Serum Human Chorionic Gonadotropin Levels Research Articles

Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols: human chorionic gonadotropin trends and patient outcomes

Ectopic pregnancy, although rare, is an important cause of female morbidity and mortality and early, effective treatment is critical. Systemic methotrexate has become widely accepted as a safe and effective alternative to surgery in the stable patient. As the number and timing of methotrexate doses differ in the 3 main medical treatment regimens, one might expect trends in serum human chorionic gonadotropin and time to resolution to vary depending on protocol. Furthermore, human chorionic gonadotropin trends and time to resolution may predict ultimate treatment success. This study hypothesized that the 2-dose methotrexate protocol would be associated with a faster initial decline in serum human chorionic gonadotropin levels and a shorter time to resolution compared to the single-dose protocol. A prospective multicenter cohort study included clinical data from women who received medical management for ectopic pregnancy. Rates of human chorionic gonadotropin change and successful pregnancy resolution were assessed. Propensity score modeling addressed confounding by indication, the potential for differential assignment of patients with better prognosis to the single-dose methotrexate protocol. In all, 162 ectopic pregnancies were in the final analysis; 114 (70%) were treated with the single-dose methotrexate and 48 (30%) with the 2-dose protocol. Site, race, ethnicity, and reported pain level were associated with differential protocol allocation (P < .001, P=.011, P < .001, and P= .035, respectively). Women had similar initial human chorionic gonadotropin levels in either protocol but the mean rate of decline of human chorionic gonadotropin from day 0 (day of administration of first dose of methotrexate) to day 7 was significantly more rapid in women who received the single-dose protocol compared to those treated with the 2-dose protocol (mean change -31.3% vs -10.4%, P= .037, adjusted for propensity score and site). The 2 protocols had no significant differences in success rate or time to resolution. In a racially and geographically diverse group of women, the single- and double-dose methotrexate protocols had comparable outcomes. The more rapid human chorionic gonadotropin initial decline in the single-dose group suggested these patients were probably at lower risk for ectopic rupture than those getting the 2-dose protocol. A prospective randomized controlled design is needed to remove confounding by indication.

Acute pelvic pain in female with ruptured ectopic pregnancy: Magnetic Resonance Imaging as problem solving tool

A 31 year old female was referred to our Magnetic Resonance Imaging (MRI) department with history of lower abdominal pain for three days. The patient had a history of irregular periods, with no definite period of amenorrhea. There was no history of bleeding per vagina. The ultrasound performed by the referring physician showed a complex right adnexal lesion abutting the uterus with no free fluid in the pelvis, prompting the physician to think of a broad ligament fibroid. Subsequently the patient tested mildly positive for urine gravindex. As the physician felt that ultrasound was not contributing to a proper diagnosis, MRI pelvis was requested to help solve the clinical problem. Blood sample was given for assessment of Serum human chorionic gonadotropin (beta hCG) level at this same time. MRI images are shown as Fig. 1, Fig. 2, Fig. 3, Fig. 4.

Effect of race/ethnicity on clinical presentation and risk of gestational trophoblastic neoplasia in patients with complete and partial molar pregnancy at a tertiary care referral center

