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1. Cavaliere A, Ermito S, Dinatale A, Pedata R: Management of molar pregnancy. J Prenat Med; 2009 Jan;3(1):15-7

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Management of molar pregnancy.
  • Gestational Trophoblastic Disease (GTD) originates from placental tissue and is among the rare human tumors that can be cured even in the presence of widespread metastases.
  • GTD include a spectrum of interrelated tumors including complete and partial hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor, that have different propensities for local invasion and spread.
  • Although most GTD develop after a mole, they can follow any antecedent pregnancy.Transvaginal ultrasound, routinary dosage of beta-hCG and current approaches to chemotherapy, let most women with malignant gestational trophoblastic disease to be cured and their reproductive function preserved.

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  • (PMID = 22439034.001).
  • [ISSN] 1971-3282
  • [Journal-full-title] Journal of prenatal medicine
  • [ISO-abbreviation] J Prenat Med
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Italy
  • [Other-IDs] NLM/ PMC3279094
  • [Keywords] NOTNLM ; chemotherapy / gestational trophoblastic disease / human chorionic gonadotropin
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2. van Trommel NE, Sweep FC, Schijf CP, Massuger LF, Thomas CM: Diagnosis of hydatidiform mole and persistent trophoblastic disease: diagnostic accuracy of total human chorionic gonadotropin (hCG), free hCG {alpha}- and {beta}-subunits, and their ratios. Eur J Endocrinol; 2005 Oct;153(4):565-75
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Diagnosis of hydatidiform mole and persistent trophoblastic disease: diagnostic accuracy of total human chorionic gonadotropin (hCG), free hCG {alpha}- and {beta}-subunits, and their ratios.
  • OBJECTIVE: Human chorionic gonadotropin (hCG) is widely used in the management of hydatidiform mole and persistent trophoblastic disease (PTD).
  • Predicting PTD after molar pregnancy might be beneficial since prophylactic chemotherapy reduces the incidence of PTD.
  • DESIGN: A retrospective study based on blood specimens collected in the Dutch Registry for Hydatidiform Moles.
  • A group of 165 patients with complete moles (of which 43 had PTD) and 39 patients with partial moles (of which 7 had PTD) were compared with 27 pregnant women with uneventful pregnancy.
  • METHODS: Serum samples from patients with hydatidiform mole with or without PTD were assayed using specific (radio) immunoassays for free alpha-subunit (hCGalpha), free beta-subunit (hCGbeta) and 'total' hCG (hCG + hCGbeta).
  • Specificity and sensitivity were calculated and paired in receiver-operating characteristic (ROC) curve analysis, resulting in areas under the curves (AUCs).
  • RESULTS: hCGbeta, hCGbeta/hCG + hCGbeta and hCGalpha/hCGbeta show AUCs ranging between 0.922 and 0.999 and, therefore, are excellent diagnostic tests to distinguish complete and partial moles from normal pregnancy.
  • To distinguish partial from complete moles the analytes hCGbeta, hCG + hCGbeta and the ratio hCGalpha/hCGbeta have AUCs between 0.7 and 0.8.
  • Although hCGalpha, hCGbeta and hCG + hCGbeta concentrations are significantly elevated in patients who will develop PTD compared with patients with spontaneous regression after evacuation of their moles, in predicting PTD, these analytes and parameters have AUCs <0.7.
  • CONCLUSIONS: Distinction between hydatidiform mole and normal pregnancy is best shown by a single blood specimen with hCGbeta, but hCGbeta/hCG + hCGbeta and hCGalpha/hCGbeta are also excellent diagnostic parameters.
  • To predict PTD, hCGalpha, hCGbeta, hCG + hCGbeta and hCGalpha/hCGbeta are moderately accurate tests, although they are not accurate enough to justify prophylactic chemotherapy treatment for prevention of PTD.

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  • (PMID = 16189178.001).
  • [ISSN] 0804-4643
  • [Journal-full-title] European journal of endocrinology
  • [ISO-abbreviation] Eur. J. Endocrinol.
  • [Language] ENG
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin; 0 / Chorionic Gonadotropin, beta Subunit, Human; 0 / Glycoprotein Hormones, alpha Subunit
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3. Gillespie AM, Kumar S, Hancock BW: Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy. Br J Cancer; 2000 Apr;82(8):1393-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Treatment of persistent trophoblastic disease later than 6 months after diagnosis of molar pregnancy.
  • Of 4257 patients with gestational trophoblastic disease (GTD) registered between 1986 and 1996 with the Trophoblastic Screening and Treatment Centre, Sheffield, 231 women required chemotherapy; 28 were treated 24 weeks or more after the initial evacuation of products of conception.
  • In 18 patients late treatment was a result of a predetermined watch and wait policy on the part of the Centre; these patients formed the study group.
  • The time interval from first evacuation (diagnosis) to start of chemotherapy was calculated for each patient.
  • Hospital records were reviewed when the interval of observation was 24 weeks or greater to determine patient characteristics, treatment and outcome.
  • Eighteen women were treated 'late' (according to Centre policy), with a median age of 30 years (range 21-57 years).
  • The interval from diagnosis to treatment ranged from 24 to, in one case, 56 weeks (median 33 weeks).
  • Fourteen of 18 women had complete moles, 3/18 had partial moles and one had unclassified disease.
  • All women had low-risk disease and were treated with single-agent methotrexate; 17 were cured with this regimen, one also required salvage chemotherapy.
  • In conclusion, where a successful surveillance programme is in operation for GTD, a wait and watch policy can be adopted without compromising patients whose definitive treatment is commenced more than 6 months after the initial diagnosis.
  • [MeSH-major] Antimetabolites, Antineoplastic / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Hydatidiform Mole / surgery. Methotrexate / therapeutic use. Neoplasm Recurrence, Local / drug therapy. Trophoblastic Neoplasms / drug therapy. Uterine Neoplasms / drug therapy. Uterine Neoplasms / surgery
  • [MeSH-minor] Adult. Dactinomycin / administration & dosage. Databases as Topic. England. Etoposide / administration & dosage. Female. Follow-Up Studies. Humans. Leucovorin / therapeutic use. Middle Aged. Pregnancy. Prognosis. Registries. Salvage Therapy. Time Factors. Treatment Outcome

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  • (PMID = 10780516.001).
  • [ISSN] 0007-0920
  • [Journal-full-title] British journal of cancer
  • [ISO-abbreviation] Br. J. Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] SCOTLAND
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 1CC1JFE158 / Dactinomycin; 6PLQ3CP4P3 / Etoposide; Q573I9DVLP / Leucovorin; YL5FZ2Y5U1 / Methotrexate
  • [Other-IDs] NLM/ PMC2363366
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4. Hossain N, Muzzafar N, Soomro N: Partial hydatidiform mole. J Coll Physicians Surg Pak; 2005 Jan;15(1):50-1
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Partial hydatidiform mole.
  • A case of partial hydatidiform mole is presented, occurring in a young primiparous woman after natural conception.
  • She presented with incomplete miscarriage.
  • Histological diagnosis of partial mole was made.
  • Failure of beta HCG to fall resulted in the start of chemotherapy.
  • WHO scoring placed her in low risk group.
  • In spite of the low risk, she required third line chemotherapy for complete eradication of disease.
  • [MeSH-major] Hydatidiform Mole, Invasive / drug therapy. Hydatidiform Mole, Invasive / pathology. Uterine Neoplasms / drug therapy. Uterine Neoplasms / pathology
  • [MeSH-minor] Adult. Cell Transformation, Neoplastic. Chorionic Gonadotropin, beta Subunit, Human / metabolism. Female. Humans. Pregnancy

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  • (PMID = 15670529.001).
  • [ISSN] 1022-386X
  • [Journal-full-title] Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
  • [ISO-abbreviation] J Coll Physicians Surg Pak
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Pakistan
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human
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5. Olvera M, Harris S, Amezcua CA, McCourty A, Rezk S, Koo C, Felix JC, Brynes RK: Immunohistochemical expression of cell cycle proteins E2F-1, Cdk-2, Cyclin E, p27(kip1), and Ki-67 in normal placenta and gestational trophoblastic disease. Mod Pathol; 2001 Oct;14(10):1036-42
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Immunohistochemical expression of cell cycle proteins E2F-1, Cdk-2, Cyclin E, p27(kip1), and Ki-67 in normal placenta and gestational trophoblastic disease.
  • The role of cell cycle protein expression in gestational trophoblastic disease is poorly understood.
  • In this study we investigated the immunostaining patterns of G(1) restriction point and G(1)-S regulatory proteins E2F-1, Cdk2, cyclin E, p27(kip1), and the proliferation marker Ki-67 on routinely processed sections of 29 hydatidiform moles (10 partial moles and 19 complete moles, including 9 persistent moles), 7 choriocarcinomas, and 7 normal placentas.
  • Ki-67 trophoblast staining decreased with increasing gestational age of the placenta, and showed maximal expression in gestational trophoblastic disease.
  • Cyclin-dependent kinase activity, as reflected by Cdk2 expression patterns, also decreased with placental maturation.
  • E2F-1 was uniquely expressed by trophoblasts of moles and choriocarcinoma.
  • Cyclin E was maximally expressed by complete moles and choriocarcinomas, and showed an inverse relationship with the cyclin-dependent kinase inhibitor p27(kip1).
  • Overexpression of cyclin E was associated with more aggressive forms of gestational trophoblastic disease.
  • However, we did not find distinguishing features between complete moles that spontaneously resolved after evacuation and persistent moles that required chemotherapy.
  • The different expression patterns of cyclin E and E2F-1 in partial and complete moles may be useful in distinguishing these two entities.
  • [MeSH-major] CDC2-CDC28 Kinases. Cell Cycle Proteins / biosynthesis. DNA-Binding Proteins. Ki-67 Antigen / biosynthesis. Trophoblastic Neoplasms / metabolism
  • [MeSH-minor] Choriocarcinoma / metabolism. Choriocarcinoma / pathology. Cyclin E / biosynthesis. Cyclin-Dependent Kinase 2. Cyclin-Dependent Kinase Inhibitor p27. Cyclin-Dependent Kinases / biosynthesis. E2F Transcription Factors. E2F1 Transcription Factor. Female. Humans. Hydatidiform Mole / metabolism. Hydatidiform Mole / pathology. Immunohistochemistry. Pregnancy. Protein-Serine-Threonine Kinases / biosynthesis. Transcription Factors / biosynthesis. Tumor Suppressor Proteins / biosynthesis. Uterine Neoplasms / metabolism. Uterine Neoplasms / pathology

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  • (PMID = 11598175.001).
  • [ISSN] 0893-3952
  • [Journal-full-title] Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc
  • [ISO-abbreviation] Mod. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Cell Cycle Proteins; 0 / Cyclin E; 0 / DNA-Binding Proteins; 0 / E2F Transcription Factors; 0 / E2F1 Transcription Factor; 0 / E2F1 protein, human; 0 / Ki-67 Antigen; 0 / Transcription Factors; 0 / Tumor Suppressor Proteins; 147604-94-2 / Cyclin-Dependent Kinase Inhibitor p27; EC 2.7.11.1 / Protein-Serine-Threonine Kinases; EC 2.7.11.22 / CDC2-CDC28 Kinases; EC 2.7.11.22 / CDK2 protein, human; EC 2.7.11.22 / Cyclin-Dependent Kinase 2; EC 2.7.11.22 / Cyclin-Dependent Kinases
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6. Pongcharoen S, Bulmer JN, Searle RF: No evidence for apoptosis of decidual leucocytes in normal and molar pregnancy: implications for immune privilege. Clin Exp Immunol; 2004 Nov;138(2):330-6
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] No evidence for apoptosis of decidual leucocytes in normal and molar pregnancy: implications for immune privilege.
  • Complete hydatidiform moles are totally paternally derived and represent complete allografts that might be expected to provoke maternal immune rejection.
  • Our previous and other studies have shown expression of Fas by increased numbers of activated decidual CD4(+) T cells in both complete and partial molar pregnancy as well as increased FasL(+) expression by molar trophoblasts compared with trophoblasts in normal pregnancies.
  • As the Fas/FasL system represents a major apoptotic pathway that can play a role in immune privilege, the aim of this study was to investigate whether apoptosis of decidual immune cells, particularly T cells, could be responsible for maternal immune tolerance in molar pregnancy.
  • Using terminal deoxynucleotidyl transferase (TdT)-mediated nick end-labelling (TUNEL), a significant increase in TUNEL(+) cells was demonstrated in decidua associated with partial (P = 0.0052) and complete (P = 0.0096) hydatidiform mole compared with normal early pregnancy.
  • Co-labelling immunoperoxidase studies showed that the TUNEL(+) cells in both normal and molar pregnancies were not activated CD45RO(+) immune cells, CD3(+) T cells, CD56(+) uterine natural killer (NK) cells or CD14(+) CD68(+) macrophages.
  • Double immunohistochemical labelling with antiactive caspase-3 and leucocyte markers confirmed the lack of leucocyte apoptosis.
  • Double immunostaining with anticytokeratin to detect trophoblast and M30 CytoDeath, which detects a neoepitope of cytokeratin 18 revealed after caspase-mediated cleavage, revealed apoptotic extravillous trophoblast cells within decidual tissue.
  • We conclude that there is no evidence that apoptosis of decidual leucocytes plays a role in maintaining maternal tolerance in either normal or molar pregnancy.
  • [MeSH-major] Apoptosis / immunology. Decidua / immunology. Hydatidiform Mole / immunology. Immune Tolerance / immunology. Leukocytes / immunology. Uterine Neoplasms / immunology
  • [MeSH-minor] Antigens, CD / analysis. Caspase 3. Caspases / analysis. Enzyme Precursors / analysis. Female. Humans. Immunoenzyme Techniques / methods. In Situ Nick-End Labeling / methods. Keratins / analysis. Killer Cells, Natural / immunology. Pregnancy. T-Lymphocytes / immunology

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  • (PMID = 15498045.001).
  • [ISSN] 0009-9104
  • [Journal-full-title] Clinical and experimental immunology
  • [ISO-abbreviation] Clin. Exp. Immunol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antigens, CD; 0 / Enzyme Precursors; 68238-35-7 / Keratins; EC 3.4.22.- / CASP3 protein, human; EC 3.4.22.- / Caspase 3; EC 3.4.22.- / Caspases
  • [Other-IDs] NLM/ PMC1809221
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7. Riadh BT, Abdellatif C, Wissal H, Leila A, Taher M, Abdelhamid K: Clinical analysis and management of gestational trophoblastic diseases: a 90 cases study. Int J Biomed Sci; 2009 Dec;5(4):321-5

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Clinical analysis and management of gestational trophoblastic diseases: a 90 cases study.
  • OBJECTIVE: The aim of the study was to identify the incidence, diagnosis, therapeutic and histological particularities of molar pregnancies and to evaluate our management of gestational trophoblastic tumors (GTT) according to the recommendations of FIGO.
  • METHODS: This was a retrospective study of 90 patients who were diagnosed with molar pregnancy from January 1991 to December 2007.
  • After remission, post molar pregnancy surveillance was continued for one year.
  • Patients whose condition required chemotherapy for GTT were attributed a FIGO/WHO score.
  • RESULTS: Molar pregnancy occurred in 90 women.
  • The frequency of molar pregnancy was 1 per 1124 pregnancies.
  • Molar pregnancies were more frequent in pauciparous patients (52.24%).
  • Treatment consisted in uterine evacuation by suction curettage.
  • Histological findings were complete mole in 66.66% of the cases and partial mole in 33.33% of the cases.
  • 81 patients (90%) achieved remission without chemotherapy and 9 patients (10%) had FIGO stage I GTT.
  • They achieved remission with a monochemotherapy.
  • CONCLUSION: The practice of ultrasonography in the first trimester of pregnancy allows an early diagnosis of molar pregnancy and an adequate treatment and follow-up.

