Trophoblastic Disease Research Articles

Epithelioid Trophoblastic Tumor in Hysterectomized Postmenopausal Woman: A Case Report and Review of the Literature

Epithelioid Trophoblastic Tumor in Hysterectomized Postmenopausal Woman: A Case Report and Review of the Literature

Contraceptive strategies for reducing the risk of reproductive cancers.

Reproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low-resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low-cost behavioral interventions to mitigate reproductive cancer risks.

Nongestational ovarian choriocarcinoma with bilateral teratoma: A rare case report and literature review.

Trophoblastic neoplasms are often associated with pregnancy, and nongestational trophoblastic neoplasms are extremely rare. Nongestational ovarian choriocarcinoma (NGCO) is a highly aggressive germ cell-derived tumor frequently presenting with early hematogenous metastasis. Herein, we report a case of a 28-year-old unmarried woman with regular menstruation who experienced vaginal bleeding 1 week after her last menstrual cycle. Doppler ultrasound revealed bilateral adnexal masses and elevated serum human chorionic gonadotropin (hCG) levels. The patient was initially misdiagnosed as presenting an ectopic pregnancy. The final pathology confirmed an International Federation of Gynecology and Obstetrics stage IA NGCO with bilateral mature teratoma of the ovary. This is an extraordinary instance of ovarian choriocarcinoma which emerged without any prior gestation, and the patient's lack of a history of pregnancy made the diagnosis ignored. After initial surgery and 1 cycle of bleomycin, etoposide, and cisplatin (BEP) chemotherapy, a laparoscopic fertility-preserving comprehensive staging surgery was performed. Two cycles of chemotherapy with BEP were administered as supplemental therapy postsurgery, and leuprorelin was administered to protect ovarian function. Menstruation resumed 4 months after chemotherapy completion, and tumor indicators were within the normal range. No signs of recurrence were observed at the 36-month follow-up. NGCO should be considered if a female patient exhibits irregular vaginal bleeding and masses in the adnexal area. The present case and our literature review also highlighted that fertility-sparing surgery and multidrug chemotherapy are effective methods for treating NGCO.

Organ-preserving treatment of a patient with a trophoblastic tumor of the placental bed (clinical observation and literature review)

Placental site trophoblastic tumor (PSTT) is а rare form of gestational trophoblastic neoplasia (GTN), accounting 0,2 % of total cases of GTN. PSTTs occur in women of childbearing age and most of them have strong desire to preserve fertility. PSSTs are tumors with unpredictable biological behavior, high chemo-resistance and possibly fatal outcome in case of metastatic disease.Hysterectomy is the primary treatment of choice in early disease. We report a rare clinical case of fertility sparing treatment for PSTT.

HELLP syndrome due to gestational trophoblastic disease

HELLP syndrome due to gestational trophoblastic disease

A Case of Placental Implantation with Exaggerated Placental Site

Objective: This study aims to investigate the clinical symptoms, diagnosis, differential diagnosis, and prognosis of exaggerated placental site (EPS), in order to reduce misdiagnosis and missed diagnosis of EPS, avoid the occurrence of serious complications such as massive hemorrhage, and provide some references for clinical doctors. Methods: Retrospective analysis of the medical history and treatment of a patient with placental implantation with exaggerated placental site. A 23-year-old female presented with persistent vaginal bleeding after medical abortion. She was diagnosed with retained products of conception and underwent hysteroscopic surgery. The preliminary postoperative pathological results indicate the possibility of EPS and placental site trophoblastic tumor (PSTT). Further immunohistochemical testing was performed, and the results suggested EPS. Results: The patient recovered well after surgery and did not require further treatment. Her serum human chorionic gonadotropin levels and transvaginal ultrasound findings were normal. Conclusion: EPS is a benign disease, and symptoms will disappear after lesion clearance, requiring no special treatment or follow-up, with a good prognosis. Due to the low incidence rate, atypical clinical symptoms, and insufficient recognition by clinical doctors, EPS are prone to misdiagnosis and missed diagnosis, leading to serious consequences such as massive hemorrhage and hysterectomy. EPS should be considered as a possible diagnosis in any woman who has irregular bleeding following medical abortion.