The reported incidence of molar pregnancy varies widely among different geographic locations. This variation has been attributed, at least in part, to racial/ethnic differences. While the incidence of molar pregnancies is decreasing, certain ethnic groups such as Hispanics, Asians, and American Indians continue to have an increased risk of developing gestational trophoblastic disease across the globe. We sought to describe the potential effect of ethnicity/race on the presentation and clinical course of complete mole and partial mole. All patients followed up for complete mole and partial mole at a single institution referral center from 1994 through 2013 were identified. Variables including age, race, gravidity, parity, gestational age, presenting signs/symptoms, serum human chorionic gonadotropin values, and development of gestational trophoblastic neoplasia were extracted from medical records and patient surveys. Patients with complete mole and partial mole were categorized into race/ethnicity groups defined as white, black, Asian, or Hispanic. Due to low numbers of non-white patients with partial mole in each non-white category, patients with partial mole were grouped as white or non-white. Continuous variables were compared using the Kruskal-Wallis test and binary variables were compared using the Fisher exact test. A total of 167 complete mole patients with known race/ethnicity status were included (57.48% white, 14.97% Asian, 14.37% black, 13.17% Hispanic). Hispanics presented at younger age (median 24.5 years) compared to whites (median 32.0 years, P= .04) and Asians (median 31.0 years, P= .03). Blacks had higher gravidity than whites (P< .001) and Hispanics (P= .05). There was no significant difference in presenting symptoms, gestational age at diagnosis, and preevacuation serum human chorionic gonadotropin level by race/ethnicity. Hispanics were significantly less likely than whites to develop gestational trophoblastic neoplasia (absolute risk difference, 28.6%; 95% confidence interval, 8.1-39.2%; P= .02). A total of 144 patients with partial mole were analyzed. There were 108 white and 36 non-white patients. Median age was 31 years for white and 29 years for non-white patients (P= .006). Median gravidity was 2 for white and 3 for non-white patients (P < .001), and median parity was 0 for white patients and 1 for non-white patients (P= .003). There were no significant differences with respect to presenting signs and symptoms, gestational age, preevacuation human chorionic gonadotropin level, or risk of progression to gestational trophoblastic neoplasia. Hispanic patients with complete molar pregnancy had a significantly lower risk of developing gestational trophoblastic neoplasia than white patients. There were no significant differences among groups interms of presenting symptoms, gestational age at diagnosis, or preevacuation human chorionic gonadotropin levels for either complete mole or partial mole patients.

Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: an observational study

To analyze the growth trend of small uterine fibroids during early pregnancy, evaluating the potential factors involved, with particular interest in hCG levels. Observational study. Tertiary care university hospital. Women who had an ultrasound diagnosis of small myomas (diameter, ≥10mm and ≤50mm) from January 2007 to December 2013, and who subsequently became pregnant within 1year. None. Three additional ultrasound examinations were performed during early pregnancy (7-8, 10-13, and 20-22 complete gestational weeks, respectively) and the modifications in diameter and volume of each uterine fibroid were recorded. A serial evaluation of hCG serum levels from 5-12weeks was performed. From the 109 women who fulfilled the study inclusion/exclusion criteria, a significant increase emerged, both for volume and diameter of the detected fibroids. Specifically, a median growth rate (GR) of 122% was observed during the interval of the first to the second ultrasound, whereas a median GR of 108% was detected during the interval between the second and the third ultrasound, and a median GR of 25% between the third and the fourth ultrasound. A significant positive correlation between hCG levels and diameter (R = 0.69) of myomas between 5 and 12weeks emerged. A remarkable nonlinear growth of small fibroids during initial pregnancy was observed, with a faster rate in the first trimester and a slowdown by midpregnancy. Those changes seem to be related to the similar increase of hCG levels until 12weeks.

Clinical Presentation of Complete Hydatidiform Mole and Partial Hydatidiform Mole at a Regional Trophoblastic Disease Center in the United States Over the Past 2 Decades.

The aim of this study was to compare the clinical presentation and incidence of postmolar gestational trophoblastic neoplasia (GTN) among cases of complete mole (CM) and partial mole (PM) from 1994 to 2013. This study included all cases of patients with CM and PM from our trophoblastic disease center between 1994 and 2013. Their clinical and pathologic reports were reviewed. Gestational age at evacuation, features of clinical presentation, human chorionic gonadotropin levels, and the rate of progression to GTN were compared. The median gestational age at evacuation was 9 weeks for CM and 12 weeks for PM (P < 0.001). Patients with PM had lower pre-evacuation serum human chorionic gonadotropin levels (P < 0.001), and they were also less likely to present with vaginal bleeding (P < 0.001), biochemical hyperthyroidism (P < 0.001), anemia (P < 0.001), uterine size greater than dates (P < 0.001), and hyperemesis (P = 0.002). Consequently, patients with PM were less likely to have been clinically diagnosed as moles compared with CM prior to uterine evacuation (P < 0.001). The development of GTN occurred in 17.7% (33/186) and 4.1% (7/169) of patients with CM and PM, respectively (P < 0.001). This study indicates that, at our center over the past 20 years, both CM and PM were usually evacuated in the first trimester of pregnancy. Because CM more commonly presents with the signs and symptoms of molar disease than PM, CM is more commonly diagnosed prior to evacuation.

