Circulating tumor cells (CTCs) have recently been considered as new prognostic and diagnostic markers for various human cancers; however, their significance in epithelial ovarian cancer (EOC) remains to be elucidated. In this study, using quantitative real-time PCR, we evaluated the expression of EPCAM, MUC1, CEA, HE4 and CA125 mRNAs, as putative markers of CTCs, in the blood of 51 EOC patients before and/or after adjuvant chemotherapy. Our results demonstrated that, before chemotherapy, the expression of EPCAM, MUC1, CEA and HE4 mRNAs were correlated to each other. CEA expression was correlated with tumor stage (r = 0.594, p = 0.000) before chemotherapy, whereas its expression after chemotherapy was correlated with serum levels of CA125 antigen (r = 0.658, p = 0.000). HE4 mRNA showed the highest sensitivity both before and after chemotherapy (82.98% and 85.19%, respectively) and the persistence of this marker after chemotherapy was associated with advanced disease stage. The expression of CA125 mRNA had negative correlation with the other markers and with tumor stage and therapy response (evaluated by the measurement of serum CA125 antigen). Collectively, our results indicated a better clinical significance of tumor-specific markers (CEA and HE4 mRNAs) compared to epithelial-specific markers (EPCAM and MUC1 mRNAs).

Objective: Gestational trophoblastic disease is a term that encompasses a spectrum of disorders all arising from the placenta. Human chorionic gonadotropin (hCG) hormone has an essential role in the diagnosis and management of gestational trophoblastic neoplasia. Measuring beta-hCG (B-hCG) levels is the only standard method of monitoring treatment response in patients on chemotherapy. Serial B-hCG levels are also helpful in defining the suitable approach and the dosage of chemotherapeutic drugs. Unfortunately, this marker may not be helpful in some cases. Therefore, the present study was conducted to determine the results of the ratio of B-hCG and hyperglycosylated human chorionic gonadotropin (H-hCG) in patients with gestational trophoblastic neoplasia. Materials and methods: This was a cross-sectional study in 22 patients with gestational trophoblastic neoplasia who were referred to an oncology clinic of an academic hospital of Mashhad University of Medical Sciences in Iran from December 2017 to May 2018. Inclusion criteria were plateau level of B-hCG (during 4 weeks) or persistent low level of hCG. After ruling out other etiologies, H-hCG level was measured and the H-hCG/total hCG ratio was evaluated. If the proportion was more than 20%, active gestational trophoblastic neoplasia was diagnosed, and if it was less than 20%, quiescent gestational trophoblastic neoplasia was diagnosed. In patients with active gestational trophoblastic neoplasia, interventional procedures involved a change in the dose intensity or chemotherapy or proposing a surgery. However, only serial follow-up was recommended in patients with quiescent gestational trophoblastic neoplasia. Then, the patients were followed during the therapy and the condition of patients was followed and recorded. Results: The mean age of patients was 31.36 ± 8.01 years. Hydatidiform mole was the most common diagnosis, accounting for approximately 64% (14) of patients. A total of 81% of patients were undergoing chemotherapy. The interval time between the onset of chemotherapy until plateau or persistent low level of hCG was 11.26 ± 4.03 weeks. The mean B-hCG level was 36.6 mIU/mL and the mean H-hCG/total hCG ratio was 6.24%. This proportion was less than 20% in 82% of patients. Among these patients, 14 patients (77.8%) had spontaneously normalized levels of B-hCG during a 6-month follow-up. Two cases underwent chemotherapy due to increased B-hCG. Other patients are still under follow-up without disease progression. Among 4 patients with a H-hCG/total hCG ratio >20%, hysterectomy was recommended to one patient duo to multiparity and the fact that the tumor was localized in the uterus. In the other patients, an increase in the dose of methotrexate or a change of chemotherapy regimen was performed, which caused a decrease in B-hCG level to normal. All patients are still under follow-up without disease progression. Conclusion: The data in this study suggests the use of H-hCG as a tumor marker in patients with persistent low level of B-hCG, which is useful to distinguish between quiescence gestational trophoblastic neoplasia, which does not need treatment, from active gestational trophoblastic neoplasia. However, further studies with larger sample size are needed to confirm and generalize the above findings. Keywords: gestational trophoblastic

Objective: The presence of a normal fetus with normal karyotype accompanied by molar changes in the placenta is a rare condition, which carries a significant risk to the mother and fetus. There is a controversy regarding the proper management of this condition. Here, we present the case of a singleton pregnancy that showed molar changes in the pathological study of the placenta, but ended up with a normal viable neonate. Case Report: A 23-year-old primigravida woman, with a 3-year history of infertility, presented with vaginal bleeding and spotting. Her ß-human chorionic gonadotropin (HCG) at 13th week was 36500 mIU/ml. Serial sonography assessments were suggestive for molar changes and a normal fetus with growth retardation but normal Doppler assessment. The patient underwent elective Cesarean section at 37 weeks gestation and a healthy female neonate with an Apgar score of 9-10, weighing 2270 g was born. Pathological assessment of the placenta confirmed the diagnosis of incomplete hydatidiform mole. After two months, the mother had no complications, her ß-HCG level was untraceable, and the infant was in good condition. Conclusion: Despite being a rare condition, partial moles can be accompanied by delivery of a normal fetus. The management of this condition still remains challenging and should be done under close monitoring with extreme caution.