scholarly journals The Controversy of Hydatidiform Mole Treatment In Women age ≥ 40 year-old

Medicinus ◽  
2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Gabriella Farah ◽  
Julita D.L Nainggolan
Keyword(s):  
Older Patients ◽  
Economic Status ◽  
Hydatidiform Mole ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Primary Treatment ◽  
Molar Pregnancy ◽  
Recommended Treatment ◽  
Suction Curettage

<p>Background: Hydatidiform mole or commonly known as molar pregnancy is one of the gestational trophoblastic disease (GTD) caused by an abnormal trophoblast proliferation. About 50% of gestational trophoblast neoplasm (GTN) arises from molar pregnancy. Higher risk of GTN was found in older patient, especially women age ≥40 years old. Management of hydatidiform mole is often faced come challenges, especially in developing country like Indonesia. Although, suction curettage is the most recommended treatment for the evacuation of molar pregnancy, hysterectomy is considerable for women who have completed childbirth and do not wish to preserve their fertility.<br />Case: Here we present case of 48 years old women with hydatidiform mole. Considering the age of the patient and the completion of her childbearing, we decided to do a laparotomy total abdominal hysterectomy for the evacuation of the mole instead of suction curettage. Turned out that this patient had an invasive mole, one of the types of gestational trophoblastic neoplasia.<br />Conclusion: Although suction curettage is the most frequent technique for molar evacuation, hysterectomy is a reasonable option as primary treatment to be performed in older patients and for those who do not wish to preserve their fertility. The other important points such as socio-economic status, education level, and geographical issues should be considered also on managing older patients with hydatidiform mole in developing countries</p>

scholarly journals Recurrent Hydatidiform Mole: A Case Report of Five Consecutive Molar Pregnancies Complicated by Thyrotoxicosis and Review of Literature

2019 ◽  
Vol 34 (1) ◽  
pp. 52-55
Author(s):  
Sabera Khatun
Keyword(s):  
Case Report ◽  
Hydatidiform Mole ◽  
Total Abdominal Hysterectomy ◽  
Normal Pregnancy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Base Hospital ◽  
Diagnostic Work

Hydatidiform mole (HM) is the most common form of Gestational Trophoblastic Disease (GTD). Recurrence of HM is extremely rare. Here we report the case report of a patient with five consecutive complete hydatidiform moles without any normal pregnancy. A 41-years old lady, was referred to Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with H/O repeated molar pregnancies. Her first molar pregnancy was in 2005, second in 2006, third in 2007 & fourth in 2014. All the molar pregnancies were managed by suction evacuation at her base hospital. Following evacuation of 4th molar pregnancy at base hospital, she was referred to BSMMU for subsequent management. Regular follow-up was done using molar card. All the pregnancies were complete hydatidiform mole (CHM) and were confirmed clinically and sonographically. None of the molar pregnancies needed treatment with chemotherapy. During her fifth molar pregnancy she developed shortness of breath and palpitation. Diagnostic work up in our hospital confirmed complete molar pregnancy with thyrotoxicosis, for which she received b-blocker agent and after normalization of thyrotoxicosis, she underwent total abdominal hysterectomy on 11. 10. 18. Now she is on regular follow up by serum bhCG and has no complication. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 52-55

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 Clinical Presentation and Management of Hydatidiform Mole in a Peripheral Tertiary Hospital

2013 ◽  
Vol 25 (2) ◽  
pp. 59-64
Author(s):  
Jaglul Haider Khan ◽  
Jannatul Ferdous ◽  
Samiya Alam
Keyword(s):  
Clinical Presentation ◽  
Economic Status ◽  
Hydatidiform Mole ◽  
Tertiary Hospital ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
College Hospital ◽  
Medical College ◽  
Abnormal Vaginal Bleeding

This study was conducted in Faridpur Medical College Hospital, Faridpur, from January 2008  to December 2008 among fifty patients, diagnosed as a case of molar pregnancy. Incidenc of  molar pregnancy was 8.27 per thousand pregnancy. Sixty percent of the patients were multiparous  and eighty percent of low socio economic status . B positive blood group was prevalent (36%)  in this study.Sixty percent( 60%) of the patients presented with amenorrhoea and abnormal  vaginal bleeding.. Most of the patients (72%) were treated with suction evacuation and curettage.  Of them hemorrhage was the most common immediate complication (80%). Complication  like shock and perforation during evacuation was 14% and 4% respectively. Three patient  (6%) developed Persistent Gestational Trophoblastic Disease(GTD) and one (2%) patient  developed choriocarcinoma with lung metastasis and died. Thirty two (64%) patients attended  for regular follow up but ten patients (20%) had attended irregularly and eight patients (16%)  had dropped out .This study shows that follow up for molar pregnancy cases is not satisfactory  in a district medical college hospital.Further improvement can be done by increasing awareness  of the patients. DOI: http://dx.doi.org/10.3329/bjog.v25i2.13741 Bangladesh J Obstet Gynaecol, 2010; Vol. 25(2) : 59-64  

A Study of Molar Pregnancy at Low Resource Settings of Tertiary Care Hospital Sindh

2021 ◽  
Vol 15 (7) ◽  
pp. 1547-1549
Author(s):  
Sabahat Fatima ◽  
A. G.ul Shaikh ◽  
Tahmina Mahar ◽  
Hameed-Ur-Rehman Bozdar ◽  
Sameena Memon ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Economic Status ◽  
Gestational Trophoblastic Disease ◽  
Common Symptom ◽  
Care Hospital ◽  
Molar Pregnancy ◽  
Socio Economic Status ◽  
Trophoblastic Disease