Methotrexate and actinomycin D chemotherapy in a patient with porphyria: a case report

BackgroundDespite their broadly recommended use as chemotherapeutic agents, the porphyrogenicity of methotrexate and actinomycin D have not been confirmed. Accordingly, it is not known whether these agents are safe for use in patients with porphyria.Case presentationIn this report, we present a case of an invasive mole with lung metastasis in a 49-year-old Japanese woman who had previously been diagnosed with acute intermittent porphyria at 27 years of age but had no recent history of acute intermittent porphyria attacks. Her serum human chorionic gonadotropin level was elevated 1 month after hysterectomy, and she was referred to our center for chemotherapy. After she received 100 mg of methotrexate, drug eruptions were observed starting on day 3 and grew progressively worse. Erythema and mucosal erosion spread throughout her body, whereupon she was administered prednisolone. In addition, our patient experienced febrile neutropenia and required granulocyte colony- stimulating factor treatment. No changes in our patient’s urinary coproporphyrin or uroporphyrin levels were detected during this entire episode. Methotrexate was replaced by actinomycin D (0.5 mg/body intravenously on days 1–5 every 2 weeks). After five uneventful cycles of actinomycin D, our patient achieved and maintained a normal serum human chorionic gonadotropin level for 3 years.ConclusionsMethotrexate and actinomycin D did not induce acute porphyric attacks in this patient with acute intermittent porphyria; however, severe adverse effects were noted with methotrexate. Although further investigation is required, our data suggest that these agents are nonporphyrinogenic and can therefore be used to treat patients with comorbid porphyria.

Late spontaneous resolution of persistent molar pregnancy

To determine the outcome of women with persistently raised but falling human chorionic gonadotrophin (hCG) levels 6 months after surgical evacuation of a molar pregnancy. An 11-year retrospective review. The United Kingdom supra-regional trophoblastic disease treatment centres at Weston Park Hospital (Sheffield) and Charing Cross Hospital (London). Women with raised but falling serum human chorionic gonadotrophin (hCG) levels 6 months after evacuation of a molar pregnancy. Retrospective case note review of eligible women identified by the electronic databases held at each supra-regional centre. The proportion of women that attain normal hCG levels spontaneously without chemotherapy. In addition, rates of gestational trophoblastic neoplasia (GTN), drug resistance, disease relapse and overall survival are reported. Thirty-five women with molar pregnancy and raised but falling serum hCG levels continued surveillance 6 months after evacuation. Levels of hCG in 30 of the patients (86%) fell to normal levels spontaneously. One woman defaulted follow up prior to hCG normalisation (3%) and the remaining four women (11%) were treated with chemotherapy due to a plateau or rise in serum hCG levels indicating GTN. All treated women were successfully salvaged by either first (n = 1) or second line (n = 2) chemotherapy or found to have persistently raised low level hCG of uncertain clinical relevance (n = 1). No women developed relapsed disease and overall survival was 100%. Women with a molar pregnancy and a raised but falling hCG level beyond 6 months from uterine evacuation can be safely observed with regular hCG monitoring and can usually avoid potentially toxic chemotherapy. Women with treated molar pregnancy may avoid chemotherapy if 6-month hCG levels are raised but falling.

