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Abramson Cancer CenterNCI CANCERLIT® Search: Gestational Trophoblastic Neoplasms - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 10790623
AU - Dreyfus M; Tissier I; Philippe E
TI -
[Gestational trophoblastic diseases. Classification, epidemiology and
genetic data]
SO - J Gynecol Obstet Biol Reprod (Paris) 2000 Apr;29(2):125-30
AD - Clinique de Gynecologie-Obstetrique et de la Reproduction Humaine,
Centre Hospitalier Regional Universitaire de Caen.
Gestational trophoblastic diseases amalgamate several entities with a
common denominator which is a hypersecretion of hCG: complete mole,
invasive or not, partial mole or triploid syndrome, gestational
trophoblastic carcinoma and trophoblastic carcinoma from the
implantation site. These entities differ by their origins, their
morphology, their evolution and their treatments. Complete moles are
diploid and in 80% of cases, chromosomes are only from paternal origin
(diandry or dispermy). Their evolution is unpredictable whatever the
molecular biology or cytogenetical methods are. Partial moles, generally
triploid, are much more frequent (10-20% of miscarriages) than the
number of cases diagnosed during the pregnancy. In 85% of cases, two
sets of chromosomes are of paternal origin. The gestational
trophoblastic carcinoma is diploid and its genetic material comes from
both parents. This probably excludes a direct filiation between complete
mole and gestational trophoblastic carcinoma. The trophoblastic tumor
from the implantation site comes from the trophoblast of the
implantation site which explain why its evolution and its prognosis are
totally distinct from the previous one. In this report, we successively
discuss the natural history of gestational trophoblastic diseases, their
epidemiology and the genetic data explaining their origins.
2
UI - 11119043
AU - Petignat P
TI -
[Re: "Gestational trophoblastic diseases." Potential mechanism of
formation of complete diploid moles]
SO - J Gynecol Obstet Biol Reprod (Paris) 2000 Nov;29(7):687-9
3
UI - 11446484
AU - Altintas A; Vardar MA
TI -
Central nervous system involvement in gestational trophoblastic
neoplasia.
SO - Eur J Gynaecol Oncol 2001;22(2):154-6
OBJECTIVE: To evaluate characteristics of patients with central nervous
system (CNS) lesions of gestational trophoblastic disease and determine
prognostic and therapeutic implications applicable to management.
METHODS: Nine patients among 56 cases of malignant gestational
trophoblastic neoplasia (GTN) were analyzed prospectively in a single
institution between the years 1990 and 1997 with at least two years of
follow-up. Brain metastases were documented by physical exam and
computed tomography scan or magnetic resonance imaging. In terms of
therapy, all of the patients received an etoposide, methotraxate,
actinomycin, cyclosphamide and vincristine (EMA-CO) regimen for 5 to 9
courses. To prevent unexpected intracranial hemorrhage, all patients
received radiation therapy. No intrathecal chemotherapy was given.
Remission was defined as three weekly beta-hCG levels below assay
sensitivity (<5 mIU/ml). RESULTS: The mean age of the patients at
diagnosis was 29.6 years. While two of the patients initially presented
with symptoms related to cranial involvement, five were diagnosed during
routine investigation for metastasis in malignant GTD and the remaining
two developed cerebral metastases during the therapy. Besides central
nervous system involvement, six had additional lung, two had hepatic and
splenic and one had pelvic metastases. Overall survival was 66.6%. Two
patients had a fulminant clinical course and were lost one month after
initial diagnosis. CONCLUSION: Early diagnosis via computed tomography
of the head and beta-hCG serum testing along with aggressive, multiagent
intervention (EMA-CO) have greatly improved patient prognosis of this
once highly fatal condition.
4
UI - 11501777
AU - Ozalp SS; Yalcin OT; Tanir HM
TI -
A hospital-based multicentric study results on gestational trophoblastic
disease management status in a developing country.
SO - Eur J Gynaecol Oncol 2001;22(3):221-2
AD - Department of Obstetrics and Gynecology, Osmangazi University Faculty of
Medicine, Eski ehir, Turkey.
OBJECTIVE: To determine the clinical management of gestational
trophoblastic disease in Turkey. MATERIAL AND METHODS: An inquiry form
was sent to 55 health centers including university hospitals, maternity
hospitals with residency programs and maternity hospitals without
residency programs in 1997. The inquiry consisted of questions about the
type of classification systems in use, distribution of cases according
to those classifications, use of prophylactic chemotherapy and its
indications, and drug preference for single-agent or combined
chemotherapies. RESULTS: The overall response rate to the conducted
inquiry was 47.1%. A clinical classification system was identified in
60% of the hospitals in Turkey. Generally, methotrexate was the most
used single-agent chemotherapy. With regard to first-line combined
chemotherapy, MAC (methotrexate, antinomycin-D, cyclophosphamide) was
the preferred combination. EMA-CO (etoposide, methotrexate,
actinomycin-D, cyclophosphamide, vincristine) was the most common used
second-line chemotherapeutic regimen. CONCLUSION: Due to insufficient
data acquisition from all the medical centers and a lack of national
population-based studies, it is difficult to draw a conclusion with
respect to the interpretation of the data about the management protocols
of gestational trophoblastic disease.