The prevalence of molar pregnancy among patients with incomplete miscarriage at a maternity teaching hospital

Background and objective: Gestational trophoblastic disease (GTD) involves a range of interrelated disorders that originate from the placenta; it can be benign or malignant. In the Kurdistan region of Iraq, data about GTD and its consequences is scarce. This study aims to identify the prevalence of GTD and its types among a cohort of Kurdish women. Methods: A cross-sectional study was conducted for a one-year duration from April 1, 2020, to April 1, 2021, at the Emergency Department of Maternity Teaching Hospital, Erbil City. Pregnant women in their first trimester and early second trimester (4–14 weeks of gestation) with vaginal bleeding, pregnant women with vaginal bleeding due to incomplete miscarriage, and pregnant women with a history of missed miscarriage were included in the study. A specialized questionnaire was prepared for the purpose of data collection. Results: Out of 380 incomplete miscarriage cases who were interviewed, fifty patients with gestational trophoblastic disease were included in the current study. The prevalence of GTD was 13.1%, and the majority of patients had a partial type of GTD. The current analysis indicated that there was a statistically significant association between the types of GTD, the personal history of molar pregnancy, and the age of participants. The analysis indicated that there is no statistical association between parity, blood group, and history of miscarriage and the type of GTD. Conclusion: The prevalence of GTD was remarkably high, and the partial type of GTD was the most common form present among the participants. The majority of the cases were diagnosed during the first trimester of the pregnancy. Complete GTD was more common among patients of advanced age.

SPOP attenuates the proliferation, invasion, and migration of choriocarcinoma JAR cells by promoting KIF23 degradation

Abstract Objectives Choriocarcinoma is a highly malignant and aggressive trophoblastic tumor. In our previous study, we discovered that the speckle-type POZ protein (SPOP), which recognizes substrates of E3 ubiquitin ligase, plays a crucial role in trophoblast-derived choriocarcinoma cell lines. Therefore, we investigated the correlation between SPOP and the substrate kinesin-like protein KIF23, as well as the role of KIF23 in choriocarcinoma cells. Methods We constructed JAR cells overexpressing SPOP using lentiviral vectors and subsequently screened the related proteins through ubiquitination-modified quantitative proteomic analysis. The relationship between KIF23 and SPOP was determined using western blotting, and CCK-8, plate cloning, flow cytometry, and Transwell assays were used to investigate the effects of KIF23 and SPOP/KIF23. Results We identified the KIF23 protein and observed that SPOP promoted its degradation. The abundance of KIF23 increased after the addition of the protease inhibitor MG132. KIF23 was highly expressed in choriocarcinoma cells. Compared with JAR cells transfected with NC–small-interfering RNA (siRNA), the proliferation, invasion, migration, and percentage of G0/G1 cells in the KIF23-siRNA group were significantly lower, and the activation of the Akt/GSK3β signaling pathway was markedly attenuated. Additionally, the sh-SPOP+KIF23-siRNA group exhibited significantly inhibited JAR cell proliferation, invasion, and migration, along with clearly attenuated activation of the Akt/GSK3β signaling pathway. Conclusions SPOP attenuates the proliferation, invasion, and migration of choriocarcinoma JAR cells by promoting KIF23 degradation.

A comparison of the clinical features of molar pregnancy in adolescents and adults

Objective: To compare the age-specific clinical features of molar pregnancy and to describe the risk factors associated with this situation.
 Method: This retrospective case-control study was conducted at the Department of Obstetrics and Gynecology. Tepecik Education and Research Hospital, Izmir, Turkey. The participants included both adolescents (≤ 19 years) and adults with histologically confirmed hydatidiform moles in our institution between January 2015 and January 2022. The interventions and main outcome measures of this study involved evaluating the clinical and ultrasonographic features, as well as the risk factors, associated with molar pregnancies in adolescents.
 Results: This study of 137 patients with molar pregnancy found that adults had a higher incidence of partial molar pregnancy (20 patients versus seven patients) and lower beta-hCG levels than adolescents (176.890.71 mIU/ml versus 253.734.47 mIU/ml). Adolescents had a higher likelihood of hyperthyroidism (25.4% versus 9.2%). bleeding on admission (4.2% versus 1.51%),. longer hospital stays (5.44 ± 2.73 days versus 3.59 ± 3.08 days). Higher rates of uterine enlargement and postoperative bleeding (15.5% versus 1.5%). Adolescents also required more analgesia (97% versus 89.4%).
 Conclusions: Adolescents with Gestational trophoblastic diseases (GTD) may present with more severe symptoms compared to adults, which can lead to delayed diagnosis and treatment. Further research is needed to better understand the underlying mechanisms and risk factors for GTDs in this population. Increased awareness and education can help improve recognition and management of GTDs in adolescents and improve their overall health outcomes.
 doi: https://doi.org/10.12669/pjms.40.5.8383
 How to cite this: Ozer M, Ozer PT, Karaca I, Karaca S, Ileri A, Budak A. A comparison of the clinical features of molar pregnancy in adolescents and adults. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8383
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Post molar choriocarcinoma with solitary renal metastasis in the absence of primary uterine tumor: a case report and review of the literature

