Human Chorionic Gonadotropin Levels Research Articles

Heterotopic pregnancy: a case report of intrauterine hydatidiform mole with tubal pregnancy.

We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an ultrasound examination 70 days after the onset of menopause. She had a history of ovulation induction. The ultrasound findings suggested a partial hydatidiform mole. She was then pathologically confirmed to have a complete hydatidiform mole after uterine suction dilation and curettage. On postoperative day 4, an ultrasound examination before discharge showed an inhomogeneous mass in the left adnexal region with mild lower abdominal pain. On postoperative day 17, the blood human chorionic gonadotropin level did not drop as expected, and a follow-up examination still indicated a mass in the left adnexal region. We were unable to rule out an ectopic hydatidiform mole. Hysteroscopy with laparoscopic exploration of the left adnexal mass and salpingotomy suggested a diagnosis of intrauterine hydatidiform mole combined with left tubal pregnancy.

Is the Human Chorionic Gonadotropin Level on Day 10 After Cleaved Embryo Transfer a Predictor of Perinatal Outcome?: A Retrospective Cohort Study.

This study aimed to determine whether human chorionic gonadotropin (hCG) levels at day 10 after day 2 cleaved embryo transfer can predict pregnancy and perinatal outcomes. Patients who underwent oocyte retrieval with minimal stimulation or natural cycles and fresh or vitrified-warmed transfer of a single, day 2 cleaved embryo at our clinic between November 2018 and December 2020 were included in this study. Patients were classified into four age groups for oocyte retrieval and into ten groups based on the hCG level on day 10 after embryo transfer; pregnancy complications and delivery and neonatal outcomes were examined. Of the 5,840 cycles, 3,722 (63.7%) and 2,118 (36.3%) were fresh-cleaved and vitrified-warmed embryo transfers, respectively. The mean hCG level was 24.8 mIU/mL and the clinical pregnancy and live birth rates per transfer were 29.6% and 23.4%, respectively. Maternal age at the time of oocyte retrieval, husband's age, treatment cycle, embryo type and grade, cell number, and hCG levels were correlated with pregnancy and delivery outcomes in the univariate analysis. Conversely, only maternal age and hCG levels were correlated with the outcomes in the multivariate analysis. hCG levels on day 10 post-transfer are a useful predictor of pregnancy and delivery outcomes after cleaved embryo transfer. Live birth rates vary with maternal age, even when hCG levels are the same, but they do not vary according to the treatment cycle or type of embryo transferred. Low hCG levels may be associated with vasa previa but did not affect delivery outcomes.

A Study to Determine the Reason for Lower Pregnancy Rates in Younger Women with Diminished Oocyte Reserve-less Chance of Implanting vs. Fetal Demise

Most studies find lower live-delivered pregnancy rates (LDPRs) following in vitro fertilization-embryo transfer (IVF-ET) in women with diminished oocyte reserve (DOR) vs. normal oocyte reserve (NOR) even in a younger population. How much of a discrepancy may depend on the degree of oocyte depletion in the DOR group and the follicular stimulation protocol. Some fertility specialists favor an FSH receptor up-regulation technique as the protocol to attain the maximum LDPRs in women with DOR. The objective of this study was to compare chemical, clinical, and LDPRs following IVF-ET to determine if the main time of embryo loss is very early, as evidenced by the largest discrepancy occurring in attaining even a chemical pregnancy, and/ or a large discrepancy between a chemical pregnancy and attaining a clinical pregnancy (ultrasound evidence of a gestational sac) or later losses as evidenced by showing a greater loss rate from clinical evidence of pregnancy to live delivery in those with DOR compared to NOR. Overall, the DOR group, with a mean serum anti-Mullerian hormone (AMH) level of 0.42 ng/mL, had 50% as much chance to have an LDPR/transfer as women with NOR (AMH of 4.66) despite the same number of day 3 embryos transferred. The main reduction in LDPRs occurred from embryo transfer failing to attain a positive clinical pregnancy in the DOR group. The least discrepancy was from attaining a clinical pregnancy to live delivery. Thus, for NOR from positive pregnancy test 59% of this younger age group will have a live delivery vs. 50% for DOR. Thus, the reduction in LDPRS/transfer in young women with DOR vs. NOR seems mostly very early so the DOR group does not even attain a positive serum beta human chorionic gonadotropin level. This suggests that this inferiority in attaining a live delivery may be related to aneuploidy involving large chromosomes or a marked decrease in the mitochondrial DNA of the embryo.

FDG PET/CT Findings of Primary Pulmonary Choriocarcinoma in a Postmenopausal Woman.

