Invasive Mole Research Articles

The impact of previous cesarean section (C/S) on the risk for post-molar gestational trophoblastic neoplasia (GTN)

ObjectiveTo investigate the relationship between previous cesarean section (C/S) and risk for post-molar gestational trophoblastic neoplasia (GTN). MethodsData from patients who were treated for hydatidiform moles between 1995 and 2016 were retrospectively reviewed. Patient age, gravidity, parity, abortion history, gestational age, pretreatment beta-human chorionic gonadotropin (HCG), previous molar pregnancy, clinical symptoms, enlarged uterus, theca lutein cyst, type of GTN, World Health Organization risk score, chemotherapy, and mode of delivery were recorded. Hazard ratios (HR) and 95% confidence intervals (CI) for variables associated with the occurrence of post-molar GTN and invasive mole were estimated by univariate and multivariate Cox proportional hazards models. ResultsFrom 1995 to 2016, 182 patients were diagnosed with molar pregnancy and underwent treatment. Patients with previous C/S (C/S group) had higher age (37.0 vs 32.8. p = 0.004), gravidity (3.1 vs 2.0, p < 0.001), and parity (1.6 vs 0.9, p < 0.001) than patients without previous C/S (non-C/S group). Post-molar GTN (43.5 vs 26.5%, p < 0.001), invasive mole (21.7 vs 3.7%, p < 0.001), hysterectomy (28.3 vs 6.6%, p < 0.001), and chemotherapy (45.7 vs 28.7%, p = 0.03) were more frequent in the C/S group. In multivariate analysis, independent risk factors for post-molar GTN were previous C/S (HR 5.1, 95% CI 2.1–12.7), abortion history (HR 6.3, 95% CI 2.5–15.6), and pretreatment β-hCG (HR 1.3, 95% CI 1.1–1.6). ConclusionsIn this study, C/S was a strong risk factor for occurrence of post-molar GTN and invasive mole. Aggressive treatment, such as multi-agent chemotherapy or hysterectomy, can be considered for hydatidiform moles in patients with a C/S history.

Gestational Trophoblastic Neoplasia

Introduction: Gestational trophoblastic neoplasia (GTN) account for less than 1% of cancers of the female reproductive system. Nearly 50% of gestational choriocarcinomas are seen after molar pregnancies. About 25% after abortions or ectopic pregnancy and another 25% after a normal pregnancy. FIGO staging and prognostic scoring index of modified WHO classification is used. Serum β-HCG assay is an important factor in the diagnosis and management of GTN. It is a sensitive tumour marker for GTN and its level is directly related to the number of viable tumour cells. Serial measurement of β-hCG levels is useful for follow-up of women diagnosed with complete or partial mole. An increasing level or plateauing of serum β-hCG is diagnostic of invasive disease which can be invasive mole or choriocarcinoma. Case Report: Patient A-was a 22 year old lady, para1, two year old child which was a normal delivery. She was asymptomatic and reported to the hospital for missed periods. Urine pregnancy test was positive. Ultrasound scan did not find any pregnancy. Beta HCG levels were very high. Then MRI was done which showed no abnormality, other than a bulky uterus. Curettage was done and the report came as trophoblastic tissue seen with possibility of choriocarcinoma. This patient was given 2 cycles of methotrexate with folinic acid after which the patient was lost to follow up. Patient B-was a 27 year old lady, para1, three year old child delivered by caesarean section. She also gave history of two subsequent abortions. She presented with menorrhagia and on examination a cervical polyp was detected. The polyp was resected and sent for histo-pathology and the report suggested choriocarcinoma. Her beta HCG was 30,000. This patient was given three cycles of multi-agent chemotherapy, MAC (Methotrexate, Actinomycin-D and Cyclophosphamide) regime and responded to treatment. Discussion: The main stay of treatment is chemotherapy. Mostly single agent chemotherapy is used methotrexate being the drug of choice. Methotrexate in the dose of 0.4 mg/kg IM or IV daily for 5 days, appears to be the most effective treatment protocol. Another widely used regimen is using folinic acid along with methotrexate. Some of the more commonly used multiagent chemotherapy combinations are – MAC, EMA-CO, EMA-EP, VBP and BEP. Conclusion: GTN can be treated with appropriate chemotherapy and supportive management, after correct staging and scoring of the disease. They are also the most curable of all cancers in women.

