Doppler study of myometrium in invasive gestational trophoblastic disease

2004 ◽  
Vol 14 (5) ◽  
pp. 972-979 ◽  
Author(s):  
S. Oguz ◽  
A. Sargin ◽  
H. Aytan ◽  
S. Kelekci ◽  
H. Dumanli
Keyword(s):  
Color Doppler ◽  
Single Agent ◽  
Resistance Index ◽  
Myometrial Invasion ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Color Doppler Ultrasound ◽  
Gestational Trophoblastic Disease ◽  
Trophoblastic Disease ◽  
Doppler Study

ObjectiveIn this prospective study, we aimed to assess the prognostic and diagnostic role of color Doppler flow of myometrium in patients with invasive gestational trophoblastic disease (GTD).MethodsThirty-seven patients, who were enrolled in the study with invasive mole, were assessed with the help of transvaginal color Doppler ultrasound before and after chemotherapy. The place and the size of the myometrial invasions were assessed.ResultsThirty patients of 37 were treated with the help of single-agent chemotherapy – methotrexate (mtx). In this group, the resistance index (RI) ratios ranged between 0.26 and 0.45 and the size of the myometrial invasion varied between 10 and 50 mm. On the other hand, six patients were treated with mtx and actinomycin D combination and one patient was treated with the help of total abdominal hysterectomy. In this group, the RI ratios ranged between 0.16 and 0.25 and the size of the myometrial invasion varied between 60 and 90 mm. Remission was achieved in all patients.ConclusionTransvaginal color Doppler study can easily detect invasive GTD. When the depth and the width of the myometrial invasion increase and when there is a low diastolic/systolic ratio, the number of courses and the need for combination of chemotherapy increase.

scholarly journals Coriocarcinoma gestacional primario de cuello uterino. Presentación de un caso

2021 ◽  
Vol 81 (04) ◽  
pp. 406-410
Author(s):  
Viviana García ◽  
◽  
Franco Calderaro Di Ruggiero ◽  
Jorge Hoegl ◽  
Carlos Quintero ◽  
...  
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
World Health ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Gestational Choriocarcinoma ◽  
Gynecology And Obstetrics ◽  
Gynecological Examination

Choriocarcinoma represents a type of malignant tumor of gestational trophoblastic disease. It can develop after a molar pregnancy, miscarriage, normal or ectopic pregnancy. Generally its seat site is the uterine body; infrequent places such as the cervix have been described. We report the case of a 37-year-old patient is reported, VI gestations IV deliveries I cesarean section I molar pregnancy, with abnormal uterine bleeding, which is referred to the Hospital Oncology Service. On gynecological examination, an exophytic mass is observed in the cervix. A biopsy was taken that reported: Gestational choriocarcinoma and plasma levels of β-hCG were verified: 13805 IU / L. A total abdominal hysterectomy was performed with preservation of the ovaries. It was concluded as stage I of the International Federation of Gynecology and Obstetrics and 8, according to the score of the World Health Organization (ST I: 8), for which adjuvant was indicated. Currently no evidence of disease. Keywords: Choriocarcinoma, gestational trophoblastic disease, cervix.

scholarly journals A hydatidiform mole in a postmenopausal woman

2018 ◽  
Vol 7 (6) ◽  
pp. 2500
Author(s):  
Mohana Dhanapal ◽  
. Padmapriya ◽  
Anbarasi Pandian
Keyword(s):  
Postmenopausal Woman ◽  
Elderly Women ◽  
Hydatidiform Mole ◽  
Total Abdominal Hysterectomy ◽  
The Elderly ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Reproductive Age ◽  
Trophoblastic Cell ◽  
Trophoblastic Disease