Choriocarcinomas usually occur in the genital tracts of reproductive-age women after a gestational event. Primary pulmonary choriocarcinoma is very rare. We describe FDG PET/CT findings of primary pulmonary choriocarcinoma with multiple intrapulmonary metastases in a postmenopausal woman with elevated serum beta human chorionic gonadotropin level. On FDG PET/CT, the large primary lung tumor showed intense FDG uptake (SUV max , 46), and the small intrapulmonary metastases showed variable FDG uptake (SUV max , 27). Primary pulmonary choriocarcinoma should be included in the differential diagnosis of FDG-avid pulmonary lesions with elevated serum beta human chorionic gonadotropin levels, including metastatic choriocarcinoma and lung cancer.

A clinical case of ectopic pregnancy with localization in the liver

The article describes a clinical case of ectopic pregnancy with localization in the liver. The patient Sh. was admitted to the gynecological department with pain in the lower abdomen and epigastrium. Clinical, laboratory and instrumental examinations were conducted in accordance with clinical recommendations. The examinations showed that human chorionic gonadotropin level was 17,440.85 mIU/ml. Pelvic ultrasound did not determine the fetal egg in the uterine cavity. However, free fluid in the pelvis (about 50 ml) was found. Repeated pelvic ultrasound revealed a paraovarial formation on the right, and free fluid in the pelvis. Laparoscopic surgery was performed, during which a fetal egg was found in the V segment of the liver. Liver resection and cholecystectomy were performed on an emergency basis. This case describes the importance of timely and correct diagnostics and determination of patient management tactics to prevent the development of life-threatening complications.

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.

The Role of Beta hCG Value Measured on the 12th and 14th Days After Embryo Transfer in Determining Early Complications of Pregnancy

Aim: This study aimed to investigate the role of beta human chorionic gonadotropin (beta hCG) levels on post embryo transfer (ET) 12th- and 14th-day, and its folding after 48 hours in predicting live birth, abortion, and biochemical pregnancy. Material and Methods: The study included 124 patients who had a positive pregnancy test after a fresh single day 3 ET at the in vitro fertilization (IVF) center between 2017 and 2021. The first beta hCG value was measured 12th day and the second 14th day after ET. The beta hCG fold was calculated by dividing the second beta hCG value by the first beta hCG value. Results: The patients' IVF indications included unexplained (n=40, 41.1%), poor ovarian reserve (n=23, 25.0%), male factor (n=31, 29.8%), and tubal factor (n=3, 4.1%). Of the 124 patients, 97 (78.2%) had a fetal sac, 81 (63.5%) had a fetal heartbeat (FHB), and 70 (56.5%) had a live birth. The results indicated that the post-ET 14th-day beta hCG level was the best predictor of biochemical pregnancy. It has a high sensitivity (92.5%) and specificity (86.6%), with an optimal cut-off value of 175 U/L. The post-ET 14th-day beta hCG level was the best predictor of a live birth. The post-ET 14th-day beta hCG value of 214.5 U/L had an 82.7% sensitivity and 74.4% specificity to predict the FHB. Conclusion: The beta hCG value, measured between the 12th and 14th days after ET, as well as the folding rate on these two days, can provide information about the pregnancy progression.

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.

Surgical Outcomes and Trends in Incidence of Ectopic Pregnancy.

We aimed to evaluate the surgical results for ectopic pregnancy (EP) treated at Fukushima Red Cross Hospital for over a 20-year period from 2002 to 2021. We evaluated the incidence, surgical procedures, site of implantation, amount of hemoperitoneum, and the proportion of cases with risk factors of EP. Two hundred and fifty-nine cases of EP were treated surgically. The incidence of EP seemed to be gradually decreasing in recent years. By pregnancy site, 235 (90.7%) of EPs were tubal pregnancies (TPs), 13 in interstitial pregnancies (IPs), 7 in ovarian pregnancies, and 4 in peritoneal pregnancies. For IPs, human chorionic gonadotropin (hCG) levels were statistically higher than with TP and intraperitoneal bleeding was less than with other EP sites. Thirty-nine patients (15.0%) were with massive hemoperitoneum (>500 mL), and laparoscopic surgery was performed in all patients with massive hemoperitoneum except in two patients. The proportion of cases with risk factors for EP such as Chlamydia trachomatis infection or history of smoking was 5.4% and 40.6%, respectively. Epidemiological research shows that the number of patients with chlamydia infection, rates of smokers, or the occurrence of EP with assisted reproductive technology has been decreasing in recent years in Japan. Appropriate surgical intervention should be selected while considering such as facility capabilities, context, and surgeon skill, especially in critical cases, such as cases involving massive hemoperitoneum and hemorrhagic shock. The recent presumed decrease in the occurrence of EP may partly be associated with the decrease in the occurrence of risk factors.

