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 Choriocarcinoma with uterine rupture presenting as acute haemoperitoneum and shock

2017 ◽  
Vol 6 (3) ◽  
pp. 1141 ◽  
Author(s):  
Mamour Gueye ◽  
Mame Diarra Ndiaye Gueye ◽  
Ousmane Thiam ◽  
Youssou Toure ◽  
Mor Cisse ◽  
...  
Keyword(s):  
Young Woman ◽  
Uterine Rupture ◽  
Gestational Trophoblastic Disease ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Rare Neoplasm ◽  
Trophoblastic Disease ◽  
Intraperitoneal Bleeding ◽  
Invasive Mole

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Invasive mole may perforate uterus through the myometrium resulting in uterine perforation and intraperitoneal bleeding. But uterine perforation due to choriocarcinoma is rare. We present a case of a young woman who presented 1 year after uterine evacuation of a molar pregnancy with invasive choriocarcinoma complicated by a uterine rupture and haemoperitoneum.

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.

Gestational Trophoblastic Disease

2018 ◽  
Author(s):  
Dario R Roque ◽  
Anze Urh ◽  
Elizabeth T Kalife
Keyword(s):  
High Risk ◽  
Chorionic Gonadotropin ◽  
Actinomycin D ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Disease ◽  
High Risk Disease ◽  
Β Hcg ◽  
Invasive Mole

Gestational trophoblastic disease (GTD) represents a group of disorders that derive from placental trophoblastic tissue, including hydatidiform moles, postmolar gestational trophoblastic neoplasia (GTN), and gestational choriocarcinoma. GTN is the most curable gynecologic malignancy and tends to be more common after a complete molar pregnancy than a partial mole. Human chorionic gonadotropin (β-hCG) represents a marker for GTD and should be followed for 6 months after molar pregnancy evacuation to rule out the development of postmolar GTN. GTN is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation. Classification for GTN as low (score ≤ 6) or high risk (score > 7) is based on the World Health Organization prognostic score. This scoring system helps select treatment, which usually entails actinomycin D or methotrexate for low-risk disease and EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) for high-risk disease. These regimens can achieve cure rates approaching 100% and over 90% for low- and high-risk disease, respectively.  This review contains 5 figures, 8 tables and 49 references Key words: choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, invasive mole

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

scholarly journals Gestational trophoblastic neoplasia: Retrospective analysis of clinical profile, treatment pattern and outcome

2016 ◽  
Author(s):  
Paramjeet Kaur ◽  
Ashok K. Chauhan ◽  
Anil Khurana ◽  
Yashpal Verma ◽  
Nupur Bansal
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Hydatidiform Mole ◽  
Single Agent ◽  
High Risk Group ◽  
Treatment Pattern ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Tumor ◽  
Villous Trophoblast ◽  
Invasive Mole

Background: Gestational trophoblastic disease is a spectrum of cellular proliferation arising from the placental villous trophoblast. Gestational triphoblastic neoplasia (GTN) is a collective term for GTD that invade locally or metastasize. GTD includes hydatidiform mole (complete and partial) and GTN include invasive mole, choricocarcinoma, placental site trophoblastic tumor and epitheliod trophoblastic tumor. Aim: To evaluate clinicopathological profile, treatment pattern and clinical outcome in patients with gestational trophoblastic neoplasia (GTN). Materials and Methods: Twelve cases of gestational trophoblastic neoplasia treated between 2012 to November 2015 in deptt of Radiotherapy – II, PGIMS, Rohtak were evaluated in this retrospective study. Data was analyzed on the basis of age, histopathology, stage, type of treatment received and treatment related toxicities. Disease free survival was estimated. Results: Out of 12 women 7 (58 %) had hydatidiform mole, 4 (33%) invasive mole and 01 (8%) had choriocarcinoma. All the cases were given chemotherapy. Two patients had low risk disease. Among high risk group seven patients had score of less than 7 and five patients had risk score of 7 or higher. Five patients were given single agent methotrexate, seven patients received multidrug regimens. All patients are on regular follow up. One patient (high risk group) expired as she did not receive treatment. Conclusion: GTN are rare and proliferative disorders with proper diagnosis and treatment most of the cases are amenable to treatment with favorable outcome.

