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Cancer Types / Gynecologic Cancers / Gestational Trophoblastic Disease and Choriocarcinoma / NCI Resources

NCI CANCERLIT^® Search: Gestational Trophoblastic Neoplasms - September 2002

National Cancer Institute^®
Last Modified: September 1, 2002

Cutaneous metastasis of gestational choriocarcinoma.
FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee.
Choriocarcinoma brain metastasis in a patient with viable intrauterine pregnancy. Case report.
False positive hCG.
Expressions of p53, proliferating cell nuclear antigen, and Ki-67 in gestational trophoblastic diseases.
[Gestational trophoblastic tumors and recent clinical information]
Salvage combination chemotherapy with 5-fluorouracil and actinomycin D for patients with refractory, high-risk gestational trophoblastic
Mixed choriocarcinoma in a postmenopausal patient.
Successful treatment of mother and baby with metastatic choriocarcinoma.
Molecular genetic analysis of placental site trophoblastic tumors and epithelioid trophoblastic tumors confirms their trophoblastic origin.
Persistent gestational trophoblastic disease presenting as left hemiparesis in a Jamaican teenager.

Table of Contents

1
UI - 12065138
AU - Chama CM; Nggada HA; Nuhu A
TI - Cutaneous metastasis of gestational choriocarcinoma.
SO - Int J Gynaecol Obstet 2002 Jun;77(3):249-50
AD - Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, Nigeria.
A 40-year-old woman presented with subcutaneous masses on her chest wall, abnormal vaginal bleeding and an enlarged uterus. Chest X-ray and liver ultrasound revealed metastatic disease to these sites, respectively. A urine human chorionic gonadotrophin assay was positive. A biopsy of the chest wall lesion and endometrium revealed choriocarcinoma. Treatment with methotrexate, actinomycin-D and cyclophosphamide led to complete resolution of the disease on examination, X-ray and ultrasound scans. The urinary pregnancy test became negative.

2
UI - 12065144
AU - FIGO Oncology Committee
TI - FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee.
SO - Int J Gynaecol Obstet 2002 Jun;77(3):285-7

3
UI - 12186481
AU - Mamelak AN; Withers GJ; Wang X
TI - Choriocarcinoma brain metastasis in a patient with viable intrauterine pregnancy. Case report.
SO - J Neurosurg 2002 Aug;97(2):477-81
AD - Department of Neurosurgery, Huntington Memorial Hospital, Pasadena, California, USA. amamelak@coh.org
The authors report the case of a woman who presented during her 30th week of pregnancy with a large brain metastasis from a previously undetected metastatic choriocarcinoma. The metastasis caused significant neurological deficit due to mass effect, necessitating rapid intervention. Medical management included a regimen of high-dose corticosteroid medications for 36 hours, followed by cesarean delivery of the fetus and craniotomy to remove the metastatic tumor, chemotherapy and radiation therapy were begun within 1 week postsurgery. Both the baby and mother survived, and as of the 1-year follow-up examination, there was no evidence of disease in the mother. This is only the second report of a metastatic choriocarcinoma associated with a simultaneous viable intrauterine pregnancy, and the only case in which surgical removal of a brain metastasis was required. Coordinated multidisciplinary treatment of mother and fetus by members of the neurosurgery, medical oncology, neonatology, and obstetrics services facilitated a good outcome in this case.

