scholarly journals Repeated ultrasound guided local infiltration of methotrexate in persistent gestational trophoblastic disease with myometrial invasion: case series and review of literature

2021 ◽  
Vol 10 (5) ◽  
pp. 2045
Author(s):  
Tamer H. Said ◽  
Yasser Elkerm
Keyword(s):  
Transvaginal Ultrasound ◽  
Hydatidiform Mole ◽  
Case Series ◽  
Myometrial Invasion ◽  
Muscle Layer ◽  
Gestational Trophoblastic Disease ◽  
Local Injection ◽  
Trophoblastic Disease ◽  
Negative Results ◽  
Invasive Mole

Gestational trophoblastic disease is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. An invasive mole is a hydatidiform mole that has grown into the muscle layer of the uterus. Invasive vesicular moles can develop from either partial or complete moles, but complete moles become invasive much more often than do partial moles. Invasive moles develop in a little less than 20% of women who have had a complete mole evacuated. Treatment of invasive mole is classically by giving systemic chemotherapy. Objectives of current study were to evaluate the effect of repeated local methotrexate injection in treatment of invasive mole. Cases with invasive mole assigned for local injection of 50 mg methotrexate in 10 cm normal saline using local injection in the myometrium under transvaginal ultrasound guidance. Follow up weekly till negative results are obtained. All cases showed rapid decrease of the level of b-hCG level after local injection and showed negative hormone results within 6 weeks after injection. Local methotrexate intra-myometrial local injection therapy has successful results in cases with persistent invasive hydatidiform mole and should be tried before referring them for systemic therapy.

scholarly journals Incidence of gestational trophoblastic disease in South Korea: a longitudinal, population-based study

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6490 ◽  
Author(s):  
Jin-Sung Yuk ◽  
Jong Chul Baek ◽  
Ji Eun Park ◽  
Hyen Chul Jo ◽  
Ji Kwon Park ◽  
...  
Keyword(s):  
Hydatidiform Mole ◽  
Malignant Neoplasm ◽  
Gestational Trophoblastic Disease ◽  
Population Based ◽  
Incidence Rates ◽  
Republic Of Korea ◽  
Trophoblastic Disease ◽  
Logistic Analysis ◽  
The Republic ◽  
Invasive Mole

Introduction We investigated the rate and longitudinal trends of gestational trophoblastic disease (GTD) incidence in the Republic of Korea between 2009 and 2015 using population-based data. Materials and Methods Data of patients diagnosed with GTD from 2009 to 2015 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (HIRA-NIS) in the Republic of Korea. The HIRA annually provides the HIRA-NIS, a collection of clinical data from over one million people. For each year, the HIRA-NIS extracted records of 13% of patients admitted at any one time during the year and 1% of all remaining patients using the weighted sample method. Results Medical records of 370,117 women with at least one pregnancy (GTD, ectopic pregnancy, abortion, or delivery) were extracted from a total of 4,476,495 records. Of these, 372 episodes of GTD were identified in women with a mean age of 35.4 ± 0.7 years. The incidence rate of GTD was 130 ± 10 cases per 100,000 pregnancies, which was classified as hydatidiform mole (HM), invasive mole, or malignant neoplasm of the placenta with incidence rates of 110 ± 10, 20 ± 0, or 10 ± 0 cases per 100,000 pregnancies, respectively. Incidence of GTD was lowest among women in their late 20 s and early 30 s. Occurrences of HM accounted for 80.3% all GTD cases. Weighted logistic analysis indicated that while age significantly affected the incidence of GTD (odds ratio (OR): 2.46; 95% confidence interval (CI) [1.79–3.37]; P < 0.001), socioeconomic status did not (OR: 1.94; 95% CI [1.0–3.79]; P = 0.05). Conclusions In the Republic of Korea, we observed overall incidence rates of GTD and HM of 1.3 and 1.1 per 1,000 pregnancies, respectively, which are similar to those reported in recent Western population-based studies. We also noted that annual incidence rates of GTD stabilized from 2009 to 2015.

scholarly journals Gestational Trophoblastic Disease: Review of Cases Managed at B P Koirala Memorial Cancer Hospital

2013 ◽  
Vol 8 (1) ◽  
pp. 18-21
Author(s):  
Jitendra Pariyar ◽  
B Shrestha ◽  
J Shrestha ◽  
J Shrestha ◽  
BP Rauniyar ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Hydatidiform Mole ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Brain Irradiation ◽  
Trophoblastic Disease ◽  
Cancer Hospital ◽  
Invasive Mole ◽  
Multiagent Chemotherapy

