Serum Human Chorionic Gonadotropin Levels Research Articles

Total Hysteroscopic Treatment of Cervical Pregnancy: The 2-step Technique

To evaluate the efficacy of total surgical treatment of ectopic cervical pregnancy [1] with a minimally invasive approach performed by hysteroscopy [2]. Step-by-step video demonstration of the surgical technique using 5 mm hysteroscopy followed by 10 mm resectoscopy. A research and university hospital (IRCCS Burlo Garofolo, Trieste, Italy). A 41-year-old woman with an ultrasound diagnosis of ectopic cervical pregnancy at 6 + 6 weeks of gestation with a beta human chorionic gonadotropin serum level of 55.951 mUI/mL. We performed a 2-step technique using 5- and 10-mm hysteroscopy (Video 1). During the first step, a 5-mm Bettocchi hysteroscope (Karl Storz, Tuttlingen, Germany) with a 5F bipolar electrode Versapoint Twizzle (Gynecare, Menlo Park, CA) was used. In this phase, the gestational sac was identified in order to confirm the diagnosis and its site of implantation. Later, the gestational sac was opened, and the pregnancy was terminated by cord section under an embryoscopic view (Fig. 1). Finally, a partial vessel coagulation was performed. Afterward, the cervix was dilated, and a resectoscopy was performed. During the second step, a 10-mm Gynecare resectoscope with the bipolar Gynecare Versapoint was used and the gestational sac with the embryo was removed; subsequently, a complete chorial villi resection was achieved. At last, a coagulation of bleeding vessels on the implantation site in order to control the hemostasis was performed (Fig. 2). The study was approved by the institutional review board. The patient was discharged 24 hours after the procedure with an uneventful postoperative course, and the beta human chorionic gonadotropin serum level became negative in 20 days. After 40 days, the ultrasound cervical findings were regular, whereas office hysteroscopy showed the implantation site scar. After 5 months, the patient was pregnant with regular intrauterine implantation (Fig. 3). The total hysteroscopic approach with a 2-step technique offers an effective, safe, and minimally invasive surgical treatment to ectopic cervical pregnancy. Considering that our method, in contrast with the recent literature [3-5], is performed without any medical treatment, we reported for the first time an approach, that deserve more clinical data to confirm its effectiveness.

Obstetric and perinatal outcomes of pregnancies according to initial maternal serum HCG concentrations after vitrified-warmed single blastocyst transfer.

Do pregnancy, obstetric and perinatal outcomes differ according to initial maternal serum human chorionic gonadotrophin (HCG) level measured on day 11 after single blastocyst transfer? Vitrified-warmed single blastocyst transfer cycles (n = 640) were collected between 1 January 2013 and 30 April 2017 with positive HCG values and retrospectively analysed by receiver operating characteristic curves to predict clinical pregnancy, ongoing pregnancy and delivery. Cycles were divided into a low HCG group (n = 155) and high HCG group (n = 485) based on cut-off value of live birth prediction. Cycles in the HCG group were subdivided into a low-high subgroup (n = 162), medium-high subgroup (n = 162) and high-high subgroup (n = 161) based on tertile points. Pregnancy rates and obstetric and perinatal outcomes were compared. The area under curves for clinical pregnancy, ongoing pregnancy and live birth prediction were 0.95, 0.81 and 0.79, respectively; corresponding cut-off values were 152.2 IU/l, 211.9 IU/l and 211.9 IU/l; HCG less than 211.9 IU/l indicated an extremely low clinical pregnancy rate (34.84%), a high early miscarriage rate (61.11%) and a low live birth rate (12.26%). Rates of gestational diabetes mellitus (GDM) (P = 0.007) and female neonates (P = 0.001) were significantly higher in the LHG group compared with the HHG group; no significant differences were observed in the low versus high HCG group overall. Lower initial maternal serum HCG levels indicated poorer clinical outcomes. Within the high HCG group, a lower initial maternal HCG level was found to be associated with GDM occurrence and proportion of female neonates.

