scholarly journals Genetics, molar pregnancies and medieval ideas of monstrous births: the lump of flesh in The King of Tars

2018 ◽  
Vol 45 (1) ◽  
pp. 2-9
Author(s):  
Natalie Goodison ◽  
Deborah J G Mackay ◽  
I Karen Temple
Keyword(s):  
Hydatidiform Mole ◽  
Seed Transmission ◽  
Warning Sign ◽  
Parental Contribution ◽  
Medieval Text ◽  
Hydatidiform Moles

The medieval English romance The King of Tars gives an account of a birth of a lump of flesh. This has been considered as fantastic and monstrous in past literature, the horrific union of a Christian and Saracen. However, while the text certainly speaks to miscegenation, we propose that this lump of flesh is actually a hydatidiform mole. We trace the hydatidiform mole from antiquity, surrounding it with contextual medieval examples, from theology, history and medicine, that also describe abnormal births as ‘lumps of flesh’. By discussing medieval ideas of monsters as a warning sign, we interpret the lump of flesh in terms of abnormal births, seed transmission, parental contribution and sin. Ideas of warning, blame and intervention present themselves as a response to moles both in medieval texts as well as in modern reactions to hydatidiform moles. We explore the epigenetics of hydatidiform moles and relate them to the medieval text. In The King of Tars, the fault for the lump of flesh could reside with either parent; we find that this is also the case in the genetic formation of the hydatidiform mole; we also argue that the epigenetics supports medieval theories of seed transmission.

scholarly journals Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis

2018 ◽  
Vol 142 (12) ◽  
pp. 1485-1502 ◽  
Author(s):  
Brigitte M. Ronnett
Keyword(s):  
Interobserver Variability ◽  
Hydatidiform Mole ◽  
Immunohistochemical Analysis ◽  
Gestational Trophoblastic Disease ◽  
Complete Hydatidiform Mole ◽  
Algorithmic Approach ◽  
Genetic Features ◽  
Polymerase Chain ◽  
Dna Genotyping ◽  
Hydatidiform Moles

Context.— Distinction of hydatidiform moles from nonmolar specimens and subclassification of hydatidiform moles as complete hydatidiform mole versus partial hydatidiform mole are important for clinical practice and investigational studies. Risk of persistent gestational trophoblastic disease and clinical management differ for these entities. Diagnosis based on morphology is subject to interobserver variability and remains problematic, even for experienced gynecologic pathologists. Objectives.— To explain how ancillary techniques target the unique genetic features of hydatidiform moles to establish diagnostic truth, highlight the issue of diagnostic reproducibility and importance of diagnostic accuracy, and illustrate use of p57 immunohistochemistry and polymerase chain reaction–based DNA genotyping for diagnosis. Data Sources.— Sources are the author's 10-year experience using ancillary techniques for the evaluation of potentially molar specimens in a large gynecologic pathology practice and the literature. Conclusions.— The unique genetics of complete hydatidiform moles (purely androgenetic), partial hydatidiform moles (diandric triploid), and nonmolar specimens (biparental, with allelic balance) allow for certain techniques, including immunohistochemical analysis of p57 expression (a paternally imprinted, maternally expressed gene) and genotyping, to refine diagnoses of hydatidiform moles. Although p57 immunostaining alone can identify complete hydatidiform moles, which lack p57 expression because of a lack of maternal DNA, this analysis does not distinguish partial hydatidiform moles from nonmolar specimens because both express p57 because of the presence of maternal DNA. Genotyping, which compares villous and decidual DNA patterns to determine the parental source and ratios of polymorphic alleles, distinguishes purely androgenetic complete hydatidiform moles from diandric triploid partial hydatidiform moles, and both of these from biparental nonmolar specimens. An algorithmic approach to diagnosis using these techniques is advocated.

scholarly journals Pemphigoid Gestationis after Spontaneous Expulsion of a Massive Complete Hydatidiform Mole

