Application Value of Contrast-Enhanced Ultrasound In The Diagnosis of Intermediate Trophoblastic Tumours

Background: As the rarest gestational trophoblastic neoplasia (GTN), intermediate trophoblastic tumours (ITTs) are very difficult to diagnose before surgery due to the lack of specificity of clinical manifestations. Routine colour Doppler ultrasonography is currently the simplest and reproducible imaging method for diagnosing ITTs, but it is not as specific as other tumours. Through the research and analysis of colour Doppler ultrasound images (CDFI) and contrast-enhanced ultrasonography (CEUS) images of ITTs, the ultrasound characteristics and CEUS perfusion characteristics are summarized, and these findings can provide a reference for the correct diagnosis of ITTs.Methods: Seven ITT patients were diagnosed and treated in our institution from January 2016 to August 2020, and the clinical data of all patients were retrospectively collected and analysed. Two sonographers who had worked for more than 5 years analysed the characteristics of the ultrasound and CEUS. Among them, the characteristics of CEUS are summarized and analysed from the four aspects of contrast enhancement method, time, boundary, and intensity. All cases were diagnosed with pathological support by ITTs.Results: The most common clinical symptoms of ITT are vaginal bleeding and amenorrhea. The serum ß-human chorionic gonadotropin (serum-hCG) level was mainly a low-grade increase, but to determine whether the serum-hCG level can be used as one of the indicators for monitoring ITT recurrence or metastasis, a large sample data analysis is needed. The lesion location, internal echo changes, and blood flow signals of ITTs were not significantly specific compared with those of other GTNs. However, the CEUS performance of ITTs has certain characteristic changes, in which the enhancement mode was mainly regional enhancement, the arterial phase showed slow, equal-slightly high enhancement, and the enhanced bounders were not very clear. Compared with the CEUS performance of other GTNs, it has a certain specificity.Conclusions: Certain characteristic changes in CEUS of ITTs, combined with clinical features, can provide help for the accurate diagnosis of ITT.Trial registration: For non-clinical or non-health care intervention on human participants of what the article reports.

Epithelioid Trophoblastic Tumour: A Case with Genetic Linkage to a Child Born over Seventeen Years Prior, Successfully Treated with Surgery and Pembrolizumab

Epithelioid trophoblastic tumours are rare neoplasms showing differentiation towards the chorion leave-type intermediate cytotrophoblast, with only a handful of cases being reported in the literature. These tumours are slow-growing and are typically confined to the uterus for extended periods of time. While the pathogenesis is unclear, they are thought to arise from a remnant intermediate trophoblast originating from prior normal pregnancies or, less frequently, gestational trophoblastic tumours. A protracted time period between the gestational event and tumour development is typical. This case describes a 49-year-old previously healthy female who presented with a completely asymptomatic uterine mass, discovered incidentally during a routine gynaecological assessment. The pathological analysis of the hysterectomy specimen confirmed an epithelioid trophoblastic tumour, involving the uterus and cervix. This is a rare gynaecological tumour. A comparative short tandem repeat analysis revealed genetic similarities to a previous healthy gestation seventeen years prior. She was successful treated with adjuvant pembrolizumab, with no evidence of disease recurrence to date.

The role of the ultrasound examination in atypical placental site trophoblastic tumour differential diagnosis and management. A case report

Placental site trophoblastic tumour (PSTT) is a very rare and unique form of gestational trophoblastic tumour, representing about 1-2% of all gestational trophoblastic tumours. Usually, the pattern is a slow growing nodule implicating the endometrium and myometrium, accompanied by abnormal uterine bleeding. Three ultrasound types of PSTT are described, but thereis no specific characteristic for diagnosis. We present the case of a patient with an atypical placental site trophoblastic tumour diagnosed two months after a caesarean scar pregnancy. In the presented case there are several particularities, such as the rapid growth and progression of the tumour, the limitation to the myometrium and the difficulty of the differential diagnosis and approach.