Ovarian Ectopic Pregnancy: Laparoscopic Excision and Ovarian Conservation

To show a case of laparoscopic excision of an ovarian ectopic pregnancy and the technique used. A university hospital (Manchester University Foundation Trust). A 23-year-old primigravida presentation at 6 weeks of gestation with an ectopic pregnancy. A 23-year-old primigravida presentation at 6 weeks of gestation with a 7-day history of light bleeding and intermittent abdominal pain. The examination was unremarkable, and the serum human chorionic gonadotropin level was 7157 IU/L. An ultrasound scan showed an ectopic pregnancy in the right adnexa, and she underwent surgical management. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic pregnancy within the right ovary; 20 IU argipressin diluted in 80 mL 0.9% sodium hypochlorite was injected between the normal ovarian tissue and the ectopic pregnancy to assist hemostasis and hydrodissection. An ultrasonic device was used to incise the ovarian cortex to identify a plane of dissection between the ectopic pregnancy tissue and the normal ovarian tissue. The ectopic pregnancy was excised with conservation of the ovary. The ovary was subsequently closed with absorbable sutures to ensure hemostasis. The ectopic pregnancy was removed in a bag through a 10-mm incision. The patient made an uneventful recovery. The serum human chorionic gonadotropin level in 7 days was <5, and no further medical management was indicated. Histology confirmed a primary ovarian ectopic pregnancy. Ovarian function was not assessed postoperatively; however, she conceived 6 weeks later with an intrauterine pregnancy. This case highlights the importance of considering nontubal ectopic pregnancies when making a diagnosis based on an ultrasound scan. Ovarian preservation with excision of ectopic pregnancy can be achieved using techniques commonly used for ovarian cystectomy. Recourse to oophorectomy should only be considered in the event of acute hemorrhage.

The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology.

The clinical predictive factors for malignant testicular histology remain unclear because of the low prevalence. Therefore, the aim of this study was to investigate predictors of malignant histology for testicular masses and decide more testis-sparing surgeries before surgery. This retrospective study enrolled 325 consecutive testicular mass patients who underwent radical orchiectomy (310/325) or testicular preserving surgery (15/325) from January 2001 to June 2016. The clinicopathological factors, including tumor diameter, cryptorchidism history, ultrasound findings, serum alpha-fetoprotein, and human chorionic gonadotropin (HCG) levels, were collected retrospectively for statistical analysis. A predictive nomogram was also generated to evaluate the quantitative probability. Among all patients, 247 (76.0%) were diagnosed with a malignant testicular tumor and 78 (24.0%) with benign histology. Larger tumor diameter (per cm increased, hazard ratio [HR] = 1.284, P = 0.036), lower ultrasound echo (HR = 3.191, P = 0.001), higher ultrasound blood flow (HR = 3.320, P < 0.001), and abnormal blood HCG (HR = 10.550, P < 0.001) were significant predictive factors for malignant disease in all testicular mass patients. The nomogram generated was well calibrated for all predictions of malignant probability, and the accuracy of the model nomogram measured by Harrell's C statistic (C-index) was 0.92. According to our data, the proportion of patients who underwent radical orchiectomy for benign tumors (24.0%) was much larger than generally believed (10.0%). Our results indicated that the diameter, ultrasonic echo, ultrasonic blood flow, and serum HCG levels could predict the malignancy in testicular mass patients.

The treatment of cervical pregnancy with high-intensity focused ultrasound followed by suction curettage: report of three cases

Objective: Cervical pregnancy (CP) is a rare type of ectopic pregnancy and is considered to be a life-threatening condition due to the risk of severe hemorrhage. Unfortunately, no consensus on standard conservative treatment for CP has been established. The study objective was to evaluate the efficacy and safety of high-intensity focused ultrasound (HIFU) followed by suction curettage for cervical pregnancy.Method: Three patients with cervical pregnancy undergoing high-intensity focused ultrasound followed by suction curettage were analyzed. Patient age, gestational age, endocervical mass, serum human chorionic gonadotrophin (HCG) level, blood loss, and time for normal menstruation recovery were recorded.Results: Three patients with cervical pregnancy were successfully treated with HIFU followed by suction curettage. After HIFU treatment, the fetal cardiac activity disappeared or the blood flow in the pregnancy tissue significantly decreased. The termination of the cervical pregnancy of all three patients was performed successfully without heavy bleeding. The estimated blood loss was 10–20 ml. The time for menstruation recovery was 30–45 days. No obvious complications of HIFU were observed in these cases.Conclusion: High-intensity focused ultrasound followed by suction curettage seems to be considered as conservative management for patients who desire to preserve their uterus.

A multi-centre, double-blind, placebo-controlled, randomised trial of combination methotrexate and gefitinib versus methotrexate alone to treat tubal ectopic pregnancies (GEM3): trial protocol

