Guideline No. 408: Management of Gestational Trophoblastic Diseases

Eiriksson, Lua; Dean, Erin; Sebastianelli, Alexandra; Salvador, Shannon; Comeau, Robyn; Jang, Ji-Hyun; Bouchard-Fortier, Geneviève; Osborne, R.; Sauthier, Philippe

doi:10.1016/j.jogc.2020.03.001

Cited by 23 publications

(17 citation statements)

References 70 publications

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“…In addition, the correlation between PD-L1 immunohistochemistry and the response to immunotherapy has not been validated in the literature and no set standards are available regarding cut off for therapy. Pembrolizumab was used successfully in this case [ 18 , 19 , 20 ], with no evidence of disease recurrence over a 12-month period.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…For patient with molar or invasive molar pregnancy, the last time of the sign of disease recurrence occurred was considered to be the onset of disease. Symptoms of specific metastasis lesion were considered for patient without any gestational related clinical manifestations [7].…”

Section: Methodsmentioning

confidence: 99%

“…Although pathological diagnosis is important, diagnosis based on clinical appearance is more practical and widely accepted in choriocarcinoma [7]. Because of the lack of specific clinical manifestations to distinguish different types of malignant trophoblastic disease, the diagnosis of choriocarcinoma is a big challenge for the gynecological oncologists.…”

Section: Diagnosis and Misdiagnosismentioning

confidence: 99%

Misdiagnosis and Chemotherapy Delaying Reduces the Chemosensitivity of Choriocarcinoma Patient: Analysis of 36 Cases

Liu¹,

Chen²,

Zhu³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: Choriocarcinoma is a curable malignant neoplasm when chemotherapy is properly implemented. However, when chemotherapy resistance occurs, disease can be fatal. Misdiagnosis is common, which may lead to delaying of the first cycle of chemotherapy and increase the possibility of chemoresistance. Methods: We analyzed 36 choriocarcinoma cases who were treated in our department about their clinical characteristics, and their diagnosis and treatment processes together with the serum β-hCG variation. Results: Analysis showed that the disease onset age, FIGO (International Federation of Gynecology and Obstetrics) stage distribution were similar to the other cohort. The primary origins were uterine canals, and the serum β-hCG elevated with or without vaginal bleeding were common, which all easily lead to misdiagnosis of benign pregnancy related diseases. Our data demonstrated that the misdiagnosis of choriocarcinoma resulted in delaying of the first cycle of chemotherapy, followed by decreased control of serum β-hCG after one chemotherapy cycle and more cycles for serum β-hCG normalization, which meant the possibility of generating chemoresistance. Conclusions: In summary, standardized surveillance and treatment process to decrease misdiagnosis rate of choriocarcinoma can be an effective measure to improve the prognosis of patients.

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“…2,3 The frequency of molar pregnancy varies from fewer than 1 in 1000 pregnancies in high-income countries, to more than 1 in 400 in lower-income countries. 3,4 Molar pregnancies present 2 serious threats for maternal morbidity and mortality: hemorrhage and neoplastic disease. The risk of hemorrhage is decreased with early diagnosis, before 12 weeks.…”

mentioning

confidence: 99%

“…Evidence of persistent elevation of serum hCG or metastases outside the uterus to pelvis, lung or beyond requires further treatment with chemotherapy. 3…”

mentioning

confidence: 99%

Hydatidiform mole in a 39-year-old woman

Slaoui

Kharbach

Baydada

2022

CMAJ

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A 39-year-old woman (gravida 4, para 3) presented at 14 weeks' gestation to the emergency department with acute pelvic pain and substantial vaginal bleeding. Her blood pressure was 80/40 mm Hg and heart rate 114 beats/min. She was afebrile. Clinical examination showed mild suprapubic tenderness with distention. Immediate point-of-care ultrasound showed that her uterus contained echogenic structures with a "snowstorm" appearance. There were no visible embryonic or fetal structures. On speculum examination, the patient's vagina was full of blood clots with grapelike vesicles (Figure 1). We resuscitated the patient with intravenous fluids and transfused her with 4 units of packed red blood cells. We performed an urgent operative cervical dilatation and ultrasound-guided aspiration of the uterine contents. She received 20 IU intravenous oxytocin and the vaginal bleeding stopped. Pathologic examination confirmed the clinical diagnosis of molar pregnancy, showing a noninvasive complete hydatidiform mole. Chromosomal study showed a diploid 46 XX karyotype. A metastatic assessment of the patient (a chest radiograph and an abdominopelvic ultrasound) was negative. At follow-up 8 weeks later, her serum β human chorionic gonadotropin (hCG) levels were undetectable.Hydatidiform mole is a gestational disorder in which the trophoblast proliferates uncontrollably, forming hydropic vesicles. 1 A complete hydatidiform mole is diploid and the result of an anucleate egg cell with only paternal DNA owing to duplication of a single sperm or, infrequently, 2 sperm. A partial mole is triploid and results from fertilization between a normal egg and duplicated sperm or 2 sperm. Neither pregnancy is viable. 2,3 The frequency of molar pregnancy varies from fewer than 1 in 1000 pregnancies in high-income countries, to more than 1 in 400 in lower-income countries. 3,4 Molar pregnancies present 2 serious threats for maternal morbidity and mortality: hemorrhage and neoplastic disease. The risk of hemorrhage is decreased with early diagnosis, before 12 weeks. Gestational trophoblastic neoplasia is diagnosed through serial hCG monitoring and imaging. Evidence of persistent elevation of serum hCG or metastases outside the uterus to pelvis, lung or beyond requires further treatment with chemotherapy. 3

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Guideline No. 408: Management of Gestational Trophoblastic Diseases

Cited by 23 publications

References 70 publications

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

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

Misdiagnosis and Chemotherapy Delaying Reduces the Chemosensitivity of Choriocarcinoma Patient: Analysis of 36 Cases

Hydatidiform mole in a 39-year-old woman

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