Form Of Gestational Trophoblastic Disease Research Articles

A prospective study of gestational trophoblastic disease profile with special reference to mortality and pregnancy outcome after successful management of the same

Background: Gestational trophoblastic disease (GTD) is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. GTD does not develop from cells of the uterus like cervical cancer or endometrial (uterine lining) cancer do. Instead, these tumors start in the cells that would normally develop into the placenta during pregnancy. GTD is unique because the maternal lesions arise from the fetal tissue as a molar pregnancy. All forms of GTD can be treated. In most cases the treatment produces a complete cure. The study was conducted to assess the various presenting features of GTD and factors associated with it.Methods: It was an observational hospital based prospective epidemiological study. Complete enumeration technique was followed and a total of 305 female patients were included in the sample. A pre-designed and pre-tested interview schedule was used to record different information and detailed history.Results: Of the 305 patients studied, 67.2% were diagnosed with H. mole, 23% patients were diagnosed with gestational trophoblastic tumor, among them 4.9% had choriocarcinoma. Majority were primigravida and of blood group O type. Pregnancy outcome after successful management of GTD were 63.3% had full term pregnancy, 20% cases had repeat molar pregnancy, 10% had spontaneous abortion while 6.7% (2/30) had pre term delivery.Conclusions: Gestational trophoblastic disease is seen most commonly in reproductive age group. If it is not diagnosed on time it can be fatal. This is a highly curable tumor even in the presence of distant metastasis.

Recurrent Hydatidiform Mole: A Case Report of Five Consecutive Molar Pregnancies Complicated by Thyrotoxicosis and Review of Literature

Hydatidiform mole (HM) is the most common form of Gestational Trophoblastic Disease (GTD). Recurrence of HM is extremely rare. Here we report the case report of a patient with five consecutive complete hydatidiform moles without any normal pregnancy. A 41-years old lady, was referred to Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with H/O repeated molar pregnancies. Her first molar pregnancy was in 2005, second in 2006, third in 2007 & fourth in 2014. All the molar pregnancies were managed by suction evacuation at her base hospital. Following evacuation of 4th molar pregnancy at base hospital, she was referred to BSMMU for subsequent management. Regular follow-up was done using molar card. All the pregnancies were complete hydatidiform mole (CHM) and were confirmed clinically and sonographically. None of the molar pregnancies needed treatment with chemotherapy. During her fifth molar pregnancy she developed shortness of breath and palpitation. Diagnostic work up in our hospital confirmed complete molar pregnancy with thyrotoxicosis, for which she received b-blocker agent and after normalization of thyrotoxicosis, she underwent total abdominal hysterectomy on 11. 10. 18. Now she is on regular follow up by serum bhCG and has no complication.
 Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 52-55

Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours

BackgroundPlacental-site trophoblastic (PSTT) and epithelioid trophoblastic tumours (ETT) are the rarest malignant forms of gestational trophoblastic disease (GTD). Our prior work demonstrated that an interval of ≥48 months from the antecedent pregnancy was associated with 100% death rate, independent of the stage. Here, we assess whether modified treatments for these patients have increased survival and identify new prognostic factors.MethodsThe United Kingdom GTD database was screened to identify all PSTT/ETT cases diagnosed between 1973 and 2014. Data and survival outcomes from our prior patient cohort (1976–2006) were compared to our new modern cohort (2007–2014), when intensified treatments were introduced.ResultsOf 54,743 GTD patients, 125 (0.23%) were diagnosed with PSTT and/or ETT. Probability of survival at 5 and 10 years following treatment was 80% (95% CI 72.8–87.6%) and 75% (95% CI 66.3–84.3%), respectively. Univariate analysis identified five prognostic factors for reduced overall survival (age, FIGO stage, time since antecedent pregnancy, hCG level, mitotic index) of which stage IV disease (HR 6.18, 95% CI 1.61–23.81, p = 0.008) and interval ≥48 months since antecedent pregnancy (HR 14.57, 95% CI 4.17–50.96, p < 0.001) were most significant on multivariable analysis. No significant differences in prognostic factors were seen between the old and new patient cohort. However, the new cohort received significantly more cisplatin-based and high-dose chemotherapy, and patients with an interval ≥48 months demonstrated an improved median overall survival (8.3 years, 95% CI 1.53–15.1, versus 2.6 years, 95% CI 0.73–4.44, p = 0.·005).ConclusionPSTT/ETT with advanced FIGO stage or an interval ≥48 months from their last known pregnancy have poorer outcomes. Platinum-based and high-dose chemotherapy may help to improve survival in poor-prognosis patients.