BackgroundTubal ectopic pregnancy (tEP) is the most common life-threatening condition in gynaecology. Treatment options include surgery and medical management. Stable women with tEPs with pre-treatment serum human chorionic gonadotrophin (hCG) levels < 1000 IU/L respond well to outpatient medical treatment with intramuscular methotrexate. However, tEPs with hCG > 1000 IU/L can take significant time to resolve with methotrexate and require multiple outpatient monitoring visits. In pre-clinical studies, we found that tEP implantation sites express high levels of epidermal growth factor receptor. In early-phase trials, we found that combination therapy with gefitinib, an orally active epidermal growth factor receptor antagonist, and methotrexate resolved tEPs without the need for surgery in over 70% of cases, did not cause significant toxicities, and was well tolerated. We describe the protocol of a randomised trial to assess the efficacy of combination gefitinib and methotrexate, versus methotrexate alone, in reducing the need for surgical intervention for tEPs.Methods and analysisWe propose to undertake a multi-centre, double-blind, placebo-controlled, randomised trial (around 70 sites across the UK) and recruit 328 women with tEPs (with pre-treatment serum hCG of 1000–5000 IU/L). Women will be randomised in a 1:1 ratio by a secure online system to receive a single dose of intramuscular methotrexate (50 mg/m2) and either oral gefitinib or matched placebo (250 mg) daily for 7 days. Participants and healthcare providers will remain blinded to treatment allocation throughout the trial. The primary outcome is the need for surgical intervention for tEP. Secondary outcomes are the need for further methotrexate treatment, time to resolution of the tEP (serum hCG ≤ 15 IU/L), number of hospital visits associated with treatment (until resolution or scheduled/emergency surgery), and the return of menses by 3 months after resolution. We will also assess adverse events and reactions until day of resolution or surgery, and participant-reported acceptability at 3 months.DiscussionA medical intervention that reduces the need for surgery and resolves tEP faster would be a favourable treatment alternative. If effective, we believe that gefitinib and methotrexate could become standard care for stable tEPs.Trial registrationISRCTN Registry ISRCTN67795930. Registered 15 September 2016.

Serum hCG threshold to assess medical abortion success

Objectives: The main aim of the study was to establish a threshold for serum human chorionic gonadotropin (hCG) level that ruled out ongoing pregnancy after induced medical abortion (MA). The secondary aim was to discover risk factors for the need for uterine aspiration.Methods: This prospective study included women who underwent MA with mifepristone–misoprostol at ≤9 weeks of gestation between 2012 and 2014. Serum hCG levels were measured 14–21 days after MA. The main outcome measure, ongoing pregnancy, was defined as the presence of an embryo with cardiac activity on transvaginal ultrasonography after MA. The receiver operating characteristic curve was plotted to determine the optimal serum hCG threshold. Risk factors for the need for uterine aspiration were calculated using multivariate logistic regression and expressed as odds ratios (ORs) with 95% confidence intervals (CIs).Results: The study included 814 women. Mean gestational age was 46.5 ± 7.4 days for ongoing pregnancies and 44.2 ± 4.8 days for MA success (p = .43). The ongoing pregnancy rate after MA was 0.9%. A serum hCG threshold ≥900 IU/l to diagnose ongoing pregnancy gave 100% sensitivity and 81.5% specificity, compared with 85.7% sensitivity and 83.5% specificity using a threshold ≥1000 IU/l. Independent risk factors for uterine aspiration requirement were: gravidity (OR 3.8; 95% CI 1.1, 13.2; p = .001), gestational age >6 weeks (OR 6.0; 95% CI 1.8, 6.0; p = .006) and previous surgical abortion (OR 2.4; 95% CI 1.1, 5.2; p < .001).Conclusion: Serum hCG measurement <900 IU/l, 14–21 days after MA, is an efficient strategy for excluding ongoing pregnancy after first trimester MA.

AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations.

AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations.

Primary hepatic pregnancy: report of a case treated with laparoscopic approach and review of the literature

To report a case of primary hepatic pregnancy complicated by acute hemoperitoneum that was treated with a laparoscopic approach. Case report and review of the literature. Obstetrics and gynecology unit of a university hospital. A 37-year-old pregnant woman who presented with vaginal bleeding. Diagnosis by abdominal ultrasound and computed tomography. Patient recovery after minimally invasive laparoscopic surgery and monitoring. A hepatic ectopic pregnancy complicated by hemoperitoneum was diagnosed. The hepatic pregnancy was surgically removed via laparoscopy through a retroperitoneal approach, and the patient's human chorionic gonadotropin level was subsequently monitored. The patient's postoperative course was uneventful, and the serum human chorionic gonadotropin level dropped to zero. Only 39 cases of hepatic pregnancy have been reported in the literature, making it an exceptional category among abdominal pregnancies. Hepatic localization should be ruled out in cases of unknown pregnancy location. Abdominal ultrasound has a key role detecting hepatic localization and excluding other abdominal implantation sites. Laparoscopic surgery represents a feasible approach for the treatment of first trimester hepatic pregnancies.