Aim: To determine the epidemiological factors/characteristics and clinical presentation of molar pregnancy Study design: Qualitative observational / retrospective study Place and duration: Department of Obstetrics and Gynaecology Unit-II, Ghulam Muhammad Mahar Medical College Sukkur from 1st January 2016 to 31st December 2020. Methodology: Forty five diagnosed cases with molar pregnancy and aged between 18-40 years were enrolled. Patient’s details demographics age, body mass index, parity and socio economic status were recorded. The total birth records and gynecological admission for the study period were also collected from the gynaecology and labour room record books case and operational registration data were obtained, descriptive statistics examined . Results: Mean age of the patients was 31.15±7.41 years with mean body mass index 26.16±7.22 kg/m2. Mean gestational age of the patients were 25.62±9.19 weeks. Twenty seven (60%) patients were multiparous and 18 (40%) were primiparous. 30 (66.7%) were illiterate and 15(33.3%) cases were literate. There were 14(31.11%) patients belonged lower class, 18 (40%) patients belonged middle and 13(28.9%) had high socioeconomic status. Twenty nine (64.4%) were from rural area and 16 (35.6%) were from urban area. Five (11.1%) patients had previous history of gestational trophoblastic disease. Abnormal vaginal bleeding was the most common symptom found in 34(75.5%) cases followed by lower abdominal pain found in 30 (66.7%) patients, hyperemesis found in 14(31.1%) and dyspnea in 9 (20%). Thirty six (80%) patients received suction evacuation and 9 (20%) cases referred. Forty one (91.1%) patients were recovered but the rest 4 (8.9%) were lost during follow up. Conclusion: Low/middle socio-economic status, illiteracy and cases from rural areas had multiparous parity was highly effected by molar pregnancy disease and it can be controlled by early diagnose to take regular follow-up by using suction evacuation. Key words: Gestational trophoblastic disease (GTD), Molar pregnancy, Primiparous, Multiparous

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 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 Genetic Screening of Susceptible Women to Recurrent Molar Pregnancy for Prevention of Gestational Choriocarcinomas

2021 ◽  
Author(s):  
Khalil Khashei Varnamkhasti
Keyword(s):  
Hydatidiform Mole ◽  
Gene Mutations ◽  
Clinical Importance ◽  
Recessive Gene ◽  
Middle Layer ◽  
Gestational Trophoblastic Disease ◽  
Compound Heterozygous ◽  
Molar Pregnancy ◽  
Gestational Choriocarcinoma ◽  
Increased Risk

Hydatidiform mole is an abnormal pregnancy characterized by hyper-proliferation of trophoblastic cells (both cytotrophoblast and syncytiotrophoblast). If the proliferation phenomenon not well controlled, e.g. due to poor medical health care system, mole can become invasive and lead to gestational choriocarcinomas. Gestational choriocarcinoma by strong metastatic potentiality, as one of the most aggressive, malignant form of gestational trophoblastic disease, could be spread through directly vascular and the middle layer of the uterine wall (Myometrium‎) and would involve distant sites such as the lungs, spleen, intestines, kidney, and liver. When a hydatidiform mole occurs once, it is known as sporadic hydatidiform mole; if it happens again, the condition is known as recurrent hydatidiform mole. In recurrent form, the gestational choriocarcinoma occurrence risk increased up to a 100-fold. Therefore, early onset identify of susceptible women to recurrent molar pregnancy is clinical importance because of the increased risk of developing neoplasia. Due to the role of maternal homozygous and compound heterozygous recessive gene, mutations have been reported in hydatidiform mole occurrence, women screening can be improved by molecular genotyping methods.

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 Metastatic Uterine Leiomyosarcoma in the Upper Buccal Gingiva Misdiagnosed as an Epulis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Andrea Cassoni ◽  
Valentina Terenzi ◽  
Davina Bartoli ◽  
Oriana Rajabtork Zadeh ◽  
Andrea Battisti ◽  
...  
Keyword(s):  
Lung Metastases ◽  
Muscle Flap ◽  
Surgical Excision ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Local Relapse ◽  
Primary Treatment ◽  
High Rate ◽  
Uterine Leiomyosarcoma ◽  
Temporalis Muscle Flap

Uterine leiomyosarcoma (LMS) is a rare tumor constituting 1% of all uterine malignancies. This sarcoma demonstrates an aggressive growth pattern with an high rate of recurrence with hematologic dissemination; the most common sites are lung, liver, and peritoneal cavity, head and neck district being rarely interested. Only other four cases of metastasis in the oral cavity have been previously described. The treatment of choice is surgery and the use of adjuvant chemotherapy and radiation has limited impact on clinical outcome. In case of metastases, surgical excision can be performed considering extent of disease, number and type of distant lesions, disease free interval from the initial diagnosis to the time of metastases, and expected life span. We illustrate a case of uterine LMS metastasis in the upper buccal gingiva that occurred during chemotherapy in a 63-year-old woman that underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy for a diagnosis of LMS staged as pT2bN0 and that developed lung metastases eight months after primary treatment. Surgical excision of the oral mass (previously misdiagnosed as epulis at a dental center) and contemporary reconstruction with pedicled temporalis muscle flap was performed in order to improve quality of life. Even if resection was achieved in free margins, “local” relapse was observed 5 months after surgery.

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