BackgroundChoriocarcinoma is a rare and highly malignant form of gestational trophoblastic disease that may develop following pregnancy, abortion, or a hydatiform mole. Renal metastatic involvement by post molar choriocarcinoma is even rarer. In this case report, we describe a unique case of post molar choriocarcinoma with a solitary renal metastasis in the absence of a primary uterine tumor and metastases in other sites, which presented with urological symptoms and spontaneous renal hemorrhage.Case presentationA 41-year-old Persian woman with history of complete hydatiform mole presented with severe flank pain, nausea, vomiting, gross hematuria, and vaginal bleeding. Laboratory tests demonstrated a serum beta human chorionic gonadotropin hormone level of 60,000 mIU/mL. Imaging studies showed a lesion at the lower pole of the left kidney with active bleeding surrounded by hematoma, as well as an empty uterine cavity. Additionally, bilateral pleural effusion was detected without any lesion within the lungs. Subsequently, the patient underwent laparotomy, partial nephrectomy, and left para-ovarian cystectomy. Endometrial curettage was also carried out. The histopathology report revealed choriocarcinoma renal metastasis with high expression of beta human chorionic gonadotropin, cytokeratin 7, and Ki 67. Moreover, there were no malignant cells in the endometrial curettage specimens, and a corpus luteum cyst was found within the para-ovarian cyst. Further investigations revealed that the pleural effusion was free of malignant cells, and there was no evidence of metastatic lesions in the brain. As a result, the patient was referred to the oncology department to receive chemotherapy, and the beta human chorionic gonadotropin levels dropped to 5 mIU/mL after receiving courses of a standard regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovin over 3 weeks. Finally, monthly measurements of beta human chorionic gonadotropin levels for 6 months indicated that levels have constantly remained within normal ranges, showing no evidence of recurrence or new metastasis.ConclusionsUrological symptoms such as hematuria or spontaneous renal hemorrhage might be the only presentation of post molar choriocarcinoma with renal involvement. Thus, it can be beneficial to measure serum beta human chorionic gonadotropin levels among females of childbearing age who present with unexplained urological symptoms, especially if there is a history of prior hydatiform mole.

Trans-Abdominal Ultrasonographic Evaluation of Molar Pregnancy

Background: Molar pregnancy is the most common benign from of gestational trophoblastic neoplasm. Molar pregnancy has distinction histologic characteristics a custic or grape like degeneration of chorionic villi, absent or inadequate vascularization of chorionic villi and abnormal proliferation of placental trophoblast. Objective: To assess the role of ultrasonography (UCG) in the evaluation of molar pregnancy. Method: This cross sectional study was carried out on consecutively selected 40 patient out of 45 patient who were suspected to suffering from molar pregnancy. This study was take place Mymensingh Medical College Hospital from those who were attended the department for ultrasonography for suspicious features of gestational trophoblastic diseases. Result: Among the 40 patients in this study 9 were 15-20 years of age, total 24 were between 20-35 years of age and 7 patients were 35-45 years of age. The range of age was 15 to 45 years. Conclusion: In conclusion ultrasonography can be accepted as an initial imaging modality in the evaluation of gestational trophoblastic diseases.

Kenneth Dawson Bagshawe. 17 August 1925—27 December 2022

Kenneth Bagshawe was a physician, a scientist and an architect of modern oncology. He was first to show that combination chemotherapy can cure a non-haematological cancer, choriocarcinoma. He demonstrated how a tumour marker in blood and urine can give a quantitative representation of the total amount of tumour, providing a monitor of response to treatment or relapse and an indicator of prognosis. He enhanced understanding and treatment of gestational trophoblastic diseases (GTD), a group of which choriocarcinoma is the most lethal member. The most common form of GTD is hydatidiform mole and he developed a national system for management, resulting in a cure rate of virtually 100%. For choriocarcinoma, the figure is today approaching 98%. His system is used in many countries, and over several decades has contributed to the cure and preservation of fertility in hundreds of thousands of women who previously had little or no hope. He used the same principles to treat testicular and ovarian germ cell tumours, again achieving high levels of cure in patients whose disease had spread and would previously have been fatal. He innovated throughout his career, seeking improved tumour specificity in diagnosis and treatment of GTD and inventing antibody-directed enzyme prodrug therapy for more common cancers. He founded the first department of oncology in the UK and devoted much time to developing the speciality, directing research funding organizations and supporting the development of the speciality worldwide. He was a dedicated, original and hugely productive pioneer of oncology.

