scholarly journals The Value of Hysteroscopy in Women with Persistently Elevated Post-Evacuation Serum Human Chorionic Gonadotropin (hCG) Level Following Evacuation of Molar Disease

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A H Bakhat ◽  
S T Fayed ◽  
A M Ibrahim ◽  
A H Naguib ◽  
M A Faris
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Gynecologic Oncology ◽  
Hydatidiform Mole ◽  
Elevated Serum ◽  
Serum Levels ◽  
Gestational Trophoblastic Disease ◽  
Invasive Disease ◽  
Maternity Hospital ◽  
Postoperative Serum

Abstract Background and rational Gestational trophoblastic disease (GTD) is a spectrum of trophoblastic diseases that encompass the hydatidiform mole (both complete and partial), as well as the potentially-malignant and malignant forms: invasive mole, choriocarcinoma and placental site trophoblastic tumor. Gestational trophoblastic neoplasia (GTN) refers to persistent elevation of serum levels of human chorionic gonadotropin (hCG). The subsequentmanagement of GTD after evacuation of the uterus relies on serial surveillance of serum hCG levels. When serum hCG levels plateau or rise, chemotherapy should promptly be initiated. Patients and Methods This study for accuracy of a diagnostic test. The current study was conducted at Gynecologic Oncology Unit and Early Cancer Detection Unit at Ain Shams University Maternity Hospital during the period between January 2016 and June 2018. Results In the present study, the case who had a vascular mass, the patient was 44 years old and she was para 4, so board decision was for TAH. Postoperative serum hCG surveillance for this case showed adequately declining levels. She, accordingly, did not receive chemotherapy. For the 19/44 (43.2%) cases who had a hysteroscopic finding of ‘an empty cavity’ were diagnosed as persistent GTN and received chemotherapy according to the protocol. The remaining 25/44 (56.8%) cases, who had a hysteroscopic finding of ‘remnants’, underwent re-evacuation. Postoperative serum hCG surveillance showed persistently elevated levels in 9/44 (20.5%) cases, who, therefore, received chemotherapy according to the protocol; and adequately declining levels in 16/44 (36.4%) cases, who, accordingly, did not receive chemotherapy. Conclusion The hysteroscopy significantly reduced the risk of chemotherapy in women with hydatidiform mole and have persistent post-evacuation elevated serum hCG level and sonographic criteria of invasive disease.

scholarly journals A Case of Rapid Transformation from Hydatidiform Mole to Invasive Mole: The Importance of β-hCG (Human Chorionic Gonadotropin) Serum Levels in Follow-Up Evaluation

2021 ◽  
Vol 22 ◽  
Author(s):  
Ali Budi Harsono ◽  
Yudi Mulyana Hidayat ◽  
Gatot Nyarumenteng Adhipurnawan Winarno ◽  
Aisyah Shofiatun Nisa ◽  
Firas Farisi Alkaff
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Serum Levels ◽  
Β Hcg ◽  
Invasive Mole ◽  
Rapid Transformation

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 Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1038-1042
Author(s):  
Yan Wan ◽  
Guoqing Jiang ◽  
Ying Jin ◽  
Zengping Hao
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Optimal Treatment ◽  
Perimenopausal Woman ◽  
Trophoblastic Disease ◽  
Reproductive Females

Abstract Gestational trophoblastic disease (GTD) commonly occurs in reproductive females, but is extremely rare in perimenopausal females. In this study, we reported a case of hydatidiform mole in a 48-year-old perimenopausal female admitted due to a giant uterine mass of 28 weeks’ gestational size. The serum human chorionic gonadotropin (HCG) level ranged from 944 to 1,286 mIU/mL before treatments. The signs of preeclampsia and hyperthyroidism were relatively prominent. Hysterectomy was performed and chemotherapy was scheduled when the serum HCG level remained at a plateau, about 528 mIU/mL. The symptoms of preeclampsia and hyperthyroidism were relieved after treatment. Accordingly, we concluded that GTD could occur in perimenopausal woman and hysterectomy usually is the optimal treatment.

scholarly journals Human chorionic gonadotropin (hCG) beta-core fragment is produced by degradation of hCG or free hCG beta in gestational trophoblastic tumors: a possible marker for early detection of persistent postmolar gestational trophoblastic disease

2001 ◽  
Vol 171 (3) ◽  
pp. 435-443 ◽  
Author(s):  
T Okamoto ◽  
K Matsuo ◽  
R Niu ◽  
M Osawa ◽  
H Suzuki
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Culture Media ◽  
Hydatidiform Mole ◽  
Subsequent Development ◽  
Gestational Trophoblastic Disease ◽  
Gel Chromatography ◽  
Trophoblastic Disease ◽  
Core Fragment ◽  
Trophoblastic Tumors