5
UI - 11593563
AU - Ngan HY; Wong LC
TI -
Early detection of persistent trophoblastic tumour by serum human
chorionic gonadotrophin monitoring after molar pregnancy.
SO - Chin Med J (Engl) 1999 Mar;112(3):260-3
AD - Department of Obstetrics and Gynaecology, University of Hong Kong, Queen
Mary Hospital, Hong Kong, China. hysngan@hkucc.hku.hk
OBJECTIVE: To study the outcome of a multi-centred post-molar pregnancy
serum human chorionic gonadotrophin (hCG) surveillance programme.
METHODS: Patients recruited into the multi-centred post-molar serum hCG
surveillance programme between 1988 and 1996 were studied. The clinical
data were obtained from medical records and computer database. RESULTS:
There were 616 patients in the study. Twenty-five (11%) of 224 patients
with molar pregnancy and 28 (7%) of 392 patients with partial molar
pregnancy were diagnosed to have persistent trophoblastic tumour (PTT)
requiring chemotherapy. Of the 53 patients treated for PTT, 58.5%
received intravenous methotrexate (MTX), 22.6% received both MTX and
actinomycin D, and 19% received CHAMOC, a multiple chemotherapeutic
regimen. Four patients receiving single drug had to change the regimen
because of poor response, and all recovered and remained well. There
were 3 cases of recurrence, one in each group of patients receiving
single, dual or multiple agents. One patient died because of treatment
complication. The rest were well with a mean follow-up of 42 months.
CONCLUSIONS: Post-molar serum hCG surveillance is important to detecting
persistent trophoblastic activity. Early treatment of PTT by the
appropriate chemotherapy has a near hundred percent cure and prevents
the progression of PTT into more advanced trophoblastic malignancy such
as choriocarcinoma.
6
UI - 11586044
AU - Okamoto T; Goto S
TI -
Resistance to multiple agent chemotherapy including cisplatin after
chronic low-dose oral etoposide administration in gestational
choriocarcinoma.
SO - Gynecol Obstet Invest 2001;52(2):139-41
AD - Department of Obstetrics and Gynecology, Chukyo Hospital, Nagoya, Japan.
Most patients with gestational trophoblastic disease in whom
single-agent or even combination chemotherapy has failed can be cured
with salvage chemotherapy including etoposide or platinum-based
regimens. Here we report a rare case of uterine choriocarcinoma
following a molar evacuation that seemed to develop during chronic
low-dose oral administration of etoposide for approximately 16 months.
Although the patient was expected to have a good chance of cure using
combination chemotherapy, the lesion was resistant to multiple-agent
chemotherapy including cisplatin. Copyright 2001 S. Karger AG, Basel
7
UI - 11597192
AU - Sebire NJ; Rees H; Paradinas F; Fisher R; Foskett M; Seckl M; Newlands E
TI -
Extravillus endovascular implantation site trophoblast invasion is
abnormal in complete versus partial molar pregnancies.
SO - Placenta 2001 Sep-Oct;22(8-9):725-8
AD - Department of Histopathology, Trophoblastic Disease Surveillance Unit,
Charing Ross Hospital, London, UK. njs@fetalpathology.co.uk
This study examines endovascular trophoblast invasion in pregnancies
complicated by complete hydatidiform mole (CM), partial hydatidiform
mole (PM) and non-molar abortions (HA). Two hundred consecutive cases
from a supra-regional referral centre for suspected trophoblastic
disease were examined histologically with particular regard to the
presence or absence of endovascular trophoblast invasion of decidual
vessels. There were 57 CM, 75 PM and 68 HA. The prevalence of normal
endovascular invasion of decidual vessels was significantly lower in CM
compared to all other clinical groups, amongst which there were no
significant differences. Endovascular trophoblast was identified in
about 80 per cent of HA and PM moles, compared to only around 25 per
cent of CM (Z = -4.0, P< 0.0001). The majority of cases of complete mole
demonstrated a similar appearance, of implantation site showing florid
interstitial extravascular trophoblast invasion with surrounding of
decidual vessels but without normal endovascular trophoblast invasion or
'plugging' seen. In many cases, there also appeared to be destruction of
decidual vessels with interstitial haemorrhage and extensive fresh blood
clot present in the histological sections. These findings may provide
some explanation regarding the mechanism of clinical findings in molar
pregnancy. Copyright 2001 Harcourt Publishers Ltd.
