scholarly journals Gestational trophoblastic neoplasia (invasive mole) following incomplete abortion- a rare case presenting with uterine perforation with gross hemoperitoneum: A case report

2017 ◽  
Vol 6 (4) ◽  
pp. 63-67
Author(s):  
G Neupane ◽  
S Acharya
Keyword(s):  
Rare Case ◽  
Single Agent ◽  
Emergency Laparotomy ◽  
Uterine Perforation ◽  
Gestational Trophoblastic Neoplasia ◽  
Vacuum Aspiration ◽  
Normal Limits ◽  
Incomplete Abortion ◽  
Beta Hcg ◽  
Invasive Mole

 Invasive mole is gestational trophoblastic neoplasia, characterized by aggressive invasion of the wall of the uterus by the trophoblastic cells. Here, we report a rare case of 17 years primigravida who presented with per vaginal bleeding and uterine perforation with gross hemoperitoneum about 1 month of manual vacuum aspiration of incomplete abortion. Resuscitation followed by emergency laparotomy with subsequent repair of uterine perforation was done. The patient received a total of 5 cycles of single agent chemotherapy (Methotrexate with leukovorin rescue). The beta hCG level became normal after 3 cycles of chemotherapy and further 2 cycles chemotherapy was administered. She was followed up for another 1 year in which her beta hCG levels were within normal limits. 

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 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

scholarly journals UTERINE PERFORATION AS A SEQUEL TO REPEATED CURETTAGE FOR MOLAR

2003 ◽  
Vol 41 (143) ◽  
pp. 401-403
Author(s):  
Bekha Manandhar ◽  
A Rana ◽  
N Pradhan ◽  
A Amatya ◽  
R Sharma
Keyword(s):  
Vaginal Bleeding ◽  
Significant Proportion ◽  
Uterine Perforation ◽  
Gestational Trophoblastic Neoplasia ◽  
Beta Hcg ◽  
Emergency Hysterectomy

An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy for uterine perforation because of repeated dilatation and curettagefor persisting vaginal bleeding following molar evacuation.As significant proportion of molar do progress into Gestational trophoblastic Neoplasiawhich in this case was choriocarcinoma; directs our attention to the fact that properfollow up of post molar cases using at least urinary beta HCG and institutingchemotherapy whenever necessary should be advocated in order to avoid such adrastic management.Key Words: Uterine perforation, molar, Gestational Trophoblastic Neoplasia (GTN)

scholarly journals A case of methotrexate resistant gestational trophoblastic neoplasia

2018 ◽  
Vol 7 (12) ◽  
pp. 5178
Author(s):  
Sanjay Singh ◽  
Akhileshwar Singh ◽  
Shakti Vardhan
Keyword(s):  
High Risk ◽  
Combination Chemotherapy ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Disease ◽  
Peripheral Hospital ◽  
Invasive Mole ◽  
Single Agent Chemotherapy

Gestational trophoblastic neoplasia (GTN) is a subset of gestational trophoblastic disease (GTD) which has a propensity to invade locally and metastasize. Patients with low risk GTN generally respond well to single agent chemotherapy (methotrexate (MTX) or actinomycin-D (ACT-D). However, high risk cases may develop resistance or may not respond to this first-line chemotherapy and are unlikely to be cured with single-agent therapy. Therefore, combination chemotherapy is used for treatment of these cases. Here we present a 25 years old P2 L2 A1 lady, who was initially treated at a peripheral hospital with multiple doses of Injection methotrexate with a working diagnosis of persistent trophoblastic disease. She didn’t respond to this treatment and reported to our centre for further management. On evaluation she was found to be a case of high risk GTN (invasive mole) (I:8) for which she was put on combination chemotherapy in the form of Etoposide-Methotrexate-Actinomycin-Cyclophosphamide-Oncovin (EMA-CO) regime. She responded to this treatment and is presently asymptomatic and is under regular follow up.

scholarly journals The Curative Effect of a Second Curettage in Low-Risk Gestational Trophoblastic Neoplasia

2020 ◽  
Vol 10 (1) ◽  
pp. 88
Author(s):  
Azar Ahmadzadeh ◽  
Mahin Najafian ◽  
Kosar Lalvand
Keyword(s):  
Drug Exposure ◽  
Endometrial Thickness ◽  
Single Agent ◽  
Low Risk ◽  
Gestational Trophoblastic Neoplasia ◽  
Kaplan Meier ◽  
Beta Hcg ◽  
Response To Chemotherapy ◽  
Time Required ◽  
Single Agent Chemotherapy

Background: Gestational trophoblastic neoplasia (GTN), despite its widespread metastases, is a very common cancer in women that is curable. Although the GTN cases show a good response to chemotherapy, in an effort to reduce toxic drug exposure, the second curettage has been suggested for some patients. In the current study, we have aimed to compare the benefits of the second curettage in comparison with single-agent chemotherapy for low-risk GTN patients. Methods: This retrospective observational study was carried out on GTN patients admitted to the gynecology department of Imam Khomeini Hospital in Ahvaz. The demographic profile of all participants was extracted. Patients' hospitalization records were also extracted from the files. Patients with an endometrial thickness above 10 mm were treated with re-curettage. The β hCG clearance time was estimated by the Kaplan Meier plot. Results: In the present study, 148 patients with low-risk GTN stage 1 were studied. The time required for β-hCG clearance in patients undergoing re-curettage was significantly lower than the chemotherapy receiving group (7 months vs. 10 months, p <0.0001). More than 50% of patients treated by re- curettage without needing chemotherapy. Moreover, the other 50% cases needed chemotherapy the number of courses was significantly lower than those received single-agent chemotherapy alone (p <0.0001). The baseline β-hCG levels were significantly lower in those who did not need chemotherapy (p = 0.012). β-hCG resolution occurred more rapidly in patients undergoing re-curettage alone, while, those who received only chemotherapy had a longer duration for β-hCG clearance. Conclusion: In general, the findings of this study showed that re-curettage could be used effectively in the treatment of GTN following molar pregnancy. This treatment reduces or eliminates the need for chemotherapy. Our findings also showed that the initial level of β-hCG could be considered as a predictive factor in response to curettage.

scholarly journals Neglected Primary Omental Pregnancy after Laparoscopic and Medical Treatment: A Difficult Diagnosis?

2013 ◽  
Vol 2013 ◽  
pp. 1-2
Author(s):  
Federica Martelli ◽  
Caterina De Carolis ◽  
Carmelo Parisi ◽  
Emilio Piccione
Keyword(s):  
Preoperative Diagnosis ◽  
Rare Case ◽  
Vital Signs ◽  
Hemodynamic Instability ◽  
Pathological Examination ◽  
Emergency Laparotomy ◽  
Difficult Diagnosis ◽  
Pelvic Organs ◽  
Normal Limits ◽  
Omental Pregnancy

The following case report describes a rare case of omental pregnancy in a fertile 34-year-old woman at 5 + 3 weeks of gestation who presented with abdominal pain. Clinical examination, vital signs, and laboratory values were within normal limits, so the woman was hospitalized and monitored. Laparoscopic exploration was performed according to the preoperative diagnosis of tubal pregnancy, but it showed normal pelvic organs. In view of the growth of theβ-HCG value, a medical approach was attempted, without success. Due to hemodynamic instability, an emergency laparotomy was performed, and it showed an omental pregnancy, confirmed at the pathological examination.

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 Department 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. Result: Out of 12 women 7 (58 %) had hydatidiform mole, 4 (33%) invasive mole and 1 (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 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.

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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