The present study was undertaken to investigate whether human chorionic gonadotropin (hCG) beta-core fragment (hCG beta cf) was directly produced by gestational trophoblastic tumors. Immunoreactivity of hCG beta cf was demonstrated in the extracts as well as in the culture media of hydatidiform mole tissues. It was also present in the extracts of choriocarcinoma tissues, and its molar concentration exceeded that of intact hCG. The presence of hCG beta cf was then confirmed by gel chromatography and Western blot analysis. Immunohistochemistry showed localization of hCG beta cf immunoreactivity to the syncytiotrophoblasts and scattered cells in the stroma of mole tissue, and to syncytiotrophoblastic cells in choriocarcinoma. Immunoreactivity of hCG beta cf was also detected in the sera of the patients with gestational trophoblastic disease, although the hCG beta cf/hCG ratio was less than one hundredth of that in the tissue extracts. Serial measurement of serum hCG beta cf levels after mole evacuation showed that they declined much more rapidly than those of hCG and became undetectable in the patients with subsequent spontaneous resolution, while hCG beta cf remained or became detectable before the rise of hCG was observed in the patients with subsequent persistent trophoblastic disease. Taken together, these results suggest that hCG beta cf is directly produced by gestational trophoblastic tumors, and monitoring of hCG beta cf in the serum after mole evacuation may be useful for early prediction of subsequent development of postmolar persistent trophoblastic disease.

A case of a hydatidiform mole in a 56-year-old woman

2005 ◽  
Vol 15 (1) ◽  
pp. 163-166
Author(s):  
C. A. R. Lok ◽  
A. F. ZüRCHER ◽  
J. Van Der Velden
Keyword(s):  
Risk Factors ◽  
Older Women ◽  
Thyroid Function ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Older Patients ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Trophoblastic Disease ◽  
Proper Diagnosis

A case of a 56-year-old woman with a mole pregnancy and a human chorionic gonadotropin (HCG)-induced thyreotoxicosis is presented. A proper diagnosis was only made after a period of patient and doctor's delay. After performing a hysterectomy, the HCG quickly normalized. Thyroid function normalized with thiamazol treatment. It is well known that older women have a higher risk to develop gestational trophoblastic disease (GTD). Furthermore, the chance of persistent trophoblastic disease is increased in this population. The literature on risk factors for developing persistent GTD and the possibilities for treatment in older patients is reviewed.

Comparison of 2 Human Chorionic Gonadotropin Immunoassays Commercially Available for Monitoring Patients With Gestational Trophoblastic Disease

2017 ◽  
Vol 27 (7) ◽  
pp. 1494-1500
Author(s):  
Rafael Sanches dos Santos ◽  
Juliana Maria Quinalha de Souza ◽  
Antonio Braga ◽  
Marcos Montanha Ramos ◽  
Rafael Cortés-Charry ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Clinical Management ◽  
Hydatidiform Mole ◽  
Spontaneous Remission ◽  
Gestational Trophoblastic Disease ◽  
Management Decisions ◽  
Serum Samples ◽  
Trophoblastic Disease ◽  
Significant Difference

ObjectiveThe aim of this study was to compare serum human chorionic gonadotropin (hCG) levels in patients with gestational trophoblastic disease (GTD) using 2 commercially available hCG immunoassays.MethodsSerum samples were obtained from patients with GTD attending the Botucatu Medical School Trophoblastic Diseases Center of São Paulo State University (UNESP), from November 2014 to October 2015. Serum hCG levels were measured with both Architect i2000SR and Immulite 2000 XPi chemiluminescence assays. Serum hCG levels were compared against the null hypothesis. Agreement in clinical management decisions based on the hCG results was determined by comparing baseline hCG measurements and the hCG curves obtained with both assays.ResultsSeventy-three patients with GTD were included in the analysis. Of these, 45 had hydatidiform mole and spontaneous remission, whereas 28 had gestational trophoblastic neoplasia (GTN). There was a perfect (zero difference) agreement in mean hCG levels between Immulite 2000 XPi and Architect i2000 when hCG is less than 100 mIU/mL. For hCG values greater than 100 mIU/mL, there was a significant difference between assays (P< 0.05), with levels measured via Architect i2000SR being higher than those measured by Immulite 2000 XPi in patients with hydatidiform mole/spontaneous remission (R2= 90%,P< 0.01) and GTN (R2= 98%,P< 0.01). Baseline clinical management decisions showed agreement in 100% (73/37) of cases (κ = 1.0,P< 0.001), whereas decisions based on hCG curve agreed in 98% (71/72) of cases (κ = 0.93,P< 0.001).ConclusionsImmulite 2000 XPi is the most frequently recommended assay for diagnosing and monitoring patients with GTD. However, our results suggest that because Immulite 2000 XPi and Architect i2000 show very similar performance in measuring hCG levels and in determining clinical management, Architect may be used as an alternative.

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