Technique for the Laparoscopic Management of a Cornual Ectopic Pregnancy

Study ObjectiveTo describe a technique for the laparoscopic management of a cornual ectopic pregnancy. DesignStep-by-step explanation of the procedure using video (Canadian Task Force classification III). SettingCornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies, with a mortality range of 2.0% to 2.5%, and this accounts for 20% of all deaths caused by ectopic pregnancies. Both medical and surgical treatments have been reported. Although laparotomy hysterectomy and cornuectomy used to be the preferred surgical approaches, more cornual ectopic pregnancies are being managed with the laparoscopic approach through cornuostomy or cornuectomy in recent years. The main concern with surgical treatment is hemorrhage and the need for cornual reconstruction, which necessitate advanced laparoscopic skills and technique. InterventionsIn this video, we describe our technique for the treatment of a cornual ectopic pregnancy. We present the case of a 21-year-old G3P2002 (gravida 3 para 2002) with the finding of a right live cornual ectopic pregnancy with gestational age of 6 weeks on pelvic ultrasound along with an elevated human chorionic gonadotropin level at 7,192 and right pelvic pain. After counseling regarding treatment options, the patient agreed with proceeding with surgery and underwent a laparoscopic right cornuectomy. Her surgery was uneventful, and she was discharged home a few hours after surgery. She was completely recovered at her postoperative follow-up visit. Her serial serum human chorionic gonadotropin levels were followed until complete resolution a few weeks later. ConclusionLaparoscopic cornuectomy is a safe and effective procedure for the management of cornual ectopic pregnancy. The use of hemostatic agents and suturing can help prevent hemorrhage and allows a safe removal of the ectopic pregnancy and repair of the uterine defect created.

Human chorionic gonadotropin, fetal sex and risk of hypertensive disorders of pregnancy: A nested case-control study.

To assess whether human chorionic gonadotropin (HCG) and fetal sex are two independent risk factors for hypertensive pregnancy in the early second-trimester of pregnancy. This was a retrospective nested case-control study based on a cohort of 2521 singleton pregnancies, among whom we recruited 98 hypertensive pregnancies (subdivided into severe preeclampsia, n=34; mild preeclampsia, n=29 and gestational hypertension, n=35) and 196 normotensive pregnancies. Maternal serum HCG levels were measured at 15-20 weeks of gestation and fetal sex was determined from the neonatal record. Mann-Whitney U and chi-square tests were performed to assess differences of HCG levels and fetal sex between groups. Logistic regressions were performed to evaluate the effect of HCG and fetal sex on hypertensive pregnancy. There were 35 male and 63 female fetuses in the hypertensive group, and 102 male and 94 female fetuses in the normotensive group (p=0.008). HCG (MoM) levels were significantly higher in only severe preeclamptic pregnancies (n=34) (p=0.013). There were no significant differences of the HCG (MoM) levels between male and female fetuses in each sub-group. aOR for increased maternal HCG levels and female fetus were 2.4 (95% CI: 1.434-3.954) and 2.9 (95% CI: 1.227-6.661) respectively in severe preeclamptic pregnancies compared with normotensive pregnancies. There is a female preponderance in hypertensive pregnancies. Increased HCG levels and female fetus are two independent risk factors for severe preeclampsia in the early second-trimester of pregnancy.

Conservative Management of Cervical Ectopic Pregnancy.

To evaluate the safety and effectiveness of conservative management for cervical ectopic pregnancies. We conducted a retrospective review of all cases of cervical ectopic pregnancy diagnosed at our tertiary care academic centre between January 2002 and July 2014. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound according to published criteria. Management decisions were made by individual clinicians. Cervical ectopic pregnancy was diagnosed in 27 women with a median age of 34 years. Two thirds of them were nulliparous, and 44% (12/27) reported infertility. The mean gestational age at diagnosis was seven weeks. The median serum human chorionic gonadotropin level was 11 300 IU/L (range 610 to 163 700). Fetal cardiac activity was present in 19 pregnancies (70%). Vaginal bleeding was the most common presentation, occurring in 23 cases (85%). Three women presented with acute life-threatening hemorrhage. All cases were successfully managed conservatively, allowing uterine preservation. Systemic methotrexate (single or multi-dose protocol) was the mainstay of therapy. Other minimally invasive interventions included ultrasound-guided injection of potassium chloride into the pregnancy, uterine artery embolization, vaginal ligation of cervical branches of the uterine arteries, and dilatation and curettage, with or without dilute vasopressin cervical infiltration and Foley catheter tamponade. Systemic methotrexate alone or in combination with other minimally invasive techniques can be effective conservative treatment for cervical pregnancies. A fertility-sparing approach is the optimal treatment for this patient population, which has high rates of infertility and nulliparity. We present a management algorithm based on our results to aid in standardizing the management of cervical ectopic pregnancies.