4
UI - 11704157
AU - Hammond CB
TI - False positive hCG.
SO - Obstet Gynecol 2001 Nov;98(5 Pt 1):719-20

5
UI - 11876401
AU - Uzunlar AK; Yilmaz F; Bayhan G; Akkus Z
TI - Expressions of p53, proliferating cell nuclear antigen, and Ki-67 in gestational trophoblastic diseases.
SO - Eur J Gynaecol Oncol 2002;23(1):79-83
AD - Department of Pathology, The Medical Faculty of Dicle University, Diyarbakir, Turkey.
OBJECTIVE: This study was done to determine whether the expressions of p53, PCNA, and Ki-67 could differentiate spontaneous abortions with hydropic changes from gestational trophoblastic diseases. MATERIALS AND METHODS: Twenty partial hydatidiform moles, 21 complete hydatidiform moles, nine invasive hydatidiform moles, three choriocarcinomas and 19 first trimester hydropic spontaneous abortions were evaluated by means of immunohistochemical methods with antibodies to p53, PCNA, and Ki-67 in this study. RESULTS: The Ki-67, PCNA, and p53 immunoreactivity was significantly higher in the gestational trophoblastic disease group than in the spontaneous abortion group with hydropic changes. None of the three parameters provided reliable discrimination among gestational trophoblastic disease subgroups. CONCLUSION: Our findings suggest that expressions of Ki-67, proliferating cell nuclear antigen and p53 can be used to differentiate between spontaneous abortion with hydropic changes and gestational trophoblastic disease when all three markers are used together.

6
UI - 12214462
AU - Shimizu T; Yaegashi N
TI - [Gestational trophoblastic tumors and recent clinical information]
SO - Gan To Kagaku Ryoho 2002 Aug;29(8):1363-70
AD - Dept. of Obstetrics and Gynecology, Tohoku University School of Medicine.
Recent clinical advances in the field of gestational trophoblastic diseases are described. WHO modified its risk factor scoring system. 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%. The risk of persistent gestational trophoblastic tumors was increased by long-term oral contraceptive use before conception. 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.

7
UI - 12209690
AU - Matsui H; Suzuka K; Iitsuka Y; Yamazawa K; Tanaka N; Mitsuhashi A; Seki
TI - K; Sekiya S Salvage combination chemotherapy with 5-fluorouracil and actinomycin D for patients with refractory, high-risk gestational trophoblastic tumors.
SO - Cancer 2002 Sep 1;95(5):1051-4
AD - Department of Obstetrics and Gynecology, Chiba University School of Medicine, Chiba, Japan. hmatsui@med.m.chiba.u.ac.jp
BACKGROUND: The objective of this study was to evaluate the efficacy and toxicity of a high-dose 5-fluorouracil and actinomycin D regimen (the FA regimen) as salvage chemotherapy for patients with high-risk gestational trophoblastic tumors (GTTs). METHODS: From 1985 to 1997, 10 patients with refractory, high-risk GTTs were treated with the FA regimen at Chiba University Hospital. Of those 10 patients, 7 patients developed drug resistance to methotrexate, etoposide, and actinomycin D combination chemotherapy (the MEA regimen); 1 patient developed recurrent disease after receiving the MEA regimen; and 2 patients developed recurrent disease after receiving combination chemotherapy with etoposide, methotrexate, and actinomycin D alternating with cyclophosphamide and vincristine (the EMA/CO regimen). The hematologic toxicity of the FA regimen was graded at every chemotherapy course. RESULTS: With the FA regimen, the survival rate was 80.0% (8 of 10 patients) for a mean follow-up of 10 years. Two patients died due to multidrug resistance, and two patients subsequently developed recurrent disease. The two patients with recurrent disease were successfully salvaged again with the MEA regimen. The toxicity of the FA regimen was evaluated in 78 cycles. Myelosuppression seemed to be the dose-limiting toxicity, and the incidences of World Health Organization Grade 4 leukocytopenia and thrombocytopenia were 6.4% and 3.8%, respectively, of 78 cycles. CONCLUSIONS: Although etoposide-containing chemotherapy is currently the most effective and well-tolerated regimen for patients with high-risk GTTs, 20-30% of patients develop resistance to etoposide-containing regimens. Salvage combination chemotherapy with FA is effective for these patients with refractory disease, and the toxicity is predictable and manageable. Copyright 2002 American Cancer Society.