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  • (PMID = 23675154.001).
  • [ISSN] 1550-9702
  • [Journal-full-title] International journal of biomedical science : IJBS
  • [ISO-abbreviation] Int J Biomed Sci
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Other-IDs] NLM/ PMC3614797
  • [Keywords] NOTNLM ; chemotherapy / gestational trophoblastic tumors / human chorionic gonadotropin / hydatiform mole / ultrasonography
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8. Hancock BW, Nazir K, Everard JE: Persistent gestational trophoblastic neoplasia after partial hydatidiform mole incidence and outcome. J Reprod Med; 2006 Oct;51(10):764-6
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  • [Title] Persistent gestational trophoblastic neoplasia after partial hydatidiform mole incidence and outcome.
  • OBJECTIVE: To report the Sheffield experience with persistent gestational trophoblastic neoplasia (GTN) after partial hydatidiform mole (PHM) and to review worldwide experience.
  • Any case of PHM leading to persistent GTN was reviewed centrally by an expert gynecologic pathologist.
  • Clinical features, treatment and outcome were recorded.
  • Forty-one developed persistent GTN.
  • Central histopathology review confirmed PHM in only 14 cases (0.91% of all those registered).
  • During the same period, 271 cases of persistent GTN originally registered as complete hydatidiform mole were reviewed; 3 were found to be PHMs (2 low, 1 high risk).
  • In all, 15 of 17 persistent PHMs required chemotherapy.
  • CONCLUSION: Persistent GTN requiring chemotherapy can occasionally occur after PHM; surveillance of all cases continues to be recommended.
  • [MeSH-major] Hydatidiform Mole / epidemiology. Neoplasm Recurrence, Local / epidemiology. Uterine Neoplasms / epidemiology
  • [MeSH-minor] England / epidemiology. Female. Humans. Incidence. Medical Records. Pregnancy. Retrospective Studies. Treatment Outcome

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  • (PMID = 17086803.001).
  • [ISSN] 0024-7758
  • [Journal-full-title] The Journal of reproductive medicine
  • [ISO-abbreviation] J Reprod Med
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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9. Kim CH, Kim YH, Kim JW, Kim KM, Cho MK, Kim SM, Nam JH, Song TB: Triplet pregnancy with partial hydatidiform mole coexisting with two fetuses: a case report. J Obstet Gynaecol Res; 2008 Aug;34(4 Pt 2):641-4
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Triplet pregnancy with partial hydatidiform mole coexisting with two fetuses: a case report.
  • Hydatidiform mole with a coexistent fetus is rare, but this condition has recently shown an increased incidence because of assisted reproduction technology.
  • Herein, we report on a case of triplet pregnancy with a partial hydatidiform mole coexisting with two fetuses.
  • After termination of pregnancy, the patient was diagnosed with persistent gestational trophoblastic disease.
  • Six courses of methotrexate chemotherapy were performed.
  • Her beta-human chorionic gonadotrophin titers then fell to a normal level.
  • [MeSH-major] Hydatidiform Mole / diagnosis. Pregnancy, Multiple. Uterine Neoplasms / diagnosis
  • [MeSH-minor] Adult. Biomarkers / metabolism. Cyclin-Dependent Kinase Inhibitor p57 / metabolism. Female. Humans. Pregnancy

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  • (PMID = 18840171.001).
  • [ISSN] 1341-8076
  • [Journal-full-title] The journal of obstetrics and gynaecology research
  • [ISO-abbreviation] J. Obstet. Gynaecol. Res.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Biomarkers; 0 / Cyclin-Dependent Kinase Inhibitor p57
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10. Tica AA, Tica OS, Georgescu CV, Mixich F, Tica VJ, Berceanu S, Ebanca E, Patrascu A, Simionescu C: Recurrent partial hydatidiform mole, with a first twin pregnancy, after treatment with clomiphene citrate. Gynecol Endocrinol; 2009 Aug;25(8):514-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Recurrent partial hydatidiform mole, with a first twin pregnancy, after treatment with clomiphene citrate.
  • This treatment resulted in a twin pregnancy, one degenerated into a partial hydatidiform mole and the other into a very early embryo death.
  • The karyotype was a mosaic one: 63% of metaphases showed triploidy - 69 XXX and 37% diploidy - 46 XX.
  • Despite all medical advice, she returned 8 months later with a new pregnancy, which proved to be a new partial hydatidiform mole, this time a single one.
  • The genetic map of both genitors was performed, showing no aberrations.
  • Unfortunately, the patient came back, once again, 5 months later, with a new positive pregnancy test.
  • Ultrasonography revealed a new very early embryo death, the histopathological analysis establishing to be a single 'pure' stop in evolution of the pregnancy.
  • As all the three pregnancies obtained after treatment with clomiphene were abnormal, two being partial hydatidiform moles and one being a premature miscarriage, without any genetic aberrations of the genitors, it seems very possible that clomiphene, apart from improving fertility, also increases the risk of abnormal ovum appearance.
  • [MeSH-major] Clomiphene / adverse effects. Fertility Agents, Female / adverse effects. Hydatidiform Mole / chemically induced. Pregnancy, Multiple. Twins. Uterine Neoplasms / chemically induced
  • [MeSH-minor] Abortion, Spontaneous / chemically induced. Adult. Embryo Loss / chemically induced. Female. Humans. Infertility, Female / drug therapy. Karyotyping. Luteoma / ultrasonography. Ovarian Neoplasms / ultrasonography. Pregnancy. Recurrence. Ultrasonography, Prenatal

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  • (PMID = 19499414.001).
  • [ISSN] 1473-0766
  • [Journal-full-title] Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
  • [ISO-abbreviation] Gynecol. Endocrinol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Fertility Agents, Female; 1HRS458QU2 / Clomiphene
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11. Shiina H, Oka K, Okane M, Tanno W, Kawasaki T, Nakayama M: Coexisting true hermaphroditism and partial hydatidiform mole developing metastatic gestational trophoblastic tumors. A case report. Virchows Arch; 2002 Nov;441(5):514-8
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  • [Title] Coexisting true hermaphroditism and partial hydatidiform mole developing metastatic gestational trophoblastic tumors. A case report.
  • We report a fetal autopsy case that was diagnosed with a mole coexistent with a live fetus at an early gestation and finally showed coexisting true hermaphroditism of 46,XX/46,XY mosaicism and partial hydatidiform mole, developing metastatic gestational trophoblastic tumors in the lungs of the mother.
  • A 23-year-old Japanese female had a mole coexistent with a fetus and showed a high chorionic gonadotropin titer in urine and serum at 10 weeks of gestation.
  • A chromosome analysis demonstrated 46,XX and 46,XY mosaicism in both umbilical cord blood and mole samples.
  • Intrapelvic organs contained a testis in the one gonad, and an ovotestis in the other gonad microscopically.
  • The testis had seminiferous tubules containing primitive germ cells, immature Sertoli cells, and cytomegalic Leydig cells.
  • The ovary in the ovotestis had numerous primitive germ cells and a few stromal cells.
  • The patient presented multiple metastatic pulmonary tumors at 1 month after the interruption, and was treated with chemotherapy for the clinical diagnosis of gestational trophoblastic tumor metastases.
  • [MeSH-major] Disorders of Sex Development / pathology. Fetus / abnormalities. Hydatidiform Mole / pathology. Pregnancy Complications, Neoplastic / pathology. Trophoblastic Neoplasms / secondary. Uterine Neoplasms / pathology
  • [MeSH-minor] Abortion, Therapeutic. Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Dactinomycin / administration & dosage. Etoposide / administration & dosage. Female. Humans. Lung Neoplasms / drug therapy. Lung Neoplasms / radiography. Lung Neoplasms / secondary. Magnetic Resonance Imaging. Male. Methotrexate / administration & dosage. Mosaicism / genetics. Neoplasms, Multiple Primary. Pregnancy

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  • (PMID = 12447683.001).
  • [ISSN] 0945-6317
  • [Journal-full-title] Virchows Archiv : an international journal of pathology
  • [ISO-abbreviation] Virchows Arch.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
  • [Chemical-registry-number] 1CC1JFE158 / Dactinomycin; 6PLQ3CP4P3 / Etoposide; YL5FZ2Y5U1 / Methotrexate
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12. Koc S, Ozdegirmenci O, Tulunay G, Ozgul N, Kose MF, Bulbul D: Recurrent partial hydatidiform mole: a report of a patient with three consecutive molar pregnancies. Int J Gynecol Cancer; 2006 Mar-Apr;16(2):940-3
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  • [Title] Recurrent partial hydatidiform mole: a report of a patient with three consecutive molar pregnancies.
  • Hydatidiform mole (HM) is the most common form of gestational trophoblastic neoplasia and is characterized by atypical hyperplastic trophoblasts and hydropic villi.
  • Here, we report the case of a patient with three consecutive partial HMs without normal pregnancy.
  • A 28-year-old woman with gravida 3, para 0, was referred to our hospital with a diagnosis of an invasive mole in December 2003.
  • She had three consecutive molar pregnancies in 2000, 2001, and 2003.
  • All three molar pregnancies were evacuated by suction curettage and the patient was followed by serial beta-human chorionic gonadotropin levels.
  • All three moles were histologically confirmed as partial moles.
  • In the first two molar events no additional treatment after evacuation was required, but in the last event, the beta-human chorionic gonadotropin levels increased and an invasive mole was suspected.
  • Diagnostic workup ruled out an invasive mole and choriocarcinoma.
  • Karyotypic analysis of the patient and her husband was normal.
  • The patient required chemotherapy for treatment of persistent disease.
  • Recurrent partial HM is a very rare clinical disorder.
  • Repetitive molar pregnancy is not an indication for chemotherapy, but persistent disease does require chemotherapy.
  • [MeSH-major] Hydatidiform Mole / diagnosis. Neoplasm Recurrence, Local / diagnosis. Uterine Neoplasms / diagnosis
  • [MeSH-minor] Adult. Chorionic Gonadotropin, beta Subunit, Human / metabolism. Female. Humans. Hydatidiform Mole, Invasive / pathology. Pregnancy. Pregnancy Outcome

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  • (PMID = 16681793.001).
  • [ISSN] 1048-891X
  • [Journal-full-title] International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
  • [ISO-abbreviation] Int. J. Gynecol. Cancer
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human
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13. Schofer JM, Tong TC, Tanen DA: Kikuchi's disease: a rare cause of cervical lymphadenitis and fever. J Emerg Med; 2005 Aug;29(2):151-3
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  • [Title] Kikuchi's disease: a rare cause of cervical lymphadenitis and fever.
  • Kikuchi's disease is a rare, self-limited cause of fever and cervical lymphadenitis often misdiagnosed as lymphoma or lupus and inappropriately treated, potentially causing numerous ED visits for unrelieved symptoms.
  • The case described is that of a 29-year-old with persistent fever and cervical lymphadenitis who presented to the ED with a suspected allergic reaction to an antibiotic.
  • The diagnosis of Kikuchi's disease was made in association with nasopharyngeal carcinoma and partial hydatidiform mole.
  • The case highlights the clinical features, diagnosis, and treatment of Kikuchi's disease.
  • [MeSH-minor] Adult. Diagnosis, Differential. Dilatation and Curettage. Drug Hypersensitivity / diagnosis. Drug Hypersensitivity / etiology. Emergency Medicine / methods. Female. Humans. Hydatidiform Mole / complications. Hydatidiform Mole / surgery. Hydatidiform Mole / ultrasonography. Nasopharyngeal Neoplasms / complications. Nasopharyngeal Neoplasms / diagnosis. Nasopharyngeal Neoplasms / therapy. Neck. Pregnancy. Remission, Spontaneous. Treatment Outcome. Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects

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  • (PMID = 16029824.001).
  • [ISSN] 0736-4679
  • [Journal-full-title] The Journal of emergency medicine
  • [ISO-abbreviation] J Emerg Med
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 8064-90-2 / Trimethoprim, Sulfamethoxazole Drug Combination
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14. Cohn DE, Herzog TJ: Gestational trophoblastic diseases: new standards for therapy. Curr Opin Oncol; 2000 Sep;12(5):492-6
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  • [Title] Gestational trophoblastic diseases: new standards for therapy.
  • Gestational trophoblastic disease (GTD) is a spectrum of rare neoplastic conditions that are highly curable, even in the presence of widely metastatic disease.
  • These diseases vary from partial hydatidiform mole, which rarely metastasizes and infrequently requires treatment with chemotherapy, to choriocarcinoma, for which multi-agent chemotherapy is the standard treatment.
  • Much has been learned regarding the epidemiology of this disease, and our understanding of the genetics underlying GTD is rapidly expanding.
  • As technology such as ultrasonography and sensitive tests for beta-human chorionic gonadotropin have evolved, the presentation of molar pregnancy has significantly changed, although the incidence of persistent GTD has not decreased.
  • This review highlights these recent advancements in the epidemiology, genetics, diagnosis, and treatment of gestational trophoblastic disease.
  • [MeSH-major] Trophoblastic Neoplasms / therapy
  • [MeSH-minor] Female. Follow-Up Studies. Humans. Neoplasm Staging. Pregnancy. Prognosis

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  • (PMID = 10975558.001).
  • [ISSN] 1040-8746
  • [Journal-full-title] Current opinion in oncology
  • [ISO-abbreviation] Curr Opin Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] UNITED STATES
  • [Number-of-references] 20
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15. Wielsma S, Kerkmeijer L, Bekkers R, Pyman J, Tan J, Quinn M: Persistent trophoblast disease following partial molar pregnancy. Aust N Z J Obstet Gynaecol; 2006 Apr;46(2):119-23
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  • [Title] Persistent trophoblast disease following partial molar pregnancy.
  • OBJECTIVE: Human chorionic gonadotrophin (hCG) follow-up data were analysed retrospectively in all patients registered in the Hydatidiform Mole Registry at the Royal Women's Hospital, Melbourne from January 1992 to January 2001 to determine the risk of persistent trophoblast disease following partial molar pregnancy and to review the present follow-up protocol of patients suffering from partial hydatidiform molar pregnancy (PHM).
  • METHODS: Demographic factors were determined for all 344 cases with a review diagnosis of PHM, included age, history of previous hydatidiform mole, gestation length, hCG levels and compliance with follow-up.
  • FINDINGS: Six of the 344 patients diagnosed with PHM required treatment with single-agent methotrexate and folinic acid rescue.
  • All six patients achieved and maintained a complete biochemical remission after chemotherapy. hCG regression assays were analysed for 235 patients: 225 patients had at least one normal hCG measurement during follow-up, of whom 152 (64.7%) patients obtained normal values within 2 months after evacuation.
  • All patients obtained normal levels within 32 weeks after evacuation of the partial hydatidiform mole.
  • No patient who achieved normal hCG levels required chemotherapy because of a recurrent gestational trophoblastic tumour.
  • RECOMMENDATIONS: This study indicates that 1.7% of all partial mole pregnancy patients needed treatment for malignant sequelae.
  • In contrast, no patient diagnosed with partial mole had a biochemical or clinical relapse after achieving normal levels of hCG, consistent with previous studies.
  • Patients who have had a partial hydatidiform mole should be followed by hCG assays until normal levels are achieved and then follow-up can be safely discontinued.
  • [MeSH-major] Chorionic Gonadotropin / blood. Hydatidiform Mole / diagnosis. Methotrexate / therapeutic use. Neoplasm Recurrence, Local / diagnosis. Uterine Neoplasms / diagnosis
  • [MeSH-minor] Adult. Australia. Biomarkers, Tumor / blood. Female. Follow-Up Studies. Gestational Age. Humans. Maternal Age. Parity. Pregnancy. Pregnancy Complications, Neoplastic / diagnosis. Pregnancy Complications, Neoplastic / drug therapy. Pregnancy Outcome. Registries. Retrospective Studies. Risk Assessment. Trophoblastic Neoplasms / diagnosis. Trophoblastic Neoplasms / drug therapy

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  • [ErratumIn] Aust N Z J Obstet Gynaecol. 2006 Jun;46(3):179. Wiesma, Sabien [corrected to Wielsma, Sabien]
  • (PMID = 16638033.001).
  • [ISSN] 0004-8666
  • [Journal-full-title] The Australian & New Zealand journal of obstetrics & gynaecology
  • [ISO-abbreviation] Aust N Z J Obstet Gynaecol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Australia
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin; YL5FZ2Y5U1 / Methotrexate
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16. Kohorn EI: Measurement of CA-125 in trophoblastic disease. Gynecol Oncol; 2000 Jul;78(1):39-42
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  • [Title] Measurement of CA-125 in trophoblastic disease.
  • OBJECTIVES: Physicians treating hydatidiform mole are still seeking means of identifying those patients who will require chemotherapy.
  • The standard accepted method is to follow human chorionic gonadotropin levels but CA-125 measurement has been suggested as a supplement that may be clinically useful.
  • This study was undertaken to validate or refute the one previous study that addresses this issue.
  • CA-125 was measured at the time of hydatidiform mole evacuation to determine (1) whether it would predict the need for chemotherapy and (2) whether it correlated with human chorionic gonadotropin and tumor load in following patients with hydatidiform mole and metastatic gestational trophoblastic disease.
  • PATIENTS AND METHODS: CA-125 was measured in serial weekly samples selected from diagnostic groups of patients with trophoblastic disease.
  • Sixteen patients had hydatidiform mole with spontaneous resolution, fourteen had nonmetastatic gestational trophoblastic tumor, and four had low-risk metastatic disease.
  • Six patients had high-risk metastatic disease.
  • Ten patients had partial hydatidiform mole and one of these required chemotherapy.
  • One patient had primary ovarian choriocarcinoma and three had placental site tumor.
  • RESULTS: The mean preevacuation CA-125 among the 15 patients with complete hydatidiform mole was 40.9 U/ml: 52.5 U/ml for 5 patients who required chemotherapy and 36.2 U/ml for 10 patients who did not require chemotherapy.
  • Among six patients with high-risk disease, CA-125 was elevated in four but in all six patients hCG remained elevated when CA-125 became negative.
  • In nine patients with partial hydatidiform mole CA-125 was elevated prior to mole evacuation and then became negative.
  • The patient with a tetraploid conceptus who required chemotherapy had negative CA-125.
  • With placental site tumor CA-125 was negative, but it was elevated with ovarian choriocarcinoma.
  • CONCLUSION: CA-125 levels do not provide reliable information in the management of patients with gestational trophoblastic disease.
  • [MeSH-major] Biomarkers, Tumor / analysis. CA-125 Antigen / analysis. Hydatidiform Mole / immunology. Uterine Neoplasms / immunology
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chorionic Gonadotropin / analysis. False Negative Reactions. Female. Humans. Predictive Value of Tests. Pregnancy. Reproducibility of Results

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  • [Copyright] Copyright 2000 Academic Press.
  • (PMID = 10873407.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / CA-125 Antigen; 0 / Chorionic Gonadotropin
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17. Khashoggi TY: Prevalence of gestational trophoblastic disease. A single institution experience. Saudi Med J; 2003 Dec;24(12):1329-33
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  • [Title] Prevalence of gestational trophoblastic disease. A single institution experience.
  • OBJECTIVE: To study the incidence and time trends of gestational trophoblastic disease in the Kingdom of Saudi Arabia (KSA).
  • RESULTS: Fifty-nine cases of hydatidiform mole (36 complete hydatidiform mole (CHM) and 23 partial hydatidiform mole (PHM) and 2 cases of choriocarcinoma were observed, out of 64,762 pregnancies registered at Security Forces Hospital, Riyadh, KSA, during an 11 year period.
  • The optimal management of this disease depends on prompt diagnosis, correct stratification of the risk category and appropriate treatment using various modalities such as chemotherapy and surgery.
  • [MeSH-major] Gestational Trophoblastic Disease / epidemiology. Gestational Trophoblastic Disease / pathology
  • [MeSH-minor] Adolescent. Adult. Age Distribution. Chemotherapy, Adjuvant. Choriocarcinoma / epidemiology. Choriocarcinoma / pathology. Choriocarcinoma / therapy. Combined Modality Therapy. Female. Follow-Up Studies. Hospitals, Public. Humans. Hydatidiform Mole / epidemiology. Hydatidiform Mole / pathology. Hydatidiform Mole / therapy. Hysterectomy / methods. Maternal Age. Neoplasm Staging. Pregnancy. Pregnancy, High-Risk. Prevalence. Retrospective Studies. Risk Assessment. Saudi Arabia / epidemiology. Survival Analysis. Treatment Outcome

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  • (PMID = 14710278.001).
  • [ISSN] 0379-5284
  • [Journal-full-title] Saudi medical journal
  • [ISO-abbreviation] Saudi Med J
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Saudi Arabia
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18. Kohorn EI, Kacinski BM, Stanley ER: Serum levels of macrophage colony-stimulating factor in trophoblastic disease. Gynecol Oncol; 2001 Mar;80(3):383-6
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  • [Title] Serum levels of macrophage colony-stimulating factor in trophoblastic disease.
  • OBJECTIVES: The aims of this study were to measure levels of colony stimulating factor (CSF-1) in patients with trophoblastic disease, to determine whether such measurement may be useful to supplement measurement of the prognostically reliable human chorionic gonadotrophin (hCG), and to assess whether measurement of CSF-1 may be helpful in predicting requirement for chemotherapy in patients with hydatidiform mole.
  • METHODS: Serial weekly serum samples were selected for CSF-1 assay from representative diagnostic groups of patients with trophoblastic disease: hydatidiform-mole with spontaneous resolution, low-risk post-hydatidiform-mole trophoblastic tumor, partial hydatidiform mole, high-risk metastatic gestational trophoblastic tumor, primary ovarian choriocarcinoma, and placental site trophoblastic tumor. hCG was measured by an in-house radioimmunoassay that measures all parts of the hCG molecule.
  • The upper level of normal CSF-1 was taken as 8 ng/ml.
  • RESULTS: In this study of 45 patients with trophoblastic disease, some very high levels of CSF-1 were encountered.
  • Generally, however, CSF-1 and hCG did not correlate.
  • CSF-1 was frequently not elevated when hCG was still significantly elevated and conversely CSF-1 was elevated when hCG was negative.
  • CONCLUSION: The measurement of CSF-1 does not appear to be useful in managing trophoblastic disease as it does not correlate with the level of hCG.
  • Occasionally, high levels of CSF-1 were found in patients with trophoblastic disease.
  • [MeSH-major] Macrophage Colony-Stimulating Factor / blood. Trophoblastic Neoplasms / blood. Uterine Neoplasms / blood
  • [MeSH-minor] Adolescent. Adult. Aged. Chorionic Gonadotropin / blood. Female. Humans. Hydatidiform Mole / blood. Hydatidiform Mole / drug therapy. Male. Middle Aged. Predictive Value of Tests. Pregnancy. Radioimmunoassay. Risk Factors

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  • [Copyright] Copyright 2001 Academic Press.
  • (PMID = 11263936.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA26504; United States / NCI NIH HHS / CA / CA32551; United States / PHS HHS / / P30-13330
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin; 81627-83-0 / Macrophage Colony-Stimulating Factor
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19. Ak I, Ozalp S: Prognostic relevance of F-18 fluorodeoxyglucose positron emission tomography and computed tomography in molar pregnancy before evacuation. J Reprod Med; 2009 Jul;54(7):441-6
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  • [Title] Prognostic relevance of F-18 fluorodeoxyglucose positron emission tomography and computed tomography in molar pregnancy before evacuation.
  • OBJECTIVE: To assess prognostic significance of tumor metabolic activity of molar tissue by preevacuation F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) in patients clinically diagnosed with molar pregnancy.
  • STUDY DESIGN: A total of 11 consecutive patients with clinical diagnosis of molar pregnancy before evacuation were enrolled.
  • After evacuation of molar tissue, histopathologic findings and clinical follow-up were used as reference standards for the study.
  • RESULTS: Six patients, 5 with complete and 1 with partial hydatidiform mole, had good outcome and normalization of beta-human chorionic gonadotropin (beta-hCG) levels within 5-7 weeks of evacuation.
  • These patients were treated with first-line single methotrexate or second-line etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine (EMA/CO) chemotherapy regimen.
  • Standardized uptake value of molar tissue within the uterus in patients with persistently/progressively elevated beta-hCG levels was significantly higher than that in patients whose serum beta-hCG levels normalized after evacuation of molar tissue.
  • CONCLUSION: Preliminary results suggest that F-18 FDG uptake within the uterus assessed by preevacuation PET/CT is predictive for probability of high-risk features of gestational trophoblastic disease or choriocarcinoma in patients with molar pregnancy.
  • [MeSH-major] Chorionic Gonadotropin, beta Subunit, Human / blood. Fluorodeoxyglucose F18. Hydatidiform Mole / radionuclide imaging. Positron-Emission Tomography / methods. Uterine Neoplasms / radionuclide imaging. Uterus / radionuclide imaging
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Agents / therapeutic use. Female. Humans. Middle Aged. Pregnancy. Prognosis. Young Adult