8
UI - 11688455
AU - Castrillon DH; Sun D; Weremowicz S; Fisher RA; Crum CP; Genest DR
TI -
Discrimination of complete hydatidiform mole from its mimics by
immunohistochemistry of the paternally imprinted gene product p57KIP2.
SO - Am J Surg Pathol 2001 Oct;25(10):1225-30
AD - Department of Pathology, Brigham and Women's Hospital and Harvard
Medical School, Boston, Massachusetts 02115, USA.
dcastrillon@partners.org
The p57KIP2 protein is a cell cycle inhibitor and tumor suppressor
encoded by a strongly paternally imprinted gene. We explored the utility
of p57KIP2 as a diagnostic marker in hydatidiform mole, a disease likely
the result of abnormal dosage and consequent misexpression of imprinted
genes. Using a monoclonal antibody on paraffin-embedded, formalin-fixed
tissue sections, the authors evaluated p57KIP2 expression in normal
placenta and in 149 gestations including 59 complete hydatidiform moles,
39 PHMs, and 51 spontaneous losses with hydropic changes. p57KIP2 was
strongly expressed in cytotrophoblast and villous mesenchyme in normal
placenta, all cases of partial hydatidiform moles (39 of 39) and all
spontaneous losses with hydropic changes (51 of 51). In contrast,
p57KIP2 expression in cytotrophoblast and villous mesenchyme was absent
or markedly decreased in 58 of 59 complete hydatidiform moles. In all
gestations p57KIP2 was strongly expressed in decidua and in intervillous
trophoblast islands, which served as internal positive controls for
p57KIP2 immunostaining. p57KIP2 immunohistochemistry can reliably
identify most cases of complete hydatidiform mole irrespective of
gestational age and is thus a useful diagnostic adjunct, complementary
to ploidy analysis, in the diagnosis of hydatidiform mole.
9
UI - 11704157
AU - Hammond CB
TI -
False positive hCG.
SO - Obstet Gynecol 2001 Nov;98(5 Pt 1):719-20
10
UI - 11718029
AU - Xiang Y; Yang X; Song H
TI -
[Clinical analysis of intracranial metastases in gestational
trophoblastic tumour]
SO - Zhonghua Fu Chan Ke Za Zhi 2001 Jul;36(7):417-20
AD - Department of Obstetrics and Genecology, Peking Union Medical College
Hospital, Peking Union Medical College, Chinese Academy of Medical
Sciences, Beijing 100730, China.
OBJECTIVE: To evaluate characteristics of patients with intracranial
metastases of gestational trophoblastic tumour (GTT) and determine the
prognostic factors and therapeutic modality. METHODS: We retrospectively
reviewed the records of 814 GTT patients treated at Peking Union Medical
College Hospital from 1984 to 1998. Of them, 382 were choriocarcinoma
and 61 developed brain metastases (16.0%); 432 were invasive mole and 8
of them presented brain metastases (1.9%). Patients with brain
metastases were divided into three categories: Group A, individuals with
no prior chemotherapy (30 cases); Group B, patients who had received
chemotherapy before transferred to our hospital (31 cases); Group C,
individuals who developed brain metastases during therapy in our
hospital (8 cases). Apart from 12 patients died before or during the
first cycle of chemotherapy, the remaining 57 patients were treated with
5-FU combined chemotherapy or etopside, methotrexate, kengshengmycin,
/vincristine, cyclophosphamide (EMA/CO) regimen, the number of courses
varied from 3 to 17 cycles. The median number of chemotherapy for each
patient was 8.2. Intrathecal methotrexate chemotherapy was utilized for
all patients. Emergency surgical decompression was performed in 4 cases
who had symptoms of highly increased intracranial pressure. RESULTS:
Apart from 12 patients died before they received regular therapy in our
hospital, remission rate of other 57 patients was 71.9%. The cumulative
survival rate for these 57 patients at 5 years was 45.8%. Women with no
prior chemotherapy (group A) had outcomes significantly better than
those who had been treated before transfer to our hospital (group B) and
there were no survivors among the patients who developed brain
metastases during active chemotherapy (group C) [P < 0.05 (A Vs B); P <
0.01 (A or B Vs C)]. CONCLUSIONS: Multiagent systemic chemotherapy
combined with intrathecal methotrexate chemotherapy still play the key
role in the management of brain metastatic GTT patients; Surgical
decompression should be performed if significant neurologic symptoms are
present.