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Naoki Matsumoto ◽  
Marie Osada ◽  
Kou Kaneko ◽  
Ken Ohara ◽  
Daito Noguchi ◽  
...  
Keyword(s):  
Hydatidiform Mole ◽  
Vital Signs ◽  
Oral Prednisolone ◽  
Skin Lesions ◽  
Complement C3 ◽  
Entire Body ◽  
Complete Hydatidiform Mole ◽  
Pemphigoid Gestationis ◽  
Spontaneous Expulsion ◽  
Hydatidiform Moles

Pemphigoid gestationis (PG) is a rare, perinatal, autoimmune, and blistering dermatosis. Only few cases of PG involving hydatidiform moles have been reported. Complete hydatidiform moles are usually evacuated by dilatation and curettage. We report a patient with a massive complete hydatidiform mole that underwent spontaneous expulsion; she subsequently developed PG. A 19-year-old unmarried nulligravid woman was referred to our hospital following excessive vaginal bleeding after an uncertain amenorrheal period. The patient presented with preshock vital signs, severe anemia, and a positive urine pregnancy test. Imaging examinations revealed a massive intrauterine mass (19 × 15 × 10 cm), suggesting a complete hydatidiform mole. She was hospitalized and treated with blood transfusion. Sixteen hours after hospitalization, the massive molar mass underwent spontaneous expulsion and bleeding ceased. Three days after the expulsion, she developed pruritic skin lesions including papules, erythemas, and bullae, which spread over her entire body. Skin biopsy revealed PG and subepidermal blister formation and linear complement C3 deposition along the basement membrane zone, and the serum anti-BP180 antibody level was found to be high on measurement. She was effectively treated with 50 mg/day of oral prednisolone. Her skin lesions disappeared, leaving pigmentation.

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.

scholarly journals Successful Primary Treatment of a Hydatidiform Mole with Methotrexate and EMA/CO

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
M. De Vos ◽  
M. Leunen ◽  
C. Fontaine ◽  
Ph. De Sutter
Keyword(s):  
Surgical Treatment ◽  
Complete Remission ◽  
Treatment Option ◽  
Hydatidiform Mole ◽  
Uterine Fibroids ◽  
Treatment Method ◽  
Primary Treatment ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Hydatidiform Moles

Background. The preferred treatment method of most hydatidiform moles is suction aspiration. In rare circumstances uterine abnormalities may preclude surgical treatment.Case. We report a case of complete molar pregnancy successfully treated with methotrexate followed by EMA/CO. A 38-year-old woman with a complete hydatidiform mole and multiple uterine fibroids underwent a failed attempt at suction aspiration. Following treatment with methotrexate, a nonmetastatic persistent trophoblastic tumour developed. Six cycles of EMA/CO led to complete remission.Conclusion. We propose that primary treatment of molar pregnancies with chemotherapy is a useful treatment option in cases where uterine abnormalities interfere with suction aspiration.

scholarly journals Decreasing incidence of registered hydatidiform moles in Denmark 1999–2014

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Helle Lund ◽  
Mogens Vyberg ◽  
Helle Højmark Eriksen ◽  
Anni Grove ◽  
Annette Østergaard Jensen ◽  
...  
Keyword(s):  
Hydatidiform Mole ◽  
Medical Abortion ◽  
Complete Data ◽  
European Countries ◽  
Histopathologic Examination ◽  
Medical Practices ◽  
The World ◽  
Data Source ◽  
Histopathological Type ◽  
Hydatidiform Moles

Abstract Incidences of hydatidiform mole (HM) registered in European countries varies from 0.98/1000 to 2.17/1000 deliveries, while higher incidences have been reported in other parts of the world. We calculated the incidence by selecting data on HMs classified as ”first”, “second” and “third” from 01.01.1999 to 31.12.2014 registered in the Danish Pathology Registry, which we previously showed to be the most complete data source on the number of HMs in Denmark. In the study period, 1976 first HMs were registered; 1080 (55%) were classified as PHMs (partial HMs) and 896 (45%) as NPHMs (HMs not registered as PHMs). The average incidence of HM was 1.98/1000 deliveries. The incidence of PHM was 1.08/1000 deliveries and the incidence of NPHM was 0.90/1000 deliveries. Forty HMs were registered as second HMs; 85% (34/40) were of the same histopathological type as the first HM. The registered incidence of HM decreased from 2.55/1000 deliveries in 1999 to 1.61/1000 deliveries in 2014 (p < 0.005). The decrease in the incidence of HM was identical with a decrease in the incidence of PHM. New medical practices such as medical abortion and only forwarding selected pregnancy products for histopathologic examination may cause a declining number of HMs registered.

