Serum Beta-human Chorionic Gonadotropin Levels Research Articles

Characteristics of Thymoma Successfully Resected by Videothoracoscopic Surgery

The inclusion criteria were established for a videothoracoscopic resection of early-stage thymoma. We retrospectively evaluated the validity of these criteria in the treatment of early-stage thymoma. The computed tomography (CT) image characteristics and clinical information comprised these criteria. The image considerations included the location of the tumor in the anterior mediastinum, a distinct fat plane between the tumor and vital organs, unilateral tumor predominance, tumor encapsulation, the existence of residual normal-appearing thymic tissue, and no mass compression effect. All enrollees were expected to be free of pleural effusion, pericardial effusion, paralysis of the hemidiaphragm, and the encasement of great vessels. An elevation of either the serum alpha-fetoprotein or beta-human chorionic gonadotropin levels, severe chest pain, superior vena cava syndrome, hoarseness, and age less than 20 years excluded the patient from enrollment. The heterogeneous content of the tumor was not an exclusion criterion, and the tumor size was not considered important. According to the above criteria, 44 patients were enrolled between November 1999 and November 2005. Twenty-seven patients had stage I thymoma and 17 had stage II thymoma. All patients successfully underwent a complete tumor resection using a three-port endoscopic technique. There was no open conversion. Based on these criteria, we can select suitable patients to confidently perform a thoracoscopic resection of early-stage thymoma.

Primary gestational choriocarcinoma of the uterine cervix. Report of a case and review of the literature

Gestational choriocarcinoma usually arises in the uterine cavity and is associated with coincident or antecedent pregnancy. Extrauterine choriocarcinomas are very rare entities, and most of these are located in the uterine cervix. In our case, a 43-year-old woman was admitted in our hospital because she had amenorrhea for 2 months and elevated serum beta-human chorionic gonadotropin levels. The patient was considered to have an ectopic pregnancy. Initially, she was treated with methotrexate, but since there was a continuous rise in human chorionic gonadotropin levels, the patient underwent a laparoscopy, along with dilatation and curettage (D&C) of the uterine cavity. Histopathologic findings, including immunohistochemical study, led to the diagnosis of choriocarcinoma of the cervix. Finally, the patient underwent a transabdominal hysterectomy and received single agent chemotherapy with methotrexate. Our case represents a primary choriocarcinoma of the cervix, which was initially misdiagnosed as an ectopic pregnancy. The difficulties in differential diagnosis are discussed. Immunohistochemical evaluation remains the mainstay of the diagnosis in most cases. Choriocarcinoma has a very good prognosis even in advanced stages, since it is a very chemosensitive tumor.

Prophylactic vaginal hysterectomy for benign hydatidiform mole

[1] Craft I, McLeod F, Green S, Djahanbakhch O, Bernard A, Twiig H, et al. Birth following oocyte and sperm transfer to the uterus. Lancet 1982;2:773. [2] Veersema S, Bernardus RE, Veersema D, Vermeiden JP, Schoemaker J. Pregnancy following transcervical transfer of oocyte and sperm. N Engl J Med 1989;320:1499. [3] Kubik CJ, Guzick DS, Berga SL, Zeleznik AJ. Establishment of pregnancies in humans after transcervical transfer of gametes immediately after oocyte retrieval. Fertil Steril 1990;54: 1174–6. [4] Zhang X, Barnes R, Confino E, Milad M, Puscheck E, Kazer RR. Delay of embryo transfer to day 5 results in decreased initial serum beta-human chorionic gonadotropin levels. Fertil Steril 2003;80:1359–63.