11
UI - 11733980
AU - Ino K; Mitsui T; Nomura S; Kikkawa F; Mizutani S
TI -
Complete remission of gestational choriocarcinoma with choroidal
metastasis treated with systemic chemotherapy alone: case report and
review of literature.
SO - Gynecol Oncol 2001 Dec;83(3):601-4
AD - Department of Obstetrics and Gynecology, Nagoya University School of
Medicine, 65 Tsurumai-cho, Nagoya, Showa-ku, 466-8550, Japan.
kazuino@med.nagoya-u.ac.jp
BACKGROUND: Gestational choriocarcinoma is a malignant tumor that
frequently metastasizes to the highly vascularized organs such as the
lung, brain, and liver via hematogenous spread. However, this tumor
rarely metastasizes to the eye and only a few cases of metastasis to the
choroid have been reported. CASE: A 17-year-old woman presented with
visual field defects, decreased vision, and increasing pain in her left
eye. She had undergone evacuation of a complete hydatidiform mole 32
months prior to the presentation. Ophthalmologic evaluation revealed a
metastatic choroidal tumor, and a CT scan showed a metastatic tumor in
the left lung. The serum hCG level was elevated at 7780 mIU/ml. A
clinical diagnosis of metastatic gestational choriocarcinoma involving
the choroid and lung was made. The patient received 13 courses of
combination chemotherapy, resulting in complete remission. Radiotherapy
and surgical treatment were unnecessary. CONCLUSION: This is a very rare
case of the successful treatment of gestational choriocarcinoma
metastatic to the choroid using systemic chemotherapy alone. (c)2001
Elsevier Science.
12
UI - 11737301
AU - Paradinas FJ; Sebire NJ; Fisher RA; Rees HC; Foskett M; Seckl MJ;
TI -
Newlands ES
Pseudo-partial moles: placental stem vessel hydrops and the association
with Beckwith-Wiedemann syndrome and complete moles.
SO - Histopathology 2001 Nov;39(5):447-54
AD - Department of Histopathology, Imperial College School of Medicine at
Charing Cross Hospital, London, UK.
AIMS: To describe the clinical and histological features of a series of
cases of placentas originally diagnosed as partial moles in which the
final diagnosis was that of placental stem villous hydrops, mesenchymal
dysplasia or Beckwith-Wiedemann syndrome. METHODS AND RESULTS: We
searched a computerized database containing cases of suspected or proven
trophoblastic disease examined at the Trophoblastic Disease Unit at
Charing Cross Hospital, London, to identify cases in which stem vessel
hydrops was present without other histological features of partial mole.
For each case, histological sections were examined and the histological
features present recorded. There were 15 cases identified. Placental
weight was above the 95th centile of the normal for gestation in all
cases in which this information was documented. In an additional five
cases the placenta was described as 'large'. All cases had marked stem
vessel hydropic change with cyst formation and in the majority of cases
some terminal villous hydrops was also present. In 13 of the 15 cases
there was marked aneurysmal dilatation of stem villous vessels. Nine had
focal chorioangiomatoid change and in four of these extramedullary
haematopoiesis was focally present in these areas. No excessive
trophoblast proliferation was noted in any case and no trophoblastic
inclusions typical of partial mole were identified. CONCLUSIONS: This
study has identified cases of stem villous hydrops, mesenchymal
dysplasia or Beckwith-Wiedemann spectrum in pregnancies initially
diagnosed as partial hydatidiform mole in the second half of pregnancy
and has highlighted the need for detailed pathological examination and
clinicopathological correlation in all such cases.
13
UI - 11768287
AU - Lin HW; Shieh CS; Chen LM; Yang YT; Han CP
TI -
Spontaneous uterine perforation mimicking ectopic pregnancy as the
initial presentation of placental site trophoblastic tumor.
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Sep;64(9):545-50
AD - Division of Obstetrics/Gynecology, Armed Forces Taichung General
Hospital, Taiwan, ROC. c332860@ms65.hinet.net
Placental site trophoblastic tumor (PSTT) is a rare form of gestational
trophoblastic disease (GTD), with only 100 cases reported in the
literature. Irregular vaginal bleeding has been reported to be the most
common presenting symptom, however, spontaneous uterine perforation,
mimicking ectopic pregnancy, as the initial presentation is extremely
rare, and has not yet been reported in the Chinese literature. Herein,
we report a 26-year-old female with PSTT complicating with uterine
perforation that mimicked ectopic pregnancy as the initial presentation.
