTRACT FROM AUTHOR]

The clinical course and sequelae of molar pregnancy pose several diagnostic and management challenges, especially conceiving after assisted reproductive technology. A review of the literature was conducted on molar pregnancy with a coexistent fetus following assisted reproductive techniques, its clinical course, and sequelae. The literature review was conducted using search terms "coexistent fetus," "hydatidiform mole," "twin," "assisted conception" AND "persistent gestational trophoblastic disease (PGTD)" OR "chemotherapy" in PubMed. A literature search identified 26 reported cases conceived following assisted conception. Management guidelines for hydatidiform mole with live fetuses are very vague and do not give specificity due to the fact that it is often associated with complications and bad obstetric outcomes. It also requires continuous monitoring and follow-up in a tertiary care center anticipating disease progression to postnatal PGTD. To assess the risk of continuation of pregnancy, multicentric studies with larger sample sizes are required to have a valid finding. [ABSTRACT FROM AUTHOR]

Hydatidiform mole is a condition characterised by abnormal trophoblastic hyperplasia and failure of embryonic tissue development. The risk of recurrence is seen to be associated with biallelic maternal mutations in NLRP7, KHDC3 L and PAD16 genes. Women with such mutations have a major risk of reproductive failure and normal pregnancy is seen in only 1.8%. We report the case of a 31‑year‑old woman with previous three molar pregnancies who on genetic testing was found to be compound heterozygous for pathogenic variants in the NLRP7 gene (c.2738A>G and c.2078G>C). Accordingly, the woman was counselled regarding assisted reproduction with oocyte donation for a normal pregnancy outcome. At present, the patient has an ongoing 5‑month pregnancy through oocyte donation. [ABSTRACT FROM AUTHOR]

Background: To determine plasma free amino acid (FAA) and carnitine levels in pregnant women with hydatidiform mole (HM). Materials and Methods: Twenty-three pregnant women with HM, and 24 healthy pregnant women as controls were enrolled in the study. FAA and carnitine concentrations were measured in plasma using liquid chromatography/tandem mass spectrometry (LC-MS). Results: The levels of alanine, arginine, and valine from the 14 amino acids examined were significantly lower in the HM group than in the healthy group (p = 0.019, p = 0.009, and p = 0.03, respectively). In addition, several carnitines, C8DC, C16:1, and C18, of the 27 carnitines examined were significantly higher in the HM group than in the control group (p = 0.021, p = 0.03, and p = 0.021, respectively). Conclusions: This study demonstrated that a decrease in some plasma FAAs and an increase in some plasma carnitine levels might be effective in the pathogenesis of HM. [ABSTRACT FROM AUTHOR]

A hydatidiform mole (HM) or molar pregnancy is the most common benign form of gestational trophoblastic disease characterized by a proliferation of the trophoblastic epithelium and villous edema. Hydatidiform moles are classified into two forms: complete and partial hydatidiform moles. These two types of HM present morphologic, histopathologic and cytogenetic differences. Usually, hydatidiform moles are a unique event, but some women present a recurrent form of complete hydatidiform moles that can be sporadic or familial. The appearance of hydatidiform moles is correlated with some genetic events (like uniparental disomy, triploidy or diandry) specific to meiosis and is the first step of embryo development. The familial forms are determined by variants in some genes, with NLRP7 and KHDC3L being the most important ones. The identification of different types of hydatidiform moles and their subsequent mechanisms is important to calculate the recurrence risk and estimate the method of progression to a malign form. This review synthesizes the heterogeneous mechanisms and their implications in genetic counseling. [ABSTRACT FROM AUTHOR]

Hydatidiform mole (HM) is a gestational trophoblastic disease. Potential risk factors are advanced maternal age, reproductive factors, oral contraceptive use, history of gestational trophoblastic disease, oxidative stress, and other environmental factors. Serum amyloid A (SAA) protein has an important role in acute phase response but is also associated with pathologic fibril formation in chronic inflammation. The aim of the current study is to determine the relationship between maternal SAA levels in patients with both complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM), and to examine its potential role in the disease in pathogenesis. Fifty healthy pregnant women in the first trimester of pregnancy with completely normal pregnancy follow-up, and 50 patients who were diagnosed with HM, who were also in the first trimester of pregnancy included in the study. There was no difference between patients and the control group according to body mass index (BMI), gravidity, parity, number of living children, number of miscarriages, level of blood TSH, and hemoglobin level between the two groups. SAA levels in patients with HM were significantly higher than those in healthy controls. This may be an important underexplored pathway mediating the relationship between oxidative stress and abnormal placental proliferation. [ABSTRACT FROM AUTHOR]