Effect of Methotrexate on Anti-Mullerian Hormone Levels, β-hCG and Tumor Size in Women with Low-Risk Gestational Trophoblast Disease

Introduction: This study aimed to evaluate the effect of methotrexate (MTX) chemotherapy on anti-mullerian hormone (AMH) levels, human chorionic gonadotropin (HCG) levels, and tumor size in women with gestational trophoblastic disease (GTD). Method: This study was conducted at Hasan Sadikin General Hospital, Bandung, West Java, from April to October 2020. The AMH level, beta human chorionic gonadotropin (ß-hCG) and tumor size in women with a low risk of GTD prior to and after MTX chemotherapy treatment were measured and compared.Results: Our study found a reduction in mean AMH level to 0.82 ng/ml after the MTX chemotherapy. The mean AMH level after chemotherapy in women with low-risk GTD decreased to 0.82 ng / ml. In addition, ß-hCG level decreased after chemotherapy with MTX. There was a negative relationship between ß-hCG level and tumor size before and after chemotherapy. Higher ß-hCG levels and tumor size before chemotherapy resulted in a further increase in AMH after chemotherapy.Discussion: There was a decrease in AMH and ß-hCG levels after three cycles of MTX chemotherapy in women with low-risk GTD. Tumor size and ß-hCG correlated with post-chemotherapy AMH results.Pengaruh Metotreksat terhadap Kadar Hormon Anti Mullerian, β-hCG dan Ukuran Tumor pada Wanita dengan Penyakit Trofoblas Gestasional Risiko RendahAbstrakPendahuluan: Penelitian ini mengevaluasi efek kemoterapi metotreksat (MTX) terhadap kadar hormon anti-mullerian (AMH), kadar human chorionic gonadotropin (HCG), dan ukuran tumor pada wanita yang didiagnosis penyakit trofoblas gestasional (GTD) risiko rendah.Metode: Penelitian ini dilakukan di Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Jawa Barat, dari bulan April hingga Oktober 2020. Kadar AMH, beta human chorionic gonadotropin (ß-hCG), dan ukuran tumor pada wanita dengan GTD risiko rendah sebelum dan sesudah pengobatan kemoterapi MTX diukur dan dibandingkan.Hasil: Pada penelitian kami menemukan penurunan kadar AMH rata-rata menjadi 0,82 ng/ml setelah kemoterapi MTX. Rata-rata kadar AMH setelah kemoterapi pada wanita dengan GTD risiko rendah menurun menjadi 0,82 ng/ml. Selain itu, kadar ß-hCG juga menurun setelah kemoterapi dengan MTX. Terdapat hubungan negatif antara kadar ß-hCG dan ukuran tumor sebelum kemoterapi dan AMH setelah kemoterapi. Kadar ß-hCG yang lebih tinggi dan ukuran tumor sebelum kemoterapi menunjukkan peningkatan lebih tinggi pada AMH setelah kemoterapi.Kesimpulan: Terjadi penurunan kadar AMH dan ß-hCG setelah tiga siklus kemoterapi MTX pada wanita dengan GTD risiko rendah. Ukuran tumor dan kadar ß-hCG berkorelasi dengan hasil kadar AMH setelah kemoterapi.Kata kunci: Kemoterapi, Metotreksat, Hormon anti-mullerian, ß-hCG, Tumor trofoblas gestasional

