Does a human chorionic gonadotropin level of over 20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole constitute an indication for chemotherapy for gestational trophoblastic neoplasia?

2018 ◽  
Vol 223 ◽  
pp. 50-55 ◽  
Author(s):  
Antonio Braga ◽  
Andressa Biscaro ◽  
Jessye Melgarejo do Amaral Giordani ◽  
Maurício Viggiano ◽  
Kevin M. Elias ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Neoplasia ◽  
Complete Hydatidiform Mole ◽  
Gonadotropin Level

scholarly journals Does Postevacuation β-Human Chorionic Gonadotropin Level Predict the Persistent Gestational Trophoblastic Neoplasia?

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Azam Sadat Mousavi ◽  
Samieh Karimi ◽  
Mitra Modarres Gilani ◽  
Setareh Akhavan ◽  
Elahe Rezayof
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Predictive Factor ◽  
Hydatidiform Mole ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Cross Sectional

β-human chorionic gonadotropin (HCG) level is not a reliable marker for early identification of persistent gestational trophoblastic neoplasia (GTN) after evacuation of hydatidiform mole. Thus, this study was conducted to evaluate β-HCG regression after evacuation as a predictive factor of malignant GTN in complete molar pregnancy. Methods. In this cross-sectional study, we evaluated a total of 260 patients with complete molar pregnancy. Sixteen of the 260 patients were excluded. Serum levels of HCG were measured in all patients before treatment and after evacuation. HCG level was measured weekly until it reached a level lower than 5 mIU/mL. Results. The only predictors of persistent GTN are HCG levels one and two weeks after evacuation. The cut-off point for the preevacuation HCG level was 6000 mIU/mL (area under the curve, AUC, 0.58; sensitivity, 38.53%; specificity, 77.4%), whereas cut-off points for HCG levels one and two weeks after evacuation were 6288 mIU/mL (AUC, 0.63; sensitivity, 50.46%; specificity, 77.0%) and 801 mIU/mL (AUC, 0.80; sensitivity, 79.82%; specificity, 71.64%), respectively. Conclusion. The rate of decrease of HCG level at two weeks after surgical evacuation is the most reliable and strongest predictive factor for the progression of molar pregnancies to persistent GTN.

scholarly journals B-hCG and H-hCG levels in patients with gestational trophoblastic neoplasia

2020 ◽  
Vol 18 (2) ◽  
pp. e34-e38
Author(s):  
Maryam Nakhaie Moghadam ◽  
◽  
Sonia Nourkhomami ◽  
Leila Mousavi Seresht ◽  
Helena Azimi ◽  
...  
Keyword(s):  
Disease Progression ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Dose Intensity ◽  
Gestational Trophoblastic Neoplasia ◽  
Low Level ◽  
Common Diagnosis ◽  
The Mean

Objective: Gestational trophoblastic disease is a term that encompasses a spectrum of disorders all arising from the placenta. Human chorionic gonadotropin (hCG) hormone has an essential role in the diagnosis and management of gestational trophoblastic neoplasia. Measuring beta-hCG (B-hCG) levels is the only standard method of monitoring treatment response in patients on chemotherapy. Serial B-hCG levels are also helpful in defining the suitable approach and the dosage of chemotherapeutic drugs. Unfortunately, this marker may not be helpful in some cases. Therefore, the present study was conducted to determine the results of the ratio of B-hCG and hyperglycosylated human chorionic gonadotropin (H-hCG) in patients with gestational trophoblastic neoplasia. Materials and methods: This was a cross-sectional study in 22 patients with gestational trophoblastic neoplasia who were referred to an oncology clinic of an academic hospital of Mashhad University of Medical Sciences in Iran from December 2017 to May 2018. Inclusion criteria were plateau level of B-hCG (during 4 weeks) or persistent low level of hCG. After ruling out other etiologies, H-hCG level was measured and the H-hCG/total hCG ratio was evaluated. If the proportion was more than 20%, active gestational trophoblastic neoplasia was diagnosed, and if it was less than 20%, quiescent gestational trophoblastic neoplasia was diagnosed. In patients with active gestational trophoblastic neoplasia, interventional procedures involved a change in the dose intensity or chemotherapy or proposing a surgery. However, only serial follow-up was recommended in patients with quiescent gestational trophoblastic neoplasia. Then, the patients were followed during the therapy and the condition of patients was followed and recorded. Results: The mean age of patients was 31.36 ± 8.01 years. Hydatidiform mole was the most common diagnosis, accounting for approximately 64% (14) of patients. A total of 81% of patients were undergoing chemotherapy. The interval time between the onset of chemotherapy until plateau or persistent low level of hCG was 11.26 ± 4.03 weeks. The mean B-hCG level was 36.6 mIU/mL and the mean H-hCG/total hCG ratio was 6.24%. This proportion was less than 20% in 82% of patients. Among these patients, 14 patients (77.8%) had spontaneously normalized levels of B-hCG during a 6-month follow-up. Two cases underwent chemotherapy due to increased B-hCG. Other patients are still under follow-up without disease progression. Among 4 patients with a H-hCG/total hCG ratio >20%, hysterectomy was recommended to one patient duo to multiparity and the fact that the tumor was localized in the uterus. In the other patients, an increase in the dose of methotrexate or a change of chemotherapy regimen was performed, which caused a decrease in B-hCG level to normal. All patients are still under follow-up without disease progression. Conclusion: The data in this study suggests the use of H-hCG as a tumor marker in patients with persistent low level of B-hCG, which is useful to distinguish between quiescence gestational trophoblastic neoplasia, which does not need treatment, from active gestational trophoblastic neoplasia. However, further studies with larger sample size are needed to confirm and generalize the above findings. Keywords: gestational trophoblastic

