Centralized surveillance of hydatidiform mole: 7-year experience from a regional hospital in China

ObjectiveTo assess the strategy and value of centralized surveillance of hydatidiform mole at a regional hospital in China and to investigate the necessity of prophylactic chemotherapy for high-risk complete hydatidiform mole.MethodsBetween February 2013 and February 2020, all women with hydatidiform mole in Dalian Women’s and Children’s Medical Center (Group) were registered for surveillance and treatment when indicated. Women with complete hydatidiform mole were categorized into low-risk and high-risk groups according to the criteria from Song Hongzhao’s trophoblastic neoplasia. Outcomes and treatments were analyzed retrospectively.ResultsIn total, 703 women with hydatidiform mole were registered for surveillance with a follow-up rate of 97.9% (688/703). 680 women were enrolled and 52 (7.6%) developed post-molar gestational trophoblastic neoplasia, all with low-risk International Federation of Gynecology and Obstetrics (FIGO) scores 0–5. Post-molar gestational trophoblastic neoplasia was diagnosed in 12.3% (51/413) of patients with complete hydatidiform moles and 0.4% (1/263) of patients were diagnosed with partial hydatidiform moles (χ2=32.415, p<0.001). Post-molar gestational trophoblastic neoplasia was diagnosed in 27.7% (28/101) of the high-risk complete hydatidiform mole group and in 7.4% (23/312) of the low-risk complete hydatidiform mole group (χ2=29.196, p<0.001). No difference in the pre-treatment assessments of patients with post-molar gestational trophoblastic neoplasia was found between the low-risk and high-risk complete hydatidiform mole groups (all p>0.05). All 52 patients with post-molar gestational trophoblastic neoplasia were cured, with a complete response rate of 61.2% (30/49) with first-line single-agent chemotherapy.ConclusionsA centralized hydatidiform mole surveillance program is feasible and effective and may improve the prognosis of patients with post-molar gestational trophoblastic neoplasia. Prophylactic chemotherapy is not recommended for women with high-risk complete hydatidiform mole with adequate surveillance.

Interactome Based Identification and Validation of Prefoldin 5α for Prognosing CNS Leukemia in B-All Patients

BackgroundThe gold standard for central nervous system (CNS) B cell acute lymphoblastic leukemia (B-ALL) diagnosis is cerebrospinal fluid (CSF) cytology with poor sensitivity. Thus, prophylactic intrathecal chemotherapy is implemented, which has severe neurological consequences necessitating discovery of CNS leukemia prognostic markers. MethodsTwo-dimensional (2D) far-western interactome analysis was performed to identify CNS+ve/-ve B-ALL CSF reactivity to lymphoblastic proteins profiled on a 2D-western blot. Those specific CNS+ve reacting spots were identified using mass spectrometry. The identified proteins were further validated by both 1D western and ELISA. An ROC curve was generated to identify the cut-off value for prognostication of CNS leukemia in B-ALL patients. ResultsUsing interactome analysis with B-ALL CNS+ve/-ve CSF, we identified prefoldin 5α (PFDN5α), cytokine induced protein 29 (CIP29), enoyl CoA hydratase (ECH1) and peroxiredoxin 6 (PRDX6). Among these proteins, PFDN5α showed statistically significant consistent low reactivity to CNS+ve CSF compared to CNS-ve. Further validation of PFDN5α-CSF reactivity using 1D western and ELISA platform confirmed our interactome analysis. Receiver Operating Characteristic (ROC) curve analysis generated from B-ALL CNS +ve (n = 25) and –ve (n = 40) CSF samples identified PFDN5α-CSF reactivity cut-off value as 0.456. In contrast, CIP29, ECH1 and PRDX6 proteins did not show any differences in CSF reactivity as seen in interactome analysis. ConclusionsUsing far-western interactome approach, we identified the prognostic significance of PFDN5α in predicting CNS leukemia. Further validation by 1D western and ELISA confirmed the significance of differential CSF reactivity of CNS+ve/-ve B-ALL CSF to PFDN5α towards prognostication of CNS leukemia. ROC curve analysis identified the cut-off value for CNS leukemia prediction as 0.456. Values above or below 0.456 could discriminate B-ALL patients either not requiring or requiring intrathecal chemotherapy respectively. Considering the prophylactic chemotherapy associated neurological consequences, PFDN5α-CSF reactivity based prognosis of CNS leukemia is important in avoiding prophylactic intrathecal chemotherapy for the effective clinical management of patients.

