Hypnosis to improve life quality in invasive mole: A case report

Background: Gestational trophoblastic disease (GTD) represents a diverse group of conditions characterized by abnormal trophoblastic proliferation within the placenta. GTD includes benign and malignant lesions, ranging from complete and partial hydatidiform moles to more severe forms like invasive moles, choriocarcinoma, placental site trophoblastic tumors (PSTTs), and epithelioid trophoblastic tumors. Given that neoplastic GTD lesions respond remarkably well to chemotherapy, early and accurate histopathological diagnosis is crucial as it directly influences treatment and prognosis. Aim and Objectives: This study examined the histomorphological features of various types of GTD alongside key clinical factors such as age, parity, and gestational period. Materials and Methods: The study was conducted in the Department of Pathology over the course of10 years, from January 2014 to January 2024. All cases of GTD confirmed through histopathological examination of hematoxylin and eosin-stained slides were included in the analysis. Results: Out of 60 diagnosed cases of GTD, 34 (56.66%) were complete hydatidiform moles, 22 (36.67%) were partial hydatidiform moles, 1 (1.67%) was an invasive mole, 1 (1.67%) was choriocarcinoma, and 2 (3.33%) were PSTTs. The age of the affected patients ranged from 18 to 45 years, with the highest incidence observed in the 20–25 year age group (30 cases, 50%). Most cases (33, 55%) occurred during the first trimester, with a predominance among primigravida patients (28 cases, 46.66%). The most common clinical presentation was per vaginal bleeding, reported in 56 cases (93.33%). Conclusion: Although GTD can lead to serious complications, including metastasis, it is treatable. In this study, the complete hydatidiform mole was the most frequently encountered lesion and is associated with a higher risk of severe complications such as persistent GTD, invasive moles, and choriocarcinoma. Thus, early and accurate histopathological diagnosis is vital for the timely initiation of therapy, ultimately reducing the mortality rate. This study highlights the various categories and histomorphological features of GTD, emphasizing the importance of understanding its clinical presentation to mitigate disease burden and complications.

Background: Gestational trophoblastic neoplasm (GTN) during pregnancy includes an associated heterogeneous group of lesions that originates from abnormal proliferation of placenta. It includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Objectives: The aim of this study was to predict the risk of invasive mole in patients with a molar pregnancy in association with -hCG level after the evacuation of molar pregnancy. Methods: The current study was a prospective cross-sectional cohort research conducted as a diagnostic study on 110 patients with molar pregnancy referring to Department of Gynecology and Oncology of Vali-Asr, Imam Khomeini Hospital of Tehran between the years of 2015 and 2016. Patients with molar pregnancy, who were hospitalized with a diagnosis of hydatidiform mole by transvagi- nal ultrasonography, were examined in the study. The ability to perform ultrasonography before and after evacuation as well as the consent to participate in the study was among the inclusion criteria for patients. The patients were studied for invasive mole fol- lowed by two ultrasonography examinations, one 48 hours and the other 21 days after evacuation. -hCG levels were also measured in successive periods of one week to six months. The association of sonography findings 48 hours and 21 days after evacuation with post-evacuation -hCG levels was investigated using Chi-square test and multinomial regression. Results: In the current study conducted on 110 patients with hydatidiform mole, the results showed that 46 patients (41.8%) suered from invasive mole. In 23 patients (50%) with invasive mole, the results of both ultrasonography 48 hours and 21 days after evacuation were positive. There was a significant correlation between ultrasonography after evacuation (positive and negative results) and the progress of -hCG after evacuation in women with invasive mole (P = 0.001); this means that in 73% of women with invasive mole, the positive -hCG results corresponded with positive 21-day sonography after evacuation, and in 41% cases, ultrasound results on day 21 were reported positive before the results of -hCG. Conclusions: Positive results of sonography accompanied with positive results of -hCG have a high eciency in the diagnosis of 1. Background Gestational trophoblastic disease (GTD) includes a het- erogeneous group of related lesions resulted from abnor- mal proliferation of placenta. GTD may be either benign or malignant. Benign lesion includes complete and par- tial hydatidiform mole and its diagnosis is based on histo- logical findings. Malignant lesion includes invasive mole, placental site trophoblastic tumors, and choriocarcinoma. Trophoblastic disease during pregnancy has the potential for local invasion and distant metastasis. This group of ma- lignant lesions is called gestational trophoblastic neopla- sia (GTN), which is a rare complication of pregnancy. GTN, occurs after normal delivery, spontaneous abortion or ec- topic pregnancy. The risk of its occurrence increases by 2,000 times after the occurrence of hydatidiform mole (1-

7 - Gestational trophoblastic disease

Gestational trophoblastic neoplasia epidemiology and treatment results in the Slovak Republic in the years 1993-2017. Retrospective analysis results of gestational trophoblastic neoplasia treatment in the Centre for gestational trophoblastic disease in the Slovak Republic in Bratislava in the years 1993-2017according to prognostic scoring and staging system FIGO/WHO (International Federation of Gynecology and Obstetrics/World Health Organization). 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%). 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.

Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia

Gestational trophoblastic neoplasia (GTN) is the term used for an uncommon group of diseases that originate in the placenta and have the potential to locally invade the uterus and metastasize. The histological entities included in this group are: partial (PHM) and complete hydatidiform mole (CHM), invasive mole (IM), choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). With the exception of PSTT and ETT, all gestational trophoblastic tumors develop from the cyto- and syncytial cells of the villous trophoblast and produce abundant amounts of human chorionic gonadotropin (hCG), the measurement of which serves as a reliable tumor marker for diagnosis, monitoring treatment response and follow-up to detect recurrence. PSTT and ETT, on the other hand, are gestational trophoblastic tumors that originate from the intermediate cells of extravillous trophoblast and produce hCG sparsely, making its use as a tumor marker less reliable. Prior to the development of effective chemotherapy for GTN in 1956 [1], the majority of patients with disease localized to the uterus were cured with hysterectomy, whereas metastatic disease was almost uniformly fatal. Currently, most women with GTN can be cured and their reproductive function preserved providing they are managed according to well-established guidelines. GTN is an uncommon disease which ideally should be managed at trophoblastic disease centers where concentration of cases provides clinicians with ample experience, opportunities for research, and improved outcomes [2]. Since many patients will be managed locally, it is the purpose of this review to familiarize clinicians who encounter these patients with the latest advances in the field in order to optimize their patient’s outcome.

Gestational trophoblastic disease

Gestational trophoblastic diseases (GTDs) include the complete and partial hydatidiform mole (benign GTDs), invasive mole, placental site trophoblastic tumor, and choriocarcinoma (malignant GTDs). GTDs, both benign and malignant, have the potential of distant metastases. The lung is the most common site of metastases. When GTDs metastasize to the lungs, there are three principal radiologic patterns, i.e. discrete pulmonary nodules, multiple small pulmonary opacities, and pictures mimicking pulmonary embolism. Most patients are asymptomatic clinically, but some may present symptoms such as dyspnea, chest pain, cough and hemoptysis. Only a few cases of GTDs with hemothoraces have been reported in the literature. Choriocarcinoma accounted for most of those cases, and not hydatidiform moles. Herein, we present a case of hydatidiform mole, a benign GTD, with subpleural lung metastasis, and a subsequent rare manifestation of hemothorax. Based on our report, hydatidiform moles with subpleural lung involvement should be considered as one of the etiologies in the clinical differential diagnosis for non-traumatic hemothorax.

Patient: Female, 46-year-oldFinal Diagnosis: Invasive moleSymptoms: Bleeding • vaginal bleedingMedication: —Clinical Procedure: Curettage • hysterectomySpecialty: Obstetrics and Gynecology • OncologyObjective:Rare diseaseBackground:Gestational trophoblastic disease (GTD) is a spectrum of disorders consisting of premalignant (ie, complete [CHM] and partial hydatidiform moles [PHM]) and malignant conditions (ie, invasive moles, choriocarcinoma, placental site trophoblastic tumors, and epithelioid trophoblastic tumor). If GTD persists after initial treatment and has persistent elevated beta human chorionic gonadotropin (β-hCG), it is referred to as post-molar gestational trophoblastic neoplasia (pGTN). To date, there is no detailed information regarding how fast invasive moles can develop from CHM. However, the risk of developing any pGTN from CHM is rare within 1 month and is greatest in the first 12 months after evacuation, with most cases presenting within 6 months.Case Report:We present a case of a 46-year-old primigravida woman with rapid transformation of an invasive mole. In the beginning, the patient had a chief concern of a uterus size greater than the gestational dates. Laboratory evaluation showed high β-hCG serum level (>300 000 mIU/mL), and ultrasonography evaluation revealed a hydatidiform mole. Suction evacuation and curettage procedures were then performed. Pathology evaluation afterwards revealed a complete hydatidiform mole without any sign of malignancy. Twenty-two days afterwards, the patient came to the emergency room with vaginal bleeding. β-hCG serum level was high (53 969 mIU/mL), and ultrasonography examination showed the presence of fluid filling the uterine cavity. The patient was then diagnosed with GTN, and hysterectomy was chosen as the treatment of choice. After the surgery, her β-hCG serum level gradually reverted back to normal.Conclusions:Invasive moles can develop less than 1 month after suction evacuation and curettage procedure for CHM. Serial β-hCG serum level evaluation according to the guideline should be performed to prevent late diagnosis, which could lead to the development of metastasis and worsen the prognosis.

