The practicability of FIGO 2000 staging for gestational trophoblastic neoplasia

2004 ◽  
Vol 14 (2) ◽  
pp. 202-205 ◽  
Author(s):  
H. Y. S. Ngan
Keyword(s):  
Solid Tumors ◽  
Classification System ◽  
Major Change ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Multicenter Trials ◽  
History Of Evolution ◽  
History Of ◽  
Risk Scoring ◽  
Criteria For Diagnosis

The FIGO 2000 gestational trophoblastic neoplasia (GTN) staging and classification has recommended three major changes in the management of GTN. The criteria for diagnosis of GTN following molar pregnancy were defined. The methods used for investigation of spread of the disease were recommended. A major change in the concept of FIGO staging in adding risk scoring to anatomical staging is novel but considered essential to best reflect the behavior of this disease which is different from other solid tumors. The history of evolution of this staging and classification system and practical points in applying this system were discussed. If this system would be used worldwide, it would be a big leap in the management of GTN where results can be compared among different centers and large multicenter trials would be possible.

scholarly journals Intramural ectopic pregnancy

2010 ◽  
Vol 18 (1-2) ◽  
pp. 30-31
Author(s):  
Biljana Lazovic ◽  
Vera Milenkovic
Keyword(s):  
Ectopic Pregnancy ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Elevated Serum ◽  
Normal Pregnancy ◽  
Primiparous Woman ◽  
Histopathological Analysis ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
History Of

Gestational trophoblastic neoplasia refers to a subset of gestational trophoblastic conditions characterized with persistently elevated serum ?-human chorionic gonadotropin, absence of a normal pregnancy, and a history of normal or abnormal pregnancies. We described a case of suspected ectopic molar pregnancy in a primiparous woman who had elevated ?-human chorionic gonadotropin and required chemotherapy to achieve remission. Final histopathological finding was ectopic pregnancy; no gestational trophoblastic neoplasia was found. This case stresses the importance of histopathological analysis in diagnosis of gestational trophoblastic neoplasia when ectopic pregnancy is present, considering that histopathological analysis is less sensitive for gestational trophoblastic neoplasia than for ectopic pregnancy.

scholarly journals Case Report: Acute abdomen presentation revealing a metastatic invasive mole with uterine rupture

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1115
Author(s):  
Fatma Dhieb ◽  
Miriam Boumediene ◽  
Armi Saoussem ◽  
Garci Mariem ◽  
Mathlouthi Nabil ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Uterine Rupture ◽  
Pulmonary Nodules ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Tumor ◽  
Clinical Presentations ◽  
History Of ◽  
Invasive Mole

Gestational trophoblastic neoplasia refers to the aggressive subset of gestational trophoblastic disease, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors may have atypical clinical presentations that can mislead the diagnosis. The reported case is a 48-year-old woman in perimenopause, without any history of vaginal bleedings nor molar pregnancy, who presented to the Emergency Department with acute abdominal pain. Serum beta human chorionic gonadotropin (β-HCG) was highly elevated at 261 675.23 mIU/ml. A complicated invasive mole was suspected, and an abdominal computed tomography was performed, showing a moderate hemoperitoneum associated to complex cystic and solid uterine mass, with a common left iliac adenomegaly and multiple pulmonary nodules. MRI showed a multiloculated cystic uterine mass with zones of hemorrhage recalling an invasive mole with perforation of the posterior uterus wall, associated to a high abundance hemoperitoneum. The diagnosis of a metastatic invasive mole complicated of uterine rupture and hemoperitoneum was retained. A surgical intervention was decided immediately and a subtotal hysterectomy with bilateral annexectomy was done. Pathologic examination of the specimen was positive for an invasive mole. The patient was proposed for chemotherapy. This case study will increase awareness of unusual clinical presentations of gestational trophoblastic neoplasia We believe that our case will contribute to the literature not only because of the rarity of this entity in perimenopausal period, but also due the atypical clinical presentation as acute abdomen without vaginal bleeding nor history of molar pregnancy evacuation

scholarly journals A case of invasive mole presenting as perforation uterus and massive haemoperitonium

2016 ◽  
Author(s):  
Arti Sharma
Keyword(s):  
Acute Abdominal Pain ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Distinct Subgroup ◽  
Rare Tumours ◽  
Packed Cell Transfusion ◽  
History Of ◽  
Invasive Mole ◽  
Uterine Fundus