Two Novel Variants in NLRP7 Gene in an Egyptian Female Patient with Consecutive Molar Pregnancies Complicated by Choriocarcinoma

ABSTRACTBackgroundHydatidiform mole, whether complete or partial mole, is one of the most common forms of gestational trophoblastic disease. It is characterized by extreme trophoblastic proliferation and atypical embryonic growth. Though almost all of complete hydatidiform moles are diploid androgenetic, scarce cases are biparental and caused mainly by mutations inNLRP7andKHDC3Lgenes. NLRP7mutations are more common and were reported in around 50–80% of cases from diverse populations whileKHDC3mutations were only found in 5–10% of cases.Case descriptionA healthy 40-year-old Egyptian woman was referred to the Clinic of Prenatal Diagnosis and Fetal Medicine Department for counseling. She was married for 20 years to a first-degree relative and experienced 17 consecutive pregnancy losses without having any live births. Uterus ultrasound revealed endometrial thickening and subseptate uterus and in her last pregnancy failure, she complained of abdominal pain and severe shortness of breath. Immunochemistry tests were positive for β-human chorionic gonadotropin and histopathology-confirmed choriocarcinoma. Genetic testing revealed two novel heterozygous variants in theNLPR7gene.ConclusionWe presented a case with 17 recurrent hydatidiform moles that was complicated by choriocarcinoma due to novel variants in theNLRP7gene.Clinical significanceThis is the first Egyptian case with recurrent hydatidiform mole. We identified novelNLPR7variants, thus expanding the mutational spectrum associated with this rare disease.How to cite this articleShalabi TA, Abdel-Hamid MS, Shaker MM. Two Novel Variants inNLRP7Gene in an Egyptian Female Patient with Consecutive Molar Pregnancies Complicated by Choriocarcinoma. Int J Infertil Fetal Med 2019;10(3):54–57.

Fertility preservation of PSTT by interventional therapy: a case report

Introduction: Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease (GTD) and this disorder is usually seen in young women with a 20% mortality rate. Although hysterectomy is useful for treating PSTT, it is not the best choice for patients who wish to preserve their fertility. Due to the fact that PSTT is resistant to chemotherapy frequently, it is very important to find new therapeutic schedules used for PSTT. Case Report: The patient is a 24-year-old female, gravida 2, para 1, with intermittent vaginal bleeding episodes for ten days following her latest pregnancy of 50 days ago. Pelvic utrasonographic results showed a 4×5×5- cm mass in hypo-hyperechogenic areas of the uterine wall and the initial serum β-hCG level was 6,359 mIU/ml. Immunohistochemical analysis revealed that the Ki-67 proliferative index was about 10%; the tumor cells showed strong diffuse staining with Pan cytokeratin, human placental lactogen (hPL), placental alkaline phosphatase, and epidermal growth factor receptor (EGFR). Meanwhile, the tumor cells also showed focal positive with hCG. The histological and immunohistochemical findings led to the diagnosis of PSTT. At first, the patient took three courses of chemotherapy and three times of curettages, but the condition was not in remission. In order to preserve the patient's fertility, the patient underwent twice uterine artery drug pouring and embolism treatment. The drugs included adriamycin, cisplatin, and methotrexate. This therapy had gained a satisfactory effect. Conclusion: When the tumor is localized to uterus without diffuse infiltrative, for younger PSTT patients who wish to conserve fertility, the authors suggest that uterine artery drug pouring and embolism treatment could be considered.

