UI - 11725738
AU - Rosen T; Sutin K; Carreno CA; Hibbett E; Funai EF
Central hemodynamic monitoring in a woman with acute respiratory
insufficiency after evacuation of a complete molar pregnancy. A case
SO - J Reprod Med 2001 Oct;46(10):916-22
AD - Division of Maternal Fetal Medicine, Department of Obstetrics and
Gynecology, and Department of Anesthesia, New York University Medical
Center, New York, New York, USA. email@example.com
BACKGROUND: The incidence of hydatiform moles in the United States is
approximately 1 in 1,200 pregnancies. Acute respiratory insufficiency is
a known complication of molar pregnancies, occurring in 8-11%. While
there have been numerous case reports and retrospective studies
describing respiratory complications following evacuation of hydatiform
moles, only a limited number of reports provide data from central
hemodynamic monitoring in patients with this complication. CASE: A
16-year-old, Hispanic woman, gravida 1, para 0, presented to the
emergency room at 13 weeks' gestational age by menstrual dating with
complaints of vaginal bleeding for two days. The serum quantitative
beta-hCG level was 1 x 10(6) mIU/mL, and a bedside sonogram was
consistent with hydatiform mole. After informed consent was obtained,
the patient underwent dilation and suction curettage. Approximately five
minutes after evacuation of the uterus was begun, the patient developed
pulmonary edema in the setting of oliguria. A pulmonary artery catheter
was inserted to determine the etiology of the edema. The initial
pulmonary capillary wedge pressure was > 18 mm Hg, consistent with
hydrostatic pulmonary edema. Volume overload in association with a
reduced colloid osmotic pressure to wedge pressure gradient was
primarily responsible for the pulmonary edema in this patient.
CONCLUSION: The majority of case reports of pulmonary complications
after evacuation of a hydatidiform mole were either presumed or
documented to be due to trophoblastic pulmonary embolism.
Thyrotoxicosis, fluid overload with dilutional anemia, preeclampsia,
sepsis, hypoalbuminemia or a combination of these factors may be more
common than trophoblastic embolization.
UI - 11801874
AU - Kendall A; Gillmore R; Newlands E
Chemotherapy for trophoblastic disease: current standards.
SO - Curr Opin Obstet Gynecol 2002 Feb;14(1):33-8
AD - Department of Medical Oncology, St Thomas' Hospital, London, UK.
Gestational trophoblastic diseases comprise a rare spectrum of disorders
in which the normal regulatory mechanisms controlling the behaviour of
trophoblastic tissue are lost. They vary from the benign complete and
partial hydatidiform moles to the frankly malignant choriocarcinoma and
placental site trophoblastic tumours. The majority will be cured by
suction curettage, followed by human chorionic gonadotrophin screening,
but some will go on to need chemotherapy. The majority of patients will
be cured even despite the presence of metastatic disease. Patients
should have their treatment stratified according to various prognostic
factors in order to ensure firstly their disease is eliminated and
secondly to reduce the incidence of long-term treatment complications.
UI - 11875864
AU - Khabouze S; Erchidi IE; Bouchikhi C; Chahtane A; Kharbach A; Chaoui A
[Gestational trophoblastic diseases. Apropos of 105 cases]
SO - Gynecol Obstet Fertil 2002 Jan;30(1):42-9
AD - Clinique Universitaire de Gynecologie-Obstetrique I, Service Pr Chaoui,
Maternite Souissi-Rabat, Maroc.
The authors report a retrospective study of 105 observations of
gestational trophoblastic diseases managed at the university clinic of
obstetric gynecology I (Pr Chaoui). Of this study, one listed 72 cases
of complete mole hydatiforme with 5 cases of sacrofetal pregnancy. The
invasive mole is found in 4 cases and the choriocarcinoma in 24 cases.
The general frequency of this pathology is of 1/770 pregnancies. The age
of our patients varies from 15 to 52 years with an average age 27 years
and the multiparity is found in 50% of the cases. 103 patients (95.5%)
consulted for metrorrhagia associated pelvic pains in 31 cases (30%).
The toxic syndrome was present in 20 patients (12%) with a preeclampsy
in 6 cases (5.71%). The physical examination showed a very increased
uterus of size in 92 cases (87.5%) associated adnexal mass in 37 cases
(35.2%). The diagnosis was especially echographic in the totality of the
cases associated or not with a proportioning of plasmatic beta HCG or
prolans urinary. The treatment of the trophoblastic disease varies
simple endo-uterine aspiration (85%) until the chemotherapy treatment
(32.4%), the hysterectomy was indicated in a third of the cases. The
evolution of the non complicated mole hydatiforme was good in 100% of
the cases, it quasi totality of the invasive moles presented a complete
remission. Among the 24 choriocarcinoma, we deplore 4 deaths in a table
of pulmonary, hepatic and cerebral metastases. In order to improve the
forecast of these diseases, the diagnosis must be early with an adequate
treatment and a rigorous monitoring.