Ectopic Pregnancy Within a Cesarean Section Scar

A gestational sac implanted in the anterior portion of the lower uterine segment is characteristic of a cesarean delivery scar pregnancy, although it is the rarest of locations for an ectopic pregnancy. More common locations for an ectopic pregnancy include the isthmus of the tube, ovaries, uterine cornua, and abdomen. In addition to sonographic diagnosis, elevated serum beta-human chorionic gonadotropin levels can help to confirm the pregnancy. If detected early, a future pregnancy may be possible; otherwise, the patient is at risk for uterine scar rupture, hemorrhage, and maternal morbidity. Ectopic pregnancies are becoming more prevalent, although it is difficult to say if it is due to an increase in cesarean sections performed, the use of in vitro fertilization procedures, or better diagnosis and documentation. This case illustrates implantation of a pregnancy within the scar of a previous cesarean section delivery, diagnosed with pelvic, endovaginal, and 3D sonography.

The efficacy and safety of managing ectopic pregnancies with transvaginal ultrasound-guided local injections of absolute ethanol

To describe the efficacy and safety of managing ectopic pregnancies (EP) with ultrasound-guided local injections of absolute ethanol (AE). 69 cases of EP following IVF performed in our clinic were treated with a local injection of 0.3 ml AE with a 23-gauge needle under transvaginal ultrasonic guidance. The efficacy was evaluated comparing serum beta-human chorionic gonadotropin (beta-hCG) levels before and after the injection. In the 60 successful cases (87%), the serum beta-hCG level decreased by 10-30% in two hours postinjection. Of these, 46 were effective with a single injection and the half-life of beta-hCG was achieved within 4 days in 45 cases. In 56 cases (including repetitive administration) serum beta-hCG levels decreased to 20 mIU/mL within 20 days. The treatment showed no side effects and could be given on an outpatient basis without anesthesia. This method was shown to be a safe, effective new approach to treating EP.

Extrauterine choriocarcinoma of the greater omentum after tubal pregnancy: case report

Extrauterine choriocarcinoma is a rare form of gestational trophoblastic tumor. Extrauterine choriocarcinoma of the greater omentum is extremely rare in the literature. A 24-year-old female with irregular vaginal bleeding, mimicking as ectopic pregnancy, underwent emergency exploratory laparotomy and local excision of the greater omentum mass. The serum beta-human chorionic gonadotropin level decreased rapidly after operation; however, it rose up again before long. Pathology showed choriocarcinoma in the greater omentum. No evidence showed lesions on uterus. No other metastasis was found. Multiple courses of combined chemotherapy were effective for this case. Surgical excision and combined chemotherapy were effective for extrauterine choriocarcinoma of the greater omentum.

Do Serum Beta-Human Chorionic Gonadotropin Levels on Day 4 Following Methotrexate Treatment of Patients with Ectopic Pregnancy Predict Successful Single-Dose Therapy?

The purpose of this study is to assess whether serum beta-human chorionic gonadotropin (beta-hCG) levels on day 4 following methotrexate (MTX) treatment in patients with ectopic pregnancy predict successful single-dose therapy or the need for subsequent surgical intervention. Retrospective analysis of patients with ectopic pregnancies treated with MTX (50 mg/m (2)) was conducted. Inclusion criteria for MTX management were serum beta-hCG < 15,000 mU/mL, absent fetal cardiac activity, ultrasonographic gestational sac < 3.5 cm, normal liver function tests, hemodynamically stable patient with no evidence of hemoperitoneum, and informed consent. Day 1, 4, and 7 serum beta-hCG levels were obtained. Outcome parameters included successful single-dose MTX management, the requirement for multiple treatments, and whether subsequent surgery was required. Receiver operator characteristic (ROC) curves were used. P < 0.05 was considered significant throughout. Eighty-three patients were studied. Of these, 60 patients were treated successfully with single doses, 16 patients required two doses, and two patients required three doses of MTX, and five underwent surgical management. Mean day 1 serum beta-hCG levels of patients successfully treated with single-dose MTX was 3938.5 (+/- 589.2 [standard deviation]) versus 1767.65 (+/- 1237.8) mU/mL in patients requiring multiple doses of MTX therapy, ( P < 0.0001). ROC curves for serum beta-hCG levels on days 1, 4, and 7 were 0.449, 0.592, and 0.754, respectively, indicating that only day 7 serum beta-hCG levels were associated with successful single-dose MTX therapy. Serum beta-hCG levels on day 4 of MTX in patients with ectopic pregnancy do not predict successful single-dose therapy or the need for surgery.