Identification of a hydatidiform mole in twin pregnancy following assisted reproduction.

The aim of this study was to identify a co-existing hydatidiform mole (HM) in twin pregnancy from the abnormal mixed-genomic products of conception (POC) after assisted reproduction by histopathological review, evaluation of p57kip2 immunostaining and short tandem repeat genotyping. Thirty-seven patients were collected with suspicion for HM by pathological morphology. They had two embryos individually transferred to their uterus after in vitro fertilization and presented two gestational sacs with undeveloped embryos or one sac with an abnormal area by ultrasonography. Thirty patients were diagnosed as singleton pregnancy, including twenty-two non-molar gestations, six trisomy gestations, one homozygous complete mole and one heterozygous partial mole. Although six patients had ultrasonic imaging of two gestational sacs, the embryonic components in the vacant sac might fade away after transferring. Other seven patients were considered as twin pregnancy by the allelic genotype from two individual conceptions. For the patients with uniform p57kip2 positivity, excessive paternal alleles indicated the potential partial HM in the twin pregnancy. For the patients demonstrated divergent and/or discordant p57kip2 immunostaining, twin pregnancy with co-existing complete HM or mosaic conception were confirmed by genotyping of different villi population respectively. These patients were monitored by serum β-HCG, while one twin pregnancy with complete mole suffered invasive mole and received chemotherapy. A strategy composed of selective clinicopathological screening, immunohistochemical interpretation and accurate genotyping is recommended for diagnostically challenging mixed-genomic POC of potential twin pregnancy with HM, especially to differentiate a non-molar mosaic conception from a partial mole.

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors.

Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease originating from the intermediate trophoblast. Compared with hydatidiform mole, invasive hydatidiform mole and choriocarcinoma, the diagnosis of PSTT is more complicated and lacks specific and sensitive tumor markers. Most PSTT patients demonstrate malignant potential, and the primary treatment of PSTT is hysterectomy. However, metastasis occasionally occurs and even causes death in a small number of PSTT patients. Most PSTT patients are young women hence fertility preservation is an important consideration. The major obstacle for PSTT patient prognosis is chemotherapy resistance. However, the current understanding of the pathogenesis of PSTT and clinical treatment remains elusive. In this review, we summarized the research progress of PSTT in recent years from three aspects: mechanism, clinical presentation, and treatment and prognosis. Well-conducted multi-center studies with sufficient sample sizes are of great importance to better examine the pathological progress and evaluate the prognosis of PSTT patients, so as to develop prevention and early detection programs, as well as novel treatment strategies, and finally improve prognosis for PSTT patients.

Long-term changes in mole cricket body size associated with enemy-free space and a novel range

Exotic species can cause ecosystem and landscape-level changes in their novel ranges, but factors associated with novel ranges can also change the invaders. By tracking trait changes over space and time, we can learn about the future ecological and economic implications of invasive species’ dispersal. Here, we investigated body size changes of two invasive mole cricket species, Neoscapteriscus borellii and N. vicinus, introduced to the U.S. from South America (≈ 1904) without natural enemies, and later exposed to them (≈ 1980) through classical biological control. We compared body sizes of N. vicinus and N. borellii in the novel range from before biological control and 30 years after, as well as N. borellii in its native range at the same time period. Contrary to expectations, our data suggest that N. borellii and N. vicinus body sizes have increased since re-establishment of interactions with their natural enemies. Our results also suggest that N. borellii body size decreased in enemy-free space after U.S. invasion and prior to biological control. Selection or reduced intraspecific competition, both likely associated with biological control, may explain the changes in body size over time. Although these results warrant further research, they provide valuable insights into the long-term effects of invasion and classical biological control.