scholarly journals “It’s not lupus”. A placental site trophoblastic tumor presenting as a lupus-like paraneoplastic syndrome. A grand round case

Lupus ◽  
2021 ◽  
pp. 096120332098176
Author(s):  
Sarah J van der Lely ◽  
Jeffrey Boorsma ◽  
Marc Hilhorst ◽  
Jesper Kers ◽  
Joris Roelofs ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Gestational Trophoblastic Disease ◽  
Grand Round ◽  
Placental Site Trophoblastic Tumor ◽  
Trophoblastic Tumor ◽  
Anchoring Bias ◽  
Placental Site ◽  
History Of

Introduction: Placental site trophoblastic tumor (PSTT) is a rare subtype of gestational trophoblastic disease. Association of PSTT and nephrotic syndrome is exceedingly rare and has been described in 8 cases thus far. In all cases hysterectomy was performed within months after onset of symptoms, leading to immediate remission of nephrotic syndrome, except for one patient who died of complications of PSTT. Case: We describe the history of a woman in which PSTT was discovered years after onset of nephrotic syndrome. Kidney biopsy revealed lupus-like mesangiocapillary nephritis and over time the patient developed additional symptoms mimicking systemic lupus erythematosus (SLE). Discussion: We provide an overview of the literature on this clinical entity and elaborate on its pathophysiology. In addition, we reflect on the phenomenon of anchoring bias, that led physicians to assume the patient had SLE without questioning this diagnosis in the light of the unexplained finding of increased tumor markers.

scholarly journals A Case of Invasive Mole

2017 ◽  
Vol 12 (2) ◽  
pp. 86-87
Author(s):  
Shahana Ahmed ◽  
Dipti Rani Shaha
Keyword(s):  
Hydatidiform Mole ◽  
The Body ◽  
Emergency Laparotomy ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Partial Hydatidiform Mole ◽  
Normal Limits ◽  
History Of ◽  
Invasive Mole

Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole or complete hydatidiform mole, invades the wall of the uterus, potentially spreading and metastasizing to other parts of the body. Here is a case who presented with history of evacuation for molar pregnancy. She presented with irregular P/V bleeding on and off and after admission silent perforation with massive haemoperitoneum was detected for which emergency laparotomy was done. She recovered and was followed up till her b-hCG levels were within normal limits. As patient presented to us with haemoperitoneum and on laparotomy, there was invasion into whole of the uterus, it could not be saved and hysterectomy was done.Faridpur Med. Coll. J. Jul 2017;12(2): 86-87

Gestational trophoblastic neoplasia

2011 ◽  
pp. 1298-1305
Author(s):  
Philip Savage ◽  
Michael J. Seckl
Keyword(s):  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Team Working ◽  
Life Saving ◽  
Placental Site ◽  
Additional Chemotherapy ◽  
Invasive Mole ◽  
Cure Rates ◽  
Prompt Diagnosis ◽  
Hydatidiform Moles

Arising from the cells of conception, gestational trophoblastic disease (GTD) forms a spectrum of disorders from the premalignant complete and partial hydatidiform moles through to the malignant invasive mole, choriocarcinoma and very rare placental site trophoblastic tumours (PSTT). The latter three conditions are also collectively known as gestational trophoblastic neoplasia (GTN) and, although uncommon, are important to recognize as this enables life-saving therapy to be commenced. About 10% of molar pregnancies fail to die out after uterine evacuation and transform into malignant GTN that require additional chemotherapy (1). These cases are usually recognized early and therefore rarely prove difficult to treat, with cure rates approaching 100% reported in most modern series (2). However, GTN can also develop after any type of pregnancy including miscarriages, term deliveries, and medical abortions. Such patients are often not suspected of having GTN and may present late with widespread disease associated with a wide variety of medical, surgical, and gynaecological problems (3). The prompt diagnosis and early effective treatment of these women is aided by an awareness and understanding of these rare, but highly curable malignancies and good team-working between physicians, gynaecologists, pathologists, and oncologists

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.

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