Extrauterine choriocarcinoma of the greater omentum after tubal pregnancy: case report

Extrauterine choriocarcinoma is a rare form of gestational trophoblastic tumor. Extrauterine choriocarcinoma of the greater omentum is extremely rare in the literature. A 24-year-old female with irregular vaginal bleeding, mimicking as ectopic pregnancy, underwent emergency exploratory laparotomy and local excision of the greater omentum mass. The serum beta-human chorionic gonadotropin level decreased rapidly after operation; however, it rose up again before long. Pathology showed choriocarcinoma in the greater omentum. No evidence showed lesions on uterus. No other metastasis was found. Multiple courses of combined chemotherapy were effective for this case. Surgical excision and combined chemotherapy were effective for extrauterine choriocarcinoma of the greater omentum.

Diagnosis of an interstitial pregnancy with 4-dimensional volume contrast imaging

The purpose of this study was to investigate the use of a new ultrasound technique, termed 4-dimensional volume contrast imaging in coronal-plane to facilitate the early detection of interstitial pregnancy. A case of interstitial pregnancy was diagnosed accurately at 6 weeks of gestation with 4-dimensional transvaginal volume contrast imaging in coronal plane technology. A scan of the uterus revealed that the eccentric gestational sac was located in the right uterotubal junctional area, lying 1 cm outside the most upper lateral edge of the uterine cavity with thick endometrial echoes. After the appropriate counseling, the patient was treated with an ultrasonographically guided intracardiac injection of 2.5 mEq of potassium chloride followed by aspiration of the gestational sac. A transvaginal scan immediately after the procedure demonstrated a collapsed empty gestational sac. Three months after the conservative treatment, the serum beta-human chorionic gonadotropin level fell to 1.17 mIU/mL, and normal echotexture of the uterus was noted. Four-dimensional volume contrast imaging in coronal-plane technology provides scan planes that are not accessible by conventional 2-dimensional scanning, with enhanced tissue contrast resolution in region of interest. This new ultrasound technique has the potential to provide more accurate, inexpensive and less variable virtual reality image-guided interventional options through more realistic interaction with the virtualized in utero condition, particularly when 2-dimensional transvaginal scan fails to differentiate between interstitial, angular, and cornual pregnancies.

Outcome Analysis for Patients With Elevated Serum Tumor Markers at Postchemotherapy Retroperitoneal Lymph Node Dissection

To evaluate the therapeutic benefit of postchemotherapy retroperitoneal lymph node dissection (PCRPLND) in patients with persistently elevated serum tumor markers. One hundred fourteen patients with metastatic germ cell cancer with elevated serum tumor markers after first-line (50 patients) or second-line chemotherapy (64 patients) who underwent PCRPLND between 1977 and 2000 with a minimum follow-up of 2-years were included in this retrospective study. The 5-year overall survival was 53.9%. Sixty-one patients (53.5%) are alive with a medium follow-up of 72 months. Fifty-three patients died of disease, with a medium time to death of 8.0 months. Mean preoperative serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (betaHCG) levels were 483 ng/mL and 555 mU/mL, respectively, with no difference in 5-year survival (P = .2). Retroperitoneal pathology revealed germ cell cancer in 53.5% of patients, teratoma in 34.2% of patients, and fibrosis in 12.2% of patients, with 5-year survival rates of 31.4%, 77.5%, and 85.7%, respectively (P < .0001). Predictors of retroperitoneal pathology included an increasing serum AFP or betaHCG, betaHCG more than 100 ng/mL, redo retroperitoneal lymph node dissection (RPLND), and second-line chemotherapy. Poor prognostic variables by multivariable analysis included betaHCG status, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. A subset of patients with elevated serum tumor markers after chemotherapy is curable with surgery. The prognostic factors predictive of outcome in this analysis include an increasing betaHCG, serum AFP level, redo RPLND, and germ cell cancer in the resected specimen. These factors, along with clinical and surgical experience, should aid in determining the appropriate integration of surgery and chemotherapy in this population.