Persistent Human Chorionic Gonadotropin After Methotrexate Treatment and an Emergency Surgical Procedure for Ectopic Pregnancy.

The case study is a 33-year-old white female with persistently elevated serum human chorionic gonadotropin (hCG) levels following methotrexate treatment and emergency surgery for ectopic pregnancy. At the time of the first methotrexate dose, the serum hCG concentration was 27,995 IU/L. The laboratory was consulted 3.5 months after the surgery, because serum hCG levels had stopped declining and had leveled off to around 80 to 90 IU/L but with negative urine pregnancy tests. Laboratory studies ruled out heterophile antibody interference and hook effect by multiple methods including analysis by different serum hCG assays, treatment with heterophile antibody blocking agents, and dilution studies. Three additional doses of methotrexate over six months were required for serum hCG concentrations to decline to undetectable levels. This case illustrates challenges that may arise with serum hCG measurements in management of ectopic pregnancies. Close collaboration between the laboratory and clinical service is key for optimal patient care.

Cervical intramedullary immature teratoma with metastatic recurrence in an adult.

Case report. We present for the first time an adult patient with cervical intramedullary immature teratoma with metastatic recurrence. Peking university Shenzhen Hospital, Shenzhen, China. A 30-year-old woman presented with rapidly progressive quadriplegia. Magnetic resonance imaging (MRI) revealed an intramedullary tumor occupying C1-C2 of the upper spinal cord. An urgent operation, consisting of decompression by laminectomy and tumor gross resection, was performed under a preoperative diagnosis of spinal glioma. The histological diagnosis was immature teratoma. The patient received local radiotherapy after gross total resection. The serum alpha fetoprotein (AFP) and human chorionic gonadotropin (HCG) levels were normal postoperatively, until these were evaluated on the 10th month with neurological deterioration. Metastatic recurrences were demonstrated on MRI with lesions located at the levels of C5-C6 and T11-12. Removal of the second tumors was performed and the pathological examination identified a malignant germ cell tumor (yolk sac tumor). The patient was then referred to chemotherapy and radiotherapy. No tumor regrowth was encountered and the patient remained stable for 6 months after adjuvant therapy. Immature teratoma should be included in the differential diagnosis of holocord tumors in the adult with rapidly progressing symptoms and if found should be radically excised if possible. Adjuvant therapy should be the salvage therapy for this recurrent tumor.

Hysteroscopic resection of retained products of conception after temporal laparoscopic uterine artery ligation

Abstract Objective To describe hysteroscopic resection of retained products of conception (RPOC) after temporal laparoscopic uterine artery ligation for prevention of massive bleeding. Materials and methods This retrospective study was based in a community medical care hospital. Eight patients with RPOC underwent hysteroscopic resection of RPOC. Before the procedure, we performed temporal laparoscopic uterine artery ligation for prevention of massive bleeding. Results Patients' clinical backgrounds, intervals between the abortion or delivery and the operation, serum human chorionic gonadotropin (hCG) level at diagnosis, surgical times, and blood loss levels during surgery were recorded. The mean patient age was 28.2 ± 4.7 years. The mean interval between the abortions or deliveries and the surgeries was 43.2 ± 20.2 days. Three patients underwent spontaneous abortions, three patients underwent artificial abortions, and two patients had vaginal deliveries. The mean serum hCG level at the initial diagnosis was 168.7 ± 310 IU/L. Rich blood flow in the RPOCs was revealed by two-dimensional Doppler ultrasound examinations. Temporal uterine artery ligation was performed in all patients. The mean surgical time was 123.6 ± 19.4 minutes, and the blood loss was minimal in all eight cases. Neither blood transfusion nor conversion to laparotomy was required. The histologic evaluation revealed trophoblastic cells in all cases. Conclusion Hysteroscopic resection of RPOC after temporal laparoscopic uterine artery ligation is an effective and safe procedure for controlling bleeding.