Study of vesicular mole and its outcomes

Vesicular mole is defined as the premalignant form of gestational trophoblasticneoplasia. I5-20% of complete moles and <5% of partial moles will develop into Gestational Trophoblastic Neoplasia. It is of clinical and epidemiological interest because of its potential for significant consequences on women's health. The study aims to determine the incidence, outcomes and complications of pregnancy with vesicular mole at SKNMC hospital, Pune. It was a retrospective study. Approval for the study was obtained from institutional ethical committee. Data was collected from OPD, OT register and Indoor patient record file from August 2015 to August 2020. Proformas were filled. All the collected data was compiled in a master chart, analysed and outcomes of different variables under study have been expressed in the form of mean, frequencies, percentages and charts. The incidence of molar pregnancy was 0.17% or 1 in 561 deliveries. Vesicular mole occurred more in the age group 16 to 25 years, was lowest in age group 31-35yrs. Vesicular mole was most common in nulliparous women. The mean gestational age of the patients at presentation was 9.4 week. Hemorrhage after suction and evacuation was seen in 26% cases needing intra and post-operative blood transfusion. 6% of patients developed thyrotoxicosis. During follow up invasive mole was diagnosed in 2 cases (6%). The case fatality rate is 2.9% in our study. 1 patient (3%) developed choriocarcinoma and died within 6months after hysterectomy and chemotherapy. The incidence of 1 in 561 deliveries which is higher than non-Asian countries 1/752 but lower than other Asian countries 1/387. The routine first trimester ultrasonography helps in early detection of asymptomatic women. If not followed up regularly it can be life threatening.

N-linked α2,6-sialylation of integrin β1 by the sialyltransferase ST6Gal1 promotes cell proliferation and stemness in gestational trophoblastic disease

IntroductionGestational trophoblastic disease (GTD) encompasses a spectrum of rare pre-malignant and malignant entities originating from trophoblastic tissue, including partial hydatidiform mole, complete hydatidiform mole and choriocarcinoma. β-galactoside α2,6 sialyltransferase 1 (ST6Gal1), the primary sialyltransferase responsible for the addition of α2,6 sialic acids, is strongly associated with the occurrence and development of several tumor types. However, the role of ST6Gal1/α2,6 -sialylation of trophoblast cells in GTD is still not well understood. MethodsThe expression of ST6Gal1 was investigated in GTD and human immortalized trophoblastic HTR-8/SVneo cells and human gestational choriocarcinoma JAR cells. We evaluated the effect of ST6Gal1 on proliferation and stemness of trophoblastic cells. We also examined the effect of internal miR-199a-5p on ST6Gal1 expression. The role of ST6Gal1 in regulating α2,6-sialylated integrin β1 and its significance in the activation of integrin β1/focal adhesion kinase (FAK) signaling pathway were also explored. ResultsST6Gal1 was observed to be highly expressed in GTD. Overexpression of ST6Gal1 promoted the proliferation and stemness of HTR-8/SVneo cells, whereas knockdown of ST6Gal1 suppressed the viability and stemness of JAR cells. MiR-199a-5p targeted and inhibited the expression of ST6Gal1 in trophoblastic cells. In addition, we revealed integrin β1 was highly α2,6-sialylated in JAR cells. Inhibition of ST6Gal1 reduced α2,6-sialylation on integrin β1 and suppressed the integrin β1/FAK pathway in JAR cells, thereby affecting its biological functions. DiscussionThis study demonstrated that ST6Gal1 plays important roles in promoting proliferation and stemness through the integrin β1 signaling pathway in GTD. Therefore, ST6Gal1 may have a potential role in the occurrence and development of GTD.

Upfront Hysterectomy Versus Primary Chemotherapy in the Management of Low-Risk Gestational Trophoblastic Neoplasia at Old Age Patients: A Prospective Study

Upfront Hysterectomy Versus Primary Chemotherapy in the Management of Low-Risk Gestational Trophoblastic Neoplasia at Old Age Patients: A Prospective Study

Comparative Investigation of Color Doppler Ultrasonography Parameters of the Uterine Artery in Patients with Post-molar GTN and Patients Recovered from Molar Pregnancy and its Role in Predicting the Probability of Occurrence

