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

Between 1976 and 1985, at the Obstetrics and Gynecology Department of Milan University, a total of 309 cases of hydatidiform mole, 223 complete moles and 86 partial moles, were monitored with the assay of beta-human chorionic gonadotropin, following a postmolar biochemical surveillance program. Spontaneous remission of the disease occurred in 287 (92.9%) patients. Marker levels were undetectable in 80.4 % of cases within 60 days after evacuation of the mole and in 19.6% between 61 and 140 days. There were 22 (7.1%) patients diagnosed as having gestational trophoblastic tumors (GTT) and treated with chemotherapy: 20 were complete moles and 2 partial moles. Considering these data, the authors suggest different follow-up times for partial and complete moles and confirm the necessity of selection criteria in a diagnosis of GTT.

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Serum levels of pregnancy-specific β1-glycoprotein (SP1) and human chorionic gonadotropin (β-HCG) in women using an intrauterine device

Contraception ◽

10.1016/s0010-7824(86)80008-7 ◽

1986 ◽

Vol 33 (5) ◽

pp. 497-501 ◽

Cited By ~ 4

Author(s):

L. Tamsen ◽

P. Eneroth

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Intrauterine Device ◽

Serum Levels ◽

Β Hcg

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

ISRN Obstetrics and Gynecology ◽

10.1155/2014/494695 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

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.

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Importance of the detection method for intact dimeric human chorionic gonadotropin without interference with the free human chorionic gonadotropin β subunit for pregnancy exclusion before liver transplantation in a woman with cholangiocarcinoma

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2005.150 ◽

2005 ◽

Vol 43 (8) ◽

Cited By ~ 1

Author(s):

Catherine Massart ◽

Catherine Lucas ◽

Nathalie Rioux-Leclercq ◽

Patricia Fergelot ◽

Véronique Pouvreau-Quillien ◽

...

Keyword(s):

Liver Transplantation ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Detection Method ◽

Gastrointestinal Cancers ◽

Cell Secretion ◽

Specific Serum ◽

Trophoblastic Tumors ◽

Β Hcg

AbstractAssay of human chorionic gonadotropin (hCG) is mainly used for the detection and monitoring of pregnancy, and for the follow-up of trophoblastic tumors. The serum free β-hCG subunit (hCGβ) is also a tumor marker in many non-trophoblastic tumors, including gastrointestinal cancers. In this work, we compared the performance of several immunoassays for pregnancy exclusion before liver transplantation and in the follow-up of a woman with cholangiocarcinoma. Serum hCG was detected with the Abbott Testpack plus hCG-Combo and measured with four automated sandwich immunoassays: ADVIA-Centaur, ACS:180, AxSYM and Dimension. hCGβ was determined by an automated fluorescence sandwich immunoassay (Kryptor-Free β hCG) and with a specific immunoradiometric assay (ELSA-F β hCG, Schering). The expression of hCG was also evaluated by immunohistochemistry on sections of intrahepatic cholangiocarcinoma cells and on peritoneal metastases. Before transplantation, discordant results were observed for pregnancy exclusion. Qualitative Testpack and Dimension tests detected no hCG-like immunoreactivity, whereas the ADVIA-Centaur, ACS:180 and AxSYM tests revealed positive levels. The same discrepancy was obtained in follow-up of the patient after liver transplantation. hCGβ assay and immunohistochemical staining revealed tumor cell secretion of hCGβ. In conclusion, a specific serum immunoassay for intact dimeric hCG without cross-reaction with hCGβ should be adopted as routine policy for pregnancy exclusion before liver transplantation.

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Recurrent Molar Pregnancy: An Obstetric Dilemma?

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1043 ◽

2012 ◽

Vol 3 (2) ◽

pp. 63-64 ◽

Cited By ~ 1

Author(s):

Lakshmi Rathna Marakani ◽

Sirisha Rao Gundabattula

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Nulliparous Woman ◽

Molar Pregnancy ◽

Persistent Disease ◽

Beta Human Chorionic Gonadotropin ◽

Β Hcg

ABSTRACT Approximately 1% of women with a molar pregnancy may have a recurrence. Chemotherapy is not indicated for recurrent molar pregnancies. An adequate interconception interval is important to ensure that the serum beta-human chorionic gonadotropin (β-hCG) from a new pregnancy does not interfere with the follow-up of the molar pregnancy that is done to detect persistent disease. We discuss the case of a nulliparous woman who had four molar pregnancies and her future reproductive options. How to cite this article Marakani LR, Gundabattula SR. Recurrent Molar Pregnancy: An Obstetric Dilemma? Int J Infertility Fetal Med 2012;3(2):63-64.