Gestational trophoblastic disease occurs in less than 1 per 1200 pregnancies. The spectrum of this disease ranges from benign hydatidiform mole to trophoblastic malignancy (placental-site trophoblastic tumor and choriocarcinoma). Benign gestational trophoblastic disease generally occurs in women of reproductive age and is extremely rare in postmenopausal women. We report a case of a 54-year-old postmenopausal woman who underwent an emergency total abdominal hysterectomy due to uncontrollable vaginal bleeding associated with an increased serum β-human chorionic gonadotropin level. The resected uterus contained an endometrial, cystic, grapelike tumor. Microscopic examination demonstrated hydropic degenerated villi with a circumferential trophoblastic cell proliferation and moderate atypia, consistent with a complete hydatidiform mole. Only isolated cases of hydatiform mole in elderly women have been reported in literature. But there still remains a risk of developing gestational trophoblastic disease in the elderly and it should always be included in the differential diagnosis of postmenopausal bleed.

scholarly journals A Rare Case of Epithelioid Trophoblastic Tumor Presenting as Hematoma of a Caesarean Scar in the Lower Uterine Segment

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 34
Author(s):  
Radomir Aničić ◽  
Aleksandar Rakić ◽  
Rastko Maglić ◽  
Dragutin Sretenović ◽  
Aleksandar Ristić ◽  
...  
Keyword(s):  
Normal Values ◽  
Color Doppler ◽  
Color Doppler Imaging ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Doppler Imaging ◽  
Peripheral Blood Flow ◽  
Trophoblastic Tumor ◽  
Trophoblastic Cells ◽  
Beta Human Chorionic Gonadotropin

Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN.

scholarly journals A Rare Gestational Trophoblastic Disease: Placental Site Trophoblastic Tumor

2016 ◽  
Author(s):  
Senem Yaman Tunç ◽  
Elif Ağaçayak ◽  
Mehmet Sait İçen ◽  
Serdar Başaranoğlu ◽  
Mehmet Sıddık Evsen ◽  
...  
Keyword(s):  
Uterine Cavity ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Placental Site Trophoblastic Tumor ◽  
Trophoblastic Tumor ◽  
Trophoblastic Cells ◽  
Placental Site ◽  
Gestational Trophoblastic Diseases ◽  
Abnormal Vaginal Bleeding

<p>Placental site trophoblastic tumor (PSTT) is a highly rare form of gestational trophoblastic diseases that arise from intermediate trophoblastic cells. By presenting this case, we aimed to review the treatment and diagnosis, approach to PSTT.<br />A 31-year-old (G2P1A1L1) patient had abnormal vaginal bleeding. Serum ß-HCG was 5.82 mIU/ml and the transvaginal USG detected a polypoid mass in uterine cavity. Probe curettage was performed. Histopathologic specimens were confirmed as PSTT. No metastasis was detected. A total abdominal hysterectomy was performed.<br />PSTT is a rare tumor. In contrast to other trophoblastic tumors, PSTT produces a small amount of ß-HCG and it is relatively insensitive to chemotherapy. Adjuvant chemotherapy is suggested to follow surgical treatment in the cases with metastasis.</p>

scholarly journals Role of uterine artery Doppler at 12 to 16 weeks of gestation in prediction of pre-eclampsia an observational study

2018 ◽  
Vol 7 (8) ◽  
pp. 3162
Author(s):  
Asha Neravi ◽  
Voorkara Udayashree
Keyword(s):  
Screening Test ◽  
Uterine Artery ◽  
Color Doppler ◽  
Resistance Index ◽  
Early Prediction ◽  
Singleton Pregnancy ◽  
Uterine Artery Doppler ◽  
Non Invasive ◽  
Doppler Study ◽  
Doppler Waveform