scholarly journals A case of unplanned pregnancy at 2 months after uterine curettage in a patient with a hydatidiform mole

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092596
Author(s):  
Jie-Qiong Cao ◽  
Ye Zhao ◽  
Ying Ma ◽  
Qiu-Man Wang ◽  
Li-Na Niu ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Apgar Score ◽  
Unplanned Pregnancy ◽  
Hydatidiform Mole ◽  
Term Pregnancy ◽  
Gonadotropin Level ◽  
Uterine Curettage

Whether an unplanned pregnancy should be terminated during follow-up of a hydatidiform mole is controversial. We report a patient who had an unplanned pregnancy with a hydatidiform mole at 2 months after uterine curettage when the human chorionic gonadotropin level had decreased to a negative value. Hydatidiform mole was confirmed by histopathology. Uterine curettage was performed twice and regular follow-ups were performed after surgery. The patient achieved a full-term pregnancy. The Apgar score of the newborn was 10 at 1, 5, and 10 minutes, and the newborn had no malformations. We conclude that the pregnancy outcome might be good in an unplanned pregnancy when the human chorionic gonadotropin level is negative.

scholarly journals IMMUNOHISTOCHEMICAL LOCALIZATION OF HUMAN CHORIONIC GONADOTROPIN

1962 ◽  
Vol 115 (2) ◽  
pp. 289-294 ◽  
Author(s):  
A. R. Midgley ◽  
G. B. Pierce
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Immunohistochemical Localization ◽  
Formalin Fixation ◽  
Cell Of Origin ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Immunohistochemical Techniques ◽  
Formalin Fixed

Through the use of immunohistochemical techniques, human chorionic gonadotropin has been localized to syncytiotrophoblastic cells of immature placenta, hydatidiform mole, chorioadenoma destruens, and choriocarcinoma. No gonadotropin has been detected in cytotrophoblast. Evidence is discussed which suggests that syncytiotrophoblast is the cell of origin of human chorionic gonadotropin. The observation that formalin fixation did not alter the ability of human chorionic gonadotropin to react with its specific antibody permitted the study of formalin-fixed paraffin-embedded tissues stored in the tissue collection. In addition, the excellence of histologic preparations following formalin fixation facilitated cytologic identification.

scholarly journals Ovarian and Adrenal Androgens and Their Link to High Human Chorionic Gonadotropin Levels: A Prospective Controlled Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
René Rodríguez-Gutiérrez ◽  
Jesús Zacarías Villarreal-Pérez ◽  
Felipe Arturo Morales-Martinez ◽  
René Rodríguez-Guajardo ◽  
Gloria González-Saldivar ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Strong Correlation ◽  
Hydatidiform Mole ◽  
Free Testosterone ◽  
Dehydroepiandrosterone Sulfate ◽  
Controlled Study ◽  
Control Group ◽  
The Difference ◽  
Prospective Longitudinal