She received wide excision of the uterine perforation margin only and
now remains disease-free, 2 years after the operation. Reviewing the
literature, while most cases of PSTT behave a benign fashion, some
exhibit malignant behavior; surgery remains the mainstay of therapy. For
patients whose disease is limited to the uterus, simple total abdominal
hysterectomy is the treatment of choice. For patients with extensive or
metastatic disease, cytoreductive surgery (total abdominal hysterectomy
and resection of extrauterine tumor load) combined with chemotherapy
should be applied. Etoposide, methotrexate, actinomycin D,
cyclophosphamide, and vincristine (EMA/CO) chemotherapy appears superior
to other available chemotherapeutic regimens in the treatment
14
UI - 11679534
AU - Pautier P; Ghione S; Brailly-Tabard S; Lhomme C; Morice P; Bidart JM
TI -
Are serum inhibin concentrations new markers of placental tumours in the
course of chemotherapy?
SO - Hum Reprod 2001 Nov;16(11):2434-7
AD - Medical Department, Gynecological Unit, Institut Gustave-Roussy, 94805
Villejuif, France. pautier@igr.fr
BACKGROUND: The study was conducted to evaluate whether the detection of
serum molecular forms of inhibin (A and B) could be useful for the
diagnosis, prognosis and follow-up of placental tumours. METHODS: A
total of 17 patients with hydatidiform mole (n = 13), invasive mole (n =
1) or choriocarcinoma (n = 3) were studied; serum concentrations of
inhibins A and B, human chorionic gonadotrophin (HCG) and its free beta
subunit (HCGbeta) were measured before chemotherapy (after mole
evacuation for eight patients) and also during the course of
chemotherapy (for 10 patients). RESULTS: After evacuation or before
chemotherapy for refractory disease, serum inhibin A and B
concentrations were found to be increased in 10/17 and 4/17 patients,
when HCG and HCGbeta were high in all patients. In 10 patients with a
follow-up during treatment, nine had a high concentration of inhibin A
which correlated with those of HCG and HCGbeta. Normalization of inhibin
A was faster than that of HCG and HCGbeta for three and six patients
respectively. There was no correlation between changes of inhibin B and
HCGbeta concentrations. CONCLUSIONS: Our results suggest that inhibins A
and B are not useful markers and that HCG determination still remains
the most useful marker for diagnosis and follow-up of placental tumours.
15
UI - 11598368
AU - Ozalp S; Yalcin OT; Tanir HM; Etiz E
TI -
Recurrent molar pregnancy: report of a case with seven consecutive
hydatidiform moles.
SO - Gynecol Obstet Invest 2001;52(3):215-6
AD - Osmangazi University Faculty of Medicine, Department of Obstetrics and
Gynecology, Gynecologic Oncology Unit, Eskisehir, Turkey.
A case of seven consecutive hydatidiform moles is presented. All of her
pregnancies revealed a molar pregnancy, 4 of which were demonstrated
histopathologically. In the context of this study, the potential risk
for malignant transformation and the obstetric outcome are highlighted.
The literature regarding recurrent molar pregnancies is reviewed.
Copyright 2001 S. Karger AG, Basel
16
UI - 1783950
AU - van de Kaa CA; Nelson KA; Ramaekers FC; Vooijs PG; Hopman AH
TI -
Interphase cytogenetics in paraffin sections of routinely processed
hydatidiform moles and hydropic abortions.
SO - J Pathol 1991 Dec;165(4):281-7
AD - Department of Pathology, University Hospital Nijmegen, The Netherlands.
The differential diagnosis of complete (CM) and partial (PM)
hydatidiform moles and hydropic abortions (HA) can be difficult when
based on histology alone. Therefore, a more objective approach of
chromosome ploidy analysis as detected by in situ hybridization (ISH)
was performed on 6 microns paraffin sections of seven cases, originally
classified as three CM, two PM, and two HA with a histologic pattern
suggestive of triploidy. Probes for repetitive DNA targets in the
(peri)centromeric region of chromosomes 1 and X and in the q arm of
chromosome Y were used to determine chromosome ploidy and sex chromosome
composition. The findings in the three CM were consistent with diploidy:
two copies of chromosomes 1 and X and none of chromosome Y. In the two
HA with a histologic pattern suggestive of triploidy, three copies of
chromosomes 1 and X and none of chromosome Y confirmed triploidy. Two
cases originally classified as PM both appeared to have two copies of
chromosome 1 with an XX pattern in one case and an XY pattern in the
other case, which is consistent with diploidy instead of triploidy.
After reviewing, both cases most likely represented CM. We conclude that
interphase cytogenetics by ISH on paraffin sections of hydatidiform
moles and hydropic abortions enables chromosome ploidy analysis with
preservation of histological context.(ABSTRACT TRUNCATED AT 250 WORDS)
17
UI - 6280746
AU - Bagshawe KD; Lawler SD
TI -
Unmasking moles.