Background: Pre-eclampsia affects 2-5% of pregnancies and is a major cause of perinatal and maternal morbidity and mortality. Doppler is a non-invasive method for evaluation of feto-placental circulation without affecting pregnancy. A high resistance index in uterine artery Doppler waveform has been shown to be the best non-invasive screening test. Thus, we have conducted this study to find out the predictive value of transvaginal uterine artery doppler in early pregnancy for the prediction of pre-eclampsia. The aim of the study was early prediction of pre-eclampsia by trans-vaginal uterine artery Doppler study at 12-16 weeks.Methods: According to the study criteria 100 antenatal women between 12 to 16 weeks of singleton pregnancy attending out patient in the Department of OBG of S. D. M. Medical College Dharwad were included. After an informed consent, the women underwent ultrasound for dating and subsequently trans-vaginal ultrasound along with color doppler was performed to obtain uterine artery indices. These women were again rescanned at 24-26 weeks of gestation trans-abdominally and further followed up clinically for development of preeclampsia.Results: Out of 100 women, 22 patients developed preeclampsia. At 12-16 weeks 35% of women had bilateral uterine artery notching, mean RI was 0.57 and PI was 0.89. When uterine artery notch at 12-16 weeks alone was considered, 34.28% of women developed preeclampsia. Detection rate increased to 85.71% when RI>0.65 was also included along with notching. Uterine artery notching at 12-16 weeks gestation had 34.29% sensitivity, 84.62% specificity, 70.51% NPV. When notch and RI>0.65 considered together sensitivity and NPV increases to 85.71% to 98.25%.Conclusions: The uterine artery Doppler waveform indices at 12-16 weeks are the best non-invasive screening test available for early prediction of preeclampsia.

Treatment for Low-Risk Gestational Trophoblastic Disease: Comparison of Single-Agent Methotrexate, Dactinomycin and Combination Regimens

2008 ◽  
Vol 63 (5) ◽  
pp. 306-307
Author(s):  
Renato Antonio Abrão ◽  
Jurandyr Moreira de Andrade ◽  
Daniel Guimarães Tiezzi ◽  
Heitor RicardoCosiski Marana ◽  
Francisco José Candido dos Reis ◽  
...  
Keyword(s):  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
Trophoblastic Disease ◽  
Combination Regimens

Low-Risk Persistent Gestational Trophoblastic Disease: Outcome After Initial Treatment With Low-Dose Methotrexate and Folinic Acid From 1992 to 2000

2002 ◽  
Vol 20 (7) ◽  
pp. 1838-1844 ◽  
Author(s):  
I. A. McNeish ◽  
S. Strickland ◽  
L. Holden ◽  
G. J.S. Rustin ◽  
M. Foskett ◽  
...  
Keyword(s):  
High Risk ◽  
Folinic Acid ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
Trophoblastic Disease ◽  
Number Of Patients ◽  
Second Tumors ◽  
Third Line ◽  
Chemotherapy Patients

PURPOSE: We have simplified the treatment of gestational trophoblastic disease (GTD) in order to reduce the number of patients exposed to potentially carcinogenic chemotherapy. Patients who score 0 to 8 on the Charing Cross scoring system are classified as low-risk and receive methotrexate (MTX) and folinic acid (FA), whereas those who score higher than 8 are classified as high-risk and receive the etoposide, methotrexate, and dactinomycin (EMA)/cyclophosphamide and vincristine (CO) regimen. PATIENTS AND METHODS: Between 1992 and 2000, 485 women with GTD were commenced on MTX/FA at Charing Cross Hospital, London, United Kingdom. If patients developed MTX resistance or toxicity, treatment was altered according to the level of beta human chorionic gonadotropin (hCG). If serum hCG was ≤ 100 IU/L, patients received dactinomycin; if hCG was greater than 100 IU/L, patients received EMA/CO. RESULTS: The median duration of follow-up was 4.7 years. Overall survival was 100% and the relapse rate was 3.3% (16 of 485 patients). hCG values normalized in 324 (66.8%) of 485 patients with MTX alone, whereas 161 (33.2%) of 485 patients required a change in treatment, 11 because of MTX toxicity and 150 because of MTX resistance. Sixty-seven patients changed to dactinomycin, of whom 58 achieved normal hCG values, and nine required third-line chemotherapy with EMA/CO. hCG values normalized in 93 (98.9%) of 94 patients who changed directly to EMA/CO from MTX. CONCLUSION: Single-agent dactinomycin has activity in patients with low-risk GTD who develop MTX resistance and whose hCG is low. Simplifying the stratification of GTD into two classes (low- and high-risk) does not compromise overall outcome and may reduce the risk of second tumors.

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