Gestational trophoblastic neoplasia (GTN) are rare tumours that constitute less than 1% of all gynecological malignancies. Invasive mole is a distinct subgroup of GTN, which follows approximately 10-15% of complete hydatiform moles. This is a case of invasive mole presenting as uterine perforation and massive haemoperitonium. The 35 year old parous woman presented with severe pallor, acute abdominal pain and hemoperitonium. She gave history of evacuation of a molar pregnancy four month back. Her serum B-HCG was elevated (80,000 IU/ml). Laprotomy revealed perforation through the uterine fundus with purple discolouration and grapes like vesicle with massive haemoperitonium. Patient was managed by hysterectomy and packed cell transfusion was given. Postoperative followup with B-HCG levels was done and chemotherapy (methotrexate and folinic acid) was given.

Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women

2016 ◽  
Vol 26 (5) ◽  
pp. 984-990 ◽  
Author(s):  
Antonio Braga ◽  
Valéria Moraes ◽  
Izildinha Maestá ◽  
Joffre Amim Júnior ◽  
Jorge de Rezende-Filho ◽  
...  
Keyword(s):  
Natural History ◽  
Early Diagnosis ◽  
Clinical Symptoms ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
History Of

ObjectiveThe aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil.MethodsA retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models.ResultsA downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat molar pregnancy. Although the duration of postmolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia.ConclusionsEarly diagnosis of complete hydatidiform mole has altered the natural history of molar pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.

Women With a Partial Mole During Their First Pregnancy and Diagnosed Earlier in Gestation Are at Increased Risk of Developing Gestational Trophoblastic Neoplasia

2014 ◽  
Vol 24 (5) ◽  
pp. 941-945 ◽  
Author(s):  
Michael J. Worley ◽  
Naima T. Joseph ◽  
Ross S. Berkowitz ◽  
Donald P. Goldstein
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
First Line ◽  
Factors Associated ◽  
Increased Risk ◽  
Partial Mole ◽  
Significant Difference ◽  
History Of

ObjectiveThe aim of this study is to identify factors associated with gestational trophoblastic neoplasia (GTN) after partial molar pregnancy.MethodsWe retrospectively evaluated clinical data from 111 patients with a partial molar pregnancy between 1995 and 2010.ResultsA total of 111 patients with a partial molar pregnancy were available for analysis. There was no significant difference between patients who did and did not develop GTN with respect to patient age, parity, history of prior molar pregnancy, presenting signs/symptoms, uterine size greater than gestational age, clinical diagnosis, preevacuation sonogram findings, or the preevacuation human chorionic gonadotropin value. Patients who developed GTN had fewer prior pregnancies (median, 2 vs 3; P = 0.02) and were more likely to have had a partial molar pregnancy as their first gestational event (37.1% vs 17.1%; P = 0.03). Among the 35 patients who developed GTN, the median time to diagnosis of GTN was 47 days (range, 25–119 days), and the median human chorionic gonadotropin value at the time of GTN diagnosis was 475 mIU/mL (range, 20–52,630 mIU/mL). All women (100%) who developed GTN had stage I disease, and all patients (100%) had low-risk GTN. All 35 women (100%) were able to achieve remission, and most (85.7%) of these patients received methotrexate as first-line chemotherapy.ConclusionsWomen with a partial molar pregnancy as their first gestational event and diagnosed earlier in gestation are more likely to develop postmolar GTN.

THE RISK FACTORS OF MOLAR PREGNANCY

2017 ◽  
pp. 53-58
Author(s):  
Lam Huong Le
Keyword(s):  
High Risk ◽  
Gestational Trophoblastic Disease ◽  
Living Standard ◽  
Control Group ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Health It ◽  
Pregnancy Risk ◽  
History Of ◽  
And Control