Identification of nonsynonymous TP53 mutations in hydatidiform moles

Hydatidiform mole (HM), an unusual pregnancy with pure or predominant paternal genetic contribution, is the most common form of gestational trophoblastic disease. Most HM regress after uterine evacuation but some will develop into persistent disease or even frank malignancy. Although p53 is highly expressed in HM, TP53 mutations have rarely been detected in previous studies. Here we screened for specific missense mutations on several TP53 hotspots in 49 HMs using a highly sensitive pyrosequencing approach and revealed the significant existence of such mutations in HM tissues. A particularly high frequency (∼59% of the cases) of p53 inactivating mutation on exon 7 has been detected. Our identification of hitherto unreported TP53 mutations in HM suggests the presence of p53 mutants and reflects the advantages of using pyrosequencing for point mutation detection in clinical samples. Traditional sequencing method may have overlooked such mutations that only occur in a small population of trophoblasts.

Relative Effects of Age, Race, and Stage on Mortality in Gestational Choriocarcinoma.

Gestational choriocarcinoma is a malignant form of gestational trophoblastic disease that usually arises after a molar pregnancy, but may follow any antecedent pregnancy. Investigations in this rare cancer are limited. We evaluated the prognostic effects of age, race, and stage in choriocarcinomas diagnosed for 4 decades. Patients diagnosed as having gestational choriocarcinoma between 1973 and 2014 from the Surveillance, Epidemiology, and End Results program were eligible. Relationships with overall survival and cancer-specific survival were evaluated using log-rank testing and Cox modeling. Multivariate analyses included adjustments for age, race, and stage. There were 947 patients with choriocarcinoma including 403 non-Hispanic white (NHW) patients, 473 with distant stage, and 142 who died. Median age at diagnosis was 25 years for non-Hispanic black (NHB) patients and 35 years for Asian/Pacific Islanders (API) compared with 29 years for NHW patients (P = 0.0001). Five-year overall survival varied between 82% and 92% when diagnosed at the age of at least 40 years compared with less than 20 years (P < 0.0001), and from 85% to 95% in patients with distant vs local disease (P < 0.0001), respectively. Multivariate analysis demonstrated that age, race, and stage were independent predictors of mortality. Risk of death increased incrementally in patients diagnosed at 20 to 39 years of age (adjusted hazard ratio [aHR], 3.87; 95% confidence interval [CI], 1.69-8.86; P = 0.001) and at least 40 years of age (aHR, 7.18; 95% CI, 2.95-17.49; P < 0.0001) compared with 20 years or younger. Non-Hispanic black patients were the only racial group at higher risk of death compared with NHW patients (aHR, 1.86; 95% CI, 1.22-2.82; P < 0.004). Distant vs local disease added an additional risk of death (aHR, 2.43; 95% CI, 1.57-3.75; P < 0.0001) over that attributable to age at diagnosis and NHB race. Similar relationships to cancer-specific survival were also observed (P < 0.05). Most patients with choriocarcinoma have excellent prognosis. However, NHB patients and patients who are diagnosed at the age of at least 20 years or have distant stage have significantly worse mortality.

Clinical characteristics and outcomes of placental site trophoblastic tumor: experience of single institution in Korea.

ObjectivePlacental site trophoblastic tumor (PSTT) is the rarest form of gestational trophoblastic disease (GTD) and the optimum management is still controversial. In this study, we analyzed the clinical features, treatment, and outcomes of 6 consecutive patients with PSTT treated in our institution.MethodsThe electronic medical record database of Samsung Medical Center was screened to identify patients with PSTT from 1994 to 2017. Medical records for the details of each patient's clinical features and treatment were extracted and reviewed. This study was approved Institutional Review Board of our hospital.ResultsA total of 418 cases of GTD, 6 (1.4%) patients with PSTT were identified. The median age of the patients was 31 years. The antecedent pregnancy was term in all 5 cases with available antecedent pregnancy information and the median interval from pregnancy to diagnosis of PSTT was 8 months. The median titer of serum beta human chorionic gonadotropin (β-hCG) at diagnosis was 190.9 mIU/mL. Five (83.3%) patients presented with irregular vaginal bleeding and one (16.7%) had amenorrhea. All patients had disease confined to the uterus without metastasis at diagnosis and were successfully treated by hysterectomy alone. All of them were alive without disease during the follow-up period.ConclusionIn this study, we observed low level serum β-hCG titer and irregular vaginal bleeding with varying interval after antecedent term pregnancy were most common presenting features of PSTT. In addition, we demonstrated hysterectomy alone was successful for the treatment of stage I disease of PSTT.