Large cell carcinoma of the lung mimicking a germ cell tumor: The potential value of chromosome analysis

A 43-year-old male with a 20 pack year smoking history presented with a 3-week history of breast enlargement, intermittent headache and blurry vision. Other than gynecomastia, the physical examination, including testicular examination, was normal. Serum beta-human chorionic gonadotropin (β-hCG) level was 2125IU/L, with a normal alpha-fetoprotein level. A scrotal ultrasound showed no abnormalities. CT imaging revealed a 6cm×5cm mass in the posterior mediastinum (Fig. 1A), low density lesions in the liver and spleen, and no retroperitoneal lymphadenopathy.

Late relapse of stage I testicular seminoma metastatic to just a para‐ureteropelvic region

A follow-up ultrasonography study 43 months after an operation for left stage I testicular seminoma in a 39-year-old man revealed left hydronephrosis. Serum beta-human chorionic gonadotropin (beta-hCG) levels were slightly increased. Computed tomography scans of the abdomen showed a bulky tumor around the ureteropelvic region without para-aortic lymph node enlargement, but did not show a clear distinction between a recurrence of the testicular tumor and an invasive ureteral tumor. After the patient underwent two cycles of chemotherapy with cisplatin and etoposide, the tumor mass decreased by approximately 60% and beta-hCG levels returned to normal. We then performed a resection of the residual tumor involving the upper ureter and left kidney and a retroperitoneal lymph node dissection under a clinical diagnosis of recurrence of the testicular tumor. Histologically, no viable cancer cells remained. The patient has been well with no evidence of recurrence for more than two years.

Realibility of serum estradiole and beta-human chorionic gonadotropin levels after embryo transfer in interpreting chance of a patient's achieving pregnancy

Realibility of serum estradiole and beta-human chorionic gonadotropin levels after embryo transfer in interpreting chance of a patient's achieving pregnancy

Beta‐Human Chorionic Gonadotropin Levels and the Likelihood of Ectopic Pregnancy in Emergency Department Patients with Abdominal Pain or Vaginal Bleeding

AbstractStrategies for diagnosing ectopic pregnancy that defer endovaginal ultrasound in women with suggestive symptoms and serum beta‐human chorionic gonadotropin (β‐hCG) levels less than 1,500 mIU/mL ignore the increased risk of ectopic pregnancy in these patients. Objective: To quantify this increased risk by establishing and comparing the β‐hCG distributions of symptomatic women with ectopic pregnancies, abnormal intrauterine pregnancies, and normal intrauterine pregnancies. Methods: The authors reviewed the records of a cohort of women who visited an urban emergency department (ED) during a 34‐month period with abdominal pain or vaginal bleeding and non‐zero quantitative β‐hCG levels. Explicit criteria were used to determine whether the pregnancy ultimately turned out to be intrauterine and normal, intrauterine and abnormal, or ectopic. Probability distributions were compared using frequency distributions, receiver operating characteristic (ROC) curves, and likelihood ratios. Results: Of 730 ED patients included in the analysis, 96 (13%) had ectopic pregnancies, 253 (35%) had abnormal intrauterine pregnancies, and 381 (52%) had normal intrauterine pregnancies. The β‐hCG distributions of patients with ectopic pregnancies and abnormal intrauterine pregnancies were similar and much lower than the β‐hCG distribution of patients with normal intrauterine pregnancies. A β‐hCG level less than 1,500 mIU/mL more than doubled the odds of ectopic pregnancy (likelihood ratio = 2.24). Of the 158 patients with β‐hCG below 1,500 mIU/mL, 40 (25%; 95% confidence interval [CI] = 19% to 32%) had ectopic pregnancies, and only 25 (16%; CI = 11% to 22%) had normal intrauterine pregnancies. Conclusions: In women with pain or bleeding and serum β‐hCG levels less than 1,500 mIU/mL, the risk of ectopic pregnancy is substantially increased, while the likelihood of normal intrauterine pregnancy is low.

Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding.

Strategies for diagnosing ectopic pregnancy that defer endovaginal ultrasound in women with suggestive symptoms and serum beta-human chorionic gonadotropin (beta-hCG) levels less than 1500 mIU/mL ignore the increased risk of ectopic pregnancy in these patients. To quantify this increased risk by establishing and comparing the beta-hCG distributions of symptomatic women with ectopic pregnancies, abnormal intrauterine pregnancies, and normal intrauterine pregnancies. The authors reviewed the records of a cohort of women who visited an urban emergency department (ED) during a 34-month period with abdominal pain or vaginal bleeding and non-zero quantitative beta-hCG levels. Explicit criteria were used to determine whether the pregnancy ultimately turned out to be intrauterine and normal, intrauterine and abnormal, or ectopic. Probability distributions were compared using frequency distributions, receiver operating characteristic (ROC) curves, and likelihood ratios. Of 730 ED patients included in the analysis, 96 (13%) had ectopic pregnancies, 253 (35%) had abnormal intrauterine pregnancies, and 381 (52%) had normal intrauterine pregnancies. The beta-hCG distributions of patients with ectopic pregnancies and abnormal intrauterine pregnancies were similar and much lower than the beta-hCG distribution of patients with normal intrauterine pregnancies. A beta-hCG level less than 1500 mIU/mL more than doubled the odds of ectopic pregnancy (likelihood ratio = 2.24). Of the 158 patients with beta-hCG below 1500 mIU/mL, 40 (25%; 95% confidence interval [CI] = 19% to 32%) had ectopic pregnancies, and only 25 (16%; CI = 11% to 22%) had normal intrauterine pregnancies. In women with pain or bleeding and serum beta-hCG levels less than 1500 mIU/mL, the risk of ectopic pregnancy is substantially increased, while the likelihood of normal intrauterine pregnancy is low.

Metastatic Dedifferentiated Chordoma With Elevated β-hCG

Chordomas are relatively uncommon bone tumors, and fewer than 10% of cases are classified as dedifferentiated chordomas. These tumors tend to be more clinically aggressive than chordomas and have a higher incidence of early distant metastases. In this case report, we describe a 24-year-old man with dedifferentiated chordoma and multiple pulmonary metastases. Further laboratory analysis revealed an elevated serum beta-human chorionic gonadotropin level. Unfortunately, the patient's clinical condition deteriorated rapidly and he died before receiving any treatment for his cancer. However, chemotherapy may play a useful role in the management of systemic disease in patients with dedifferentiated chordoma.

Serum beta-human chorionic gonadotropin levels and endometrial thickness after medical abortion

Serum beta-human chorionic gonadotropin levels and endometrial thickness after medical abortion

Venous cavernous hemangioma of the testis

T images presented are from a 77-year-old man who was admitted to the hospital with a 1-year history of hoarseness. A recent workup revealed an advanced squamous cell carcinoma of the larynx (T3N2CM0). He was admitted to the hospital to begin his first course of neoadjuvant chemotherapy with 5-fluorouracil (5-FU) and cisplatinum. His admission genitourinary examination revealed a large solid-appearing mass of the left testicle. The patient claimed that the testicle had been enlarged for “50 years.” An ultrasound of the testis demonstrated a large inhomogeneous mass with multiple hypoechoic regions and calcific shadowing (Fig. 1). The serum beta-human chorionic gonadotropin and alfa-feto protein levels were normal. The patient underwent an inguinal exploration. The cord structures were normal. The left testicle was firm and irregularly enlarged. A left radical orchiectomy was performed. The bivalved gross specimen is seen in Figure 2. The microscopic evaluation demonstrates vascular channels consistent with a large cavernous hemangioma of the testis (Figs. 3A and B). Cavernous hemangiomas are benign vascular tumors. Only 25 cases of testicular hemangiomas have been cited previously in the literature.1 In the present case, it was believed that the mass was probably benign because it had been present for many years. The sonographic features were more suggestive of a malignant process. Thus a radical orchiectomy was performed. This lesion, while rare, should be included in the differential diagnosis of testicular masses.