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  • (PMID = 19691261.001).
  • [ISSN] 0024-7758
  • [Journal-full-title] The Journal of reproductive medicine
  • [ISO-abbreviation] J Reprod Med
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Chorionic Gonadotropin, beta Subunit, Human; 0Z5B2CJX4D / Fluorodeoxyglucose F18
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20. Tasci Y, Dilbaz S, Secilmis O, Dilbaz B, Ozfuttu A, Haberal A: Routine histopathologic analysis of product of conception following first-trimester spontaneous miscarriages. J Obstet Gynaecol Res; 2005 Dec;31(6):579-82
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  • [Title] Routine histopathologic analysis of product of conception following first-trimester spontaneous miscarriages.
  • AIM: To evaluate the histopathologic findings relating to tissue samples collected at surgical uterine evacuation in first-trimester spontaneous miscarriages.
  • METHODS: In this retrospective study, histopathologic diagnosis of the tissue samples obtained via surgical uterine evacuation in patients who were admitted to the Early Pregnancy Clinic in a 12-month period with the diagnosis of incomplete miscarriage (n = 970), missed miscarriage (n = 406) and anembryonic miscarriage (n = 230) in the first trimester was recorded and compared with the presurgery diagnosis.
  • RESULTS: Uterine evacuation was performed in cases of incomplete miscarriage (n = 970, 60.4%), missed miscarriage (n = 406, 25.2%) and anembryonic miscarriage (n = 230, 14.3%).
  • Histopathologic examination revealed the product of conception in 1119 patients (69.7%), while partial hydatidiform mole was diagnosed in 33 patients (2.1%).
  • Complete hydatidiform mole was detected in only seven cases (0.43%).
  • Decidual tissue without chorionic villi was reported in 272 patients (16.9%), raising the suspicion of presence of other pathology.
  • CONCLUSIONS: By routine histopathologic assessment of products of first-trimester spontaneous miscarriages, important pathologies such as molar pregnancy and placental trophoblastic disease can be diagnosed.
  • Histopathological assessment has great value in the identification of an ectopic pregnancy or infection when compared with clinical and laboratory findings.
  • [MeSH-major] Abortion, Spontaneous / pathology
  • [MeSH-minor] Abortion, Incomplete / pathology. Abortion, Missed / pathology. Adolescent. Adult. Decidua / pathology. Female. Gestational Trophoblastic Disease / pathology. Humans. Hydatidiform Mole / pathology. Middle Aged. Pregnancy. Pregnancy Trimester, First. Retrospective Studies. Uterine Neoplasms / pathology

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  • (PMID = 16343264.001).
  • [ISSN] 1341-8076
  • [Journal-full-title] The journal of obstetrics and gynaecology research
  • [ISO-abbreviation] J. Obstet. Gynaecol. Res.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Japan
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21. Zhou Q, Lei XY, Xie Q, Cardoza JD: Sonographic and Doppler imaging in the diagnosis and treatment of gestational trophoblastic disease: a 12-year experience. J Ultrasound Med; 2005 Jan;24(1):15-24
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  • [Title] Sonographic and Doppler imaging in the diagnosis and treatment of gestational trophoblastic disease: a 12-year experience.
  • OBJECTIVE: To evaluate the clinical utility of sonography with Doppler examination in the diagnosis and treatment of gestational trophoblastic disease (GTD).
  • METHODS: A retrospective analysis of 355 cases of GTD seen over a 12-year period in 2 large university referral hospitals in China was performed.
  • Sonographic and Doppler examinations were performed to diagnose the presence of molar tissue, detect invasive disease, assess disease recurrence, and monitor the efficacy of chemotherapy.
  • RESULTS: Of the 355 patients with GTD, 106 had a classic hydatidiform mole (CHM), 33 had a partial hydatidiform mole (PHM), 184 had an invasive hydatidiform mole (IHM), and 32 had choriocarcinoma.
  • Sonography showed abnormal molar tissue confined to the endometrial cavity in all cases of CHM.
  • In cases of IHM and choriocarcinoma, soft tissue invasion and cystic vascular spaces within the myometrium were shown.
  • Cases of PHM had a thickened, hydropic placenta with a concomitant fetus.
  • Doppler waveforms showed resistive indices of 0.55 (SD, 0.06) for CHM, 0.56 (SD, 0.04) for PHM, 0.28 (SD, 0.06) for IHM, 0.25 (SD, 0.05) for choriocarcinoma, and 0.66 (SD, 0.04) for normal pregnancies.
  • The abnormal sonographic and Doppler findings in invasive disease resolved when chemotherapy was successful.
  • CONCLUSIONS: Sonography and Doppler imaging were helpful in diagnosing GTD, in determining whether invasive disease was present, in detecting recurrence of disease, and in following the effectiveness of chemotherapy.
  • [MeSH-major] Gestational Trophoblastic Disease / ultrasonography. Uterine Neoplasms / ultrasonography
  • [MeSH-minor] Adult. Choriocarcinoma / ultrasonography. Female. Humans. Hydatidiform Mole / ultrasonography. Middle Aged. Pregnancy. Ultrasonography, Doppler

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  • (PMID = 15615924.001).
  • [ISSN] 0278-4297
  • [Journal-full-title] Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
  • [ISO-abbreviation] J Ultrasound Med
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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22. Baasanjav B, Usui H, Kihara M, Kaku H, Nakada E, Tate S, Mitsuhashi A, Matsui H, Shozu M: The risk of post-molar gestational trophoblastic neoplasia is higher in heterozygous than in homozygous complete hydatidiform moles. Hum Reprod; 2010 May;25(5):1183-91
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The risk of post-molar gestational trophoblastic neoplasia is higher in heterozygous than in homozygous complete hydatidiform moles.
  • BACKGROUND: Complete hydatidiform mole (CHM) is a high-risk pregnancy for gestational trophoblastic neoplasia (GTN).
  • Patients with CHM have a 10-30% chance of trophoblastic sequelae.
  • CHM includes androgenic homozygous (monospermic) and androgenic heterozygous (dispermic) moles.
  • A prospective cohort study was conducted to assess risk of GTN in homozygous and heterozygous CHM using short tandem repeat (STR) polymorphisms, and a meta-analysis of previous reports.
  • METHODS: Twenty-eight consecutive molar pregnancies were evacuated and followed by regular hCG measurements to detect GTN.
  • Cytogenesis of the mole was determined by STR polymorphisms of molar tissue and parental blood.
  • A meta-analysis of the GTN rate from previous reports was conducted using Mantel-Haenszel methods.
  • RESULTS: Of 28 molar pregnancies, 24 were homozygous and three were heterozygous CHM.
  • The remaining mole was diandric triploidy (a partial hydatidiform mole).
  • Of the 24 homozygous CHMs, six (25%) cases developed GTN and received chemotherapy.
  • Meanwhile, all three cases (100%) of heterozygous mole developed GTN and needed chemotherapy.
  • The GTN risk was higher in heterozygous (P = 0.029, Fisher's exact test) than homozygous moles.
  • A systematic review revealed only five previous reports (with more than 15 cytogenetically diagnosed cases), and the pooled relative risk of persistent GTN for heterozygous mole was not significant (odds ratio, 2.0; 95% confidence interval, 0.98-4.07).
  • [MeSH-major] Hydatidiform Mole / genetics. Uterine Neoplasms / genetics
  • [MeSH-minor] Adult. Chorionic Gonadotropin / blood. Cohort Studies. Female. Heterozygote. Homozygote. Humans. Male. Microsatellite Repeats. Middle Aged. Pregnancy. Prospective Studies. Risk Factors. Young Adult

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  • (PMID = 20208060.001).
  • [ISSN] 1460-2350
  • [Journal-full-title] Human reproduction (Oxford, England)
  • [ISO-abbreviation] Hum. Reprod.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
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23. Berkowitz RS, Goldstein DP: Current management of gestational trophoblastic diseases. Gynecol Oncol; 2009 Mar;112(3):654-62
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • OBJECTIVES: This review was undertaken to describe current understanding of the natural history of molar pregnancy and persistent gestational trophoblastic neoplasia (GTN) as well as recent advances in their management.
  • MATERIALS AND METHODS: Recent literature related to molar pregnancy and GTN was thoroughly analyzed to provide a comprehensive review of the current knowledge of their pathogenesis and treatment.
  • RESULTS: Studies in patients with familial recurrent molar pregnancy indicate that dysregulation of parentally imprinted genes is important in the pathogenesis of complete hydatidiform mole (CHM).
  • CHM is now being diagnosed earlier in pregnancy in the first trimester changing the clinical presentation and making the histologic appearance more similar to partial hydatidiform mole (PHM) and hydropic abortion.
  • Flow cytometry and immunostaining for maternally-expressed genes are helpful in distinguishing early CHM from PHM or hydropic abortion.
  • Patients with molar pregnancy have a low risk of developing persistent GTN after achieving even one non-detectable hCG level (hCG <5 mIU/ml).
  • Patients with high-risk metastatic GTN require aggressive combination chemotherapy in conjunction with surgery and radiation therapy to attain remission.
  • CONCLUSION: Our understanding of the natural history and management of molar pregnancy and GTN has advanced considerably in recent years.
  • While most patients can anticipate a high cure rate, efforts are still necessary to develop effective new second-line therapies for patients with drug-resistant disease.
  • [MeSH-major] Gestational Trophoblastic Disease / therapy
  • [MeSH-minor] Female. Humans. Hydatidiform Mole / pathology. Hydatidiform Mole / therapy. Pregnancy

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  • (PMID = 18851873.001).
  • [ISSN] 1095-6859
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 149
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24. Wong LC, Ngan HY, Cheng DK, Ng TY: Methotrexate infusion in low-risk gestational trophoblastic disease. Am J Obstet Gynecol; 2000 Dec;183(6):1579-82
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Methotrexate infusion in low-risk gestational trophoblastic disease.
  • OBJECTIVES: The current study attempts to evaluate the effectiveness of methotrexate infusion therapy in the management of low-risk gestational trophoblastic disease and to find out whether an increase in the dose intensity can effect a faster remission and a shorter treatment duration.
  • Between June 1990 and August 1998, 59 patients with low-risk trophoblastic disease were treated with methotrexate at a dose of 100 mg/m(2) as an intravenous bolus over 30 minutes followed by a 12-hour infusion of methotrexate at a dose of 200 mg/m(2).
  • Folinic acid was not given unless the serum methotrexate reached a toxic level 24 hours after infusion (toxic level, 10 micromol/L).
  • Actinomycin D was added in patients with a partial response.
  • The follow-up period of these patients ranged from 12 to 113 months, with a median of 58.5 months and a mean of 55.7 months.
  • Twenty-eight patients went into biochemical remission after one methotrexate infusion.
  • Five patients showed a partial biochemical response.
  • A relapse developed in 2 of the 54 complete responders at 3 months and 18 months after the initial therapy.
  • Both patients received combination therapy consisting of methotrexate, etoposide, and bleomycin.
  • They went into biochemical remission and have remained disease-free at the time of analysis.
  • All of the 59 patients were in biochemical remission at the time of analysis.
  • No significant side effects were observed except that Stevens-Johnson syndrome developed in 1 patient.
  • CONCLUSIONS: Methotrexate infusion therapy described in this study is effective in the treatment of low-risk gestational trophoblastic disease.
  • The omission of consolidation therapy and folinic acid rescue decreases the cost and duration of treatment.
  • [MeSH-major] Antimetabolites, Antineoplastic / therapeutic use. Hydatidiform Mole / drug therapy. Methotrexate / therapeutic use
  • [MeSH-minor] Adult. Antineoplastic Agents, Phytogenic / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Bleomycin / therapeutic use. Etoposide / therapeutic use. Female. Humans. Infusions, Intravenous. Neoplasm Recurrence, Local / drug therapy. Pregnancy. Prospective Studies. Remission Induction. Risk Factors

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  • (PMID = 11120531.001).
  • [ISSN] 0002-9378
  • [Journal-full-title] American journal of obstetrics and gynecology
  • [ISO-abbreviation] Am. J. Obstet. Gynecol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / Antineoplastic Agents, Phytogenic; 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; YL5FZ2Y5U1 / Methotrexate
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25. Chen LM, Lengyel ER, Bethan Powell C: Single-agent pulse dactinomycin has only modest activity for methotrexate-resistant gestational trophoblastic neoplasia. Gynecol Oncol; 2004 Jul;94(1):204-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Single-agent pulse dactinomycin has only modest activity for methotrexate-resistant gestational trophoblastic neoplasia.
  • RESULTS: Patients had antecedent pregnancies of complete mole (7), partial mole (1), missed abortion (1), and choriocarcinoma (1).
  • One patient underwent hysterectomy during methotrexate treatment.
  • Six of 10 (60%) patients achieved complete remission with single-agent pulse dactinomycin.
  • Two others responded to a 5-day regimen of dactinomycin, 1 responded to a multidrug regimen, and 1 had chemo-resistant disease dying of metastatic choriocarcinoma.
  • After median follow-up of 11.9 months, 9 of 10 patients remain without relapse.
  • A mean of 3.3 (1-6) cycles were given-4.5 (3-6) for responders and 1.5 (1-2) for nonresponders.
  • In 33 cycles of chemotherapy administered, there were 46 toxicity events: all events were graded as 1.
  • While WHO scores were comparable between responders and nonresponders (mean 3.8 vs. 4.5), hCG levels were lower in responders (mean 37 vs. 3634) but the sample size was too small to reach statistical significance.
  • Prediction of remission may be more closely associated with hCG levels than with WHO score alone.
  • [MeSH-major] Antibiotics, Antineoplastic / therapeutic use. Dactinomycin / therapeutic use. Gestational Trophoblastic Disease / drug therapy. Methotrexate / pharmacology
  • [MeSH-minor] Adult. Drug Administration Schedule. Drug Resistance, Neoplasm. Female. Humans. Middle Aged. Pregnancy. Risk Factors