Objectives: Molar pregnancy is the gestational trophoblastic disease and impact on the women’s health. It has several complications such as toxicity, infection, bleeding. Molar pregnancy also has high risk of choriocarcinoma which can be dead. Aim: To assess the risks of molar pregnancy. Materials and Methods: The case control study included 76 molar pregnancies and 228 pregnancies in control group at Hue Central Hospital. Results: The average age was 32.7 ± 6.7, the miximum age was 17 years old and the maximum was 46 years old. The history of abortion, miscarriage in molar group and control group acounted for 10.5% and 3.9% respectively, with the risk was higher 2.8 times; 95% CI = 1.1-7.7 (p<0.05). The history of molar pregnancy in molar pregnancy group was 9.2% and the molar pregnancy risk was 11.4 times higher than control group (95% CI = 2.3-56.4). The women having ≥ 4 times births accounted for 7.9% in molar group and 2.2% in control group, with the risk was higher 3.8 times, 95% CI= 1.1-12.9 (p<0.05). The molar risk of women < 20 and >40 years old in molar groups had 2.4 times higher than (95% CI = 1.1 to 5.2)h than control group. Low living standard was 7.9% in molar group and 1.3% in the control group with OR= 6.2; 95% CI= 1.5-25.6. Curettage twice accounted for 87.5%, there were 16 case need to curettage three times. There was no case of uterine perforation and infection after curettage. Conclusion: The high risk molar pregnancy women need a better management. Pregnant women should be antenatal cared regularly to dectect early molar pregnancy. It is nessecery to monitor and avoid the dangerous complications occuring during the pregnancy. Key words: Molar pregnancy, pregnancy women

Methodology of institutional analysis and its implication for contemporary framework of Islamic banks

Humanomics ◽  
2015 ◽  
Vol 31 (2) ◽  
pp. 183-200 ◽  
Author(s):  
Omar Javaid
Keyword(s):  
Islamic Law ◽  
Institutional Analysis ◽  
Institutional Framework ◽  
Methodological Error ◽  
Islamic Banks ◽  
Cultural Changes ◽  
Content Type ◽  
Distribution Of Wealth ◽  
History Of Evolution ◽  
History Of

Purpose – This paper aims to investigate the possibility of a methodological error made by the concerned scholars and academics of Islamic finance & economics to understand and study the modern framework of financial institutions, where they intend to practice Islamic law of contract. This error has led them to expect something which the institutional modern framework of banks, adopted by Islamic banks (for e.g.), wasn’t designed to accomplish, hence the disappointment. Design/methodology/approach – This study reviews the literature on history of evolution of banking industry and the corresponding ideological and cultural changes in the European society which drove this evolution; this is followed by a conceptual analysis to identify the institutional components inconsistent with ethos of Islamic norms and ethos. Findings – After review of history and evolution of modern banking framework, in the light of Hollingsworth frame of institutional analysis, it is inferred that the said framework was designed for a secular, liberal and capitalist society to efficiently and effectively enhance freedom and accumulate capital and wealth, without much regard for equitable distribution of wealth and economic justice. These goals are very much in contrast with the normative premise of Islamic Economics, which cannot be efficiently used to achieve the related objective. This indicates that framework of banking was narrowly understood by the concerned scholars and academics, without considering its history of evolution and intended objectives, before adopting for IBs. Practical implications – The disconnect between the Western institutional framework and ethos of Islam implies that the concerned need to look deeper and holistically while adapting Western institutions, so that necessary alteration is done in advance, if such an adoption is inevitable. Originality/value – This study introduces a new dimension for the concerned scholars, academics and practitioners to reanalyze the institutional framework adopted from the West, so that necessary adjustments can be worked out to make the said framework compatible with the ethos of Islamic economics.

Entre Reforma e Contra-Reforma

1999 ◽  
Vol 7 (14) ◽  
pp. 99-116
Author(s):  
António Moreira Teixeira ◽  
Keyword(s):  
Creative Process ◽  
Major Change ◽  
Important Change ◽  
Artistic Expression ◽  
Divine Inspiration ◽  
History Of ◽  
The Way

By 1576, in order to obtain the censor’s permission to publish his two last treatises, the artist and philosopher Francisco de Holanda was forced to produce a major change in his conception of art. In an anticipation of the trend that was going to spread all over Europe some decades later, he agreed to replace his neo-platonic notion of an art of divine inspiration for a new conception of the artistic expression centred on the aristotelic caracterization of the human creative process. However, in doing that, Holanda paved the way for the development of a true methaphysics of art. In this article, the author intends to establish the network of philosophical influences that made possible this important change of course in the history of european aesthetics, as well as determine its implications.

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