Predictive value of maternal serum human chorionic gonadotropin levels in pregnancies achieved by in vitro fertilization with single cleavage and single blastocyst embryo transfers

To compare serum hCG levels after transfer of a single fresh cleavage embryo and of a single fresh blastocyst embryo and to determine the predictive value of serum hCG levels for pregnancy outcomes. A single center retrospective cohort study. Tertiary university health center. All fresh single ETs between December 2008 and December 2013. None. Mean serum hCG levels on day 16 after oocyte collection, after the transfer of a fresh single cleavage embryo and a fresh single blastocyst embryo were compared. Multivariable regression analysis was performed to determine the association of potential factors on hCG value and a clinical pregnancy. One thousand twenty-six fresh single ETs were analyzed, 801 (638 pregnancies) from a single blastocyst transfer and 225 (167 pregnancies) from a single cleavage ET. The mean hCG levels resulting from a single fresh blastocyst transfer (299 ± 204 IU/L) were significantly higher than those from a cleavage transfer (245 ± 204 IU/L). This difference remained after adjusting for confounding variables. The threshold value predicting a clinical pregnancy for a cleavage embryo was 100 IU/L, and for a blastocyst transfer, 133 IU/L. Our study suggests that initial serum hCG values are higher after the transfer of a single fresh blastocyst embryo compared with after a single fresh cleavage ET, even after adjusting for confounding variables.

Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature.

The objective of this study was to determine the outcome of using ultrasound-guided local methotrexate injection as the first-line treatment of cesarean scar pregnancy (CSP). A literature review was performed on all eligible reports using this modality as the first-line treatment of CSP. Relevant publications were obtained from the PubMed electronic database from inception to December 2014. Ninety-six cases from 95 women reported in 17 articles were reviewed. The success rate was 73.9% after a single local methotrexate injection. An accumulated success rate of 88.5% could be achieved after additional local or intramuscular methotrexate administration. Eleven cases (11.5%) failed methotrexate treatment and required surgical interventions. Except for women with serum human chorionic gonadotropin levels higher than 100 000 IU/L, ultrasound-guided local methotrexate injection could be considered as a first-line treatment modality for CSP.

PD2-11 DOES TUMOR SIZE, ULTRASONOGRAPHIC FINDINGS, SERUM HUMAN CHORIONIC GONADOTROPIN(HCG) LEVEL CAN PREDICT THE LIKELIHOOD OF BENIGN TESTICULAR HISTOLOGY?

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Penis/Testis/Urethra: Benign Disease1 Apr 2015PD2-11 DOES TUMOR SIZE, ULTRASONOGRAPHIC FINDINGS, SERUM HUMAN CHORIONIC GONADOTROPIN(HCG) LEVEL CAN PREDICT THE LIKELIHOOD OF BENIGN TESTICULAR HISTOLOGY? Gang Song Gang SongGang Song More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.194AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To predict the likelihood of benign histology for testicular masses and decide more testis-sparing surgeries prior to operation. METHODS During the years Jan 2005 - Mar 2014, 254 consecutive operations of testicular masses were performed in our hospital. The majority (245/254, 96.5%) underwent radical orchiectomy. Only nine (9/254, 3.5%) were testicular preserving surgeries for considering benign tumors, which have been confirmed by histology after operation. We searched for the concordance between age, tumor size, ultrasonographic findings, serum alpha fetoprotein(AFP) and human chorionic gonadotropin(HCG) level, body mass index(BMI) and pathology status(benign vs malignant). RESULTS Benign lesions were found in 69 patients(27.2%), including epidermoid cysts(n=33), tubercular lesions(n=10), cysts(n=6), inflammation lesions(n=6), mature teratoma(n=3), lipoma(n=1), leiomyoma(n=2) and so on. Malignant findings were in the other 185 patients, including seminoma, embryonal carcinoma or mixed germ cell tumor, non Hodgkin's lymphoma, malignant interstitial cell tumor. The median diameter of benign tumor was 2.5 cm(0.5-14.0 cm), the median diameter of malignant tumor was 5.0 cm(0.7-23.0 cm). The tumor size, ultrasonographic findings, serum HCG level had significant difference between the benign and malignant groups. Receiver Operation Characteristic(ROC) analysis showed a cut-off value of 3.4 cm tumor size with 80.6% sensitivity and 76.4% specificity. Logistic regression showed that tumor size, ultrasonographic findings, serum HCG level were independent predictors for benign tumors. If the possibility calculated from the logistic regression was 0.84 or more, the patient might be malignant with 79.0% sensitivity and 90.0% specificity. CONCLUSIONS Tumor size, ultrasonographic findings, serum HCG level can predict the likelihood of benign testicular histology. Testis-sparing surgery should be decided if the possibility of benign histology is high. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e44 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gang Song More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The value of HCG serum concentrations after trigger in predicting pregnancy and live birth rates in IVF–ICSI