Comparison of local injection of methotrexate and linear salpingostomy in the conservative laparoscopic treatment of ectopic pregnancy

To compare local injection of metothrexate (MTX) and linear salpingostomy in the conservative laparoscopic treatment of ectopic pregnancy. Prospective, nonrandomized study, July 1991 to May 1994. Department of obstetrics and gynecology in a university hospital. Fourteen women with unruptured ectopic pregnancies without documented fetal heart motion and size below 50 mm as measured by ultrasound. All 14 women underwent the laparoscopic treatment by either local injection of MTX or linear salpingostomy (7 patients each). Both treatments were successful in all patients. Mean length of operation was 32 +/- 5 minutes (range 25-35 min) in the MTX group versus 67 +/- 15 minutes (range 50-90 min) in the salpingostomy group. Mean length of hospital stay was 2.7 days (range 1-5 days) and 1.7 days (range 1-3 days), respectively. No intraoperative complications occurred, and the postoperative course was uneventful in all women. Mean disappearance time of serum beta-human chorionic gonadotropin (hCG) levels was similar in both groups, although in the linear salpingostomy group the decrease was immediate. No difference in tubal patency on follow-up hysterosalpingography was observed between the two groups. Although this is a preliminary report with a small number of patients, both types of treatment were safe and effective. An advantage of linear salpingostomy was the predictable and consistent decline of circulating beta-hCG, and consequently a reduced need for a close follow-up. Local MTX injection was safe, economic, effective, and easy to perform, and in our experience the surgical time was statistically shorter than that for linear salpingostomy. Therefore, in selected patients, local injection of MTX could be the treatment of choice for unruptured ectopic pregnancy, avoiding a longer and potentially more dangerous procedure. Long-term outcomes do not seem to differ between the two types of treatment.

Ultrasonographic examination by emergency physicians of patients at risk for ectopic pregnancy.

To evaluate a diagnostic protocol that includes the early use of endovaginal sonography (EVS) by emergency physicians of patients at risk for ectopic pregnancy. During this prospective study, pregnant patients > or = 18 years old and at risk for ectopic pregnancy were assessed. Emergency physicians who had completed a training program performed EVS on a convenience sample of eligible women. Clinical disposition was based on predetermined clinical, laboratory, and ultrasonographic criteria. The EVS examinations were reviewed on video by a gynecologist whose interpretation was correlated with the emergency physician EVS readings and with the final clinical diagnoses. Quantitative serum beta-human chorionic gonadotropin (beta hCG) levels were determined for patients who had no definite intrauterine pregnancy (IUP) on EVS. Of 152 patients studied during a 12-month period, four were lost to follow-up. Emergency physician ultrasonographic diagnoses included: definite IUP, 87/148 (59%); probable abnormal IUP, 17/148 (11%); definite ectopic pregnancy, 3/148 (2%); and no definite IUP, 41/148 (28%). The gynecologist agreed with 93% of the initial interpretations. Twelve of 16 patients who had the final diagnosis of ectopic pregnancy were admitted from the ED with this diagnosis. The ultrasonographic diagnosis of the other four was no definite IUP, and no mass or free fluid. For the latter four patients, the presenting serum beta hCG level was < 2,000 mIU/mL (First International Reference Preparation). They were diagnosed as having ectopic pregnancy after serial outpatient EVS and beta hCG measurements. The application of EVS to emergency practice appears promising. Emergency physicians trained in its use and who apply this diagnostic tool in conjunction with a defined protocol can stratify the risk of patients who have the potential for ectopic pregnancy.