Gestational trophoblastic disease: an update on pathology, diagnosis and stateof- the-art management

Mangili, Giorgia; Cioffi, Raffaella; Bergamini, Alice; Sabetta, G.; Vasta, Francesca; Candotti, Giorgio; Rabaiotti, Emanuela; Petrone, Micaela; Taccagni, Gianluca; Bocciolone, Luca; Candiani, Massimo

doi:10.36129/jog.33.02.03

Cited by 4 publications

(6 citation statements)

References 67 publications

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“…Moreover, other clinical scenarios could benefit from minimally invasive technology, until the most rare and unusual complications such as sigmoidal pregnancy which may origin also a viable pregnancy [19]. In conclusion, CSP remains a challenging case to diagnose and manage and high index of suspicion [20] is required to allow early initiation of management. In the absence of clear guidelines for treatment, individualized plans are recommended.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of a 13 weeks viable ectopic cesarean section Scar pregnancy: a case report

Sleiman¹,

Feghali²,

Daccache³

et al. 2022

Ital J Gynaecol Obstet

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Background. Cesarean scar ectopic pregnancy is a rare type of life-threatening pregnancy whereby the embryo implants on a uterine scar, due to a previous cesarean section. It accounts for about 4.2% of total ectopic pregnancies. It is very rare that an ectopic scar pregnancy arrives undetected up to 13 weeks, but this is the case of some patients, not regularly scanned during the early pregnancy. The objective of our case report is to present a novel conservative laparoscopic approach in such cases. Case presentation. A 28-year-old G3P2A0 patient, presented to our primary care for heavy vaginal bleeding. The ultrasound performed confirmed a viable 13week embryo ectopic scar pregnancy. In this regard, the case was considered eligible for a conservative laparoscopic intervention treatment which was divided in the following steps: extensive dissection of the bladder; identification of the ectopic pregnancy at the level of the lower segment; extraction of the product of conception; suturing of the lower segment defect. Conclusions. The success of this technique may help amplifying its usage in other similar scenarios. In particular, the failure of medical treatment may be the first indication in trespassing the laparoscopic surgery approach. Further investigations about minimally invasive technologies seems undeferrable.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic management of a 13 weeks viable ectopic cesarean section Scar pregnancy: a case report

Sleiman¹,

Feghali²,

Daccache³

et al. 2022

Ital J Gynaecol Obstet

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“…Postmolar GTN requires treatment ( Figure 1 ) if a weekly increase in β-hCG is detected at least three consecutive times over a period of at least 2 weeks, or when a plateau of β-hCG values is present for four consecutive measurements over a period of at least 3 weeks, or in the case of persistence of β-hCG 6 months after evacuation or in the case of histological diagnosis of choriocarcinoma [ 17 ]. The choice of treatment is based on the evaluation of the International Federation of Gynecology and Obstetrics (FIGO) anatomic staging of the disease ( Table 1 ) and FIGO prognostic score ( Table 2 ), which estimates the risk of developing chemoresistance [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Standard treatment of GTN comprises single-agent or multiagent chemotherapy for low-risk or high-risk disease, respectively [ 5 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with high-risk scores ( Figure 1 ) are commonly treated with multiagent chemotherapy [ 5 , 17 ]. Multiagent chemotherapy with EMA/CO (etoposide, methothrexate, dactinomicyn, cyclophosphamide, vincristine) has a reported remission rate of 91% [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, before starting EMA-CO, low-dose EP (etoposide 100 mg/m 2 and cisplatin 20 mg/m 2 on days 1 and 2, repeated weekly) decreases the early mortality rate from 7.2% to 0.7% [ 26 ]. In particular, in the case of brain metastases, the MTX dose in the EMA should be increased to 1 g/m 2 , alternating it weekly with CO [ 17 ]. Multiagent therapy should be continued for 6–8 weeks from normalization of β-hCG values (3–4 cycles of consolidation) [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN)

Mangili

Sabetta

Cioffi

et al. 2022

Cancers

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Background: Gestational trophoblastic disease includes a rare group of benign and malignant tumors derived from abnormal trophoblastic proliferation. Malignant forms are called gestational trophoblastic neoplasia (GTN) and include invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Standard treatment of GTN is chemotherapy. The regimen of choice mainly depends on the FIGO prognostic score. Low-risk and high-risk GTN is treated with single-agent or multiagent chemotherapy, respectively. In the case of chemoresistance, immunotherapy may represent a new therapeutic strategy. Methods: Literature obtained from searches on PubMed concerning GTN and immunotherapy was reviewed. Results: Programmed cell death 1 (PD-1) and its ligands (PD-L1/2) are expressed in GTN. Published data on PD-1/PD-L1 inhibitors alone in GTN were available for 51 patients. Pembrolizumab is an anti-PD-1 inhibitor used in chemoresistant forms of GTN. In the TROPHIMMUN trial, Avelumab, a monoclonal antibody inhibiting PD-L1, showed promising results only in patients with GTN resistant to monochemotherapy. Conversely, in patients with resistance to multiagent chemotherapy, treatment with Avelumab was discontinued due to severe toxicity and disease progression. The association of Camrelizumab and Apatinib could represent a different treatment for forms of GTN refractory to polychemotherapy or for relapses. Conclusions: Anti-PD-1 or anti-PD-L1 might represent an important new treatment strategy for the management of chemoresistant/refractory GTN.

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Non-gestational choriocarcinoma: unraveling the similarities and distinctions from its gestational counterpart

Mangla,

Palo,

Kanikaram

et al. 2023

Int J Gynecol Cancer

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Choriocarcinoma is a highly vascular and invasive tumor of anaplastic trophoblast, predominantly made up of cytotrophoblasts and syncytiotrophoblasts without villi. Based on its origin, choriocarcinoma can be either gestational or non-gestational. Non-gestational choriocarcinoma can be of germ cell origin, or can be seen in association with a somatic high-grade malignancy. It is difficult to differentiate gestational from non-gestational choriocarcinoma, especially in the reproductive age group. It is important to distinguish between the two, for accurate staging and prognostication, deciding the primary treatment modality, (ie, surgery or chemotherapy), and tailoring follow-up timeframes after diagnosis. An extensive literature search was performed regarding all cases of non-gestational choriocarcinoma, published before March 2023. A note was made of whether the origin of choriocarcinoma was ascertained and how gestational choriocarcinoma was differentiated from non-gestational choriocarcinoma. The keywords used for literature search were “non-gestational choriocarcinoma”, “primary choriocarcinoma”, “ovarian choriocarcinoma”, “ovarian germ cell tumors”, or “choriocarcinomatous differentiation”. This review aims to summarize the similarities and differences in the epidemiology, pathogenesis, clinical presentation, and management guidelines between gestational and non-gestational choriocarcinoma, which can form an important educational resource for clinicians and laboratory physicians dealing with such cases.

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Gestational trophoblastic disease: an update on pathology, diagnosis and stateof- the-art management

Cited by 4 publications

References 67 publications

Laparoscopic management of a 13 weeks viable ectopic cesarean section Scar pregnancy: a case report

Laparoscopic management of a 13 weeks viable ectopic cesarean section Scar pregnancy: a case report

Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN)

Non-gestational choriocarcinoma: unraveling the similarities and distinctions from its gestational counterpart

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