Gestational Trophoblastic Disease

A middle-aged woman presented with vaginal bleeding leading to the identification of a uterine mass and serum hCG level of more than 700,000 mIU/mL. Imaging revealed no evidence of a gestational sac or fetal pole. She underwent hysterectomy. The photograph is of a bisected uterus containing a network of vesicular villi connected by fibrous strands historically referred to as resembling a “cluster of grapes.” Which of the following type of gestational trophoblastic disease does this patient most likely have?a.Nonmolar gestation with hydropic degenerationb.Partial hydatidiform molec.Complete hydatidiform mole (CHM)d.Choriocarcinoma Answer: c. Complete hydatidiform mole Complete hydatidiform mole is a form of gestational trophoblastic disease that results from fertilization of an abnormal empty ovum by 2 sperms or 1 sperm that replicates.1Di Cintio E. Parazzini F. Rosa C. Chatenoud L. Benzi G. The epidemiology of gestational trophoblastic disease.Gen Diagn Pathol. 1997; 143: 103-108PubMed Google Scholar, 2Lindor N.M. Ney J.A. Gaffey T.A. Jenkins R.B. Thibodeau S.N. Dewald G.W. A genetic review of complete and partial hydatidiform moles and nonmolar triploidy.Mayo Clin Proc. 1992; 67: 791-799Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar It is estimated to occur at a rate of 1 per 1000 pregnancies in the United States.1Di Cintio E. Parazzini F. Rosa C. Chatenoud L. Benzi G. The epidemiology of gestational trophoblastic disease.Gen Diagn Pathol. 1997; 143: 103-108PubMed Google Scholar Most CHMs are diploid, with 46,XX being the most common karyotype.1Di Cintio E. Parazzini F. Rosa C. Chatenoud L. Benzi G. The epidemiology of gestational trophoblastic disease.Gen Diagn Pathol. 1997; 143: 103-108PubMed Google Scholar, 2Lindor N.M. Ney J.A. Gaffey T.A. Jenkins R.B. Thibodeau S.N. Dewald G.W. A genetic review of complete and partial hydatidiform moles and nonmolar triploidy.Mayo Clin Proc. 1992; 67: 791-799Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar No fetus develops, but the placental tissue develops as a mass of vesicular villi, each about 1 cm, that fills the uterine cavity. Microscopy shows enlarged villi with central cisterns, stromal karyorrhexis, and a circumferential pattern of mixed trophoblastic hyperplasia (arrow). Complete evacuation is often sufficient treatment, and serum hCG is serially followed until it returns to 0. Because of increased risk (2%-3%) of choriocarcinoma in CHM, hysterectomy is often performed in patients older than 40 years.

Analysis of p53 expression in partial hydatidiform mole and hydropic abortion

Gestational trophoblastic disease (GTD) is a heterogeneous group of disorders characterized by abnormal trophoblast tissue. Molar and non-molar hydropic placental changes are the most common forms of GTD. Differential diagnosis of GTD is sometimes problematic. Recently, p53 expression was identified as a good marker for distinguishing GTD types. Comparison of p53 expression in partial hydatidiform mole (PHM) and hydropic abortion. In this prospective cross-sectional study, molar and non-molar hydropic pregnancy specimens were collected. Immunohistochemical staining, based on the Labeled Streptavidin Biotin (LSAB) technique, was carried out on multiple 4 mm paraffin block sections prepared from formalin-fixed trophoblastic tissues. Polymer-based Envision was used to assess p53 tumor suppressor protein immunoreactivity. p53 expression was then compared between both groups. In the study, 40 patients were included: 20 with confirmed PHM and 20 with hydropic pregnancy. p53 protein was positive in 60% of patients with PHM and 25% of patients with hydropic pregnancy. The p53 positive rate was significantly higher in patients with PHM (p = 0.027). Moreover, patients with PHM had a significantly high grade of staining (p<0.001). Our findings indicate that immunohistochemical analysis of p53 protein can be used to distinguish PHM and hydropic pregnancy.