Results of treatment of gestational trophoblastic neoplasia in the Slovak Republic in the years 1993–2017

Overview Objective: Gestational trophoblastic neoplasia epidemiology and treatment results in the Slovak Republic in the years 1993–2017. Methods: Retrospective analysis results of gestational trophoblastic neoplasia treatment in the Centre for gestational trophoblastic disease in the Slovak Republic in Bratislava in the years 1993–2017 according to prognostic scoring and staging system FIGO/WHO (International Federation of Gynecology and Obstetrics/World Health Organization). Results: The Centre for Gestational Trophoblastic Disease was created in the Slovak Republic in the year 1993, after the split of former Czechoslovakia. A total of 100 patients with gestational trophoblastic neoplasia were treated in this Centre in the years 1993–2017. According to prognostic scoring and staging system FIGO/ WHO, 74% patients were at a low risk and 26% of patients were at a high-risk of gestational trophoblastic neoplasia. There were 56, 2, 32 and 10% patients in stages I, II, III, and IV, respectively. The total curability and mortality rates were 96 and 4%, respectively. The curability rate 100% was achieved in stages I–III and in all placental site trophoblastic tumours, and the curability rate 60% was achieved in stage IV. In the years 1993 –2017, the incidences were 1 in 59,315 pregnancies and 1 in 42,299 deliveries for choriocarcinoma, 1 in 489,348 pregnancies and 1 in 348,965 deliveries for placental site trophoblastic tumours, 1 in 139,814 pregnancies and 1 in 99,704 deliveries for invasive mole, and 1 in 39,947 pregnancies and 1 in 28,487 deliveries for persistent gestational trophoblastic neoplasia. In the Czech Republic in the same period of time, there were treated 281 (301) patients with the curability rate 98.6% (98.7%). Conclusion: The results of the treatment of gestational trophoblastic neoplasia in the Slovak Republic are comparable with those achieved by leading centers specialized for the treatment of this disease in Europe and in the world. Early detection and centralisation of the treatment are crucial points for successful treatment, as the high curability rate of gestational trophoblastic neoplasia is achieved by effective therapy. Keywords: gestational trophoblastic neoplasia – choriocarcinoma – placental site trophoblastic tumour – epithelioid trophoblastic tumour – invasive mole – curability – mortality – reproductive outcomes

Application value of contrast-enhanced ultrasound in the diagnosis of intermediate trophoblastic tumours

Background Through the research and analysis of colour Doppler ultrasound images (CDFIs) and contrast-enhanced ultrasonography (CEUS) images of intermediate trophoblastic tumours (ITTs), the ultrasound characteristics and CEUS perfusion characteristics are summarized, and these findings can provide a reference for the correct diagnosis of ITTs. Methods Seven ITT patients were diagnosed and treated in our institution from January 2016 to August 2020, and their clinical characteristics and ultrasound image characteristics were studied. Results The most common clinical symptoms of an ITT are vaginal bleeding and menopause. In the study, 6 patients had a history of menopause, 5 patients had irregular vaginal bleeding, and 1 patient was asymptomatic. The serum ß-human chorionic gonadotropin (ß-hCG) level was mainly a low-grade increase, and the average level was approximately 8167 IU/L. However, the ß-hCG level in one patient with lung metastasis was not high (53.2 IU/L), and the ß-hCG level in the other patient with ovarian and bladder metastases was high (55422.2 IU/L). In grey-scale ultrasound, ITTs can be divided into 3 types: type I, where most of the lesions protrude into the uterine cavity (2 patients); type II, where the lesions are partly located in the uterine cavity and partly in the muscle layer (3 patients); and type III, where the lesions are limited to the myometrium (2 patients). The internal echo of the lesion can be divided into solid and cystic-solid echo. CDFI shows that blood flow signals from minimal to abundant. The enhancement mode of CEUS is mainly regional enhancement (5 patients), the arterial phase is mainly slow and equal-slightly high enhancement (6 patients), and the enhancement boundary is not clear (6 patients). Conclusions Certain characteristic changes in CEUS of ITTs, combined with clinical features, can provide help for the accurate diagnosis of ITT.

Placental site trophoblastic tumour: five challenges of patient clinical management

Placental site trophoblastic tumour is a rare form of gestational trophoblastic disease accounting for about 1%–2% of all trophoblastic tumours. Diagnosis and management of placental site trophoblastic tumour can be difficult.We report a case of a 30-year-old woman diagnosed with a placental site trophoblastic tumour and identify the challenges in diagnosis and treatment of this rare situation. The presenting sign was abnormal vaginal bleeding that started 3 months after delivery. Image exams revealed an enlarged uterus with a heterogeneous mass, with vesicular pattern, and the increased vascularisation serum human chorionic gonadotropin level was above normal range. The histological diagnosis was achieved through hysteroscopic biopsy. Staging exams revealed pulmonary micronodules. The patient was successfully treated with hysterectomy and chemotherapy. The latest follow-up (37 months after diagnosis) was uneventful, and the patient exhibited no signs of recurrence or metastasis.