257P - Treatment results of low risk gestational trophoblastic neoplasia (GTN) from a tertiary hospital, Chennai, India

BackgroundGTN comprises a unique group of tumours that originate from trophoblastic tissues which includes Invasive mole, choriocarcinoma and Placental site trophoblastic tumour and with proper treatment low-risk GTN is 100% curable. This study was carried out to evaluate the management outcome of low risk GTN patients to the accepted 1st line treatment regimens followed in the hospital. Methods205 patients of gestational trophoblastic disease who were registered at the institute between January 2016 and December 2018 were analysed retrospectively. Risk stratification & Staging was done according to Revised FIGO 2002 staging system. All low risk patients were included the study. ResultsOut of 205,46 (22%) patients were diagnosed with GTN (low-risk 43/205(21.5%). 37(86.04%) patients received single agent Methotrexate (weekly) while 4 (9.3%) patients received Actinomycin D (bi-weekly) as first line. Methotrexate/LV was given for 2 patients. 67.5%(n = 25/37) achieved Complete Response (CR) on Methotrexate while 32.4%(n = 12/37) went on to get second line.62.5%(n = 10/16) received ACT-D in second line while multi-drug chemotherapy was given to 5 patients (31%,5/16). CR was achieved in 84.62%(n = 11) in 2nd line while 1 patient went on to get 3rd line chemotherapy. Anemia was the most common complication associated with the disease and treatment. ConclusionsLow- risk GTN is a highly chemo-sensitive tumor and 100% curable. methotrexate as single agent produced 67.5% of complete remission. Single agent methotrexate is still one of the preferred first-line regimes for low risk GTN. Legal entity responsible for the studyThe author. FundingHas not received any funding.The author has declared no conflicts of interest.

Gestational Trophoblastic Disease: Prevalence, Management and Follow-Up at a Tertiary Center in Oman—An 11-Year Study

The objective of this study is to estimate the prevalence, management and follow-up of gestational trophoblastic disease (GTD) in a tertiary care center, Royal Hospital, in Oman over the last 11 years from January 2007 till December 2017. This study also looked into the reproductive outcome after trophoblastic disease treatment. This retrospective, descriptive study was carried out at Royal Hospital from Jan. 2007 to Dec. 2017. All cases with a histopathological report of hydatidiform molar disease were included. Demographic characteristics, clinical presentation physical signs, treatment and follow-up including reproductive outcome and recurrence rate were included. Two hundred and thirty-six women with GTD were included in the study. Mean maternal age was 35 years, mean gravidity 5 and parity 3. Prevalence of complete mole was 83 cases (35.1%), partial mole 144 cases (61%), choriocarcinoma (0.42%), placental site (0.42%) and invasive mole (1.27%). Thyrotoxicosis, preeclampsia and anemia were 3.8%, 7.2% and 0.8%, respectively. Mean gestational age was 10.57 ± 3.2 weeks at presentation. Persistent disease was observed in 12.3%. About 5% received chemotherapy. Metastasis was reported in 4.7% of cases, 81.8% to the lung. About 38% conceived later. This study highlights the importance of proper assessment and follow-up of histopathology diagnosis. GTD usually has a good prognosis and reproductive outcome if properly followed up and treated.

An Acoustic Trap to Survey and Capture Two Neoscapteriscus Species

There is an extensive history of mole cricket integrated pest management (IPM) research in Florida, USA (Kerr et al. 2014; Mhina et al. 2016), much of which has incorporated acoustic trapping as a monitoring tool. The acoustic trap design described in this report provides a method for surveying 2 Neoscapteriscus mole cricket species relatively autonomously at low cost, which can facilitate future efforts to study the biology, ecology, and distribution of invasive mole crickets (e.g., Walker 1988). In a broader context, however, there remains considerable need to reduce the costs and simplify the technology of these and other traps based on inexpensive microcontroller platforms, not only for Neoscapteriscus species, but also for other pests that mate based on either acoustic or vibrational communication (Mankin 2012). Sumario Existe una extensa historia de investigaciones sobre el manejo integrado de plagas (MIP) del grillo topo en la Florida, EE. UU. (Kerr et al. 2014; Mhina et al. 2016), una gran parte de las cuales ha incorporado el atrapamiento acustico como herramienta de monitoreo. El diseno de la trampa acustica descrito en este informe proporciona un metodo para estudiar 2 especies de grillo topos del genero Neoscapteriscus de forma relativamente autonoma a bajo costo, lo que puede facilitar los esfuerzos futuros para estudiar la biologia, ecologia y distribucion de los grillo topos invasivos (por ejemplo, Walker 1988). Sin embargo, en un contexto mas amplio, sigue existiendo una necesidad considerable de reducir los costos y simplificar la tecnologia de estas y otras trampas basadas en plataformas economicas de microcontroladores, no solo para las especies de Neoscapteriscus, sino tambien para otras plagas que se aparean en base a la comunicacion acustica o vibracional (Mankin 2012). Key Words: mole cricket; forage; turfgrasses; survey View this article in BioOne .

