Thyroid Function in Molar Pregnancies

Introduction: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. Vaginal bleeding being the most common occasionally, molar pregnancy is complicated by hyperthyroidism, which may require treatment. Aims: To determine thyroid function test and association of hyperthyroidism among the cases of molar pregnancy. Methods: This is a hospital-based cross-sectional study conducted in the department of Obstetrics and Gynecology, Nepalgunj Medical College and Teaching Hospital, Kohalpur. Sixty cases of molar pregnancy were included during the study period from February 2020 to January 2021.Patients having history of known thyroid disorders were excluded. Results: Prevalence of molar pregnancy in our study was 5.4 per thousand pregnancies in our hospital. Molar pregnancy and hyperthyroidism, both were common in the age group of 21-35 years. Hyperthyroidism was present in 10% patients. Enlarged thyroid was seen in 3.3%, tremor was present in 3.3%, and palpitation in 21.5%. Five (8.3%) patients with hyperthyroidism were underweight. Majority of patients with hyperthyroidism, beta humanchorionic gonadotrophhin level was more than three lakhs and it was mostly associated with complete hydatidiform mole compared to partial hydatidiform mole. Thyroid storm was not experienced in any of the patients. Conclusion: The rate of molar pregnancy is high. Hyperthyroidism in molar pregnancy is not uncommon. High levels of human chorionic gonadotropin, complete hydatiform mole are directly associated with hyperthyroidism. Awareness of this condition is important for diagnosis and treatment to prevent life threatening complications.

Histology and Cell Biology: An Introduction to Pathology 5th Edition 2020

Linking basic science to clinical application throughout, Histology and Cell Biology: An Introduction to Pathology, 5th Edition, helps students build a stronger clinical knowledge base in the challenging area of pathologic abnormalities. This award-winning text presents key concepts in an understandable, easy-to-understand manner, with full-color illustrations, diagrams, photomicrographs, and pathology photos fully integrated on every page. Student-friendly features such as highlighted clinical terms, Clinical Conditions boxes, Essential Concepts boxes, concept mapping animations, and more help readers quickly grasp complex information. Features new content on cancer immunotherapy, satellite cells and muscle repair, vasculogenesis and angiogenesis in relation to cancer treatment, and mitochondria replacement therapies. Presents new material on ciliogenesis, microtubule assembly and disassembly, chromatin structure and condensation, and X chromosome inactivation, which directly impact therapy for ciliopathies, infertility, cancer, and Alzheimer’s disease. Provides thoroughly updated information on gestational trophoblastic diseases, molecular aspects of breast cancer, and basic immunology, including new illustrations on the structure of the T-cell receptor, CD4+ cells subtypes and functions, and the structure of the human spleen. Uses a new, light green background throughout the text to identify essential concepts of histology – a feature requested by both students and instructors to quickly locate which concepts are most important for beginning learners or when time is limited. These essential concepts are followed by more detailed information on cell biology and pathology. Contains new Primers in most chapters that provide a practical, self-contained integration of histology, cell biology, and pathology – perfect for clarifying the relationship between basic and clinical sciences. Identifies clinical terms throughout the text and lists all clinical boxes in the table of contents for quick reference. Helps students understand the links between chapter concepts with concept mapping animations on Student Consult™ – an outstanding supplement to in-class instruction. Student Consult™ eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

Epigenetic Dysregulation of Trophoblastic Gene Expression in Gestational Trophoblastic Disease

Gestational trophoblastic diseases (GTDs) have not been investigated for their epigenetic marks and consequent transcriptomic changes. Here, we analyzed genome-wide DNA methylation and transcriptome data to reveal the epigenetic basis of disease pathways that may lead to benign or malignant GTDs. RNA-Seq, mRNA microarray, and Human Methylation 450 BeadChip data from complete moles and choriocarcinoma cells were bioinformatically analyzed. Paraffin-embedded tissues from complete moles and control placentas were used for tissue microarray construction, DNMT3B immunostaining and immunoscoring. We found that DNA methylation increases with disease severity in GTDs. Differentially expressed genes are mainly upregulated in moles while predominantly downregulated in choriocarcinoma. DNA methylation principally influences the gene expression of villous trophoblast differentiation-related or predominantly placenta-expressed genes in moles and choriocarcinoma cells. Affected genes in these subsets shared focal adhesion and actin cytoskeleton pathways in moles and choriocarcinoma. In moles, cell cycle and differentiation regulatory pathways, essential for trophoblast/placental development, were enriched. In choriocarcinoma cells, hormone biosynthetic, extracellular matrix-related, hypoxic gene regulatory, and differentiation-related signaling pathways were enriched. In moles, we found slight upregulation of DNMT3B protein, a developmentally important de novo DNA methylase, which is strongly overexpressed in choriocarcinoma cells that may partly be responsible for the large DNA methylation differences. Our findings provide new insights into the shared and disparate molecular pathways of disease in GTDs and may help in designing new diagnostic and therapeutic tools.