Gestational Trophoblastic Disease - Clinicopathological Study at Tertiary Care Hospital.

Gestational Trophoblastic Disease (GTD) is a term used for a group of pregnancy-related tumours. These consist of various tumours and tumour like lesions characterized by proliferation of trophoblastic tissue. Amongst GTD, hydatidiform moles are the most common form. These lesions sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma. To study the clinicopathologic characteristics and prevalence of different forms of gestational trophoblastic disease in a tertiary care hospital. The present study was descriptive, observational, analytical type done in Department of Pathology at tertiary care hospital from May 2012 to April 2016. All cases clinically suspected of GTD were included and confirmation was done by histopathological study on H&E stained slides. The cases of GTD were classified according to WHO classification. Detailed histomorphological features and beta human Chorionic Gonadotropin (hCG) levels were correlated. During study period, 18345 deliveries were reported; out of which 77 cases were diagnosed as GTD. Almost 97.40% cases were of hydatidiform moles, 1.30% cases of choriocarcinoma and 1.30% cases of Placental Site Trophoblastic Tumour (PSTT). Among the cases of hydatidiform mole 57.34% were complete mole and 41.33% cases were of partial mole. The common clinical presentation was per vaginal bleeding and amenorrhea. The blood group A was most commonly observed in patient (49.35%). In majority of cases beta hCG levels were between 50,000 to 100000 mIU/ml. The correlation between beta hCG level and GTD were done. Pregnant females clinically presenting with abnormal vaginal bleeding must be evaluated for GTD. Histopathological examination is helpful for confirmatory diagnosis. Follow up of such patients is essential for early detection of malignant trophoblastic tumours.

Historical, morphological and clinical overview of placental site trophoblastic tumors: from bench to bedside.

Placental site trophoblastic tumor (PSTT) is a form of gestational trophoblastic disease that originates from the implantation of an intermediate trophoblast. It was described for the first time by Von F. Marchand in 1895 as belonging to chorioepithelioma sui generis, a pathological condition with many variations and a progressive degree of malignancy. We have conducted a literature review in MEDLINE about epidemiology, etiopathogenesis and clinical features of PSTT. Moreover, a case that occurred in our institution was reported. Our research has highlighted that existing published data about PSTT are not uniform. The number of cases described in the literature has updated and the clinical features of selected "case series" of patients diagnosed with PSTT were showed. The etiopathogenesis was discussed. It was noted that current prognostic factors still allow important information regarding PSTT to be obtained, albeit fragmentary. The lack of uniformity in data collection seen so far has limited full knowledge of PSTT. For this reason, we suggest a model (PSTT model) that collects and unifies PSTT evidence as this would be useful to identify worldwide precise prognostic factors, which are still lacking. When PSTT is diagnosed, the proper procedure seems to be total hysterectomy, with sampling of pelvic lymph nodes and ovarian conservation. For advanced-stage diseases, (stage III and IV) a combination of surgery and polychemotherapy is suggested.

Pituitary metastasis of choriocarcinoma: A case report.

Choriocarcinoma is an aggressive obstetric or gynecological neoplasm with a high malignant potential. It is a form of gestational trophoblastic disease and often secondary to hydatidiform mole, and intrauterine or ectopic pregnancy. Choriocarcinoma has a proclivity to metastasize to the lung, vagina, pelvis or liver in over 50% of patients, which always occurs in the early stage of the disease. With an appropriate amount of chemotherapy, the tumor may be treated effectively. However, pituitary metastasis of choriocarcinoma is extremely rare. To the best of our knowledge, no cases of choriocarcinoma metastasizing to the pituitary have been cited previously. Here, we report a case of choriocarcinoma that presented with pituitary metastasis.