Clinical characteristics and outcomes of extrauterine epithelioid trophoblastic tumors.

Epithelioid trophoblastic tumor (ETT) derived from intermediate trophoblasts is one type of gestational trophoblastic neoplasia (GTN), and it accounts for less than 2% of all gestational trophoblastic diseases (GTD). Extrauterine ETT is extremely rare, and there is currently no consistent strategy for its treatment and management. Therefore, the aim of the study is to analyze and summarize the clinicopathologic features of extrauterine ETT with or without metastasis. The Web of Knowledge, Google Scholar, EMbase, congress of library, and PubMed were searched for extrauterine ETT without primary uterine lesions. All available data were extracted from published case reports or serial case reports, and then, the clinical and pathological characteristics were analyzed. Twenty-two clinical studies consisting of 27 patients diagnosed with extrauterine ETT, according to the given inclusion and exclusion criteria, were included in the study. A total of 27 cases of extrauterine ETT were identified. Of these cases, four (14.81%) were located in the lungs, three (11.11%) in the ovaries, two (7.41%) in the vagina, and eight (29.63%) patients had other primary lesions. The patients originated from different continents, with 59% located in Asia and 26% in North America. Among 23 patients, the antecedent pregnancy prior to the diagnosis was full-term in 12 cases, abortion in 6 cases, hydatidiform mole in 3 cases, and invasive mole in 1 case. From the available antecedent information on pregnancy, the median interval from pregnancy to diagnosis of extrauterine ETT was 4years. Additionally, the median gravidity and para of the patients was three times and two times, respectively. The median hCG titer was 14,374mIU/mL in 5 patients, and the mean β-HCG titer was 3,724,805mIU/mL in 14 patients. For all patients, the disease was confined to extrauterine ETT at diagnosis. From the available information, 20 cases were successfully treated by extraction of local lesions, and 12 cases received chemotherapy. Diagnosis was confirmed by histological tests. The Ki-67 staining ranged from 8.7 to 80%, and tumors were positive for hCG, PLAP, EMA, and p63. In this study, we observed that abnormal levels of serum hCG titers and the local presentation of lesions with varying intervals after antecedent term pregnancy were the most common presenting features of extrauterine ETT. In addition, we found that the extraction of extrauterine lesions was needed for the treatment of extrauterine ETT. Of course, the follow-up was also important.

Expression of p57 immunomarker in the classification and differential diagnosis of partial and complete hydatidiform moles.

BACKGROUND:Hydatidiform mole (HM) is characterized histologically by cystic swelling of the chorionic villi, accompanied by variable trophoblastic proliferation. The most important reason for the correct recognition of moles is that they are associated with an increased risk of persistent trophoblastic disease (invasive mole) or choriocarcinoma.AIMS AND OBJECTIVES:The aim of the study was to determine whether there is any role of p57 in differentiating partial and complete moles by immunohistochemical staining.MATERIALS AND METHODS:A prospective observational study was undertaken in which 40 cases of molar pregnancy included over a period of 2 years. Detailed clinical and family histories were obtained from each patient. Histopathological examination followed by immunohistochemical study with p57 done in each case. Ultrasonography findings and serial titers of serum beta-human chorionic gonadotropin were noted whenever necessary.RESULTS:Among the forty cases included, 25 (62%) had complete molar (CM) pregnancy, whereas the rest 15 (38%) had partial mole (PM). Both CM and PM were more pronounced in the age group of 20–25 years (44% and 60%, respectively), and among nulliparous women (68% and 70% respectively), 17 (42.5%) mothers had a prior history of abortion. In the histologically unequivocal cases of complete mole, 96% (24 of 25) did not express p57 and a single case was focal positive. In contrast, it was strongly and continuously expressed in both villous cytotrophoblast and stromal cells in all cases of PM (15 of 15).CONCLUSION:p57 immunomarker is very helpful to diagnose and differentiate complete and partial HM.