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Serum β-hCG Levels Between 13-20 Weeks Gestation Can Predict Development of Pregnancy Induced Hypertension

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i1.21609 ◽

2018 ◽

Vol 13 (1) ◽

pp. 12-14

Author(s):

Gurpreet Kour ◽

Sandeep Kour

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Predictive Value ◽

Pregnancy Induced Hypertension ◽

Median Score ◽

Pregnant Females ◽

Induced Hypertension ◽

Β Hcg

Aims: To find out predictive value of Serum β Human Chorionic Gonadotropin (β HCG) levels between 13-20 weeks of gestation in predicting the development of pregnancy induced hypertension (PIH) or pre-eclampsia, eclampsia.Methods: Serum β HCG level was estimated in 200 normotensive patients between 13-20 weeks of gestation. The median value of Serum β HCG was calculated and patients were divided into two groups as per two times Multiple of Median (2MOM) values of Serum β HCG i.e. those above and below the 2MOM values. The patients were followed up to delivery and were evaluated for the development of PIH, pre-eclampsia and eclampsia.Results: As per the median score of Serum β HCG in studied patients, the determined value of 2MOM was 30845 mIU/ml. Out of 200 patients, 23 (11.5%) patients were found to have values of Serum β HCG ≥ 2MOM. Twelve (52%) patients in Serum β HCG ≥ 2MOM group developed hypertension on follow up as compared to 13 (7.3%) patients in < 2MOM group (p< 0.0001). Also patients in the ≥ 2MOM group had higher prevalence of maternal and fetal complications.Conclusion: Serum β HCG levels between 13-20 weeks of gestation can predict development of PIH in pregnant females

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Production of human chorionic gonadotropin—β subunit associated with an osteolytic meningioma

Journal of Neurosurgery ◽

10.3171/jns.2002.97.1.0197 ◽

2002 ◽

Vol 97 (1) ◽

pp. 197-199 ◽

Cited By ~ 3

Author(s):

Cheng-shyuan Rau ◽

Jui-wei Lin ◽

Cheng-loong Liang ◽

Tao-chen Lee ◽

Han-jung Chen ◽

...

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Elevated Serum ◽

Immunohistochemical Analysis ◽

Serum Levels ◽

Β Subunit ◽

Content Type ◽

First Case ◽

Β Hcg ◽

Microscopy Examination

✓ An osteolytic meningioma in a 36-year-old woman was accompanied by elevated serum levels of human chorionic gonadotropin—β subunit (β-HCG), which returned to normal after removal of the tumor. Light microscopy examination demonstrated a transitional meningioma. Immunohistochemical analysis revealed that the tumor cells had a positive reaction for β-HCG. This case illustrates the possibility that meningioma may be associated with clinically detectable secretion of β-HCG. To the authors' knowledge, this is the first case in which meningioma has been shown to secrete β-HCG. The authors believe that meningioma should be considered in the differential diagnosis of choriocarcinoma, embryonal cell tumor, germinoma, and metastatic ovarian tumor associated with elevated levels of β-HCG.

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Polypeptide Nicks Cause Erroneous Results in Assays of Human Chorionic Gonadotropin Free β-subunit

Clinical Chemistry ◽

10.1093/clinchem/38.1.26 ◽

1992 ◽

Vol 38 (1) ◽

pp. 26-33 ◽

Cited By ~ 23

Author(s):

Andrew Kardana ◽

Laurence A Cole

Keyword(s):

Down Syndrome ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Hydatidiform Mole ◽

Normal Pregnancy ◽

Cross Reactivity ◽

Beta Subunit ◽

Peptide Bonds ◽

Trophoblastic Disease ◽

Invasive Mole

Abstract Pregnancy and trophoblastic disease testing laboratories measure human chorionic gonadotropin (hCG; human choriogonadotropin) free beta-subunit to screen for Down syndrome and to diagnose persistent trophoblastic disease (invasive mole and choriocarcinoma). The results from various laboratories, however, vary widely for similar groups of patients. Average concentrations of free beta-subunit reported for persistent trophoblastic disease, for instance, range from 2.6% to 37% of total hCG. On hCG and its free beta-subunit, peptide bonds can be missing between beta-subunit residues 44 and 45 or between residues 47 and 48 (nicked molecules). To explore the possibility that the disparity in the reported concentrations of free beta-subunit was due to differences in recognition of nicked molecules by different antibodies, we generated 0% and 100% nicked beta-subunit standards and investigated their recognition in three separate immunoassays of free beta-subunit. The immunoassay with antibody 1E5 did not recognize nicked beta-subunit (4% cross-reactivity with nicked beta-subunit) and thus detected only intact beta-subunit. The immunoassay with antibody FBT11 gave similar results with nicked and nonnicked thus standards (96% cross-reactivity with nicked beta-subunit), as did the assay with antibody B204 (73% cross-reactivity with nicked beta-subunit). These two immunoassays thus measured total (nicked + nonnicked) beta-subunit. We used the three immunoassays to examine sera from normal pregnancy, Down syndrome pregnancy, hydatidiform mole, and persistent trophoblastic disease, all of which contain nicked and nonnicked beta-subunit molecules. The results obtained resembled the studies with nicked beta-subunit standards. The results from the FBT11 and B204 assays (total beta-subunit) were highest, results from the 1E5 assay (intact molecules only) being as much as 10 times lower. We conclude that nicks in beta-subunit and the extent of recognition of nicked molecules by different antibodies affect the concentrations reported for free beta-subunit.

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

QJM ◽

10.1093/qjmed/hcaa056 ◽

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.

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

Current Gynecologic Oncology ◽

10.15557/cgo.2020.0007 ◽

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

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