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  • (PMID = 15262143.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antibiotics, Antineoplastic; 1CC1JFE158 / Dactinomycin; YL5FZ2Y5U1 / Methotrexate
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26. Matsui H, Iitsuka Y, Suzuka K, Seki K, Sekiya S: Subsequent pregnancy outcome in patients with spontaneous resolution of HCG after evacuation of hydatidiform mole: comparison between complete and partial mole. Hum Reprod; 2001 Jun;16(6):1274-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Subsequent pregnancy outcome in patients with spontaneous resolution of HCG after evacuation of hydatidiform mole: comparison between complete and partial mole.
  • This study compared subsequent pregnancy outcome in patients with complete and partial hydatidiform moles.
  • Among 1052 patients with molar pregnancy (complete mole, 801; partial mole, 251) monitored at Chiba University Hospital between 1981 and 1999, 891 patients (84.7%) had spontaneous resolution of human chorionic gonadotrophin (HCG) after mole evacuation, and 161 patients (15.3%) required chemotherapy.
  • The pregnancy outcome was not significantly different in patients with complete and partial moles, and was comparable with that in the general Japanese population.
  • The incidence of repeat molar pregnancy in patients with complete and partial mole (1.3 and 1.5% respectively) was 5-fold higher than that of the general population, while no increased risk of persistent gestational trophoblastic tumour (GTT) associated with later molar pregnancy was observed.
  • During HCG follow-up, 10 patients (1.1%) developed secondary high-risk GTT between 14 and 54 months after mole evacuation.
  • In conclusion, patients with complete and partial mole can anticipate a normal future reproductive outcome, and pregnancies after experiencing hydatidiform mole may not affect the development of high-risk GTT.
  • [MeSH-major] Chorionic Gonadotropin / blood. Hydatidiform Mole / surgery. Pregnancy Outcome
  • [MeSH-minor] Adolescent. Adult. Female. Humans. Middle Aged. Pregnancy. Recurrence. Risk Factors. Trophoblastic Neoplasms / epidemiology. Trophoblastic Neoplasms / etiology. Uterine Neoplasms / epidemiology. Uterine Neoplasms / etiology

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  • (PMID = 11387305.001).
  • [ISSN] 0268-1161
  • [Journal-full-title] Human reproduction (Oxford, England)
  • [ISO-abbreviation] Hum. Reprod.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
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27. Seckl MJ, Fisher RA, Salerno G, Rees H, Paradinas FJ, Foskett M, Newlands ES: Choriocarcinoma and partial hydatidiform moles. Lancet; 2000 Jul 1;356(9223):36-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Choriocarcinoma and partial hydatidiform moles.
  • BACKGROUND: Partial hydatidiform moles (PMs) rarely require chemotherapy and have never previously been proven to transform into choriocarcinoma, the most malignant form of gestational trophoblastic disease (GTD).
  • Consequently, some have questioned whether women with PMs need human chorionic gonadotropin (hCG) follow-up.
  • METHODS: Patients with a PM who developed a subsequent choriocarcinoma were identified from our GTD database.
  • FINDINGS: Of the 3000 patients with PM, 15 required chemotherapy for persisting GTD.
  • In one patient, the local pathologist could not differentiate between a PM or a hydropic abortion and neither central histological review nor hCG follow-up were obtained.
  • The PM was confirmed to be triploid in all three cases and genetic analysis showed that the subsequent choriocarcinomas contained identical single maternal and two paternal alleles at several independent loci.
  • [MeSH-major] Cell Transformation, Neoplastic / pathology. Choriocarcinoma / diagnosis. Hydatidiform Mole / diagnosis. Uterine Neoplasms / diagnosis
  • [MeSH-minor] Adult. Alleles. Chorionic Gonadotropin / blood. Female. Flow Cytometry. Humans. Lung Neoplasms / diagnosis. Lung Neoplasms / secondary. Lung Neoplasms / therapy. Male. Microsatellite Repeats. Polyploidy. Pregnancy

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  • [CommentIn] Lancet. 2000 Oct 21;356(9239):1443-4 [11052615.001]
  • (PMID = 10892763.001).
  • [ISSN] 0140-6736
  • [Journal-full-title] Lancet (London, England)
  • [ISO-abbreviation] Lancet
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] ENGLAND
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
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28. Niemann I, Hansen ES, Sunde L: The risk of persistent trophoblastic disease after hydatidiform mole classified by morphology and ploidy. Gynecol Oncol; 2007 Feb;104(2):411-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The risk of persistent trophoblastic disease after hydatidiform mole classified by morphology and ploidy.
  • OBJECTIVE: Hydatidiform mole can be classified by histopathologic characteristics and by genetic constitutions and most complete moles are diploid, whereas most partial moles are triploid.
  • We investigated the concordance between these two classifications, characterized moles with conflicting classifications, and compared the ability of the two classifications to discriminate between patients with and without a substantial risk of persistent trophoblastic disease.
  • METHODS: 294 cases of consecutively collected hydropic placentas clinically suspected of hydatidiform mole made the basis of this retrospective study.
  • Data on possible chemotherapy were collected for each patient.
  • RESULTS: 270 of the conceptuses were histopathologically classified as hydatidiform mole.
  • Among the 24 conceptuses classified as non-molar miscarriage, 20 were triploids, 2 were diploid androgenetic and 2 were diploid biparental.
  • 5% of the patients with hydropic placentas classified as partial mole encountered persistent trophoblastic disease; however, the genome was diploid in all these moles.
  • None of 131 patients with a triploid hydropic gestation encountered persistent trophoblastic disease.
  • CONCLUSION: As full concordance between the histopathologic and the genetic classifications was not found, we believe that features beyond the genetic constitution influence the development of morphologic features in hydatidiform moles.
  • We recommend that gestations suspected of hydatidiform mole are subjected to histopathologic examination.
  • If hydatidiform change and trophoblastic hyperplasia are identified, the ploidy should be used to identify patients with a high risk of persistent trophoblastic disease.
  • [MeSH-major] Hydatidiform Mole / genetics. Hydatidiform Mole / pathology. Ploidies. Trophoblastic Neoplasms / genetics. Trophoblastic Neoplasms / pathology. Uterine Neoplasms / genetics. Uterine Neoplasms / pathology
  • [MeSH-minor] Animals. Chickens. Choriocarcinoma / drug therapy. Choriocarcinoma / genetics. Choriocarcinoma / pathology. Female. Humans. Pregnancy. Retrospective Studies. Trout

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  • (PMID = 17011616.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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29. Horn LC, Kowalzik J, Bilek K, Richter CE, Einenkel J: Clinicopathologic characteristics and subsequent pregnancy outcome in 139 complete hydatidiform moles. Eur J Obstet Gynecol Reprod Biol; 2006 Sep-Oct;128(1-2):10-4
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Clinicopathologic characteristics and subsequent pregnancy outcome in 139 complete hydatidiform moles.
  • OBJECTIVE: The most common form of gestational trophoblastic disease is the complete hydatidiform mole (CHM).
  • The study reports our experience of clinicopathologic characteristics and subsequent pregnancy outcome of patients with CHM.
  • STUDY DESIGN: One hundred fifty-one subsequent cases with initial diagnosis of CHM were re-evaluated histopathologically.
  • Clinical characteristics, the need for chemotherapy and subsequent pregnancy outcome were evaluated.
  • RESULTS: Twelve out of 151 cases were re-evaluated as hydropic abortion, as partial hydatidiform moles or were insufficient for morphologic examination and therefore excluded from further analysis.
  • Twenty-six patients (19%) required chemotherapy because of gestational trophoblastic neoplasia (GTN; low-risk: 23 out of 26).
  • The subsequent pregnancy rate was 15% (21/139).
  • Four women presented with recurrent CHM with a spontaneous normalization of HCG levels after D&C.
  • CONCLUSIONS: The clinical and morphologic diagnosis of CHM is a challenge, and diagnosis as well as treatment should be multidisciplinary and centralised.
  • One fifth of CHM are at risk of a GTN, but the cure rate is 100% with adequate management.
  • Pregnancy outcome following CHM is complicated by an increased risk of abortion.
  • [MeSH-major] Hydatidiform Mole / complications. Pregnancy Outcome. Uterine Neoplasms / complications
  • [MeSH-minor] Abortion, Spontaneous / etiology. Adolescent. Adult. Female. Humans. Middle Aged. Pregnancy. Recurrence. Retrospective Studies

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  • (PMID = 16530318.001).
  • [ISSN] 0301-2115
  • [Journal-full-title] European journal of obstetrics, gynecology, and reproductive biology
  • [ISO-abbreviation] Eur. J. Obstet. Gynecol. Reprod. Biol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Ireland
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30. Weaver DT, Fisher RA, Newlands ES, Paradinas FJ: Amniotic tissue in complete hydatidiform moles can be androgenetic. J Pathol; 2000 May;191(1):67-70
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Amniotic tissue in complete hydatidiform moles can be androgenetic.
  • The purpose of this study was to determine whether amniotic tissue found associated with cases of complete hydatidiform mole (CM) was genetically identical to the CM, and therefore part of the molar pregnancy, or genetically dissimilar to the CM, suggesting derivation from a twin pregnancy.
  • DNA was prepared from formalin-fixed, paraffin-embedded blocks of tissue containing both CM and amnion.
  • Maternal DNA was prepared from decidual tissue in the same blocks, or from a maternal blood sample.
  • Fluorescent microsatellite genotyping was carried out to determine the origin of both the CM and the amniotic tissue.
  • In one of six cases examined, the amniotic tissue was genetically different from the CM and was therefore likely to be derived from a twin pregnancy.
  • In the five remaining cases, the amniotic tissue was genetically identical to the CM and was likely to be derived from the same conceptus.
  • It is concluded that androgenetic CM can support the development of amniotic tissue and that some early embryonic development may occur in CM.
  • The presence of amnion, or other fetal tissues, associated with molar tissue should not therefore always be considered indicative of a diagnosis of partial mole (PM).
  • [MeSH-major] Amnion / pathology. Hydatidiform Mole / genetics. Hydatidiform Mole / pathology. Pregnancy, Multiple
  • [MeSH-minor] Alleles. Female. Genotype. Humans. Microsatellite Repeats. Polymerase Chain Reaction. Polymorphism, Genetic. Pregnancy

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  • [Copyright] Copyright 2000 John Wiley & Sons, Ltd.
  • (PMID = 10767721.001).
  • [ISSN] 0022-3417
  • [Journal-full-title] The Journal of pathology
  • [ISO-abbreviation] J. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] ENGLAND
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31. Growdon WB, Wolfberg AJ, Goldstein DP, Feltmate CM, Chinchilla ME, Lieberman ES, Berkowitz RS: Low-risk gestational trophoblastic neoplasia and methotrexate resistance: predictors of response to treatment with actinomycin D and need for combination chemotherapy. J Reprod Med; 2010 Jul-Aug;55(7-8):279-84
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Low-risk gestational trophoblastic neoplasia and methotrexate resistance: predictors of response to treatment with actinomycin D and need for combination chemotherapy.
  • OBJECTIVE: To determine whether any clinical parameters predict the need for multiagent chemotherapy for treatment of low-risk gestational trophoblastic neoplasia (GTN) after the development of methotrexate (MTX) resistance.
  • STUDY DESIGN: We retrospectively analyzed clinical data from the New England Trophoblastic Disease Center from women with post-molar GTN between 1973 and 2003.
  • RESULTS: We analyzed data from 150 women (40 with partial mole, 110 with complete mole) who received single-agent MTX for low-risk GTN using FIGO and WHO scoring systems.
  • Of the 45 women who developed MTX resistance, the majority (37/45) of these patients received actinomycin D, with 10 patients ultimately requiring multiagent chemotherapy.
  • The requirement for multiagent chemotherapy following MTX resistance was associated with a beta-hCG > 600 mlU/mL 1 week following initial MTX therapy (p < 0.03).
  • Conversely, a beta-hCG < 600 mlU/mL 1 week following initial MTX therapy was as-sociated with a 93% probability of remission with actinomycin D alone.
  • CONCLUSION: The prognosis for patients with low-risk GTN following molar gestation is excellent, with 100% remission rate, though a small but significant proportion (7%) required multiagent chemotherapy.
  • The need for multiagent chemotherapy was associated with beta-hCG levels 1 week following initial MTX therapy.
  • [MeSH-major] Antimetabolites, Antineoplastic / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Drug Resistance, Neoplasm. Gestational Trophoblastic Disease / drug therapy. Methotrexate / therapeutic use
  • [MeSH-minor] Adolescent. Adult. Chorionic Gonadotropin, beta Subunit, Human / blood. Cyclophosphamide / therapeutic use. Dactinomycin / administration & dosage. Dactinomycin / therapeutic use. Etoposide / administration & dosage. Female. Humans. Middle Aged. Pregnancy. Registries. Remission Induction. Retrospective Studies. Uterine Neoplasms / drug therapy. Uterine Neoplasms / pathology

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  • (PMID = 20795339.001).
  • [ISSN] 0024-7758
  • [Journal-full-title] The Journal of reproductive medicine
  • [ISO-abbreviation] J Reprod Med
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / Chorionic Gonadotropin, beta Subunit, Human; 1CC1JFE158 / Dactinomycin; 6PLQ3CP4P3 / Etoposide; 8N3DW7272P / Cyclophosphamide; YL5FZ2Y5U1 / Methotrexate; MAC combination
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32. Yamada T, Matsuda T, Kudo M, Yamada T, Moriwaki M, Nishi S, Ebina Y, Yamada H, Kato H, Ito T, Wake N, Sakuragi N, Minakami H: Complete hydatidiform mole with coexisting dichorionic diamniotic twins following testicular sperm extraction and intracytoplasmic sperm injection. J Obstet Gynaecol Res; 2008 Feb;34(1):121-4
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  • [Title] Complete hydatidiform mole with coexisting dichorionic diamniotic twins following testicular sperm extraction and intracytoplasmic sperm injection.
  • We present the first report of complete hydatidiform mole (HM) with coexisting dichorionic diamniotic twins.
  • This pregnancy was achieved after testicular sperm extraction and intracytoplasmic sperm injection (ICSI) for azoospermia in the woman's husband.
  • Standard in vitro fertilization may cause multisperm fertilization and increase triploid partial HM and complete HM, which arise from dispermic fertilization.
  • In our case, paternal isodisomy in the molar tissue was confirmed by microsatellite analysis suggesting that it resulted from duplication of a haploid paternal genome following monospermic fertilization of an inactivated oocyte or from monospermic fertilization of an inactivated oocyte with a diploid sperm.
  • Although the patient was eager to continue the pregnancy, the size of the HM component increased rapidly and termination of the pregnancy was required for pre-eclampsia-like symptoms at 15 weeks of gestation.
  • After the operation, chemotherapy was initiated for persistent trophoblastic disease.
  • [MeSH-major] Hydatidiform Mole / diagnosis. Twins. Ultrasonography, Prenatal. Uterine Neoplasms / diagnosis
  • [MeSH-minor] Abortion, Induced. Adult. Combined Modality Therapy. Diagnosis, Differential. Female. Humans. Pregnancy. Sperm Injections, Intracytoplasmic