Avoid making a mountain out of an invasive hydatidiform mole: do a pregnancy test!

Avoid making a mountain out of an invasive hydatidiform mole: do a pregnancy test!

Gestational Trophoblastic Disease at Sultan Qaboos University Hospital: Prevalence, Risk Factors, Histological Features, Sonographic Findings, and Outcomes.

ObjectivesWe sought to assess the prevalence of gestational trophoblastic diseases (GTD) among pregnant women at Sultan Qaboos University Hospital (SQUH) and compare our results with the international studies. We also sought to determine the risk factors, histological features, sonographic findings, and outcomes in women with GTD.MethodsWe conducted a retrospective cohort study of all women diagnosed with GTD and followed at SQUH between November 2007 and October 2015. We collected data on maternal demographics, risk factors, sonographic features, histological diagnosis, follow-up period, and chemotherapy treatment from the hospital information system.ResultsSixty-four women with GTD were included in the study with a mean age of 31.0±7.5 years, mean gravidity 4.0, and parity 2.0. The prevalence of GTD was 0.3% (one in 386 births), and the most common risk factors were increased maternal age and multiparity. A partial hydatidiform mole was diagnosed in 54.7%, complete hydatidiform mole in 43.8%, and invasive mole in 1.6% of women. Eleven percent of women required chemotherapy. Typical ultrasound features for partial molar pregnancy were present in 54.7% of our sample, while snowstorm appearance was seen in 89.3% of those with complete mole. Negative beta-human chorionic gonadotropin was achieved 70 days after diagnosis in 41 women.ConclusionsThe awareness of the risks and complications of GTD among physicians with close follow-up is paramount. There is a need to establish a national registry of GTD cases in Oman.

Partial Mole Coexistence with a Normal Live Fetus in Twin Pregnancy

We present a case of dizygotic diamiontic twin pregnancy in which one fetus was normal with normal placenta, the 2nd fetus was normal appearing with partial molar placenta. All required investigation and clinical assessments were carried out and revealing partial molar pregnancy in one fetus and normal placenta of the other one. Maternal BhCG was high for gestational age.The patient was a 31-year-old presented to Central Private Hospital; her gestational age was 22 weeks +5 days following IVF (after 10 years of primary infertility) of diazygotic diamiontic twin pregnancy as a case of vaginal bleeding from 8 weeks of gestation with uterine contractions.&#x0D; The patient had gestational DM &amp; hyperthyroidism. Appropriate treatment regarding her conditions was implemented&#x0D; All appropriate management was implemented. The patient continued to bleed. Within few days of admission she had premature uncomplicated labor with normal vaginal delivery (gestational age was23 Wks +3 days), both babies appeared normal, one placenta morphologically &amp;histologically typical of H.mole. The other one completely was normal.&#x0D; Monitoring of serum BhCG and follow up transvaginal US was done until BhCG level returned to normal after 3 months of delivery without chemotherapy.&#x0D; Close monitoring of pregnancy from early stages and discussing the possible complications to mother and baby (such as baby may be chromosomally abnormal &amp;may not survive) with parents is important to manage such complications.&#x0D; It is also necessary to have post-natal close follow up for maternal BhCG levels to assess any possibility of invasive mole or choriocarcinoma.

The potential value of red blood cell distribution width in patients with invasive hydatidiform mole.