The aim of this study was to determine if an association existed between serum human chorionic gonadotrophin (HCG) level at 12 h after trigger and IVF and intracytoplasmic sperm (ICSI) treatment outcomes. Women undergoing initial IVF–ICSI and embryo transfer treatment using the long luteal phase gonadotrophin-releasing hormone agonist protocol between April 2012 and March 2013 for tubal factor were included (n = 699). In the clinical pregnancy group, HCG after trigger was significantly elevated (276.0 ± 5.1 versus 198.5 ± 6.1 mIU/mL; P < 0.001). The optimal cut-off value proposed by the receiver operating characteristic analysis (area under curve = 0.730) for HCG was 201.2 mIU/ml. Compared with the lower HCG group, the clinical pregnancy rate in the higher HCG group was increased in obese and non-obese patients (77.8% versus 57.3%, P < 0.05; 85.6% versus 53.0%, P < 0.01, respectively). Adjusted for age and body mass index, an increase of HCG was associated with a better IVF–ICSI treatment outcome (OR 4.39, 95% CI 2.99 to 6.45). Clinical pregnancy rate was significantly higher across increasing quartiles of HCG. An elevated level of serum HCG at 12 h after trigger was associated with a better IVF–ICSI outcome.

Gestational choriocarcinoma with uterine serosal metastasis mimicking ruptured ectopic pregnancy: A case report.

Primary gestational choriocarcinoma is commonly present in the uterus in cases of atypical genital bleeding. Symptoms similar to those of an ectopic pregnancy develop when an extra-uterine lesion is present in the abdominal cavity, and lesions have been detected in the ovaries and fallopian tubes in a number of cases. In the present study, we describe a patient with choriocarcinoma that metastasized to the uterine serosa and caused symptoms similar to those of an ectopic pregnancy. The patient was a 30-year-old female who presented to our hospital with atypical genital bleeding and a positive pregnancy test 3 months after missed abortion at 10 weeks of gestation. Transvaginal ultrasonography revealed the absence of a gestational sac in or outside the uterus, and intra-abdominal bleeding was noted. An ectopic pregnancy was suspected based on these findings, and emergency laparotomy was performed. A hemorrhagic mass was present on the uterine serosa, and was subsequently resected. Trophoblastic disease was suspected following histopathological examination, for which intra-uterine curettage was performed and choriocarcinoma was diagnosed. Lung metastasis was detected on computed tomography, and a high serum human chorionic gonadotropin (hCG) level persisted following surgery. The lesion disappeared following five cycles of methotrexate+ etoposide+actinomycin D therapy, which was performed as postoperative chemotherapy, and the patient's serum hCG level decreased to below the detection limit. In this case of choriocarcinoma, the primary lesion was present in the uterus and had metastasized to the uterine serosa, which is a very rare metastatic site. This uterine serosal metastatic lesion bled and caused symptoms similar to those of an ectopic pregnancy. Certain patients who undergo surgery for a suspected peritoneal pregnancy may have gestational choriocarcinoma, similar to this case.