Background. Although the association between human chorionic gonadotropin (hCG) and hyperandrogenism was identified more than 40 years ago, relevant questions remain unanswered.Design and Methods. We conducted a prospective, longitudinal, and controlled study in 23 women with a diagnosis of a complete hydatidiform mole (HM).Results. All participants completed the study. Before HM evacuation mean hCG was markedly higher in the cases than in the control group (P≤0.001). Free testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) were found to be higher in the cases (2.78 ± 1.24 pg/mL and 231.50 ± 127.20 μ/dL) when compared to the control group (1.50 ± 0.75 pg/mL and 133.59 ± 60.69 μ/dL) (P=0.0001and 0.001), respectively. There was a strong correlation between hCG and free T/total T/DHEA-S concentrations (r=0.78;P≤0.001,r=0.74;  P≤0.001, andr=0.71;  P≤0.001), respectively. In the cases group 48 hours after HM evacuation, hCG levels were found to be significantly lower when compared to initial levels (P=0.001) and free T and DHEA-S declined significantly (P=0.0002and 0.009).Conclusion. Before uterus evacuation, hCG, free T, and DHEA-S levels were significantly higher when compared with controls finding a strong correlation between hCG and free T/DHEA-S levels. Forty-eight hours after HM treatment hCG levels declined and the difference was lost. A novel finding of our study is that in cases, besides free T, DHEA-S was also found to be significantly higher and both the ovaries and adrenal glands appear to be the sites of this androgen overproduction.

Maternal serum human chorionic gonadotropin level at fifteen weeks is a predictor for preeclampsia

1996 ◽  
Vol 175 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Françoise Muller ◽  
Lionel Savey ◽  
Bernard Le Fiblec ◽  
Laurence Bussières ◽  
Gérard Ndayizamba ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Maternal Serum ◽  
Gonadotropin Level

Clinical Utility of Hyperglycosylated hCG in Serum Taken before Hydatidiform Mole Evacuation to Predict Persistent Trophoblastic Disease

2006 ◽  
Vol 21 (1) ◽  
pp. 45-49 ◽  
Author(s):  
H. Ngo Duc ◽  
N.E. van Trommel ◽  
F.C.G.J. Sweep ◽  
L.F.A.G. Massuger ◽  
C.M.G. Thomas
Keyword(s):  
Diagnostic Accuracy ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Subsequent Development ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Trophoblastic Disease ◽  
Central Registry ◽  
Hydatidiform Moles

Objective Human chorionic gonadotropin (hCG) is widely used in the management of hydatidiform mole and persistent trophoblastic disease (PTD). Studies on hyperglycosylated human chorionic gonadotropin (invasive trophoblast antigen, ITA) in PTD are limited. In serum samples taken before evacuation of molar pregnancies we measured the concentrations of free hCG β-subunit (free hCGβ), “total” hCG (hCG+hCGβ) and ITA, and determined whether ITA, the two other hCG analytes, or the calculated ratios of hCGβ/hCG+hCGβ, hCGβ/ITA and hCG+hCGβ/ITA could predict the later development of PTD. Design A retrospective study based on blood specimens collected in the Dutch Central Registry for Hydatidiform Moles. The study group comprised 97 patients with hydatidiform moles who did not develop PTD after mole evacuation and 33 patients who did develop PTD. Methods Serum samples from 130 patients with hydatidiform mole with or without PTD were assayed using specific (radio)immunoassays for free hCGβ, total hCG, and ITA. From these analytes we also calculated the ratios hCGβ/hCG+hCGβ, hCGβ/ITA, and hCG+hCGβ/ITA. To predict the development of PTD from these analytes and parameters we performed receiver-operating characteristic (ROC) curve analysis, resulting in areas under the curve (AUCs) that represented the diagnostic accuracy which was rated in a range from excellent (AUC >0.9 or <0.1) to poor (AUC 0.4–0.6). Results The diagnostic accuracy of ITA was moderate (0.618) and not different from that of free hCGβ (0.610) and hCG+hCGβ (0.622). Conclusions ITA as well as the other analytes and parameters in serum taken prior to evacuation from patients with molar pregnancies cannot be used to predict the subsequent development of persistent trophoblastic disease.

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