BackgroundRed blood cell distribution width (RDW) has attracted increasing attention in cancer. The aim of this study was to assess the changes of RDW in patients with invasive hydatidiform mole and analyze the relationship between RDW and invasive hydatidiform mole.MethodsA retrospective analysis was performed on 102 patients diagnosed as invasive hydatidiform mole in the First Affiliated Hospital of Guangxi Medical University from January 2009 to March 2018. A total of 120 healthy subjects were used as a control group. The Mann‐Whitney U test was used for comparison between the invasive hydatidiform mole and control groups. Comparison of RDW with other blood parameters was performed using Spearman's. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) were also determined.ResultsThe RDW, platelet‐lymphocyte ratio (PLR), neutrophil‐lymphocyte ratio (NLR), and absolute lymphocyte count were significantly elevated in the invasive hydatidiform mole group compared with control group. The hemoglobin (Hb) concentration, mean red blood cell volume (MCV) and platelet count (PLT) were significantly lower in invasive hydatidiform mole group than control group. Grade III and above invasive hydatidiform mole patients had higher levels of RDW than grade I and II patients. Correlation analysis showed that RDW was negatively correlated with Hb, MCV, NLR, and neutrophil count, but positively correlated with PDW and different stages of invasive hydatidiform mole. The ROC curve showed that the AUC of the RDW was 0.660 (95% CI 0.581‐0.740; P < 0.01).ConclusionThis study reveals the potential value of RDW in invasive hydatidiform mole.

Rapidly Progressive and Severe Hirsutism from Hyperreactio Luteinalis within a Background of Polycystic Ovary Syndrome

Gestational trophoblastic disease and hyperreactio luteinalis (HL) are rare, but important, etiologies of hyperandrogenism that need to be further studied. We present a case of rapidly progressing hirsutism and marked biochemical androgen excess in the context of pregnancy. A 26-year-old woman with a past medical history of obesity, prediabetes, and polycystic ovary syndrome presented with worsening hirsutism and markedly elevated testosterone levels. She was subsequently found to be pregnant, with extremely elevated levels of serum β-human chorionic gonadotropin. Subsequent work-up led to the identification of molar pregnancy and bilaterally enlarged ovaries, suggestive of HL. Following surgical intervention and therapy with methotrexate for invasive mole, she experienced improvement in both biochemical and clinical androgen excess features. With the prevalence of polycystic ovary syndrome, many women present to medical providers with hirsutism or other findings of hyperandrogenism. However, rapid progression of existing hirsutism or severe hirsutism should prompt more extensive evaluations to rule out rare etiologies. One such etiology found in pregnancy is HL, in which high levels of β-human chorionic gonadotropin can stimulate production of benign theca lutein cysts, leading to marked hyperandrogenism and virilizing symptoms.

HDlive Flow for Diagnosis of Invasive Mole

HDlive Flow for Diagnosis of Invasive Mole

Incidence of gestational trophoblastic disease in South Korea: a longitudinal, population-based study.

IntroductionWe investigated the rate and longitudinal trends of gestational trophoblastic disease (GTD) incidence in the Republic of Korea between 2009 and 2015 using population-based data.Materials and MethodsData of patients diagnosed with GTD from 2009 to 2015 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (HIRA-NIS) in the Republic of Korea. The HIRA annually provides the HIRA-NIS, a collection of clinical data from over one million people. For each year, the HIRA-NIS extracted records of 13% of patients admitted at any one time during the year and 1% of all remaining patients using the weighted sample method.ResultsMedical records of 370,117 women with at least one pregnancy (GTD, ectopic pregnancy, abortion, or delivery) were extracted from a total of 4,476,495 records. Of these, 372 episodes of GTD were identified in women with a mean age of 35.4 ± 0.7 years. The incidence rate of GTD was 130 ± 10 cases per 100,000 pregnancies, which was classified as hydatidiform mole (HM), invasive mole, or malignant neoplasm of the placenta with incidence rates of 110 ± 10, 20 ± 0, or 10 ± 0 cases per 100,000 pregnancies, respectively. Incidence of GTD was lowest among women in their late 20 s and early 30 s. Occurrences of HM accounted for 80.3% all GTD cases. Weighted logistic analysis indicated that while age significantly affected the incidence of GTD (odds ratio (OR): 2.46; 95% confidence interval (CI) [1.79–3.37]; P < 0.001), socioeconomic status did not (OR: 1.94; 95% CI [1.0–3.79]; P = 0.05).ConclusionsIn the Republic of Korea, we observed overall incidence rates of GTD and HM of 1.3 and 1.1 per 1,000 pregnancies, respectively, which are similar to those reported in recent Western population-based studies. We also noted that annual incidence rates of GTD stabilized from 2009 to 2015.

A promising therapeutic strategy for metastatic gestational trophoblastic disease: Engineered anticancer gene-expressing stem cells to selectively target choriocarcinoma.