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  • (PMID = 18226144.001).
  • [ISSN] 1341-8076
  • [Journal-full-title] The journal of obstetrics and gynaecology research
  • [ISO-abbreviation] J. Obstet. Gynaecol. Res.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Japan
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33. Bruchim I, Kidron D, Amiel A, Altaras M, Fejgin MD: Complete hydatidiform mole and a coexistent viable fetus: report of two cases and review of the literature. Gynecol Oncol; 2000 Apr;77(1):197-202
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Complete hydatidiform mole and a coexistent viable fetus: report of two cases and review of the literature.
  • OBJECTIVE: The aim of this study was to report the clinical features, management, and outcome of two cases of complete hydatidiform mole with a coexisting viable fetus and to review the literature.
  • PATIENTS: In this article, we report on the well-documented follow-up of 2 cases of twin pregnancies with complete hydatidiform mole and a viable fetus, both of which ended with the delivery of a normal infant at 41 and 26 weeks of gestation.
  • Since 1977, the year in which complete and partial moles were characterized as distinct pathologic entities, 15 cases (including our 2) have been reported.
  • RESULTS: Persistent GTT developed in eight patients (53.3%) and four patients (27.7%) developed metastatic disease.
  • Seventy-five percent patients with persistent GTT were treated with single-agent chemotherapy.
  • CONCLUSION: Complete hydatidiform mole and coexistent fetus is a rare occurrence and is associated with an increased risk of persistent gestational trophoblastic tumor.
  • Based on currently available information, it seems that in the presence of a stable pregnancy, normal karyotype, and a normal sonogram it is reasonable to allow the pregnancy to continue.
  • [MeSH-major] Fetal Viability. Hydatidiform Mole / pathology. Pregnancy Complications, Neoplastic / pathology. Trophoblastic Neoplasms / etiology. Uterine Neoplasms / pathology
  • [MeSH-minor] Adult. Female. Humans. Ovulation Induction. Pregnancy. Pregnancy Outcome. Risk Factors. Twins

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  • [Copyright] Copyright 2000 Academic Press.
  • [CommentIn] Gynecol Oncol. 2000 Dec;79(3):524-5 [11104636.001]
  • (PMID = 10739712.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] UNITED STATES
  • [Number-of-references] 19
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34. Aytan H, Caliskan AC, Demirturk F, Koseoglu RD, Acu B: Cervical partial hydatidiform molar pregnancy. Gynecol Obstet Invest; 2008;66(2):142-4
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  • [Title] Cervical partial hydatidiform molar pregnancy.
  • BACKGROUND: Cervical hydatidiform molar pregnancy is an exceedingly rare occurrence that has been reported only twice before.
  • CASE: We report a 25-year-old, G4P1D&C2 woman with a positive pregnancy test and vaginal bleeding.
  • A cervical pregnancy with hydatidiform mole was detected on transvaginal ultrasound and color Doppler examinations.
  • Histopathological examination revealed a partial hydatidiform molar pregnancy.
  • Serial beta-hCG measurements showed a decline without need for adjuvant chemotherapy.
  • CONCLUSION: Conservative fertility-sparing management was successful in this potentially fatal rare case.
  • [MeSH-major] Cervix Uteri / pathology. Hydatidiform Mole / pathology. Pregnancy, Ectopic / pathology
  • [MeSH-minor] Adult. Chorionic Gonadotropin / blood. Female. Histocytochemistry. Humans. Magnetic Resonance Imaging. Pregnancy


35. Lurain JR: Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol; 2010 Dec;203(6):531-9
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  • [Title] Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole.
  • Gestational trophoblastic disease includes hydatidiform mole (complete and partial) and gestational trophoblastic neoplasia (invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor).
  • The epidemiology, pathology, clinical presentation, and diagnosis of each of these trophoblastic disease variants are discussed.
  • Particular emphasis is given to management of hydatidiform mole, including evacuation, twin mole/normal fetus pregnancy, prophylactic chemotherapy, and follow-up.
  • [MeSH-major] Gestational Trophoblastic Disease / drug therapy. Gestational Trophoblastic Disease / pathology. Uterine Neoplasms / pathology
  • [MeSH-minor] Abortion, Therapeutic / methods. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Choriocarcinoma / diagnosis. Choriocarcinoma / drug therapy. Choriocarcinoma / mortality. Choriocarcinoma / pathology. Combined Modality Therapy. Female. Follow-Up Studies. Humans. Hydatidiform Mole / drug therapy. Hydatidiform Mole / pathology. Hysterectomy / methods. Pregnancy. Risk Assessment. Survival Rate. Treatment Outcome

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  • [Copyright] Copyright © 2010 Mosby, Inc. All rights reserved.
  • (PMID = 20728069.001).
  • [ISSN] 1097-6868
  • [Journal-full-title] American journal of obstetrics and gynecology
  • [ISO-abbreviation] Am. J. Obstet. Gynecol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
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36. Maestá I, Leite FV, Michelin OC, Rogatto SR: Primary pulmonary choriocarcinoma after human chorionic gonadotropin normalization following hydatidiform mole: a report of two cases. J Reprod Med; 2010 Jul-Aug;55(7-8):311-6
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  • [Title] Primary pulmonary choriocarcinoma after human chorionic gonadotropin normalization following hydatidiform mole: a report of two cases.
  • BACKGROUND: Primary pulmonary choriocarcinoma (PPC) is rare and frequently leads to death.
  • CASES: Two young patients presented with previous molar pregnancy and spontaneous serum human chorionic gonadotropin (hCG) normalization.
  • Patient 1 was referred to our center after partial response to chemotherapy.
  • During further chemotherapy, liver metastasis was detected by positron emission tomography.
  • Right hepatectomy was performed, and hCG declined for 28 days, but increased again despite chemotherapy.
  • Patient 2 presented with persistently high hCG, though the affected organ was not identified.
  • Chemotherapy was unsuccessful.
  • Pulmonary lobectomy was performed; 2 weeks later, hCG was normal and consolidation with 2 cycles of chemotherapy was administered.
  • Gestational origin of the tumor was confirmed by molecular genetic analysis (polymorphic microsatellite markers).
  • Early diagnosis, prompt chemotherapy, and surgical resection in a specialized center improves the prognosis.
  • [MeSH-major] Choriocarcinoma / pathology. Hydatidiform Mole / pathology. Lung Neoplasms / pathology. Neoplasms, Second Primary / pathology. Uterine Neoplasms / pathology
  • [MeSH-minor] Adult. Chorionic Gonadotropin / blood. Fatal Outcome. Female. Humans. Liver Neoplasms / secondary. Liver Neoplasms / therapy. Pneumonectomy. Pregnancy

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  • (PMID = 20795344.001).
  • [ISSN] 0024-7758
  • [Journal-full-title] The Journal of reproductive medicine
  • [ISO-abbreviation] J Reprod Med
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
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37. Sebire NJ, Lindsay I: Current issues in the histopathology of gestational trophoblastic tumors. Fetal Pediatr Pathol; 2010;29(1):30-44
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Gestational trophoblastic neoplasia (GTN) encompasses several entities including complete (CHM) and partial (PHM) hydatidiform mole (HM) and the malignant gestational trophoblastic tumors (GTTs), choriocarcinoma (CC), and placental-site trophoblastic tumor (PSTT), including epithelioid trophoblastic tumor (ETT).
  • To detect pGTN, postmolar surveillance by measurement of maternal human chorionic gonoadotropin (hCG) levels should be performed.
  • With such a protocol, many cases of pGTN are identified early at a presymptomatic stage based on plateuing or rising hCG concentrations and subsequently treated successfully with chemotherapy.
  • In such cases, histopathological confirmation of the precise nature of the pGTN usually is not available.
  • However, GTT also may present clinically with primary or metastatic disease, either following and unrecognized HM or developing from a nonmolar gestation.
  • However, PSTTs, represent malignant differentiation toward implantation-site type trophoblast, with lower hCG levels and less response to chemotherapy.
  • [MeSH-major] Gestational Trophoblastic Disease / pathology
  • [MeSH-minor] Female. Humans. Pregnancy

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  • (PMID = 20055562.001).
  • [ISSN] 1551-3823
  • [Journal-full-title] Fetal and pediatric pathology
  • [ISO-abbreviation] Fetal Pediatr Pathol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] England
  • [Number-of-references] 47
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38. Growdon WB, Wolfberg AJ, Goldstein DP, Feltmate CM, Chinchilla ME, Lieberman ES, Berkowitz RS: Evaluating methotrexate treatment in patients with low-risk postmolar gestational trophoblastic neoplasia. Gynecol Oncol; 2009 Feb;112(2):353-7
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  • [Title] Evaluating methotrexate treatment in patients with low-risk postmolar gestational trophoblastic neoplasia.
  • OBJECTIVE: To identify clinical factors associated with requiring more than a single course of Methotrexate (MTX) to achieve remission among women with low-risk postmolar gestational trophoblastic neoplasia (GTN).
  • METHODS: We studied 150 women with persistent GTN after diagnosis of complete (n=110) or partial mole (n=40) to identify possible predictors of requiring additional treatment after a single treatment of methotrexate (MTX).
  • All women had low-risk disease using FIGO and WHO scoring systems.
  • RESULTS: Seventy women (47%) required additional courses of chemotherapy, of whom 45 (64%) received chemotherapy other than MTX.
  • Multivariate analysis revealed that complete mole histology, presence of metastasis, single day MTX infusion and any increase in serum beta human chorionic gonadotropin (beta-hCG) level 1 week after MTX therapy were independent predictors of requiring additional MTX or alternative chemotherapy.
  • Dilatation and curettage (D+C) within 1 week after the diagnosis of persistence did not affect future chemotherapy requirements (p>0.64).
  • Following complete mole, beta-hCG levels >2000 mIU/mL at 1 week post MTX were associated with a 89% risk of additional cycles chemotherapy including MTX and a 65% risk of alternative chemotherapy.
  • CONCLUSIONS: Metastatic disease, MTX infusion protocol and complete mole histology were independently associated with the need for additional chemotherapy after an initial course of MTX for women with low risk GTN.
  • D+C at persistence did not alter the chemotherapy requirement.
  • Elevated beta-hCG level at 1 week after the initial course of MTX was also an independent factor predicting the need for additional courses of MTX or alternative chemotherapy.
  • [MeSH-major] Antimetabolites, Antineoplastic / therapeutic use. Gestational Trophoblastic Disease / drug therapy. Methotrexate / therapeutic use
  • [MeSH-minor] Adult. Chorionic Gonadotropin, beta Subunit, Human / blood. Female. Humans. Hydatidiform Mole / pathology. Neoplasm Staging. Predictive Value of Tests. Pregnancy. Risk Factors

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  • (PMID = 19059633.001).
  • [ISSN] 1095-6859
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / Chorionic Gonadotropin, beta Subunit, Human; YL5FZ2Y5U1 / Methotrexate
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39. Xue WC, Khoo US, Ngan HY, Chan KY, Chiu PM, Tsao SW, Cheung AN: Minichromosome maintenance protein 7 expression in gestational trophoblastic disease: correlation with Ki67, PCNA and clinicopathological parameters. Histopathology; 2003 Nov;43(5):485-90
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  • [Title] Minichromosome maintenance protein 7 expression in gestational trophoblastic disease: correlation with Ki67, PCNA and clinicopathological parameters.
  • AIMS: To assess the proliferative activity of gestational trophoblastic disease (GTD) using one of the novel proliferation markers (MCM7) and to determine its prognostic value in hydatidiform mole (HM).
  • METHODS AND RESULTS: Immunohistochemical staining for MCM7 was performed on 122 samples of paraffin-embedded trophoblastic tissues including 22 normal first-trimester placentas, 12 term placentas, 12 spontaneous miscarriages (SM), 21 partial moles (PM), 44 complete hydatidiform moles (CM), and 11 choriocarcinomas (CCA).
  • The correlations between the proliferative indices assessed by MCM7, proliferating cell nuclear antigen (PCNA) and Ki67 (MIB1) immunoreactivity as well as clinical progress were assessed.
  • MCM7 index was significantly higher in PM and CM than in SM (P = 0.007, P < 0.001) but not between PM and CM themselves (P = 0.560).
  • Eighteen of the 65 patients with HM developed persistent trophoblastic disease (PTD) requiring chemotherapy.
  • There was no significant difference in MCM7 indices between the patients who developed PTD and those who did not (P = 0.312).
  • MCM7 indices correlated well with Ki67 (P = 0.002) but not with PCNA (P = 0.054) indices.
  • CONCLUSIONS: We conclude that MCM7 is useful in differentiating molar and non-molar gestations but is not helpful in discriminating PM from CM or in predicting PTD.
  • [MeSH-major] Biomarkers, Tumor / analysis. Gestational Trophoblastic Disease / metabolism. Gestational Trophoblastic Disease / pathology. Ki-67 Antigen / biosynthesis. Proliferating Cell Nuclear Antigen / biosynthesis
  • [MeSH-minor] Female. Humans. Immunohistochemistry. Placenta / metabolism. Placenta / pathology. Pregnancy. Prognosis