Underexpression of 4 Placenta-Associated MicroRNAs in Complete Hydatidiform Moles

2012 ◽  
Vol 22 (6) ◽  
pp. 1075-1080 ◽  
Author(s):  
Quan Na ◽  
Dan Wang ◽  
Weiwei Song
Keyword(s):  
In Situ Hybridization ◽  
Hydatidiform Mole ◽  
Polymerase Chain Reaction Analysis ◽  
Normal Pregnancy ◽  
Differentially Expressed ◽  
Control Group ◽  
Differentially Expressed Mirnas ◽  
Hydatidiform Moles

ObjectiveSeveral placental microRNAs (miRNAs) have been identified as placenta-associated miRNAs with the potential of estimating the condition of the placenta. However, our understanding of these miRNAs is limited. The aim of this study was to determine the expression of 8 placenta-associated miRNAs (miR-512-3p, miR-517a, miR-517b, miR-518b, miR-519a, miR-1185, miR-1283, and miR-1323) in complete hydatidiform mole (CHM).MethodsSamples were obtained from patients with CHM (CHM group, n = 12) and elective terminations of normal pregnancy (control group, n = 20). We detected differentially expressed placenta-associated miRNAs in placenta by quantitative real-time reverse transcriptase–polymerase chain reaction analysis. Subsequently, we assessed the expression location of differentially expressed miRNAs by in situ hybridization analysis.ResultsFour placenta-associated miRNAs (miR-517a, miR-517b, miR-518b, and miR-519a) were underexpressed in the CHM group, compared with the control group (P < 0.01). When further investigating these 4 miRNAs with regard to in vivo localization by in situ hybridization, we found that 2 miRNAs (miR-517b and miR-518b) were detected exclusively in the trophoblast layer, with little signal (if any) observed in villous stroma cells.ConclusionsThe results show that 4 miRNAs (miR-517a, miR-517b, miR-518b, and miR-519a) are deregulated in CHM, which suggests the involvement of these miRNAs in the functions of CHM placenta.

The changes of gene expression profiles in hydatidiform mole and choriocarcinoma with hyperplasia of trophoblasts

2004 ◽  
Vol 14 (5) ◽  
pp. 984-997 ◽  
Author(s):  
J. Q. Cui ◽  
Y. F. Shi ◽  
H. J. Zhou ◽  
J. Q. Li
Keyword(s):  
Gene Expression ◽  
Cell Proliferation ◽  
Cdna Microarray ◽  
Expression Profiles ◽  
Hydatidiform Mole ◽  
Gene Expression Profiles ◽  
Small Subunit ◽  
Altered Expression ◽  
Expression Of Genes ◽  
Hydatidiform Moles

The purpose of this study is to investigate changes of gene expression profiles in hydatidiform moles (HM) and choriocarcinoma and to explore causes of trophoblastic hyperplasia. Using cDNA microarray, 4096 genes were analyzed in two pairs of the tissues of HM versus normal villi and in two pairs of normal primary culture trophoblasts versus JAR cell line of choriocarcinoma. The expressions of two genes in normal villi and HM, as well as in JAR and JEG-3, were examined with the help of immunohistochemistry, immunoblot, and reverse transcriptase-polymerase chain reaction in order to confirm the findings of cDNA microarray. Twenty-four genes were upregulated and 65 genes were downregulated in all HM. Four hundred thirty-three genes were upregulated and 380 genes were downregulated in JAR. Forty-six genes were upregulated in both HM and choriocarcinoma, whereas 13 genes were downregulated. Genes associated with the inhibition of cell proliferation were significantly downregulated, whereas genes associated with cell proliferation, malignant transformation, metastasis, and drug resistance were upregulated. Thymidine kinase-1 (TK-1) and small subunit ribonucleotide reductase (RRM-2) were overexpressed in HM, JAR, and JEG-3. The expressions of TK-1 and RRM-2 in moles were positively correlated with proliferative index of trophoblasts. Our results suggest that altered expression of genes exist in HM and choriocarcinoma. Trophoblastic hyperplasia may be involved in the overexpression of DNA synthetic enzymes.