Gestational trophoblastic disease (GTD) is an unusual disease occurring in pregnancy that originates from abnormal trophoblastic cells and comprises a group of diseases with different properties of invasion, metastasis and recurrence. The GTD group includes hydatidiform moles and gestational trophoblastic neoplasms (GTNs), with GTNs being divided into invasive moles, choriocarcinoma, placental site trophoblastic tumors and epithelioid trophoblastic tumors. The present review focuses on current effective treatments for GTD, including conventional and novel promising direct enzyme prodrug therapies (DEPTs). Conventional therapies, such as chemotherapy and hysterectomy, are currently used in a clinical setting; however, the use of diverse DEPTs, including antibody-DEPT and gene-DEPT is also being attempted to cure GTNs. In addition, gene delivery tools using genetically engineered neural stem cells (NSCs) are presently being examined for the treatment of GTNs. The tumor-tropism of NSCs by chemoattractant factors is a unique characteristic of these cells and can serve as a vehicle to deliver anticancer agents. Previous studies have demonstrated that injection with NSC-expressing suicide genes into xenograft animal models has a significant inhibitory effect on tumor growth. Stem cells can be genetically engineered to express anticancer genes, which migrate to the metastatic sites and selectively target cancer cells, and are considered to effectively target metastatic GTNs. However, the safety issue of stem cell therapy, such as tumorigenesis, remains a challenge. Novel therapies comprising a combination of conventional and novel promising treatments are anticipated to be definitive treatments for metastasized and/or recurrent patients with GTNs.

Molar Pregnancy with Hyperthyroidism: A Therapeutic Challenge

Gestational trophoblastic disease is a rare complication of pregnancy that may be associated with an increased likelihood of hyperthyroidism secondary to rising levels of human chorionic gonadotrophin (HCG). Most of these cases remain undiagnosed leading to thyrotoxic crisis during and after operative intervention. We report a case of molar pregnancy with secondary hyperthyroidism who presented to us with a history of vaginal bleeding, palpitations, hyperemesis and abdominal distension. She had hysterotomy under general anaesthesia but went in acute cardio-pulmonary distress during the post-operative period for which she required prolonged intubation and tracheostomy. She became euthyroid after 2 weeks with anti-thyroid drugs. In view of ultrasound findings and rising beta HCG, a diagnosis of invasive mole was made and was started on chemotherapy. She responded well to the treatment and was finally discharged after normalisation of HCG values.

Gestational Trophoblastic Neoplasia

Background: gestational trophoblastic neoplasia forms a wide variety of rare conditions arising from abnormal proliferation of the trophoblastic cells in the placental microvilli. They consist of vesicular mole “partial and complete”, invasive mole, placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor (ETT) and choriocarcinoma. They can be classified into premalignant forms which include vesicular mole and malignant forms which include the rest. Aim of the Work: this study aimed tostudy the epidemiological and clinical data, as well as treatment regimes and their outcome included response and related toxicity among patients with gestational trophoblastic neoplasia treated in this study.Patients and Methods: in this retrospective study, medical records of all patients with GTN presented to Oncology Department, Al-Hussein University Hospital in the period from January 2007 to June 2017 was retrieved from the archives and medical data was reviewed and analyzed. Results: median age of patient was 37.5 (Range 20-55), molar pregnancy was the most common pathological type (40%), followed by invasive mole (31.4%), while choriocarcinoma was diagnosed in 25.7% and only 2.9% of patients had placental site trophoblastic disease. According to FIGO score; 26 patients (74.3%) showed low risk and 9 patients (25.7%) showed high risk. In low risk patients, 30.8% of patients were kept under follow up while, (69.2%) received chemotherapy, 61.1% of them achieved complete remission on methotrexate as first line chemotherapy, while the rest 38.9% achieved complete response on EMA-CO or dactinomycin as 2nd line chemotherapy. Methotrexate wasn’t effective in high risk patients, while EMA-CO had much better response achieving (66.7%) complete response rate, with 2 cases of early death in those patients. Conclusion: this retrospective study represented a single center experience and had relatively small number of cases. A large multicenter prospective trial is recommended.