Brief History and Advancements of Vaccination Against Avian Coccidiosis: A Review

Coccidiosis is a major protozoal disease that severely affects livestock and other animals, especially poultry. Seven species of Eimeria cause avian coccidiosis in poultry and evolve from the epithelial cells of intestine, readily induce illness and cause death to a varying extent. Prophylactic chemotherapy was a dominant choice for the control of coccidiosis but resistance to the drug was a major factor of therapy failure. Protective immunity was produced in chickens with any of Eimeria species as only species-specific immunity can be produced by recently used vaccines. Attenuation can be achieved by the serial passages in all seven Eimeria species. In chicken, the first attempt against coccidiosis caused the introduction of live oocysts, the basis of which led to the discovery of first live attenuated commercial vaccine, Paracox1. As the emerged recombinant vaccines were replaced as a first choice, there is still a dire need to do more work on new techniques like DNA vaccine formulation along with the role of dendritic cells to produce immunity and cross-protection against avian coccidiosis. This article describes step-by-step developments in the vaccination process from the last 70 years along with a brief discussion on novel techniques to induce immunity against coccidiosis.

The effect of prophylactic chemotherapy on treatment outcome of postmolar gestational trophoblastic neoplasia

Background: Prophylactic chemotherapy (P-chem) was considered as an effective method to prevent malignant transformation of high-risk HM. However, P-chem might increase the risk of subsequent drug resistance and delay the time to diagnosis of gestational trophoblastic neoplasia (GTN). The objective of this study was to evaluate whether P-chem increased the drug resistance rate of postmolar GTN and whether the first-line chemotherapy of low-risk GTN after P-chem should be different from P-chem.Methods: Postmolar GTN were divided into P-Chem group and control group, according to whether they received P-Chem. The control group and P-Chem group were matched according to age, high-risk/low-risk GTN. Postmolar GTN patients without P-chem were randomly selected as the control group at 3:1. The clinical parameters of these patients were collected and compared.Results: Totally 455 low-risk and 32 high-risk postmolar GTN patients were treated at our hospital between 2008.01.01 and 2017.12.31. WHO risk score, chemotherapy cycles to achieve hCG normalization and resistant rate were similar between P-chem (27 cases) and control (81 cases) group, no matter in low-risk or high-risk GTN. Among low-risk GTN patients, interval from hydatidiform mole to GTN was significantly longer in P-chem group than control (44 vs 69 days, P=0.001). Total chemotherapy cycles and resistant rate were similar between low-risk GTN treated with same agent as P-chem (group A) and alternative agent (group B). But group A needed more chemotherapy cycles to achieve hCG normalization than group B, no matter in all 24 GTN received P-chem (4.4 vs 2.8, p=0.024) or in 22 GTN received methotrexate as P-chem (3 vs 2, p=0.004).Conclusions: P-chem delayed the time to GTN diagnosis, but didn’t increase risk score or lead to drug resistance of postmolar GTN. Alternative agent different from P-chem had the potential of increasing chemotherapy response in low- risk postmolar GTN.

Invasive Molar Pregnancy in a Woman Aged 55 Years: A Case Report

BACKGROUND: Gestational trophoblastic diseases (GTDs) are a group of rare human tumors by abnormal trophoblastic proliferation. GTD is neoplasia that develops from the trophoblastic element of blastocyst. In this case, some specific features of the trophoblast are retained, while the hCG (Human Chorionic Gonadotropin) synthesis and invasion potential of the underlying tissues are preserved. CASE REPORT: We reported a 55-year-old patient with invasive (destructive) mole hydatidiform “FIGO I” with invasion in myometrium wall. This diagnostic was suggested by abnormal (dysfunctional) vaginal bleeding, amenorrhea period, and low abdominal pain. Our paraclinical investigation was physical examination, transabdominal, and transvaginal ultrasound and complete blood count. Transabdominal and transvaginal ultrasound reveal enlarged uterus volume, with dimensions 18/12/5 cm and with Doppler rich blood supply through myometrium and endometrium. Therapeutic method applied was abdominal hysterectomy and bilateral salpingo-oophorectomy. Anatomopathological report revealed a complete invasive mole. After the surgical intervention, the patient was no treated with methotrexate as prophylactic chemotherapy (recommended by oncologists) because the level of β-hCG was very low. CONCLUSION: Examining the tissue after a miscarriage in women at extreme ages should raise a suspicion of mole. Molar pregnancy should be excluded in these cases.

Primary T-Cell Lymphoma of The Testis Presenting In A Young Adult

We report the case of a 40-year-old male presented with a painless right testicular swelling. Right radical orchidectomy was performed. The pathological diagnosis was peripheral T-Cell lymphoma-not otherwise specified (PTCL-NOS). According to Ann Arbor staging, the initial clinical stage was IEa. Treating him with four courses of the CHOEP protocol and intrathecal prophylactic chemotherapy was unsuccessful; with the appearance of orbital infiltration and a loco-regional extension. Although the patient started a second line chemotherapy, he unfortunately succumbed to death.