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  • (PMID = 14636275.001).
  • [ISSN] 0309-0167
  • [Journal-full-title] Histopathology
  • [ISO-abbreviation] Histopathology
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Ki-67 Antigen; 0 / Proliferating Cell Nuclear Antigen
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40. Berkowitz RS, Tuncer ZS, Bernstein MR, Goldstein DP: Management of gestational trophoblastic diseases: subsequent pregnancy experience. Semin Oncol; 2000 Dec;27(6):678-85
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Management of gestational trophoblastic diseases: subsequent pregnancy experience.
  • Patients with gestational trophoblastic disease (GTD) can usually achieve complete sustained remission while retaining their fertility even in the presence of wide-spread metastasis.
  • Following complete and partial mole, our patients had 1,239 and 205 later pregnancies, respectively, which resulted in 68.6% and 74.1% term live births, respectively.
  • Patients with either type of hydatidiform mole have, in general, a normal later pregnancy experience.
  • After one molar pregnancy, the risk of a molar pregnancy in a later conception was about 1%.
  • Our patients who received chemotherapy for persistent gestational trophoblastic tumor had 522 later pregnancies, which resulted in 358 (68.6%) term live births and only 10 (2.5%) major and minor congenital anomalies.
  • Data from other centers involving 2,598 later pregnancies also indicate that after chemotherapy patients can generally anticipate a normal future reproductive outcome.
  • [MeSH-minor] Female. Humans. Pregnancy. Pregnancy Outcome

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  • (PMID = 11130475.001).
  • [ISSN] 0093-7754
  • [Journal-full-title] Seminars in oncology
  • [ISO-abbreviation] Semin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 58
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41. Garner E, Goldstein DP, Berkowitz RS, Wenzel L: Psychosocial and reproductive outcomes of gestational trophoblastic diseases. Best Pract Res Clin Obstet Gynaecol; 2003 Dec;17(6):959-68
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Current therapy for molar pregnancy and gestational trophoblastic neoplasias (GTNs) has resulted in high cure rates with preservation of fertility, even in the setting of chemotherapy for widespread metastatic disease.
  • Data from the New England Trophoblastic Disease Center on later pregnancies following complete and partial mole, as well as persistent GTN show that patients can, in general, anticipate normal subsequent pregnancy outcome.
  • Nevertheless, patients and their partners often express anxiety and fear related to the risk of disease recurrence and the outcome of subsequent pregnancies after treatment for gestational trophoblastic disease.
  • [MeSH-major] Gestational Trophoblastic Disease / psychology. Pregnancy Outcome
  • [MeSH-minor] Attitude to Health. Chorionic Gonadotropin / blood. Emotions. Female. Humans. Hydatidiform Mole / psychology. Male. Marriage. Pregnancy. Prognosis. Quality of Life. Recurrence. Stress, Psychological. Uterine Neoplasms / psychology

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  • (PMID = 14614892.001).
  • [ISSN] 1521-6934
  • [Journal-full-title] Best practice & research. Clinical obstetrics & gynaecology
  • [ISO-abbreviation] Best Pract Res Clin Obstet Gynaecol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
  • [Number-of-references] 28
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42. Schorge JO, Goldstein DP, Bernstein MR, Berkowitz RS: Recent advances in gestational trophoblastic disease. J Reprod Med; 2000 Sep;45(9):692-700
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  • [Title] Recent advances in gestational trophoblastic disease.
  • Recent advances have increased our understanding of gestational trophoblastic disease, and epidemiologic studies have demonstrated that there are important differences in risk factors for complete and partial mole.
  • Complete moles are now increasingly being diagnosed in the first trimester, affecting their clinical presentation and pathologic characteristics.
  • While important advances have been made in chemotherapy, it is now recognized that etoposide is associated with a risk of second tumors.
  • Several studies have advanced understanding of the molecular biology of gestational trophoblastic disease, and this is important for the eventual development of new and innovative therapy.
  • [MeSH-minor] Antineoplastic Agents / adverse effects. Antineoplastic Agents / therapeutic use. Chorionic Gonadotropin, beta Subunit, Human / blood. Etoposide / adverse effects. Etoposide / therapeutic use. Female. Humans. Incidence. Pregnancy. Prognosis. Risk Factors

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  • (PMID = 11027078.001).
  • [ISSN] 0024-7758
  • [Journal-full-title] The Journal of reproductive medicine
  • [ISO-abbreviation] J Reprod Med
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Chorionic Gonadotropin, beta Subunit, Human; 6PLQ3CP4P3 / Etoposide
  • [Number-of-references] 60
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43. Khoo SK, Baartz D, Sidhu M, Yip WL, Tripcony L: Analysis of risk factors for persistent gestational trophoblastic disease. Aust N Z J Obstet Gynaecol; 2009 Dec;49(6):657-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Analysis of risk factors for persistent gestational trophoblastic disease.
  • SETTING: Persistent disease is a serious consequence of molar pregnancies.
  • Its early detection is critical to effective chemotherapy.
  • Therefore, determination of risk becomes an important clinical decision.
  • OBJECTIVES: To determine the relative risk of persistent disease in a cohort of patients with partial and complete molar pregnancies by analysis of five factors derived from a database using multivariate analysis.
  • RESULTS: Of 686 patients, 78 developed persistent disease which required treatment (rate of 11.3%).
  • Risk was markedly increased when serum human chorionic gonadotrophin (HCG) failed to reach negative by 12 weeks after evacuation [hazard ratio (HR) = 120.78, P < 0.001].
  • Risk was markedly decreased when the interval from last pregnancy exceeded 12 months (HR = 0.24, P = 0.005).
  • Other factors such as patient's age, stage of gestation and serum HCG level at presentation were not found to be strongly associated with risk of persistent disease.
  • CONCLUSION: These findings support the application of the following two factors in risk prediction for molar pregnancies: > 12 weeks to become HCG negative and interval from last pregnancy < 12 months.
  • They will contribute to a greater awareness of persistent disease and assist in early detection and effective chemotherapy.
  • [MeSH-major] Hydatidiform Mole / diagnosis. Hydatidiform Mole / etiology. Uterine Neoplasms / diagnosis. Uterine Neoplasms / etiology
  • [MeSH-minor] Adult. Age Factors. Chorionic Gonadotropin / blood. Cohort Studies. Female. Gestational Age. Humans. Neoplasm, Residual. Pregnancy. Retrospective Studies. Risk Factors. Time Factors. Young Adult

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  • (PMID = 20070718.001).
  • [ISSN] 1479-828X
  • [Journal-full-title] The Australian & New Zealand journal of obstetrics & gynaecology
  • [ISO-abbreviation] Aust N Z J Obstet Gynaecol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Australia
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
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44. Garner EI, Lipson E, Bernstein MR, Goldstein DP, Berkowitz RS: Subsequent pregnancy experience in patients with molar pregnancy and gestational trophoblastic tumor. J Reprod Med; 2002 May;47(5):380-6
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  • [Title] Subsequent pregnancy experience in patients with molar pregnancy and gestational trophoblastic tumor.
  • Modern therapy for molar pregnancy and gestational trophoblastic tumors has resulted in high cure rates and preservation of fertility, even in the setting of metastatic disease requiring chemotherapy.
  • Patients and their partners facing future pregnancy after treatment for gestational trophoblastic disease express fear related to risk of disease recurrence and outcome of subsequent pregnancies.
  • Data from the New England Trophoblastic Disease Center on later pregnancies following complete and partial mole as well as persistent gestational trophoblastic tumor show that patients, in general, can anticipate normal subsequent pregnancy outcomes.
  • [MeSH-major] Gestational Trophoblastic Disease / epidemiology. Neoplasm Recurrence, Local / epidemiology. Pregnancy Outcome. Uterine Neoplasms / epidemiology
  • [MeSH-minor] Female. Humans. Hydatidiform Mole / complications. Hydatidiform Mole / epidemiology. Medical Records. New England / epidemiology. Pregnancy

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  • (PMID = 12063876.001).
  • [ISSN] 0024-7758
  • [Journal-full-title] The Journal of reproductive medicine
  • [ISO-abbreviation] J Reprod Med
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 49
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45. Chiu PM, Ngan YS, Khoo US, Cheung AN: Apoptotic activity in gestational trophoblastic disease correlates with clinical outcome: assessment by the caspase-related M30 CytoDeath antibody. Histopathology; 2001 Mar;38(3):243-9
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  • [Title] Apoptotic activity in gestational trophoblastic disease correlates with clinical outcome: assessment by the caspase-related M30 CytoDeath antibody.
  • AIMS: The objective of this study was to assess apoptotic activity in gestational trophoblastic disease (GTD) and its prognostic value in hydatidiform mole (HM).
  • METHODS AND RESULTS: Expression of the specific caspase cleavage site within cytokeratin 18 was assessed immunohistochemically using the monoclonal antibody M30 CytoDeath in 12 spontaneous abortions, 22 partial and 57 complete HM, eight choriocarcinoma (CCA) and 28 normal placentas.
  • A significantly higher M30 index in HM and CCA was found when compared with normal placentas and spontaneous abortions (P < 0.001).
  • The M30 index of those HM which spontaneously regressed was significantly higher than those HM which developed persistent disease requiring chemotherapy (P < 0.001).
  • The M30 index correlated with another apoptotic index previously detected by TdT-mediated dUTP nick-end labelling (TUNEL) (P = 0.007) and the proliferation index assessed by the Ki67 antigen (P = 0.034).
  • Assessment of apoptotic activity in HM by the M30 index may be considered as an alternative prognostic indicator for predicting the clinical behaviour.
  • [MeSH-minor] Abortion, Spontaneous / metabolism. Apoptosis. Choriocarcinoma / metabolism. Female. Follow-Up Studies. Humans. Hydatidiform Mole / metabolism. Hydatidiform Mole / pathology. In Situ Nick-End Labeling. Pregnancy. Prognosis. Trophoblastic Tumor, Placental Site / metabolism. Trophoblastic Tumor, Placental Site / pathology

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  • (PMID = 11260306.001).
  • [ISSN] 0309-0167
  • [Journal-full-title] Histopathology
  • [ISO-abbreviation] Histopathology
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 68238-35-7 / Keratins; EC 3.4.22.- / Caspases
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46. Mourali M, Fkih C, Essoussi-Chikhaoui J, Ben Haj Hassine A, Binous N, Ben Zineb N, Boussen H: Gestational trophoblastic disease in Tunisia. Tunis Med; 2008 Jul;86(7):665-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Gestational trophoblastic disease in Tunisia.
  • OBJECTIVE: The aim of our study is to evaluate the frequency of the gestational trophoblastic disease (GTD) in Tunisia, and describe its risk factors and clinical presentations.
  • We also precise therapeutic features used in our country and compare them to those proposed in the literature and finally suggest concrete recommendations.
  • The frequency of the CHM (complete hydatiform mole) is estimated to 68.15% of all the cases of GTD and 1 per 1347 deliveries whereas the frequency of the PHM (partial) is estimated to 30.57% and 1 per 3004 deliveries.
  • The mean gestational age at the moment of the diagnosis is of 11.5 week of amenorrhea (WA) for CHM and 11 WA for the PHM.
  • The metrorrhagia is present in 75% of the CHM and 67% of the PHM.
  • The mean rate of HCG is 162 x 10(3) UI/l.
  • Vacuum aspiration was performed in all the CHM and in 89.5% of the PHM.
  • One patient followed up for PHM was treated by hysterectomy.
  • Two patients were treated by initial chemotherapy for invasive mole and metastatic mole.
  • After treatment of the molar pregnancy, two patients (1.27%) recurred.
  • The patients must be surveyed during at least one year to detect the occurrence of a GTN.
  • The classification and treatment of the GTN must be codified Modem therapy for gestational trophoblastic diseases (GTDs) has resulted in high cure rates while preserving fertility.
  • [MeSH-major] Hydatidiform Mole / epidemiology
  • [MeSH-minor] Adolescent. Adult. Female. Gestational Age. Humans. Menorrhagia / etiology. Middle Aged. Pregnancy. Retrospective Studies. Tunisia / epidemiology. Vacuum Curettage

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  • (PMID = 19472728.001).
  • [ISSN] 0041-4131
  • [Journal-full-title] La Tunisie médicale
  • [ISO-abbreviation] Tunis Med
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] Tunisia
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47. Sivanesaratnam V: Chien-Tien Hsu Memorial Lecture. Fertility and gynaecologic malignancies. J Obstet Gynaecol Res; 2001 Feb;27(1):1-15
MedlinePlus Health Information. consumer health - Tumors and Pregnancy.