Intermediate trophoblast—A distinctive, unique and often unrecognized population of trophoblastic cells

The trophoblast forms an outer layer of the blastocyst in the developing placenta and fetal membrane chorion. It is composed of different types of cells. Two main cell types are cytotrophoblasts and syncytiotrophoblasts. The third type of trophoblastic cells, often “forgotten” in most of histological and embryological textbooks, is morphologically and functionally between the first and second one, therefore, it is called the intermediate trophoblast. There is no mention of it in the internationally accepted Terminologia Embryologica. This term is not universally used by pathologists as some of them prefer the name extravillous trophoblast. This review provides an overview of morphology, localization, function and immunohistochemistry of different types of intermediate trophoblast cells. An indisputable reason for categorizing these cells as a distinct group is the fact that they are a source of various forms of gestational trophoblastic disease.

Outcomes of Non-Metastatic Gestational Trophoblastic Neoplasia: Twelve Year Experience from a Northern Thailand Tertiary Care Center.

Gestational trophoblastic neoplasia (GTN) is the malignant form of gestational trophoblastic disease. In non-metastatic GTN, the outcomes of treatment are impressive with methotrexate (MTX) or actinomycin D. We retrospectively reviewed the outcomes of non-metastatic GTN treated at our center from January, 1999 to December, 2013. One hundred and nine patients were recruited to the study. The median age was 33.1 years and over 90% were referral cases. Abnormal vaginal symptoms developed in 37.6% while 56.4% were asymptomatic. The most common antecedent pregnancy was a complete mole (92.7%) with the median interval time from antecedent pregnancy to GTN development being 2.0 months. The median pretreatment B-hCG was 5,624 mIu/ ml. The most common first line treatment was methotrexate (MTX) and folinic acid (91.7%) followed by weekly MTX (4.6%), etoposide+ MTX+actinomycin D (EMA) (2.8%), and actinomycin D (0.9%), with the median number of cycles at 5.0. The positive response to first line chemotherapy was 73.8%. The patients were given subsequent chemotherapeutic regimens after resistance to the first line therapy and showed a final remission rate of 89.9%.The significant factor that was frequently found in patients who were non-responders to the first line treatment was a hysterectomy procedure. Two patients developed lung metastasis and brain metastasis at one and four years after the first treatment, respectively. In conclusion, the outcomes of non-metastatic GTN were excellent. However, the patients need long term follow up due to the possibility of developing multiple organ metastases.

An uncommon cause of pain and bleeding during pregnancy

Abstract Gestational trophoblastic disease (GTD) is characterized by abnormal development of trophoblasts that develop into placenta during pregnancy. It is one of the common causes of irregular bleeding per vaginum during pregnancy. Hydatidiform mole is a benign form of GTD, which is marked by excess swelling of villi and is classified into complete hydatidiform mole and partial hydatidiform mole. The partial hydatidiform mole is usually present in intrauterine locations but forty cases so far have been reported in literature, where extra uterine locations in hydatidiform mole were noted. 1 We report an unusual presentation of partial type tubal ectopic hydatidiform mole in a patient with 8 weeks of amenorrhea, wherein an ultrasonography scan showed a large complex multicystic mass in the right adnexa with a normal appearing uterus.