SO - Br J Obstet Gynaecol 1982 Apr;89(4):255-7
18
UI - 6565615
AU - Arnholdt H; Elser H; Dormer P
TI -
[Partial hydatidiform mole with significantly increased serum HCG levels
in the triploidy syndrome]
SO - Geburtshilfe Frauenheilkd 1984 May;44(5):328-32
The authors report on a triploid pregnancy with foetal malformations and
a sonographically diagnosed partial hydatit mole. The course of this
pregnancy was characterised by pre-eclampsia. The fact that in this
case, for example, HCG serum levels were very high and persisted post
abortum, similar to the concentrations seen in complete hydatit mole,
underlines the difficulties in assessing and diagnosing a partial
hydatit mole.
19
UI - 3348314
AU - Song HZ; Wu PC; Wang YE; Yang XY; Dong SY
TI -
Pregnancy outcomes after successful chemotherapy for choriocarcinoma and
invasive mole: long-term follow-up.
SO - Am J Obstet Gynecol 1988 Mar;158(3 Pt 1):538-45
AD - Department of Obstetrics and Gynecology, Peking Union Medical College
Hospital, Beijing, China.
In order to preserve the fertility of young patients with
choriocarcinoma and invasive mole, chemotherapy alone was given without
hysterectomy in 265 cases from 1959 through 1980. By the end of 1985,
205 patients had become pregnant after recovery, with a total of 355
pregnancies. Among these, 23 were terminated by induced abortions, 26 as
miscarriages, two as ectopic gestations, two as intrauterine deaths, and
three as stillbirths. Among 303 livebirths (including four sets of
twins), six infants died neonatally, three of whom were found to have
congenital anomalies incompatible with life, and two died during
infancy. All the remaining 295 children had normal growth and
development, the oldest now being 25 years of age. The rates of fetal
wastage, malformations, twin pregnancies, and neonatal and infantile
deaths did not deviate from the normal. Cytogenetic study of the
peripheral lymphocytes of 94 of the children revealed no increase of
chromosomal aberrations. The rates of recurrence of disease and of death
caused by recurrence of disease in these were not increased in
comparison with those in patients who underwent hysterectomy. These data
indicate that treatment of malignant trophoblastic neoplasms with
chemotherapy alone is compatible with the preservation of fertility in
most women.
20
UI - 2693267
AU - Kainer F; Wessel J; Struck E; Jiminez E
TI -
[Sonographic diagnosis in partial mole with increased HCG in triploidy
syndrome]
SO - Gynakol Rundsch 1989;29 Suppl 2():460-1
21
UI - 11774786
AU - Chechia A; Koubaa A; Makhlouf T; Anis B; Terras K; Hamouda B; Mezni F
TI -
[Molar pregnancy. Retrospective study of 60 cases in Tunisia]
SO - Tunis Med 2001 Aug-Sep;79(8-9):441-6
AD - Service de gynecologie obstetrique A Hopital Charles Nicolle, Tunis.
To identify the epidemiologic, clinical end therapeutic particularities
of molar pregnancies in Tunisia. A retrospective study of 60 cases of
molar pregnancy Diagnosis of MP was base on elevated urine HCG level
and/or histologic examination of uterine revision done for all patients.
The incidence of MP is 1/793(60/47624) pregnancies. The mean age of
patients was 31.7 years and 16 patients had more than 35 years. The
metrorragia is the main symptom (91.6%). Excessive uterine enlargement
and lutein ovarian cysts were observed respectively in 57 and 6.6% of
cases. Human chorionic gonadotropin level was upper than 50,000 UI/l in
91.4% of cases. Ultrasonography contributed to diagnosis in 82.8% of
cases. Histological findings were complete molar in 33 cases and partial
molar in 27 cases. 6 of 33 patients having complete molar developed
persistent gestational trophoblastic tumor. Actinomycin D induced
complete remission in all cases. Molar pregnancy is a relatively common
disease in Tunisia. Careful and reliable human chorionic gonadotropin
monitoring is essential for the early detection of post molar persistent
gestational trophoblastic tumor.
22
UI - 2992274
AU - Parazzini F; La Vecchia C; Pampallona S; Franceschi S
TI -
Reproductive patterns and the risk of gestational trophoblastic disease.