Hydatidiform moles (HMs) are divided into two types: partial hydatidiform mole (PHM) which is most often diandric monogynic triploid and complete hydatidiform mole (CHM) which is most often diploid androgenetic. Morphological features and p57 immunostaining are routinely used to distinguish both entities. Genetic analyses are required in challenging cases to determine the parental origin of the genome and ploidy. Some gestations cannot be accurately classified however. We report a case with atypical pathologic and genetic findings that correspond neither to CHM nor to PHM. Two populations of villi with divergent and discordant p57 expression were observed: morphologically normal p57 + villi and molar-like p57 discordant villi with p57 + stromal cells and p57 − cytotrophoblasts. Genotyping of DNA extracted from microdissected villi demonstrated that the conceptus was an androgenetic/biparental mosaic, originating from a zygote with triple paternal contribution, and that only the p57 − cytotrophoblasts were purely androgenetic, increasing the risk of neoplastic transformation. [ABSTRACT FROM AUTHOR]

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.

Nephrotic syndrome (NS) during pregnancy is a fairly rare pathology and its descriptions in the literature are few. For a long time, NS was associated only with an exacerbation of chronic glomerulonephritis or de novo nephritis, however, the experience of recent years has shown that NS can be a manifestation of the classical obstetric pathology preeclampsia (PE). The appearance of massive proteinuria with the development of NS is most typical for early PE, which, of course, makes diagnosis difficult, especially if PE develops at an unusually early time (up to 20 weeks). To describe PE that does not fit into the classical criteria, the term atypical PE is now used, the development of which can be promoted by both obstetric and somatic risk factors. The presented clinical observation describes the development of early (within 14 weeks) severe PE with the NS at the onset of the disease in a patient with the first multiple pregnancy and complete hydatidiform mole (HM) of one of the fetuses. The progression of nephropathy with the addition of thrombotic microangiopathy and HELLP syndrome made it possible to assume the diagnosis of PE with a high probability. The rapid relief of all clinical manifestations after delivery confirmed this assumption. The role of HM as the main trigger of unusually early PE is discussed. Apparently, the patient's trophoblast disease in the form of hydatidiform mole caused the formation of a severe angiogenic imbalance already in the early stages of pregnancy, which led to the development of PE, which manifested NS as a consequence of podocytopathy due to VEGF deficiency. Thus, the development of NS in a pregnant patient without a history of kidney disease dictates, first of all, the exclusion of PE, until proven otherwise.

Siti Salima,1 Mulyohadi Hadi Wibowo,1 Birgitta M Dewayani,2 Aisyah Shofiatun Nisa,1 Firas Farisi Alkaff3,4 1Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia; 2Department of Pathology of Anatomy, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia; 3Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia; 4Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the NetherlandsCorrespondence: Siti Salima, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62811223830, Email s.salima@unpad.ac.id Firas Farisi Alkaff, Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia, Tel +6281330101993, Email f.f.alkaff@umcg.nl; firasfarisialkaff@fk.unair.ac.idAbstract: Hydatidiform mole (HM) is an aberrant pregnancy characterized by atypical trophoblastic hyperplasia, hydropic chorionic villi, and deprived fetal development. There are two types of HM, ie, complete (CHM) and partial (PHM). Both CHM and PHM can recur; however, the recurrence of PHM is very scarce compared to CHM. In this report, we present a case of a 33-year-old woman with recurrent PHM for 7 times without any normal pregnancy in-between. PHM was determined by histology examination. The patient underwent suction curettage and was followed up with serial β-hCG levels. Recurrent PHM, although rare, is associated with an increased incidence of malignancy. A series of clinical and β-hCG evaluation should be warranted because of the possibility of gestational trophoblastic neoplasia development.Keywords: hydatidiform mole, pregnancy, partial hydatidiform mole, case report

Hydatidiform moles, including both complete and partial moles, constitute a subset of gestational trophoblastic diseases characterized by abnormal fertilization resulting in villous hydrops and trophoblastic hyperplasia with or without embryonic development. This involves chromosomal abnormalities, where one or two sperms fertilize an empty oocyte (complete hydatidiform mole (CHM); mostly 46,XX) or two sperms fertilize one oocyte (partial hydatidiform mole (PHM); mostly 69,XXY). Notably, recurrent occurrences are associated with abnormal genomic imprinting of maternal effect genes such as NLRP7 (chromosome 19q13.4) and KHDC3L (chromosome 6q1). Ongoing efforts to enhance identification methods have led to the identification of growth-specific markers, including p57 (cyclin-dependent kinase inhibitor 1C; CDKN1C), which shows intact nuclear expression in the villous cytotrophoblast and villous stromal cells in PHMs and loss of expression in CHMs. Treatment of hydatidiform moles includes dilation and curettage for uterine evacuation of the molar pregnancy followed by surveillance of human chorionic gonadotropin (HCG) levels to confirm disease resolution and rule out the development of any gestational trophoblastic neoplasia. In this review, we provide a synopsis of the existing literature on hydatidiform moles, their diagnosis, histopathologic features, and management.

