Does hysteroscopy in women with persistent gestational trophoblastic disease reduce the need for chemotherapy? A prospective, single-arm, clinical trial pilot study

Background This study aimed to describe the efficacy of hysteroscopy in the management of women with the persistent gestational trophoblastic disease (PGTD)/GTN to reduce the need for chemotherapy. Materials and methods This prospective, single-arm, clinical trial study was recruited in an educational referral hospital between September 2018 and September 2019. Totally, 30 participants with a history of hydatidiform mole that was managed by uterine evacuation and developed low risk persistent gestational trophoblastic disease were recruited. Hysteroscopy was performed for removal of persisted trophoblastic tissue. Serum beta-hCG titer was measured before and 7 days after the procedure. Results The mean ± SD age of the participants was 31.4 ± 4.6 years. There was a significant difference (p = 0.06) between that mean ± SD of beta-hCG titer before (8168.4 ± 1758) and after (2648.8 ± 5888) hysteroscopy. Only two (6.6%) cases underwent chemotherapy due to no drop in the beta-hCG titer. Conclusion Hysteroscopy may play a significant role in the management of GTN, although it requires validation in larger prospective randomized studies and longer follow-up.

A RARE CASE OF CHRONIC ECTOPIC PREGNANCY

Chronic ectopic pregnancy is a life threatening condition which is challenging to diagnose, occurs when trophoblastic tissue invades implanted structure causing a protracted destruction at site of attachment, leads to repeated minor bleeding. And with time a haematocele is formed, leading to inflammatory reaction and chronic pelvic adhesions which resemble complex pelvic mass1. Here 25 year old female presented with amenorrhea for 5 weeks with pain in abdomen and was diagnosed to have chronic ectopic pregnancy on MRI.

Does Hysteroscopy in Women with Persistent Gestational Trophoblastic Disease Reduce the Need for Chemotherapy? A Prospective, Single Arm, Clinical Trial Pilot Study

Background: This study aimed to describe the efficacy of hysteroscopy in the management of women with persistent gestational trophoblastic disease to decrease the chemotherapy need.Materials and methods: This prospective, single-arm, clinical trial study was conducted at a tertiary educational referral hospital between September 2018 and September 2019. In the follow-up of the patients diagnosed with hydatidiform mole and managed by uterine evacuation, 30 cases developed low risk persistent gestational trophoblastic disease. Hysteroscopy was performed for removal of persisted trophoblastic tissue, before chemotherapy. Serum beta-hCG titer was measured before and 7 days after the procedure.Results: Mean±SD age of the participants was 31.4±4.6 years. There was a significantly difference (p=0.06) between that mean±SD of beta-hCG titer before (8168.4±1758) and after (2648.8±5888) treatment. Two (6.6%) cases needed chemotherapy due to no decrease in beta-hCG titer. Conclusion: Although, hysteroscopy may play a significant role in the management of persistent gestational trophoblastic disease but requires validation in larger prospective randomized studies and longer follow-up.

Persistent free-floating pelvic trophoblastic cysts following an interstitial ectopic pregnancy

Persistent trophoblast after ectopic pregnancy has been demonstrated at the surgical site or as peritoneal implants. A 37-year-old woman (G5P2) experienced persistently low levels of beta-human chorionic gonadotropin (hCG) after surgical treatment for an interstitial pregnancy. Evaluation for persistent trophoblast, gestational trophoblastic neoplasm and heterophilic antibodies was negative. After 15 months without resolution, she elected for hysterectomy. We found four smooth, freely floating avascular cysts intraoperatively; pathological evaluation identified the cysts as trophoblastic tissue. Serum beta-hCG resolved postoperatively and remained negative at 1 year. Our case demonstrates the novel finding of trophoblastic tissue existing as free-floating cysts in the peritoneal cavity. With appropriate suspicion, these cysts can be identified on radiologic investigation and removed laparoscopically.

Rare primary abdominal ectopic pregnancy in the pouch of Douglas

A 35-year-old Nepalese woman, referred by her general practitioner for per vaginal spotting and abdominal pain for the past 12 days with a background history of 5 weeks of amenorrhoea and a quantifiable beta-human chorionic gonadotrophin of 18 900 IU/L. Subsequent pelvic ultrasound revealed a cystic lesion with peripheral vascularity in the pouch of Douglas indicating possible ectopic pregnancy with no intrauterine gestational sac seen. Subsequent to that, she underwent a diagnostic laparoscopy that revealed 150 mL of blood in the pouch of Douglas with no other obvious evidence of tubal or ovarian ectopic pregnancy seen. There was, however, a resemblance of trophoblastic tissue noted on the wall of the pouch of Douglas that was further investigated to reveal a primary ectopic pregnancy of the pouch of Douglas with no trophoblastic infiltration.

Understanding and management of gestational trophoblastic disease

Gestational trophoblastic disease or neoplasia covers a spectrum of benign and malignant conditions arising from pregnancies with highly abnormal development of trophoblastic tissue. In this brief review, we discuss the different features of these different conditions and their origins and risk factors and introduce some of the more novel and controversial treatment options currently being explored.