SO - Am J Obstet Gynecol 1985 Aug 1;152(7 Pt 1):866-70
The relation between reproductive pattern and the risk of gestational
trophoblastic disease was evaluated in a case-control study conducted in
Northern Italy on 310 women with histologically confirmed gestational
trophoblastic disease and two control groups consisting of 290 obstetric
subjects and 394 patients in hospital for acute, nonobstetric,
nongynecologic conditions. Compared to that for nulliparous women, the
estimated age-adjusted relative risk of trophoblastic disease for parous
women was 0.6 (90% confidence limit = 0.4 to 0.9) when obstetric
controls were used as a comparison group and 0.4 (95% confidence limit =
0.2 to 0.6) compared with other controls. Conversely, a history of
spontaneous abortions was associated with elevated risk of gestational
trophoblastic disease, and the risk increased significantly with
increasing number of spontaneous abortions. When the combined effect of
parity and spontaneous abortions was considered, the major factor
influencing the risk of gestational trophoblastic disease was the
existence of one or more previous term pregnancies.
23
UI - 11776858
AU - Xiang Y; Yang X; Du J
TI -
[The role of hysterectomy in the therapy of gestational trophoblastic
tumor]
SO - Zhonghua Zhong Liu Za Zhi 1999 Mar;21(2):139-41
AD - Peking Union Medical College Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100730.
OBJECTIVE: To evaluate the role of hysterectomy for patients with
gestational trophoblastic tumor. METHODS: A total of 68 cases of
gestational trophoblastic neoplasia treated by hysterectomy from
1985-1997 at PUMC hospital was retrospectively analyzed. Thirty-eight
cases were diagnosed as choriocarcinoma and 30 as invasive mole.
RESULTS: Twenty-three elder patients who didn't desire to preserve
fertility were selected for hysterectomy after short courses of
chemotherapy. Twenty-two of them had complete remission (95.6%). The
average total course of chemotherapy was 4.2. Of twenty-seven
chemo-refractory cases who were suspected of an isolated lesion in the
uterus, delayed hysterectomy as an adjunct to chemotherapy was
performed. Twenty of them achieved complete remission (74.1%), with an
average 9.4 courses of chemotherapy. Emergency hysterectomy was
indicated in 18 patients with uterine perforation or life-threatening
hemorrhage. Seventeen of the emergent cases had complete remission
(94.4%), who had received an average 7.6 courses of chemotherapy.
CONCLUSION: Although the development of effective chemotherapy has
resulted in improved survival of patients with gestational trophoblastic
tumor, hysterectomy remains an important adjunct treatment in a selected
subset of patients. Modified radical hysterectomy is recommended for the
indicated patients.
24
UI - 11718570
AU - Katsumata Y; Nomura S; Ino K; Iwanaga K; Kurosawa N; Ito T; Okada M;
TI -
Tsujimoto M; Kikkawa F; Mizutani S
Progesterone stimulates the expression of aminopeptidase
A/angiotensinase in human choriocarcinoma cells.
SO - Placenta 2001 Nov;22(10):831-6
AD - Department of Obstetrics and Gynecology, Nagoya University School of
Medicine, Nagoya 466-8550, Japan.
In human placenta aminopeptidase A (APA), a principal enzyme that
converts angiotensin II to angiotensin III, seems to be involved in
angiotensin II metabolism during pregnancy. In this study, we
investigated the possible effects of progesterone and estrogen on APA
mRNA and protein levels in choriocarcinoma cells as a model for
placenta. By RNase protection assay, progesterone induced higher APA
mRNA levels than estrogen at the same concentration. Progesterone
exhibited dose-dependent stimulation of APA mRNA, 1.8-fold increase at
10(-6) m for 24 h treatment. Progesterone at 10(-6) m increased APA mRNA
levels within 12 h and in time-dependent fashion up to 24 h.
Fluorescence-activated cell sorting analysis and measurements of APA
activities revealed the induction of APA protein by progesterone.
Expression of progesterone receptors (PR) and glucocorticoid receptors
(GR) were determined in these cells by RT-PCR, which suggested that the
progesterone's actions might be displayed through PR and/or GR. These
findings may serve as a useful model to study the effects of
progesterone on angiotensin II metabolism in placenta, although the
physiological validity of these studies remains to be clarified.
Copyright 2001 Harcourt Publishers Ltd.
25
UI - 11775947
AU - Li Z; Xiang Y; Dai L
TI -
[Prediction of malignant transformation of hydatidiform mole by mRNA
determination of matrix metalloproteinases and tissue inhibitor of
metalloproteinases]
SO - Zhonghua Fu Chan Ke Za Zhi 2000 Sep;35(9):547-50
AD - Department of Obstetrics and Gynecology, Hubei Sanxia Medical College,
Hubei Province 443007, China.