Association of Serum Proteins Electrophoretic Pattern and Serum Hormones in Women with Spontaneous Pregnancy Loss.

Pregnancy is the state of carrying a developing embryo or fetus within a female body. Once pregnancy is established, a range of endocrinological events appear in its maintenance, finally helping in the successful pregnancy. The complications which are usually observed in pregnancy are gestational diabetes, preeclampsia, preterm labor, and spontaneous pregnancy loss or miscarriage, while 10%-15% of clinically recognized pregnancies terminate into spontaneous miscarriage. Thus, many attempts have been made by different researchers for the diagnosis of high-risk pregnancy on altered protein pattern using placental villous tissue or follicular fluid, but these are difficult to obtain and results of different studies are not constant. This study was designed to identify the association (if any) among serum protein(s) electrophoretic pattern and different serum hormones in normal pregnant women (controls) and gestational age-matched women with spontaneous pregnancy loss (cases). This study was carried out for 1½ year from October 2018 to March 2020 and included 120 participants (60 normal pregnant women and 60 women with spontaneous pregnancy loss) between 20 and 45 years of age with no mean age difference. The electrophoresis of serum was carried out using slab gel electrophoretic unit and serum thyroid-stimulating hormone (TSH), total tri-iodothyronine (TT3), total thyroxine (TT4), prolactin, and beta human chorionic gonadotropin (β-hCG) levels were analyzed using TSOSH AIA analyzer at Adesh University, Bathinda. Significant variations in the expression of proteins with molecular weight around ~150 kDa, ~50 kDa, and ~25 kDa were observed in normal pregnant women and women with spontaneous pregnancy loss. However, the protein band of ~50 kDa was found to be highly expressed in the serum of 1st and 2nd trimester women experiencing spontaneous pregnancy loss. Therefore, selected protein band of ~50 kDa was further processed by ECI-mass spectrophotometry QUAD time of flight and 365 different proteins were found, out of these; 34 proteins were found to be unidentified protein products (Verified using NCBI data base). Further, TT3, total proteins, β-hCG, and prolactin level were found to be low, whereas, TSH was found to be high in women experiencing spontaneous pregnancy loss. However, difference in the level of β-hCG in the 1st trimester and TT4 among normal pregnant women and women with spontaneous pregnancy loss was observed to be statistically insignificant. This study indicated that the evaluation of serum protein variations along with hormonal profile may provide valuable information about high-risk pregnancy. Moreover, the differential expression of proteins in women with spontaneous pregnancy loss can be further explored to develop potential biomarker for the early identification of high-risk pregnancy and appropriate preventive measure.

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.

Exceptional Case of Spontaneous Ovarian Hyperstimulation Syndrome in Complete Molar Pregnancy: A Case Study

Spontaneous ovarian hyperstimulation syndrome (OHS) is an uncommon condition. We report the case of a 38-year-old woman admitted to the emergency department with vaginal bleeding, pelvic pain, and an extraordinarily high human chorionic gonadotropin (hCG) level of 1,000,000 mIU/mL. Uterine aspiration confirmed a complete hydatidiform mole. Ten days post-discharge, she returned, exhibiting severe abdominal pain, vomiting, an hCG level of 46,769 mIU/mL, and ultrasound evidence of theca lutein cysts (right ovary: 1329 cm³; left ovary: 500 cm³) along with ascites. Suspected of having OHS, she was hospitalized for clinical management. Treatment included intravenous hydration, analgesia, thromboprophylaxis, and daily laboratory tests, leading to symptomatic improvement despite rising hCG levels. After a 35-day hospital stay, she commenced chemotherapy at a specialized cancer hospital. This case emphasizes the importance of healthcare professionals being alert and aware of the possibility of this diagnostic suspicion in such cases, particularly highlighting the need for hospitalization in moderate to severe instances.