Metastasia Lesion of Gestation Trophoblastic Tumor in Abdominopelvic Cavity Diagnosed by Sonographic and Doppler Imaging

Objective: The purpose of this study was to review clinical data of metastasia lesion of gestation trophoblastic tumor (GTT) in abdominopelvic cavity by color Doppler ultrasound. Subjects and Methods: A retrospective analysis of 13 cases of GTT in China was performed. Clinical appearances, serum human chorionic gonadotropin (hCG) levels, sonographic findings, Doppler waveforms, and patient outcomes were followed up. Color Doppler ultrasound was performed to diagnose the presence of GTT, detect metastasia lesion in abdominopelvic cavity, assess disease recurrence, and monitor the efficacy of chemotherapy. Results: Of the 13 patients with GTT, 4 had choriocarcinoma which 3 cases occurred after an abortion, 1 after a year of dilation and suction evacuation for the hydatidform mole. Metastasia lesion in abdominopelvic cavity was detected by color Doppler ultrasound in all cases of choriocarcinoma, among which the metastasia lesion were found at uterine fundus, near uterus, colon and cystic vascular space near the uterus, repectively. 9 cases with an invasive hydatidiforn mole (IHM) occurred after one to three months of dilation and suction evacuation for the hydatidform mole, consistant with the hCG levels markedly elevating. Metastasia lesion in abdominopelvic cavity was also detected by color Doppler ultrasound besides invasive lesion in uterine muscular layer in all cases of IHM, among which 3 cases showed metastasia lesion in cystic vascular space near the uterus, 2 cases were detected in side wall of pelvic cavity, while the rest were found in abdominal cavity, right kidney, colon and near uterus, respectively. Meanwhile, the image of metastasia lesion with IHM was similar to choriocarcinoma’s. And the reticular structure, the cystic vascular space and solid lesion may be showed by ultrasound. The metastasia lesion had abundant flow. Doppler waveforms showed resistive indices of 0.34 (SD 0.07) for metastasia lesion. There was the same lower-impedance as invasive lesion in uterine muscular layer. Except an IHM with the renal metastasia lesion having been followed, abnormal sonographic and Doppler findings in other metastasia disease all disappeared after surgical operation or chemotherapy were successful. Conclusions: Sonography and Doppler imaging were helpful in detecting metastasia lesion in abdominopelvic cavity, and in following the effectiveness of chemotherapy. And it should be taken full examination for GTT by Color Doppler ultrasound in order to avoid mistake.

The role of unexplained high serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) levels in the second trimester to determine poor obstetric outcomes.

Objective:To investigate the relationship between gestational complications and high levels of maternal serum alfa-fetoprotein (MSAFP) and/or beta human chorionic gonadotropin (hCG) and to determine whether these markers are effective predictors of poor pregnancy outcomes.Materials and Methods:In this study, we enrolled a total of 679 women at 15-20 gestational weeks with MSAFP and hCG below or above 2.0 multiples of the median (MoM); of those, 200 women with normal MSAFP and hCG MoM formed the control group. Pre-eclampsia, intrauterine growth retardation (IUGR), preterm labor, preterm delivery, placental abruption, placenta previa, placenta accreta, preterm premature rupture of the membranes (PPROM), intrauterine fetal death, as well as neonatal and perinatal morbidity rates were evaluated.Results:A significant relationship was found between adverse pregnancy outcomes and abnormal elevation of hCG and AFP levels in the second trimester. In cases of isolated elevation of hCG, preeclampsia and preterm labor/spontaneous preterm birth rate were slightly higher than in the control group (p=0.043, p=0.015), while IUGR, PPROM, placental abruption, and intrauterine fetal death rates were all similar (p=0.063, p=0.318, p=1.00, p=0.556).In case having an elevation in both markers, increased rate of obstetric complications have been observed. A significant relationship was found between the high levels of maternal serum AFP and hCG MoM and poor pregnancy outcomes like preeclampsia, IUGR, PPROM, intrauterine fetal death (p=0.003, p=0.001, p=0.040, p=0.006).Conclusion:To our knowledge, up to now, no definitive follow-up and treatment protocols have been established for patients at increased risk. In light of these findings, it is recommended to inform and educate patients about the most likely signs and symptoms of complications, to make more often antenatal visits, to perform more frequent ultrasound examination (fetal growth, AFI, etc.), NST, arterial/venous doppler, biophysical profile, and cervical length measurements in high-risk group.