UI - 11818116
AU - Tews G; Yaman C; Ebner T
Fatal trophoblastic embolism during cesarean section.
SO - Int J Gynaecol Obstet 2002 Feb;76(2):179-80
AD - Department of Gynecology and Obstetrics, Women's General Hospital, Linz,
UI - 11919242
AU - McNeish IA; Strickland S; Holden L; Rustin GJ; Foskett M; Seckl MJ;
Low-risk persistent gestational trophoblastic disease: outcome after
initial treatment with low-dose methotrexate and folinic acid from 1992
SO - J Clin Oncol 2002 Apr 1;20(7):1838-44
AD - Department of Medical Oncology, Trophoblastic Tumour Screening and
Treatment Center, Charing Cross Hospital, London, United Kingdom.
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 < or = 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.
UI - 11787040
AU - van Wijk IJ; de Hoon AC; Griffioen S; Mulders MA; Tjoa ML; van Vugt JM;
Identification of triploid trophoblast cells in peripheral blood of a
woman with a partial hydatidiform molar pregnancy.
SO - Prenat Diagn 2001 Dec;21(13):1142-5
AD - Molecular Biology Laboratory, Department of Clinical Chemistry, Vrije
University Medical Centre, Amsterdam, The Netherlands.
In a woman with a partial hydatidiform molar pregnancy with 69,XXY
karyotype, the presence of male fetal cells of trophoblastic origin was
demonstrated in maternal blood by X/Y-chromosome specific PCR and by
immunostaining combined with FISH on two cell populations isolated from
maternal blood. Blood was obtained three weeks prior to the detection of
fetal demise, at 13 weeks' gestation. Results were confirmed on
formalin-fixed paraffin-embedded molar tissue, removed at 16 weeks'
gestational age for therapeutic reasons. The results indicate that both
plasma and cells from maternal peripheral blood might be useful for
non-invasive prenatal diagnosis of fetal aneuploidies, as described in
the current case with a partial molar pregnancy. Copyright 2001 John
Wiley & Sons, Ltd.
UI - 11408866
AU - Amezcua CA; Bahador A; Naidu YM; Felix JC
Expression of human telomerase reverse transcriptase, the catalytic
subunit of telomerase, is associated with the development of persistent
disease in complete hydatidiform moles.
SO - Am J Obstet Gynecol 2001 Jun;184(7):1441-6
AD - Department of Pathology, Women's and Children's Hospital, University of
Southern California Keck School of Medicine, Los Angeles 90033, USA.
OBJECTIVE: This study was undertaken to determine the putative role of
telomerase activity and human telomerase reverse transcriptase (hTERT)
expression in the development of persistent disease in patients with a
diagnosis of complete hydatidiform mole. The ribonucleoprotein
telomerase has been shown to have a major role in the process of
cellular immortality and carcinogenesis. The reactivation of this enzyme
that occurs in the development of malignancies appears to be limited by
the regulation of its catalytic subunit hTERT. Compared with their
somatic counterparts, most human malignancies demonstrate telomerase
activity, and this activity is dependent on the cellular presence of
hTERT. The role of telomerase in the pathogenesis of complete
hydatidiform moles is not clearly understood. Moreover, the role of
hTERT in trophoblastic disease, as well as in the development of
persistent trophoblastic disease, has yet to be elucidated. STUDY
DESIGN: Telomerase activity and hTERT expression were analyzed in the
initial uterine evacuation specimen of 54 complete hydatidiform moles by
use of the telomeric repeat amplification protocol assay and reverse
transcription-polymerase chain reaction methods. The results were
compared and then correlated with the development of persistent
trophoblastic disease. RESULTS: Among the 54 patients who were examined
with a diagnosis of complete hydatidiform mole, persistent trophoblastic
disease requiring postevacuation chemotherapy developed in 6. In the
remaining 48 patients, spontaneous remission of the disease occurred
after uterine evacuation. Both telomerase activity and hTERT expression
were detected in all 6 cases of persistent disease on the initial molar
tissue sampled. Among the 48 nonpersistent moles, telomerase activity
was detected in 29 (60%) and hTERT expression was demonstrated in 26
(54%). The detection of hTERT expression was significantly associated
with the presence of persistent disease (P =.035). Moreover, the absence
of hTERT expression in molar tissue obtained from uterine evacuation
demonstrated a 100% negative predictability in determining cases of
complete mole that were nonpersistent. CONCLUSIONS: Compared with
telomerase activity, the expression of hTERT is significantly associated
with the development of persistent disease in complete hydatidiform
moles. The absence of hTERT expression in the initial tissue sample from
complete moles may have potential clinical value in determining patients
who will eventually undergo spontaneous remission after uterine
UI - 11899519
AU - Havsteen H
[Diagnosis of malignant trophoblastic disease in women]
SO - Ugeskr Laeger 2002 Feb 25;164(9):1235-6
UI - 11766153
AU - Shapter AP; McLellan R
Gestational trophoblastic disease.