Dupilumab, a human IgG4 monoclonal antibody against IL-4Rα subunit, inhibits IL-4 and IL-13, the major drivers of human type 2 inflammatory diseases such as CRSwNP and asthma. CRSwNP is associated with nasal discharge, obstruction and reduced sense of smell, with a reduction in quality of life (QoL) and decrease in sleep quality. Dupilumab improves all aspects of disease-specific QoL but no data is available for sleep quality. The aim of this study is to investigate sleep quality in CRSwNP patients treated with Dupilumab. Patients were consecutively enrolled. Anthropometrics data, lung function tests, ENT scores, and bio-humoral data were collected. In order to evaluate sleep impairment, the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) were used at the first visit, and after one and three months of treatment. We enrolled 29 patients (15F, mean age 53.7±9.8). 13 patients with CRSwNP and 16 with both CRSwNP and asthma. Before Dupilumab treatment ESS was 9 [IQ5-10], ISI was 13 [IQ10-18] and PSQI 9 [IQ7-12]. After one month of therapy, we reported a significant improvement in sleep quality: ISI (8vs13,p<0.05); PSQI (6vs9,p<0.05) but no changes in ESS (6vs9,p1.5). The improvement continued at three months: ISI (7vs13,p<0.001); PSQI (5.5vs9,p<0.05) when also a reduction in ESS (3vs9,p<0.05) ) was observed. Concerning sleep quality assessment, no differences were detected when divided by pathologies (CRSwNP vs CRSwNP and asthma). In conclusion Dupilumab demonstrated a rapid and significant improvement in sleep quality, insomnia, and sleepiness in patients with CRSwNP

Gestational trophoblastic disease (GTD) represents a group of disorders that derive from placental trophoblastic tissue, including hydatidiform moles, postmolar gestational trophoblastic neoplasia (GTN), and gestational choriocarcinoma. GTN is the most curable gynecologic malignancy and tends to be more common after a complete molar pregnancy than a partial mole. Human chorionic gonadotropin (β-hCG) represents a marker for GTD and should be followed for 6 months after molar pregnancy evacuation to rule out the development of postmolar GTN. GTN is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation. Classification for GTN as low (score ≤ 6) or high risk (score > 7) is based on the World Health Organization prognostic score. This scoring system helps select treatment, which usually entails actinomycin D or methotrexate for low-risk disease and EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) for high-risk disease. These regimens can achieve cure rates approaching 100% and over 90% for low- and high-risk disease, respectively. This review contains 5 figures, 8 tables and 49 references Key words: choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, invasive mole

Introduction: Gestational tropoblastic disease (GTD) comprises of heterogeneous group of pregnancy related disorders which occurs due to highly abnormal development and proliferation of tropoblastic tissue. The spectrum encompasses benign conditions like partial and complete hydatidiform mole, malignant condition like invasive mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor. The most common disease among the above is the complete mole. There is wide variation in the incidence and risk factors of occurrence of GTD in different geographic regions. In present study, we evaluate incidence, clinical profile and management of GTD at a tertiary care centre. Material and Methods: The present study is prospective observational study done in department of obstetrics and gynecology at a tertiary care centre for duration of 2 years. All the cases diagnosed as gestational tropoblastic disease were included in study. The incidence, clinical presentation, management and six months follow up data were analyzed. Observation and Results: There were 12,046 pregnancies, 11952 deliveries and 11620 live births during the present study. The total number of cases diagnosed to have GTD was 30, and they were included in study. This gave an incidence of 2.49 /1000 pregnancies, 2.51 /1000 deliveries and 2.58 /1000 live births. The most common presenting symptom was blood per vagina, noted in 21(70%) patients. Other symptoms were pain abdomen 11(37%), vomiting 4(13%). Only 2(7%) had classic symptom of passage of grape like vesicles. Histopathology examination showed 23 patients had complete hydatidiform mole, 6 had partial hydatidiform mole and one had invasive mole. Conclusion: The incidence of hydatidiform mole and other forms of GTD were comparable to other reported studies in literature. Those pregnant patients, who are clinically or sonologically diagnosed as GTD should be evaluated properly and managed accordingly. These patients need proper follow up care to prevent complications and further, preserve fertility in them.

Pathology of gestational trophoblastic disease (GTD)

Expression of laminin receptor 1 in gestational trophoblastic diseases and normal placenta and its relationship with the development of postmolar tumors

Guideline No. 408: Management of Gestational Trophoblastic Diseases