Aims: This study was done to analyze the clinical presentation and management outcomes of gestational trophoblastic disease managed at B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal. Methods: Descriptive study was conducted at B.P. Koirala Memorial Cancer Hospital. Case records of all gestational trophoblastic cases from January 2001 to December 2007 were analyzed regarding clinical details, investigations and treatment outcomes. Results: Forty-five cases of 16 to 50 years (mean 29.1 years) had gestational trophoblastic disease, among which 19 (43%) were of Tibeto- Burmese and 15 (33%) Indo-Aryan ethnic group. Hydatidiform mole, invasive mole and choriocarcinoma were observed in 17 (37.8%), six (13.3%) and 22 (48.8%) cases respectively. In seven cases (15.5%) molar pregnancy had occurred in primigravida, seven cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. Vaginal bleeding was the commonest presentation and 26 (57.8%) cases had anaemia. Eleven (24.5%) cases had theca luteal cyst, 17 (37.8%) had lung metastasis and 4 (8.9%) had brain metastasis. Chemotherapy was administered in 34 (75.5%) cases, among which 15 (33.3%) received single agent and 18 (40%) received multiagent chemotherapy. Hysterectomy was done in nine (20%) cases. Brain irradiation was done in a case with brain metastasis. Five (11.2%) cases with high WHO risk score left the hospital against medical advice. There were three (6.6%) mortalities. Thirty-seven (72.1%) cases were in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 18-21 DOI: http://dx.doi.org/10.3126/njog.v8i1.8855

scholarly journals A rare presentation of invasive mole with an arterio-venous malformation: a case report

2020 ◽  
Vol 9 (5) ◽  
pp. 2180
Author(s):  
Atmajit Singh Dhillon ◽  
Vartika Pathak
Keyword(s):  
Case Report ◽  
Venous Malformation ◽  
Hydatidiform Mole ◽  
Emergency Admission ◽  
Gestational Trophoblastic Disease ◽  
Severe Bleeding ◽  
Rare Presentation ◽  
Trophoblastic Disease ◽  
Common Etiology ◽  
Invasive Mole

Gestational trophoblastic disease comprises of various pathologies with hydatid form mole bring a common etiology. Emergency admissions of patients of gestational trophoblastic disease is very rare. Here we present a case report of an emergency admission of patient with hydatidiform mole and severe bleeding and then was managed for the same during the course of hospital stay.

scholarly journals Recurrent hydatidiform mole transformed into invasive mole with co-morbid depression- a rare case report

2017 ◽  
Vol 6 (7) ◽  
pp. 3197
Author(s):  
Nisha Bhagat ◽  
Rajnish Raj
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Placental Site Trophoblastic Tumor ◽  
Trophoblastic Disease ◽  
Placental Site ◽  
Rare Case Report ◽  
Invasive Mole ◽  
Methotrexate Chemotherapy

The gestational trophoblastic disease is a group of interrelated lesions that arise from abnormal proliferation of placental trophoblast. It comprises of hydatidiform mole (partial or complete), invasive mole, placental site trophoblastic tumor and choriocarcinoma. The occurrence of hydatidiform mole in more than two conceptions is known as recurrent hydatidiform mole. Although, its incidence is less than 2% but it may progress to invasive mole or choriocarcinoma. The case of 26-year old female is reported; she had five consecutive molar pregnancies and the sixth one developed into invasive mole with co-morbid depression that was managed by methotrexate chemotherapy, antidepressant and psychotherapy. 

scholarly journals Ultrasound Imaging of Gestational Trophoblastic Disease

2013 ◽  
Vol 7 (1) ◽  
pp. 105-112
Author(s):  
Wayne Tie ◽  
Kathrene Tajnert
Keyword(s):  
Ultrasound Imaging ◽  
Color Doppler ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Accurate Diagnosis ◽  
Abnormal Growth ◽  
Trophoblastic Disease ◽  
Trophoblastic Cells ◽  
Gestational Trophoblastic Diseases ◽  
Invasive Mole

ABSTRACT Gestational trophoblastic diseases (GTD) comprise several entities which all arise due to abnormal growth of trophoblastic cells of the placenta. These disease processes range from benign to malignant. GTD are classified as complete hydatidiform mole, partial mole, invasive mole and choriocarcinoma. The imaging of choice for detecting trophoblastic disease is B-mode ultrasonography and color Doppler. When ultrasonography corresponds with the classic clinical presentation, accurate diagnosis is possible in a majority of cases of GTD. This article goes through several cases of GTD. Each case will demonstrate and review the principles of ultrasound diagnosis of different forms of GTD and apply it to the presented case studies. With early and accurate diagnosis with the help of ultrasonography, the cure rate for GTD is high. How to cite this article Tie W, Tajnert K, Plavsic SK. Ultrasound Imaging of Gestational Trophoblastic Disease. Donald School J Ultrasound Obstet Gynecol 2013;7(1):105-112.