BackgroundPost-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 presentationA 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.ConclusionIn 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.

Gestational trophoblastic disease (GTD) is an abnormal pregnancy caused by the placenta, which can potentially metastasise. Suction evacuation is recommended for diagnosis and treatment, and dilatation and evacuation (D&E) is usually performed under intravenous anaesthesia due to the short operation time and minimal blood loss. We refer to the guidelines produced by the Japan Society of Obstetrics and Gynaecology (JSOG), and acknowledge that practices vary globally. However, to the best of our knowledge, there is no evidence on perioperative management and arrangements in D&E required for managing giant hydatidiform moles, such as preventing massive haemorrhage, respiratory dysfunction with a pathogenesis like ovarian hyperstimulation syndrome (OHSS), or intensive care needs. This case report describes perioperative considerations for managing a giant hydatidiform mole using D&E in a uterus enlarged to the third-trimester pregnancy size. A 28-year-old multiparous woman was clinically diagnosed with a hydatidiform mole after a spontaneous miscarriage due to abnormal genital bleeding, systemic oedema, and abdominal distention. Ultrasound and computed tomography showed a ballooning uterus with a third-trimester pregnancy size, a robust intrauterine mass, and ascites. Serum hCG levels were extremely high (>3,000,000 mIU/mL), confirming the clinical diagnosis of a hydatidiform mole. Emergency D&E was safely performed under multidisciplinary perioperative management, with careful preparation and support. This is a rare experience-based case report and valuable documentation detailing multidisciplinary perioperative management under general anaesthesia. To the best of our knowledge, this is the first report describing the considerations, details, and innovations required in the perioperative management of giant hydatidiform moles using D&E.

Objectives: Human chorionic gonadotropin (hCG) levels are essential for the management of trophoblastic diseases. This study aimed to compare the sensitivities and relationships of two hCG measurement methods (total hCG and the free β-subunit of hCG) in managing gestational trophoblastic disease (GTD). Design and Methods: We analyzed data from patients treated for GTD at Chiba University Hospital between 2008 and 2019. We focused on cases where both total hCG (mIU/mL) and the free β-subunit of hCG (ng/mL) were measured on the same day. Results: Out of 80 patients (mean age 38.9 ± 11.7 years) and 158 measurements, 26 had values below the sensitivity threshold for both tests. Fifty-nine measurements were positive for total hCG but below the sensitivity threshold for the free β-subunit of hCG, whereas only two showed the opposite. Seventy-one measurements were positive for both total hCG and the free β-subunit of hCG. There was a significant correlation between total hCG and the free β-subunit of hCG with both positive values, (r = 0.94, p

Hydatidiform mole and co-existing fetus (HMCF) is a rare obstetric disease, including complete hydatidiform mole with co-existing fetus (CHMCF) and partial hydatidiform mole with a co-existing fetus (PHMCF). A case of CHMCF was reported by continuous monitoring of thyroid function, human chorionic gonadotropin and fetal status during pregnancy up to 37 weeks of gestation and delivery of a live infant by cesarean section. CHMCF is a clinically rare and high-risk disease. Therefore, pregnancy, parturition and postpartum follow -up should be carefully diagnosed and closely monitored through ultrasound, magnetic resonance imaging (MRI) and chromosomal karyotype analysis in institutions with prenatal diagnosis and gynecological oncology centers. [ABSTRACT FROM AUTHOR]

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HIGHLIGHTS • This study aimed to identify the characteristics of Gestational Trophoblastic Neoplasia (GTN). • GTN is chemosensitive, but without appropriate therapy and follow-up, GTN will develop into complications and fatalities. ABSTRACT Objective: Gestational Trophoblastic Neoplasia (GTN) is a pregnancy-related malignancy due to abnormal proliferation of trophoblastic tissue. This study aimed to identify the characteristics of patients with GTN to help diagnose cases of GTN earlier and provide better treatment. Materials and Methods: This was a descriptive retrospective study on medical records of patients with GTN in Dr. Soetomo General Academic Hospital Surabaya, Indonesia, during the period of January 2018 to December 2020 with a total sampling technique. There were 41 patients with GTN included as study subjects. Results: Forty-one cases of GTN met the inclusion criteria out of the fifty medical records collected. The majority of patients aged 21 – 30 years old (34%) and had parity status without data (42%). Regarding the clinical profile based on prognostic factors, the predominant patients (71%) also had no data about the time interval between the end of the last pregnancy and the first time diagnosed by GTN, Those with more than 100,000 mIU/ml of beta-hCG levels were 32%, and those without metastases were 41.5%. Most patients belonged to the low-risk group (49%) and received chemotherapy (71%) with the MTX LD regimen (69%). Conclusion: GTN occurred predominantly in reproductive women that belonged to the low-risk group. Furthermore, chemotherapy is one of the chosen therapy for those patients.