Spectrum of Gestational Trophoblastic Disease Secondary to Dilation and Evacuation - Our Experience at a Tertiary Care Centre in Mullana, Ambala

BACKGROUND Gestational trophoblastic diseases have varying clinical presentations with certain diagnostic signs and symptoms. A strong correlation between gestational trophoblastic diseases (GTD) and a previous history of dilation & evacuation (D & E) has been documented in the limited available literature. We wanted to study the spectrum of gestational trophoblastic disease secondary to dilation & evacuation. METHODS A two-year study including all the females who were admitted to MMIMSR Hospital in view of suspicion of gestational trophoblastic disease was conducted with all having a common history of dilatation and evacuation in the recent past. RESULTS Through the analysis we saw the spectrum of GTD including partial mole, complete mole, invasive mole and choriocarcinoma, as well as its complications in the form of arterio-venous malformation (AVM). CONCLUSIONS The two-year experience suggests that dilatation and curettage may predispose a female of reproductive age group to develop gestational trophoblastic disease in the future. Hence, a high index of suspicion is necessary for timely diagnosis and intervention. The study further helped us understand the wide spectrum of the disease and its associated complications. KEY WORDS Abortion, AVM, Dilatation and Evacuation, GTD, GTN

INCIDENCE OF TROPHOBLASTIC TUMORS: A RETROSPECTIVE CASE STUDY AT RIMS RANCHI

Background: The gestational trophoblastic diseases encompass a wide range of conditions that vary in their clinical presentation, their propensity for spontaneous resolution, local invasion and metastasis and their overall prognosis. Advanced or adolescent maternal age has consistently correlated with higher rates of complete Hydatidiform mole. Material and Methods: It is a retrospective record based study, performed in Department of pathology RIMS, Ranchi. Study population included all cases which were clinically suspected of gestational trophoblastic disease, with common clinical presentation of abnormal vaginal bleeding, amenorrhea, pain abdomen, from January 2017- December 2020. Results: Hydatidiform mole was found to be the most common form of gestational trophoblastic diseases. Our study shows maximum cases of GTD falls in the age group of 20-29 years followed by 30-39 years.

An invasive mole with pulmonary metastases in a 55-year-old postmenopausal Syrian woman: a case report and review of the literature

Background Invasive mole is a subtype of gestational trophoblastic neoplasms (GTNs) that usually develops from the malignant transformation of trophoblastic tissue after molar evacuation. Invasive moles mostly occur in women of reproductive age, while they are extremely rare in postmenopausal women. Case presentation We present the case of a 55-year-old postmenopausal Syrian woman who was admitted to the emergency department at our hospital due to massive vaginal bleeding for 10 days accompanied by constant abdominal pain with diarrhea and vomiting. Following clinical, laboratory and radiological examination, total hysterectomy with bilateral salpingo-oophorectomy was performed. Histologic examination of the resected specimens revealed the diagnosis of an invasive mole with pulmonary metastases that were diagnosed by chest computed tomography (CT). Following surgical resection, the patient was scheduled for combination chemotherapy. However, 2 weeks later the patient was readmitted to the emergency department due to severe hemoptysis and dyspnea, and later that day the patient died in spite of resuscitation efforts. Conclusion Although invasive moles in postmenopausal women have been reported previously, we believe our case is the first reported from Syria. Our case highlights the difficulties in diagnosing invasive moles in the absence of significant history of gestational trophoblastic diseases. The present study further reviews the diagnostic methods, histological characteristics and treatment recommendations.