Diagnostic accuracy validation study of the M6 model without initial serum progesterone (M6NP) in triage of pregnancy of unknown location

ObjectivesThe M6 prediction model stratifies the risk of development of ectopic pregnancy (EP) for women with pregnancy of unknown location (PUL) into low risk or high risk, using human chorionic gonadotrophin (hCG) and progesterone levels at the initial visit to a gynaecological emergency room and hCG level at 48 h. This study evaluated a second model, the M6NP model, which does not include the progesterone level at the initial visit. The main aim of this study was to validate the diagnostic accuracy of the M6NP model in a population of French women. Study designBetween January and December 2021, all women with an hCG measurement from the gynaecological emergency department of a teaching hospital were screened for inclusion in this study. Women with a pregnancy location determined before or at the second visit were excluded. The diagnostic test was based on logistic regression of the M6NP model, with classification into two groups: high risk of EP (≥5%) and low risk of EP (<5%). The reference test was the final outcome based on clinical, biological and sonographic results: failed PUL (FPUL), intrauterine pregnancy (IUP) or EP. Diagnostic performance for risk prediction of EP, and also IUP and FPUL, was calculated. ResultsIn total, 759 women with possible PUL were identified. After screening, 341 women with PUL were included in the main analysis. Of these, 186 (54.5%) were classified as low risk, including three (1.6%) with a final outcome of EP. The remaining 155 women with PUL were classified as high risk, of whom 60 (38.7%), 66 (42.8%) and 29 (18.7%) had a final outcome of FPUL, IUP and EP, respectively. Of the 32 women with PUL with a final outcome of EP, 29 (90.6%) were classified as high risk and three (9.4%) were classified as low risk. Therefore, the performance of the M6NP model to predict EP had a negative predictive value of 98.4%, a positive predictive value of 18.7%, sensitivity of 90.6% and specificity of 59.2%. If the prediction model had been used, it is estimated that 4.5 visits per patient could have been prevented. ConclusionThe M6NP model could be used safely in the French population for risk stratification of PUL. Its use in clinical practice should result in a substantial reduction in the number of visits to a gynaecological emergency room.

Bifocal germ cell tumor of pineal germinoma and neurohypophyseal embryonal carcinoma: illustrative case.

Bifocal germ cell tumors, with primarily identical tissue composition, occur concurrently in the neurohypophyseal and pineal regions. A 16-year-old male patient exhibited increased intracranial pressure symptoms, with concurrent tumors in the pineal and neurohypophyseal regions, causing obstructive hydrocephalus. His serum human chorionic gonadotropin level was elevated, measuring 506.6 mIU/mL. Upon gross endoscopic examination, the pineal tumor appeared white, whereas the neurohypophyseal tumor appeared red and hemorrhagic. Because of the limited sample size of the latter, a frozen section biopsy was feasible only for the pineal lesion, which indicated the presence of a germinoma. Subsequently, carboplatin and etoposide were administered, resulting in the reduction of the pineal tumor, but no effect was observed in the neurohypophyseal tumor. Histopathological analysis confirmed the pineal lesion as a germinoma, whereas the neurohypophyseal lesion was an embryonal carcinoma. Thus, the treatment was altered to ifosfamide, carboplatin, and etoposide (ICE), leading to a response in both tumors. The patient underwent three additional cycles of ICE therapy and high-dose chemotherapy, followed by whole craniospinal irradiation, achieving complete remission. Although most bifocal germ cell tumors share the same histological tissue, occasional differences may arise, necessitating separate biopsies for accurate assessment.

Removal of an Intrauterine Polypoid Lesion Resolved Chemotherapy-resistant Gestational Trophoblastic Neoplasia: A Case Report.

Single-agent chemotherapy typically has curative outcomes in patients with low-risk gestational trophoblastic neoplasia (GTN). Although surgical intervention is a potential alternative, its efficacy in these patients remains unclear. This report describes a case in which surgical excision of a uterine polypoid lesion resolved chemotherapy-resistant low-risk GTN. A 43-year-old patient received pulse actinomycin D treatment for post-molar low-risk GTN without extrauterine metastasis. However, the patient showed resistance to the chemotherapy regimen. There was no initial evidence of protrusion of GTN into the uterine cavity; however, a polypoid lesion grew into the uterine cavity during therapy. This growth was successfully excised via a transvaginal approach using forceps with minimal blood loss. There was a postoperative decrease in human chorionic gonadotropin levels, which ultimately reached the predetermined threshold without the need for changing the therapeutic protocol. Surgical resection should be considered a viable therapeutic strategy for uterine polypoid growth in chemotherapy-resistant low-risk GTN.