Objectives: Hydatiform mole can progress to gestational trophoblastic neoplasia (GTN), and we are looking for non-invasive methods to predict it. Old age, higher serum BHCG levels, and expression of genes, such as VEGF-EG, HIF-1α, and TGF-ß are known as predictive factors. We performed this study to evaluate the role of bilateral uterine artery doppler ultrasound in predicting postmolar- GTN. Methods: In this prospective cohort study, 42 patients with complete molar pregnancy were examined. Inclusion criteria confirmed molar pregnancy by histopathological examination. Exclusion criteria were patients more than 40 years old, patients with completed family childbearing planning, and diagnosis of GTN during the routine histopathological study. Before molar evacuation and four weeks later, bilateral uterine artery doppler sonography to determine the PI, RI, and PSV was performed. Serum BHCG levels were also measured before molar evacuation and weekly after evacuation until it exhibited spontaneous remission or developed GTN. Results: About 36 patients were cured, and six others developed post-molar GTN. The bilateral uterine artery doppler sonography between the two groups showed a lower UA RI in the post-molar-GTN group before evacuation (P=0.048). Data demonstrated significant increases in Right.UA.RI (P=0/008), Left.UA.PI (P=0/037), and Right.UA.PSV (P=0/024) in the spontaneous remission group during 28 days follow-up period. There were no significant differences in these parameters in the GTN group throughout the time of follow-up. Conclusion: It seems that Doppler ultrasound plays a role in predicting GTN following uterine evacuation. A lower resistance in the uterine artery before evacuation and the remaining uterine artery blood flow constant after evacuation is associated with the development of post-molar- GTN.

A meta-analysis of predictive value of blood biomarkers in gestational trophoblastic neoplasia.

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to play a diagnostic and predictive role in gestational trophoblastic disease. However, the conclusions are still ambiguous. This meta-analysis aimed to evaluate the combined predictive value of NLR and PLR in the malignant progression of gestational trophoblastic disease. Method: Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, Wanfang and China Biomedical Literature Database were searched for the relevant literature published up to 1October 2022. Study selection and data extraction were performed independently by two reviewers. All analyses wereperformed using Revman, MetaDisc and STATA software. Results: A total of 858 patients from five studies were included in this meta-analysis. The pooled sensitivity and specificity of NLR were 0.8 (95% CI: 0.71-0.88) and 0.73 (95% CI: 0.69-0.76), respectively, and the area under curve of the summary receiver operating curvewas 0.81. The pooled sensitivity and specificity of PLR were 0.87 (95% CI: 0.75-0.95) and 0.49 (95% CI: 0.44-0.54), respectively, and the area under curve of thesummary receiver operating curvewas 0.88. I2 statistic and Deek's funnel plot showed no heterogeneity and publication bias. Conclusion: NLR can accurately predict the progression from hydatidiform mole to gestational trophoblastic neoplasia and is a promising biomarker in further follow-up.

Role of Uterine Artery Ligation and Chemotherapy in Atypical Cases of Gestational Trophoblastic Disease: A Case Report of Atypical GTD Diagnosis & Management

Introduction Gestational trophoblastic disease[1 i ] is a rare developmental form of proliferative trophoblastic tissue in women of reproductive age that involves both benign and malignant entities that include hydatidiform mole (complete or partial), choriocarcinoma, invasive mole, epithelioid trophoblastic tumor (ETT), and placental site trophoblastic tumor (PSTT). Four of these known as gestational trophoblastic neoplasia [2 ii], and hydatidiform is most common type of GTD. Gestational trophoblastic neoplasia (GTN) is a type of gestational trophoblastic disease that is almost always malignant, and can metastasize and be fatal if not treated. The ultimate treatment for GTD includes surgery (evacuation of the proliferative trophoblastic tissue, hysterectomy), chemotherapy regimens, radiotherapy and emerging targeted therapies. It is one of the most chemotherapy responsive and highly curable cancer. In most instances, it is cured by surgical evacuation of the uterus. If persistent, it is treated with chemotherapy which provides response in >90% of the cases. In the unresponsive persistent cases and if the women has completed her child bearing, hysterectomy is generally recommended. Here, we report a case of atypical GTD {uncommon, that is not fitting a single diagnosis} treated by chemotherapy and bilateral uterine artery ligation.

An unusual case of metastatic trophoblastic neoplasm presenting with diffuse cystic lung disease and pulmonary artery pseudoaneurysms in a teenager.

Diffuse cystic lung diseases (DCLDs) are a diverse group of lung disorders characterized by the presence of multiple air filled cysts within the lung tissue. These cysts are thin walled and surrounded by normal lung tissue. In adults, DCLD can be associated with various conditions such as lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis, cancers, and more. In children, DCLD is often linked to lung developmental abnormalities, with bronchopulmonary dysplasia being a common cause. Patients with pulmonary cysts are typically asymptomatic, but some may experience mild symptoms or pneumothorax. While DCLD in children is rarely due to malignancy, metastatic lung disease can be a cause. It is important for clinicians to be aware of the possibility of metastatic lung disease when encountering DCLD.