Curative surgery for placental site trophoblastic tumors

Placental site trophoblastic tumors (PSTTs) are the least common form of gestational trophoblastic disease: only approximately 300 cases have been reported [1]. They can complicate any type of pregnancy, and the time between delivery and diagnosis can be long. Patients can present with vaginal bleeding, amenorrhea, or a uterine mass. The β human chorionic gonadotropin (β-hCG) concentration is usually moderate and much lower than in patients with choriocarcinoma [2]. PSTTs are particularly resistant to chemotherapy and need specificmanagement. When identified early, the prognosis can be favorable when complete excision is performed [2,3]. The aim of the present report is to present two PSTTs treated by hysterectomy with residual tumor noted on examination of the uterus. Written informed consent for publication was obtained from the two patients, and the present report was written with the approval of the institutional review board of Lille University Hospital, France. In October 2009, awoman aged 24 years presented to Lille University Hospital with vaginal bleeding. She had previously had one normal pregnancy and one spontaneous abortion. Her serum concentration of β-hCG was approximately 300 IU/L. Ultrasonography showed a uterine mass, and magnetic resonance imaging (MRI) revealed a rounded endometrial formation distorting the shape of the myometrium (Fig. 1A). A significant homogeneous enhancement was observed with gadolinium. In April 2010, a woman aged 35 years also presented with vaginal bleeding. She had had one previous normal pregnancy and one complete hydatidiformmole. Her β-hCG level was 21 IU/L. Ultrasonography showed a 13-mm endometrial thickening. Standard staging, including pelvic MRI, was negative, without uterine mass in the endometrium or myometrium. In both cases, PSTT was diagnosed after uterine curettage. Surgical hysterectomy was subsequently performed, after which the β-hCG levels returned to normal in both patients. Gross findings of hysterectomy showed a nodularmass in the uterus infiltrating themyometrium in patient 1 (Fig. 1B). Nomacroscopic lesionwas seen in patient 2 (Fig. 1C). Histological examination revealed the samemononuclear trophoblastic proliferation with admixed multinucleate cells separating myometrial fibers in both patients (Fig. 1D and E), extending to three-quarters of the myometrium in patient 1 and limited to the inner third of the myometrium in patient 2 (International Federation of Gynecology and Obstetrics stage I for both cases). The appearance of PSTTs on imaging varies. Themost frequent ultrasonographic abnormality is a focal echogenic myometrial nodule [4]. MRI typically shows a myometrial mass isointense to adjacent normal myometrium on T1-weighted images and isointense to slightly hyperintense on T2-weighted images. Inconstant prominent blood vessels have been shown to be related to the physiological vascular invasion of extra villous trophoblast. By contrast with PSTT, choriocarcinoma is always a highly vascular tumor. For endometrial carcinoma, MRI is also helpful for assessment of the depth of myometrial invasion and extrauterine disease spread. Nevertheless, imaging findings are not specific, and some PSTTs are undetectable, as in the second case presented here. Diagnosis is made on the basis of intermediate trophoblast proliferation growing in and infiltrating myometrial fibers. Therefore, intrauterine aspiration is insufficient; a uterine curettage is necessary. PSTTs grow slowly, tend to spread through the uterus and can involve the lymph nodes with late metastasis. Preoperative staging requires pelvic, abdominal, and chest computed tomography, and pelvic and brain MRI. The most effective treatment for non-metastatic disease is hysterectomy [2]. In a series of 55 PSTTs, only one hysterectomy International Journal of Gynecology and Obstetrics 130 (2015) 84–88

Epithelioid trophoblastic tumour: a report of two cases

An epithelioid trophoblalstic tumour (ETT) is an extremely rare form of gestational trophoblastic disease (GTD). 1 Usually, patients are of child-bearing age with a prior gestation. 2 The uterus is the most common site for an ETT. 3 This tumour has the same clinical behaviour as that of a placental site trophblastic tumour, but the treatment options may differ. Histologically, an ETT is a distinct neoplasm whose cytological features and growth patterns mimic those of squamous cell carcinoma. 3 An ETT does not appear to be as chemosensitive as other GTDs, making hysterectomy the treatment of choice in patients with disease confined to the uterus. 3 This tumour may present a diagnostic challenge to the pathologist, while clinicians often face problems with treating this tumour because of its rarity. We describe two cases of an ETT occurring in two women, one aged 44 years and the other 42 years.

Molar Pregnancy Causing Thyrotoxicosis in a Teenage Girl With Type 1 Diabetes Mellitus.

Molar pregnancy, also known as hydatidiform mole, is the most common form of gestational trophoblastic disease. Although rare, hyperthyroid signs and symptoms may be indicative of molar pregnancy. We describe a case of a teenage girl with type 1 diabetes mellitus who presented with thyrotoxicosis secondary to molar pregnancy.

Choriocarcinoma with Uterine Rupture and Shock: A Rare Case Report

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Choriocarcinoma is frequently preceded by a complete mole, ectopic pregnancy, nonmolar intrauterine abortion, and uncommonly by a partial mole. It is treated medically with chemotherapeutic drugs usually. However, we managed to save a life with appropriate and timely surgical intervention in a case of choriocarcinoma who presented with uterine rupture, haemoperitoneum, anaemia and hypovolemic shock. The patient underwent exploratory laparotomy and hysterectomy followed by systemic chemotherapy.