Methotrexate as the first-line treatment of unruptured tubular ectopic pregnancies with high initial human chorionic gonadotropin levels: A retrospective cohort

ObjectivesTo evaluate the effectiveness of the first-line medical management with Methotrexate (MTX) in the treatment of patients with stable tubal Ectopic Pregnancies (EPs) and varying ranges of Beta-Human Chorionic Gonadotropin (β-HCG) levels. Materials and methodsIn this retrospective cohort study, we reviewed the medical records of a total of 184 patients with the diagnosis of tubal EP, who received MTX as their first-line treatment. Patients with a baseline β-HCG< 4800 mIU/mL received single-dose MTX (n = 136) and those with an initial β-HCG≥ 4800 mIU/mL underwent the double-dose MTX regimen (n = 48). The treatment success was determined by evaluating the reported weekly β-HCG levels of the patients. ResultsBaseline β-HCG and mass size in the single-dose group were 1895.1 ± 1463.4 mIU/mL and 2.2 ± 1.1 cm, respectively, compared to 17,867.6 ± 31,870.5 mIU/mL and 2.3 ± 1.1 cm in the double-dose group. Treatment duration was 30.6 ± 16.9 days for single dose and 41.0 ± 27.0 days for double dose, with additional MTX in 27.2% and 12.5% in respective groups. Single dose achieved a 92.6% success rate, and double dose, 81.3%, without serious adverse effects. No significant effects were seen for either baseline β-HCG and mass size on the treatment success rates of both groups (p-value>0.05). However, the presence of Fetal Heart Rate (FHR) was associated with poorer responses only in the single-dose group (p-value=0.034). ConclusionsMedical management with MTX shows promise as a first-line treatment for tubal EPs with β-HCG> 2000, suggesting a potential reassessment of existing guidelines in light of this emerging evidence. However, further research seems crucial in this field.

Maternal thyroid function and free beta human chorionic gonadotrophin level in triploid pregnancies of paternal origin

Maternal thyroid function and free beta human chorionic gonadotrophin level in triploid pregnancies of paternal origin

Surgical management of mediastinal mature cystic teratoma of the elderly remaining asymptomatic

BackgroundMediastinal teratoma is an uncommon disease, nevertheless they represent the most common mediastinal germ cell tumors. It may grow silently for several years and remain undiagnosed until the occurrence of a complication.AimThe main aim of this article is to illustrate the silent evolution of an anterior mediastinal teratoma for over 70 years without presenting any notable complications.Case presentationWe present the case of a 70-year-old female, treated for hypertension referred to our department for managing a voluminous mediastinal mass, discovered fortuitously by a general practitioner in a chest X-ray. The anamnesis didn’t relate any chest pain, cough, dyspnea nor hemoptysis. The clinical examination, in particular pleuropulmonary, was unremarkable. The workup (Chest X-Ray and CT scan) demonstrated a voluminous pleural mass at the expense of the right mediastinal pleura, rounded in shape, with calcified wall and fluid content. Blood tests did not demonstrate eosinophilia, and hydatid IgG serology was negative. serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels were found to be normal. The patient subsequently underwent a right posterolateral thoracotomy with resection of the lesion. The mass was dissected very carefully and then resected in toto. The macroscopic and microscopic histological examination demonstrated a mature cystic teratoma. Surgical resection was an adequate treatment and the prognosis was excellent for the patient.ConclusionCystic mature teratomas are rare thoracic tumors, often recognized by radiological examination. This article relates the silent evolution that a teratoma could have, and the late appearance of symptoms that it could have.

Endocrine pathologies and pregnancy: features of medical control of patients

Metabolic changes constantly occur in the mother and her fetus during pregnancy, and the role of hormones in maintaining normal fetal growth and development cannot be overestimated. The scale of endocrine control necessary to maintain physiological functions during pregnancy is clearly demonstrated by the dramatic changes in the hormonal profile and its fluctuations observed from the prenatal to the postpartum period. Differential sensitivity to fluctuations in placental hormones may also play a role in the development of perinatal mental health disorders. Thus, endocrine homeostasis is important for the successful course of pregnancy and its favorable outcome. It is important to note that pregnancy is a period when a woman’s endocrine system undergoes significant changes and adaptations. Endocrine pathologies, such as diabetes mellitus or hypothyroidism, can significantly aggravate this process and increase the risk of various complications. The study is necessary to determine the optimal strategies for medical monitoring and treatment of pregnant women with endocrine disorders. This includes choosing the most appropriate methods for controlling hormone levels, monitoring blood glucose, and ensuring proper medication correction. This article discusses endocrinopathies that occur during pregnancy. Special attention is paid to pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), glucose metabolism disorders and methods of screening for GDM. Thyroid diseases associated with human chorionic gonadotropin (HCG) and thyroxine-binding globulin (TBG) levels are also discussed, as well as the effect of these conditions on the euthyroid status.

Relationship between first trimester maternal PAPP-A (pregnancy associated plasma protein-A) and free β-hCG (human chorionic gonadotropin) levels with fetal birth weight

Relationship between first trimester maternal PAPP-A (pregnancy associated plasma protein-A) and free β-hCG (human chorionic gonadotropin) levels with fetal birth weight