SO - Obstet Gynecol Clin North Am 2001 Dec;28(4):805-17
AD - Department of Gynecology, Lahey Clinic Medical Center, Burlington,
Massachusetts 01805, USA.
Gestational trophoblastic disease consists of a broad spectrum of
conditions ranging from an uncomplicated partial hydatidiform molar
pregnancy to stage IV choriocarcinoma with cerebral metastases.
Fortunately, with the advent of combination chemotherapy, the patient
with advanced-stage disease has a significant chance of achieving
complete remission. In addition, several studies have demonstrated that
patients with a history of gestational trophoblastic neoplasia do not
experience an increased risk of complications with future pregnancies.
Patients who have undergone chemotherapy do not seem to experience an
increase in the risk for congenital anomalies in their offspring.
Patients with a history of hydatidiform molar pregnancy should be
advised that they are at increased risk of future molar pregnancies,
with a risk of 1% in subsequent gestations after one molar pregnancy and
a risk as high as 23% after two molar gestations. Although patients
should be reassured regarding their reproductive future, they should be
advised to seek prompt medical attention once gestation is suspected so
that an early work-up can be initiated if pregnancy is confirmed.
UI - 11821296
AU - Chen RJ; Chu CT; Huang SC; Chow SN; Hsieh CY
Telomerase activity in gestational trophoblastic disease and placental
tissue from early and late human pregnancies.
SO - Hum Reprod 2002 Feb;17(2):463-8
AD - Department of Obstetrics and Gynecology, National Taiwan University
Hospital, Taipei, Taiwan. firstname.lastname@example.org
BACKGROUND: The aim of this study was to evaluate telomerase activity in
tissue from cases of gestational trophoblastic disease (GTD) and in
placental tissue from early and late human pregnancies. METHODS: We used
a telomeric repeat amplification protocol assay to measure telomerase
activity in 132 tissue samples from normal early pregnancies,
spontaneous abortions, normal late pregnancies, cases of late-pregnancy
intrauterine fetal death, and GTD. RESULTS: Telomerase activity was
detected more often in normal early pregnancies and cases of GTD than in
spontaneous abortions and normal late pregnancies (P < 0.001). During
early gestation, no significant difference in detection rates was found
between normal pregnancies and complete hydatidiform mole. As
gestational age increased, detection rates for normal pregnancies
decreased significantly (P = 0.0001), while for complete hydatidiform
mole no significant changes occurred. CONCLUSIONS: Our findings indicate
that placental tissue from normal early pregnancies and neoplastic
tissue from GTD possess similar levels of telomerase activity.
Decreasing regulation of telomerase activity is present in normal
pregnancies but not in complete hydatidiform mole. The fact that
telomerase activity decreases in cases of fetal demise, and as pregnancy
progresses, also suggests that placental senescence may play a role in
the development and ageing of the placenta.
UI - 11821297
AU - Matsui H; Iitsuka Y; Suzuka K; Yamazawa K; Seki K; Sekiya S
Outcome of subsequent pregnancy after treatment for persistent
gestational trophoblastic tumour.
SO - Hum Reprod 2002 Feb;17(2):469-72
AD - Department of Obstetrics and Gynecology, Chiba University School of
Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
BACKGROUND: This study analysed subsequent pregnancy outcome in patients
treated for persistent gestational trophoblastic tumour (GTT). METHODS:
Between 1974 and 1999, a total of 378 patients with GTT (83 patients
with high-risk and 295 patients with low-risk GTT) were treated at Chiba
University Hospital, Japan. Of these 378 patients, 363 (96.0%) achieved
primary remission and 315 survivors have been followed at our hospital.
RESULTS: To date, 129 patients have had 243 subsequent conceptions.
While pregnancy outcome was comparable with that of the general Japanese
population, the incidence of repeat molar pregnancy (2.1%) was
approximately seven times higher than that of the general population.
During the mandatory HCG follow-up period of 1 year, 15 patients
conceived within 6 months of completion of chemotherapy. The incidence
of spontaneous abortion in these 15 patients was significantly higher
than that in patients who conceived after a waiting period of >6 months
(P = 0.0053). CONCLUSIONS: Patients treated for GTT may anticipate a
normal future reproductive outcome, although it would be better to avoid
pregnancy for at least 6 months after completion of chemotherapy.
UI - 11953736
AU - Misra M; Levitsky LL; Lee MM
Transient hyperthyroidism in an adolescent with hydatidiform mole.
SO - J Pediatr 2002 Mar;140(3):362-6
AD - Pediatric Endocrine Unit, Massachusetts General Hospital, Boston, MA,
UI - 11357806
AU - Riegert-Johnson DL; McClary D; McIver B
Gestational trophoblastic disease: another cause of nausea and vomiting
SO - Mayo Clin Proc 2001 May;76(5):566
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