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • A slightly increased risk of breast cancer has been reported in current users and those who had used hormonal contraceptives (OCs) within 10 years; this risk declined with time and disappeared after 10 years.
  • Women who started OC before age 20 had a higher relative risk; the disease did not spread beyond the breast in the majority.
  • The relative risks of squamous cell carcinoma and adenomatous carcinoma of the cervix have been reported to be 1.3 and 1.5, respectively in ever-users of OCs; however, the aetiology of cervical cancer is multifactoral.
  • Therapy of gynaecological malignancies may have an influence on subsequent fertility.
  • Amenorrhoea developing after treatment of hydatidiform mole may be due to choriocarcinoma, recurrent mole or a normal pregnancy.
  • Choriocarcinoma can also develop after a partial mole.
  • The risk of fetal teratogenicity from chemotherapy is present only if conception occurs during or immediately following the treatment cycles.
  • Fertility is not impaired following chemotherapy.
  • Gynaecological cancer occurring in pregnancy is uncommon; it presents the clinician with a difficult situation to manage.
  • In most instances the cancer is treated as though the patient is not pregnant; the timing and mode of delivery needs individualization.
  • The overall prognosis for breast cancer complicating pregnancy is poor.
  • Ovarian cancer in pregnancy has a good prognosis because of the early stage at diagnosis.
  • [MeSH-major] Breast Neoplasms. Fertility. Genital Neoplasms, Female. Pregnancy Complications, Neoplastic
  • [MeSH-minor] Female. Humans. Pregnancy. Risk Factors

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  • (PMID = 11330724.001).
  • [ISSN] 1341-8076
  • [Journal-full-title] The journal of obstetrics and gynaecology research
  • [ISO-abbreviation] J. Obstet. Gynaecol. Res.
  • [Language] eng
  • [Publication-type] Lectures
  • [Publication-country] Japan
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48. Nizam K, Haider G, Memon N, Haider A: Gestational trophoblastic disease: experience at Nawabshah Hospital. J Ayub Med Coll Abbottabad; 2009 Jan-Mar;21(1):94-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Gestational trophoblastic disease: experience at Nawabshah Hospital.
  • BACKGROUND: Gestational Trophoblastic Disease (GTD) is a heterogeneous group of diseases that includes partial and complete hydatidiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumour.
  • The malignant potential of this disease is higher in South East Asia in comparison to western countries.
  • This retrospective, descriptive case series was conducted in the Department of Obstetric and Gynaecology Nawabshah Medical College Hospital, from 1st Jan 2007 to 30th Dec 2007.
  • METHODS: The case records of all the gestational trophoblastic cases during study period were analysed regarding their history, clinical examination, investigations, treatment and follow-up.
  • The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and the follow-up.
  • RESULTS: There were a total of 1056 Obstetric admissions during the study period, which included 30 cases of trophoblastic disease with a frequency of GTD was 28 per 1000 live births.
  • Of these 30 cases, 21 (70%) patients had hydatidiform mole, 7 (23.3%) patients had invasive disease and 2 (6.6%) patients had choriocarcinoma.
  • Twenty three patients (76.6%) received chemotherapy while 25 (83.3%) patients had suction evacuation and 4 (13.3%) patients underwent hysterectomy.
  • Among all patients, 29 (96.7%) fully recovered and 1 (3.3%) died because of extensive disease; metastasis extending up to brain.
  • The disease was common in extremes of ages, low para and grand multiparous women.
  • Hydatidiform mole was the commonest type of trophoblastic disease in these patients.
  • Most common presenting complaint was bleeding per vagina followed by pain in lower abdomen.
  • [MeSH-major] Gestational Trophoblastic Disease / diagnosis
  • [MeSH-minor] Adolescent. Adult. Choriocarcinoma / diagnosis. Choriocarcinoma / epidemiology. Choriocarcinoma / therapy. Chorionic Gonadotropin, beta Subunit, Human / blood. Female. Humans. Hydatidiform Mole / diagnosis. Hydatidiform Mole / epidemiology. Hydatidiform Mole / therapy. Hydatidiform Mole, Invasive / diagnosis. Hydatidiform Mole, Invasive / epidemiology. Hydatidiform Mole, Invasive / therapy. Incidence. Pakistan / epidemiology. Pregnancy. Retrospective Studies. Trophoblastic Tumor, Placental Site / diagnosis. Trophoblastic Tumor, Placental Site / epidemiology. Trophoblastic Tumor, Placental Site / therapy. Uterine Neoplasms / diagnosis. Uterine Neoplasms / epidemiology. Uterine Neoplasms / therapy. Young Adult

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  • (PMID = 20364752.001).
  • [ISSN] 1025-9589
  • [Journal-full-title] Journal of Ayub Medical College, Abbottabad : JAMC
  • [ISO-abbreviation] J Ayub Med Coll Abbottabad
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Pakistan
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human
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49. Rob L, Robová H, Pluta M, Kulovaný E, Hrehorcák M, Chmel R, Schlegerová D, Kodet R, Macek M: [Regression of hCG in various types of molar pregnancies--clinical course and prognosis]. Ceska Gynekol; 2001 Jul;66(4):230-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] [Regression of hCG in various types of molar pregnancies--clinical course and prognosis].
  • OBJECTIVE: To evaluate spontaneous regression curves of hCG serum positivity in patients with surgically treated molar pregnancies.
  • Comparison of complete, partial and invasive mole.
  • The study should result in optimalisation of follow up criteria of molar pregnancies in respect to their potential malignant change.
  • Dpt., Oncogynecology div., 2nd Medical Faculty, FNM, Charles University Prague, Pathology Dpt., 2nd Medical Faculty, Institute of Biology and Medical Genetics.
  • METHODS: Evaluation of spontaneous regression curves of serum hCG levels in 104 molar pregnancies.
  • 46 patients with partial hydatiform mole, 48 patients with complete hydatiform mole, 10 patients with invasive mole.
  • Regression curves of hCG positivity in particular moles were statistically evaluated by Fischer test and t-test.
  • RESULTS: There is statistically significant difference in spontaneous regression of hCG positivity in different types of molar pregnancies.
  • Recommended criteria for gestational trofoblastic disease (GTD) diagnosis and follow up are fully applicable in clinical practice.
  • There is exception in partial hydatiform moles, where plateau in hCG regression does not necessarily implicate chemotherapy in patient with good compliance.
  • CONCLUSION: Early diagnosis of GTD predominantly due to the widespread use of ultrasonography changes classical clinical features of molar pregnancies.
  • Spontaneous regression in hCG positivity in serum is more rapid in patients with partial hydatiform mole, slower in complete hydatiform mole and invasive mole.
  • There is no significant change in malignant potential regarding early detection and treatment.

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  • (PMID = 11569415.001).
  • [ISSN] 1210-7832
  • [Journal-full-title] Ceska gynekologie
  • [ISO-abbreviation] Ceska Gynekol
  • [Language] CZE
  • [Publication-type] Comparative Study; English Abstract; Journal Article
  • [Publication-country] Czech Republic
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
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50. Lorigan PC, Sharma S, Bright N, Coleman RE, Hancock BW: Characteristics of women with recurrent molar pregnancies. Gynecol Oncol; 2000 Sep;78(3 Pt 1):288-92
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Characteristics of women with recurrent molar pregnancies.
  • OBJECTIVES: The aim of this study was to examine the incidence and characteristics of women who develop a second molar pregnancy after a previous episode of gestational trophoblastic disease.
  • METHODS: A retrospective analysis was carried out on completed registration forms from referring hospitals in the North of England to the Sheffield Trophoblastic Screening Service over a 13-year period.
  • All cases of second molar pregnancy were identified.
  • Details of histology, blood group, ethnic origin, age, and subsequent pregnancies were examined.
  • RESULTS: Between 1 January 1985 and 31 December 1997, 5030 patients were registered for follow-up and 275 (5.5%) required treatment for persistent disease.
  • Thirty-five women had a subsequent molar pregnancy, a total of 0.70% of all registrations.
  • There was no significant difference in age at first registration between those who were registered for one molar event and those who developed a subsequent molar pregnancy.
  • The risk of a second molar event was highest in the second year after the initial diagnosis and reduced thereafter.
  • There was a trend toward an increased risk of second molar pregnancy in Indian/Pakistani women when compared to Caucasian women (relative risk 2.4) but this was not significant at conventional levels.
  • There was a significantly increased incidence of blood group B in patients that developed a molar pregnancy when compared to the normal population (P < 0.05), but there was no difference in distribution of blood group between those registered for their first molar event and those with two or more events.
  • Patients who presented with a partial mole tended to have a partial mole as the second event but patients who presented with a complete mole were at risk of a subsequent complete mole, partial mole, or choriocarcinoma.
  • Six percent of patients required chemotherapy for the second molar event, indicating no increase in aggressiveness in second moles.
  • Two patients had three molar events.
  • CONCLUSION: In the United Kingdom the risk of second molar pregnancy is less than 1%.
  • There is an increased risk of molar pregnancy in women with blood group B and a trend toward an increased risk of second molar pregnancy in Indian/Pakistani women.
  • Only 6% of patients required chemotherapy for the second mole; a second molar pregnancy is not an indication for chemotherapy.
  • [MeSH-major] Hydatidiform Mole / epidemiology. Uterine Neoplasms / epidemiology
  • [MeSH-minor] ABO Blood-Group System. Adolescent. Adult. Age Factors. Child. England / epidemiology. Ethnic Groups. Female. Humans. Incidence. Neoplasm Recurrence, Local / blood. Neoplasm Recurrence, Local / epidemiology. Neoplasm Recurrence, Local / pathology. Pregnancy. Registries

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  • [Copyright] Copyright 2000 Academic Press.
  • (PMID = 10985882.001).
  • [ISSN] 0090-8258
  • [Journal-full-title] Gynecologic oncology
  • [ISO-abbreviation] Gynecol. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / ABO Blood-Group System
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51. Sivanesaratnam V: Management of gestational trophoblastic disease in developing countries. Best Pract Res Clin Obstet Gynaecol; 2003 Dec;17(6):925-42
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Management of gestational trophoblastic disease in developing countries.
  • In Malaysia, the incidence of molar pregnancy and gestational trophoblastic neoplasia is 2.8 and 1.59 per 1000 deliveries, respectively; the disease is more common among the Chinese compared to the Malays and Indians.
  • While uterine suction is the preferred method of uterine evacuation of hydatidiform mole, complete evacuation was not achieved at the first attempt in 25% of cases.
  • Partial moles comprise 30% of all moles; these need follow up similar to that for complete moles as they are potentially malignant.
  • In the management of invasive moles, chemotherapy should not be withheld in the presence of metastases or failure of regression of hCG.
  • Prophylactic hysterectomy and prophylactic chemotherapy are not recommended.
  • However, in those patients with unsatisfactory hCG regression curves indicating 'at risk' in developing gestational trophoblastic neoplasia (GTN), 'selective preventive chemotherapy' appears appropriate.
  • Chemotherapy remains the main modality of treatment for GTN.
  • As tumour bulk and location of disease are important determinants in outcome, we categorized our patients into low, medium- and high-risk groups with survivals of 100, 98 and 61.7% respectively.
  • [MeSH-major] Developing Countries. Gestational Trophoblastic Disease / therapy
  • [MeSH-minor] Antineoplastic Agents / adverse effects. Brain Neoplasms / secondary. Choriocarcinoma / prevention & control. Female. Humans. Hydatidiform Mole / surgery. Hydatidiform Mole, Invasive / therapy. Hysterectomy / methods. Jaundice / etiology. Pregnancy. Risk Factors. Trophoblastic Tumor, Placental Site / surgery. Uterine Neoplasms / prevention & control. Uterine Neoplasms / surgery

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  • (PMID = 14614890.001).
  • [ISSN] 1521-6934
  • [Journal-full-title] Best practice & research. Clinical obstetrics & gynaecology
  • [ISO-abbreviation] Best Pract Res Clin Obstet Gynaecol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents
  • [Number-of-references] 33
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52. Shimizu T, Yaegashi N: [Gestational trophoblastic tumors and recent clinical information]. Gan To Kagaku Ryoho; 2002 Aug;29(8):1363-70
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • This change was proposed to combine both the basic FIGO anatomic staging with the modified WHO risk factor scoring system.
  • Patients who score as low-risk are treated with single agent chemotherapy, such as methotrexate (MTX), and patients refractory to MTX are treated with a combination chemotherapy, EMA/CO.
  • Patients who score as high-risk are treated with EMA/CO, and patients refractory to the first line chemotherapy may be successfully treated with EP/EMA.
  • Recent epidemiological data showed that women with complete hydatidiform moles could anticipate normal reproduction in the future.
  • Studies found that pregnancies after treatment of molar pregnancy resulted in 69% full-term, live births; 8% premature deliveries; 1% ectopic pregnancies, and 0.5% stillbirths.
  • First-trimester spontaneous abortions occurred in 17% of pregnancies, and major and minor malformations were detected in 0.4% of infants.
  • Patients with hydatidiform mole were at increased risk of developing molar pregnancy in subsequent conceptions.
  • After having one molar pregnancy, the risk of having molar disease in a future gestation was about 1%.
  • In a large, multicenter, case-control study, the risk was shown to be increased in women who had ever used oral contraceptives, but was highest for women taking oral contraceptives during the cycle in which they became pregnant.
  • Partial hydatidiform moles were never previously proven to transform into choriocarcinoma; however, a recent study with molecular techniques clearly showed that partial moles could transform into choriocarcinoma.
  • All patients with suspected partial moles should be reviewed centrally and require hCG follow-up.
  • [MeSH-major] Trophoblastic Neoplasms / therapy. Uterine Neoplasms / therapy
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Cisplatin / administration & dosage. Contraceptives, Oral / adverse effects. Cyclophosphamide / administration & dosage. Dactinomycin / administration & dosage. Etoposide / administration & dosage. Female. Humans. Hydatidiform Mole / pathology. Methotrexate / administration & dosage. Pregnancy. Prognosis. Vincristine / administration & dosage

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  • Hazardous Substances Data Bank. DACTINOMYCIN .
  • Hazardous Substances Data Bank. VINCRISTINE .
  • Hazardous Substances Data Bank. METHOTREXATE .
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  • (PMID = 12214462.001).
  • [ISSN] 0385-0684
  • [Journal-full-title] Gan to kagaku ryoho. Cancer & chemotherapy
  • [ISO-abbreviation] Gan To Kagaku Ryoho
  • [Language] jpn
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Contraceptives, Oral; 1CC1JFE158 / Dactinomycin; 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; 8N3DW7272P / Cyclophosphamide; Q20Q21Q62J / Cisplatin; YL5FZ2Y5U1 / Methotrexate; EMA-CO protocol; VP-P protocol
  • [Number-of-references] 15
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