scholarly journals A rare case of invasive mole following evacuation of molar pregnancy and its management

2016 ◽  
Author(s):  
Krati Gandhi ◽  
Pushpa Dahiya
Keyword(s):  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Mri Findings ◽  
Loss To Follow Up ◽  
Abnormal Growth ◽  
Trophoblastic Disease ◽  
Placental Site ◽  
Β Hcg ◽  
Invasive Mole

Introduction: Gestational trophoblastic disease (GTD) is a spectrum of abnormal growth and proliferation of trophoblasts that continue even beyond the end of pregnancy. It comprises of hydatidiform mole, invasive mole, choriocarcinoma and placental site tumor. Invasive mole (Choreoadenoma destruens) comprises about 5-8% of all GTD. It has invasive and destructive potentialities. Case Report: We report a case of 22 yr old female, G3P0A2, with 3 months amenorrhea with c/o pain abdomen since 4 days with no c/o bleeding p/v, with raised level of β hcg after two spontaneous abortions. On clinical examination vitals were stable. P/A ut 16-18 wks, doughy feel, slight tender. P/V os closed, ut 16-18 wks, bpv+. Ultrasonography shows multicystic lesion in cervix and vagina with loss of fat planes with UB. β hcg level was more than 5,00,000. Suction evacuation was done and products sent for histopathology. MRI Pelvis was also done in which invasive mole was diagnosed. 4 doses of inj. Methotrexte f/b folinic acid was given but β hcg levels did not fall by log 10. On histopath there was no evidence of invasive mole but 2nd line chemotherapy (EMACO) was started on the basis of MRI findings. Patient has received 5 cycles of EMACO REGIME with β hcg level being followed and is on decreasing trend, has reached to 5.90 mIU/ml. Conclusion: Patient of molar pregnancy should be followed regularly for early diagnosis of persistent gestational trophoblastic disease and adequate management as loss to follow up patients may land up into complications.

Spectrum of Pathological Lesions in Uterine Specimens with Focus on Gestational Trophoblastic Disease in Karachi

2020 ◽  
Keyword(s):  
Hydatidiform Mole ◽  
Endometrial Stromal Sarcoma ◽  
Gestational Trophoblastic Disease ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
P Value ◽  
Cross Sectional ◽  
Endometrial Polyps ◽  
Trophoblastic Disease ◽  
Proliferative Endometrium

Background: The most common benign pathological lesion in women of reproductive age is uterine leiomyoma. Gestational trophoblastic disease includes tumors and tumor like lesions originating from trophoblastic tissue. The aim of this study was to find the spectrum of molar pregnancy and uterine pathologies focusing on gestational trophoblastic disease as no study has been done in the past few years. Methods: Endometrial and uterine specimens of patients (n=436) between the ages of 15-65 years were collected from a private hospital in Karachi from December 2018 to December 2019. This cross-sectional study was carried out by pathological diagnosis of patients’ samples under light microscopy using hematoxylin and eosin staining. Stratification was done about age and nature of specimen to control the effect modifiers. The post stratification Chi square test was applied and p value <0.05 was considered significant. Results: Mean age of the patients was 36.1 years ±7.8. Total 436 uterine biopsies included 260(59.6%) hysterectomies, 56(12.8%) endometrial curetting’s, 117(26.8%) evacuation specimens and 3(0.7%) polypectomies. Common pathologies included 124(28.4%) leiomyomas, 61(14%) proliferative endometrium, 52(11.9%) adenomyosis and 32(7.3%) endometrial polyps. Gestational trophoblastic disease was seen in 9(2.06%). Seven (87.5%) were partial hydatidiform moles, one (12.5%) exaggerated placental site reaction and one choriocarcinoma. Mole was common between 26-30 years with mean age of 27.2 years and prevalence was 6/100 abortions. Conclusion: Leiomyoma was the commonest (28.4%) uterine pathology followed by proliferative endometrium (14.5%). However, endometrial stromal sarcoma and endometriosis were found 0.2% each. High prevalence of mole was seen in this study. Partial mole was most common and choriocarcinoma was least common. Keywords: Hydatidiform Mole; Pathology; Prevalence.

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.

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