8
UI - 12060455
AU - Ramondetta LM; Silva EG; Levenback CF; Burke TW
TI - Mixed choriocarcinoma in a postmenopausal patient.
SO - Int J Gynecol Cancer 2002 May-Jun;12(3):312-6
AD - Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. lramonde@mail.mdanderson.org
Gestational trophoblastic disease rarely presents in patients beyond the reproductive years. To our knowledge, this is the first case of mixed trophoblastic disease in a postmenopausal woman. We present here a case of a 60-year-old woman with evidence of a pelvic mass and pulmonary metastasis. Surgery revealed an 8 x 6 x 6 cm multinodular uterine tumor involving the right adnexa. Histologic review was consistent with choriocarcinoma with intermediate trophoblastic features. Postoperative beta-hCG was 381 561 mIU/ml.We conclude that maintaining a high index of suspicion facilitates the identification of postmenopausal patients with metastatic gestational trophoblastic disease. This case reconfirms the deceptive presentation of the "great masquerader".

9
UI - 12144689
AU - McNally OM; Tran M; Fortune D; Quinn MA
TI - Successful treatment of mother and baby with metastatic choriocarcinoma.
SO - Int J Gynecol Cancer 2002 Jul-Aug;12(4):394-8
AD - Department of Gynae-oncology, Ward 43, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, Scotland.
The second case of successful management of a mother and neonate with metastatic choriocarcinoma is described. A response to paclitaxel in the face of platinum-refractor disease in the mother is also detailed. In a woman with a history of gestational trophoblastic disease, a high index of suspicion and thereby early diagnosis lead to prompt treatment in both mother and neonate.

10
UI - 12213732
AU - Oldt RJ 3rd; Kurman RJ; Shih IeM
TI - Molecular genetic analysis of placental site trophoblastic tumors and epithelioid trophoblastic tumors confirms their trophoblastic origin.
SO - Am J Pathol 2002 Sep;161(3):1033-7
AD - Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA.
Trophoblastic tumors represent a unique group of human neoplasms because they are derived from fetal tissue. Except for choriocarcinoma, the neoplasms that develop from human trophoblast are poorly characterized. Placental site trophoblastic tumors and epithelioid trophoblastic tumors are thought to arise from intermediate (extravillous) trophoblasts based on histopathological studies, but direct molecular evidence of a trophoblastic origin has not been established. In this study, we performed molecular analysis in an attempt to confirm their presumable trophoblastic origin. We demonstrated that such tumors contain a Y-chromosomal locus and/or new (paternal) alleles not present in adjacent normal uterine tissue in all 31 informative cases. Loss of heterozygosity was found in 60% of tumors and all 42 tumors assessed contained wild-type K-ras. All of the trophoblastic tumors were heterozygous in at least 1 of 10 single-nucleotide polymorphism markers studied in contrast to homozygosity in all 10 single-nucleotide polymorphism markers in most complete hydatidiform moles indicating that these tumors are not related to complete hydatidiform moles. This study provides the first molecular evidence that placental site trophoblastic tumors and epithelioid trophoblastic tumors are of fetal (trophoblastic) origin.

11
UI - 12232933
AU - Gokula RM; Falconer HG; Smith FO
TI - Persistent gestational trophoblastic disease presenting as left hemiparesis in a Jamaican teenager.
SO - West Indian Med J 2002 Jun;51(2):116-8
AD - Mandeville Public Hospital, Mandeville, Manchester, Jamaica. rgokula@hotmail.com
A 19-year-old woman, who delivered a macerated stillborn at 32 weeks' gestation and had persistent postpartum vaginal bleeding, presented with a left hemiparesis three and a half months after delivery. A clinical diagnosis of persistent gestational trophoblastic disease (GTD) was made, based on quantitative serum beta-hCG of more than 200,000 IU/ml, cannon ball metastases on chest X-ray and two ring enhancing lesions, metastases, in the right parietal lobe on Computed Axial Tomography (CAT) scan of the brain. Despite combination chemotherapy, with methotrexate, cyclophosphamide and actinomycin D, her condition worsened and she died.

The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.

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