CLIC1 Protein: A Candidate Prognostic Biomarker for Malignant-Transformed Hydatidiform Moles

2011 ◽  
Vol 21 (1) ◽  
pp. 153-160 ◽  
Author(s):  
Zhong-Hua Shi ◽  
Chun Zhao ◽  
Hong Wu ◽  
Wei Wang ◽  
Xiao-Mei Liu
Keyword(s):  
Malignant Transformation ◽  
Gel Electrophoresis ◽  
Prognostic Biomarker ◽  
Hydatidiform Mole ◽  
Protein A ◽  
Two Dimensional Gel Electrophoresis ◽  
Channel Protein ◽  
Proteomic Approach ◽  
Intracellular Channel ◽  
Hydatidiform Moles

Objectives:The purpose of this study was to identify prognostic biomarkers indicating malignant transformation of hydatidiform moles (HMs).Methods:Two-dimensional gel electrophoresis-based proteomic approach was used to compare the protein profiles of complete benign moles (3 samples) with those of malignant-transformed moles (3 samples). Matrix-assisted laser desorption/ionization time of flight mass spectrometry was used to identify differentially expressed proteins. Western blot was used to verify the results of 2-dimensional gel electrophoresis, and immunohistology was used to explore the function of these proteins in gestational trophoblastic disease.Results:Eighteen proteins, deregulated in the malignant-transformed group compared with the benign group (ratio ≥2;P< 0.05), were identified. A bioinformatic analysis indicated that most of these 18 proteins were involved in the processes of cell proliferation and cell survival. Among the 18 proteins, chloride intracellular channel protein 1 (CLIC1) was chosen for further study. Our results showed that the levels of CLIC1 expression in choriocarcinoma tissue were higher than in complete HM tissue (P< 0.01). Chloride intracellular channel protein 1 expression was increased in the tissues of malignant-transformed HMs compared with nontransformed HMs (P< 0.01).Conclusion:Our findings suggest that CLIC1 could be a potential new prognostic biomarker for hydatidiform mole that undergoes malignant transformation.

Early identification of persistent trophoblastic disease with serum hCG concentration ratios

2008 ◽  
Vol 18 (2) ◽  
pp. 318-323 ◽  
Author(s):  
N. E. Van Trommel ◽  
H. Ngo Duc ◽  
L. F.A.G. Massuger ◽  
C. P.T. Schijf ◽  
C. G.J. Sweep ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Early Identification ◽  
Gold Standard ◽  
Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
Diagnostic Potential ◽  
Central Registry ◽  
Hydatidiform Moles

The objective of the present study was to assess the diagnostic potential of serum human chorionic gonadotropin (hCG) ratios obtained at different intervals after evacuation of hydatidiform mole to diagnose persistent trophoblastic disease (PTD) and to compare its diagnostic accuracy with the current FIGO 2000 criteria as a gold standard. We calculated hCG ratios from serum hCG concentrations of 204 patients (86 with and 118 without PTD) registered with the Dutch Central Registry for Hydatidiform Moles between 1977–2004. The hCG ratios obtained in week 1, 3, and 5 after evacuation identified, respectively, 20%, 52%, and 79% of patients with PTD (median: 3.0 weeks) at the 95% specificity level, while FIGO 2000 criteria identified, respectively, 0%, 16%, and 66% (median: 4.7 weeks). It is concluded that a serum hCG ratio identifies patients with PTD approximately 2 weeks earlier than the internationally accepted FIGO 2000 criteria and identifies more than 75% of patients who develop PTD by the fifth week after evacuation.

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