OBJECTIVE: To investigate the relationship between the messenger
RNA(mRNA) levels of matrix metalloproteinases(MMP-9, MMP-2) and tissue
inhibitor of metalloproteinase (TIMP-1, TIMP-2) and malignant
transformation of hydatidiform mole. METHODS: Total RNA were isolated
from tissues of 22 normal chorionic villi samples and 37 cases of
hydatidiform mole. The mRNA expression of MMP-9, MMP-2, TIMP-1, TIMP-2
genes were determined by RT-PCR. RESULTS: The differences of the mRNA
expression of MMP-9, MMP-2, TIMP-1, TIMP-2 genes in the tissues of
hydatidiform mole and normal preganacy villus were not significant (P >
0.05). The ratio of MMP-9/TIMP-1 in molar tissues with malignant
transformation was higher than those in molar tissues without malignant
transformation and in normal villus. CONCLUSION: It is a correlative
relation beween MMP-9/TIMP-1 and malignancy of hydatidiform mole. The
ratio of MMP-9/TIMP-1 might be used as an index for prediction of
malignant transformation of hydatidiform mole.
26
UI - 11737472
AU - Balaram P; John M; Enose S; Symaladevi PK
TI -
Demonstration of TGF-alpha-EGFR and EGF-EGFR autocrine loops and their
relation to proliferation in complete hydatidiform moles (CHM).
SO - Int J Gynecol Cancer 2001 Sep-Oct;11(5):397-402
AD - Regional Cancer Center, Trivandrum, Kerala, India.
rcctvm@md2.vs.nl.net.in
Complete hydatidiform moles (CHM) are the most common form of
gestational trophoblastic disease. The prevalence rate is much higher in
the state of Kerala, India, than in other parts of the world. The
biology and role of growth factors are not fully understood in these
tumors. In this study, we have immunohistochemically evaluated the
expression of epidermal growth factor (EGF) and transforming growth
factor alpha (TGF-alpha) along with their receptor, epidermal growth
factor receptor (EGFR), and we have related them to the proliferative
activity in normal placenta and CHM using the expression of
proliferating cell nuclear antigen (PCNA) as the marker of
proliferation. The results suggest activation of both EGF-EGFR and
TGF-alpha-EGFR autocrine pathways in both types of tissues, with a
predominance of the TGF-alpha-EGFR autocrine pathway in CHM. This is
especially so in the more aggressive cases of CHM, the persisting group
of diseases.
27
UI - 11717924
AU - Xiang Y; Yang X; Yang N; Song H
TI -
A comparative study of transvaginal ultrasonography and pelvic
arteriogram in assessment of patients with gestational trophoblastic
tumour.
SO - Chin Med Sci J 1998 Mar;13(1):45-8
AD - Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730.
OBJECTIVE: To compare the reliability of transvaginal ultrasonography
with pelvic arteriography in the assessment of patients with gestational
trophoblastic disease. METHODS: Transvaginal ultrasonography was
performed in 24 patients with gestational trophoblastic tumour. Within
one week after ultrasound investigation, pelvic arteriography was
carried out in each patient. Of 24 cases, 16 patients hadn't been
treated by chemical reagent, 5 had accepted 2 to 5 courses of
chemotherapy, and 3 had achieved complete remission before both
investigations performed. RESULTS: In 3 patients with complete
remission, 2 had no evidence of abnormal findings either on transvaginal
ultrasonography or on pelvic arteriography, 1 showed intramyometrial
lesions by both methods. In the remaining 21 patients, all demonstrated
a abnormal uterine image, and 5 of them accompanied with the finding of
parametrium metastatic signs by transvaginal ultrasonography; these
abnormal results were confirmed by pelvic arteriographic imaging.
However, in two cases without clinical and ultrasonic signs of
parametrium metastasis, pelvic arteriography indicated the early
metastasis of parametrium vessels. CONCLUSIONS: Even though it is
difficult to predict the early parametrium metastasis in patients with
gestational trophoblastic disease by B-ultrasonic investigation, our
data would support the introduction of transvaginal ultrasonography in
the diagnosis and evaluation of gestational trophoblastic tumour.
28
UI - 11787207
AU - Mittak M; Samlik J; Satinsky L; Foltys A
TI -
[Metastatic choriocarcinoma as a cause of hemorrhage in the digestive
tract and abdominal cavity]
SO - Rozhl Chir 2001 Oct;80(10):538-40
AD - Chirurgicka klinika, Fakultni nemocnice s poliklinikou, Ostrava-Poruba.
marcel.mittak@fnspo.cz
Authors present a case report of an young woman with metastatic
choriocarcinoma. Clinical presentation of the disease was intracerebral
bleeding concurring with intestinal bleeding and bleeding from ruptured
spleen according to metastatic spread. Physicians firstly didn't think
of choriocarcinoma because of small incidence of the disease and long
period after the patient's latest pregnancy. At last the aggressive
treatment was successful. Authors would like to bring out the reality
that the surgeon could be the first who is faced with diagnosis and
treatment of serious complications of choriocarcinoma.
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