Initial serum human chorionic gonadotropin levels predict live birth outcomes following frozen embryo transfer with and without preimplantation genetic testing for aneuploidy (PGT-A)

Initial serum human chorionic gonadotropin (hCG) levels have an established association with IVF pregnancy outcomes1-3. However, many studies that have examined this association involved fresh transfers, transfer of multiple embryos, and embryos at varying stages of development. As contemporary practice patterns have shifted towards frozen transfer of a single blastocyst, evaluating the predictive value of initial hCG levels in this population is of interest. Additionally, it is not known if the predictive value of the initial hCG level is different for embryos that have undergone PGT-A. The objective of this study is to evaluate early serum human chorionic gonadotropin levels as a predictor of live birth following frozen embryo transfer (FET) of a single blastocyst with and without PGT-A. Retrospective cohort study. All FETs of a single blastocyst at a large IVF center between 2010 and 2016 were reviewed for inclusion. Only those FET cycles resulting in a positive hCG nine days post-transfer were included in this analysis. Initial hCG levels were stratified and live birth rates were analyzed. Chi square analysis was used to compare live birth rates for each hCG category following transfer of embryos with and without PGT-A. A total of 5280 FET cycles were included and 3417 (64.7%) of those cycles resulted in live birth. The mean hCG for a pregnancy resulting in live birth was 185 (+101.4) versus 60.7 (+76.1) mIU/mL for a non-viable gestation (P<0.01). Table 1 displays the live birth rate following FET of embryos with and without PGT-A, stratified by hCG level 9 days post-transfer. Initial serum hCG levels < 50 mIU/mL were associated with reduced live birth rates. For initial hCG levels between 50 and 150 mIU/mL, the live birth rate was approximately 10% higher following transfer of a genetically screened embryo.Tabled 1Live Birth RatesInitial hCG (mIU/mL)Live birth rate with PGT-A (n=3,592)Live bith rate with no PGT-A (n=1,688)P-value0.1-5094/779 (12.1%)48/510 (9.4%)0.1450.1-100377/534 (70.6%)163/269 (60.6%)<0.01100.1-150549/688 (79.8%)199/283 (70.3%)<0.01150.1-200487/567 (85.9%)207/244 (84.8%)0.70>200947/1024 (92.5%)346/382 (90.6%)0.24 Open table in a new tab Even when initial serum hCG levels nine days after FET are low, there is still a chance of live birth. When the initial hCG level is between 50 and 150 mIU/mL, live birth rates are significantly higher with genetically screened embryos.

Carcinoma of unknown primary site and ectopic pregnancy diagnosed at laparoscopic surgery: a rare coexistence

The authors present a case of carcinoma of unknown primary site detected accidentally during laparoscopic surgery for ectopic pregnancy. A 36-year-old female patient (para 1, gravida 1) was referred to the present hospital with suspected ectopic pregnancy. Transvaginal ultrasound showed a right adnexal mass and echo-free space in the pelvic cavity. Her serum human chorionic gonadotropin level was 7,590 mIU/ml. The authors made a preoperative diagnosis of ectopic pregnancy and performed laparoscopic surgery. The ampulla of the right fallopian tube was enlarged and showed blood clotting. They noticed a white solid mass of size 1 cm on the peritoneum around the right pelvic ligament. Pathologic examination findings of the specimen were consistent with carcinoma. Immunohistochemical stains suggested high-grade neuroendocrine carcinoma. Routine metastatic workup could not reveal the original site. The final diagnosis was carcinoma of unknown primary site. The authors reviewed other case reports on neoplasms coexisting with ectopic pregnancy.

Controversies in family planning: persistently elevated serum human chorionic gonadotropin levels after aspiration abortion

Low but rising serum human chorionic gonadotropin (hCG) levels occur infrequently after an induced abortion. Because this scenario rarely occurs after suction aspiration, clinicians may have higher suspicion for an uncommon diagnosis. The differential diagnosis includes both common and uncommon diagnoses, such as incomplete abortion, heterotopic or ectopic pregnancy, a new intrauterine pregnancy and gestational trophoblastic neoplasia. The etiology of this presentation may be unclear, especially in the absence of abnormal bleeding or pain which would suggest incomplete abortion, or when significant time has passed since the procedure. We describe two cases of an uncommon presentation of retained products of conception after aspiration abortion in which hCG levels were low but rising.

The Clinical Significance of a Small Component of Choriocarcinoma in Testicular Mixed Germ Cell Tumor (MGCT).

The clinical significance of limited choriocarcinoma in a malignant mixed germ cell tumor (MGCT) is unknown. Men with a MGCT with ≤5% choriocarcinoma at radical orchiectomy (RO) between 2000 and 2016 from our consult service were studied. Of 50 men in our cohort, we had clinical information for 30 men. Median follow-up was 41 months (1 to 168 mo). Median tumor size was 4.5 cm (1.1 to 8.0 cm). In total, 22/30 (73%) cases were pT1, 6/30(20%) cases were pT2, and 2/30 (7%) cases were pT3. In total, 4/30(13%) cases had lymph node metastases and 2/30 (7%) cases had distant metastases at the time of RO. In 30 cases with RO we had information on immediate postorchiectomy treatment: 14/30 (46.7%) active surveillance, 4/30 (13.3%) retroperitoneal lymph node dissection, 10/30 (33.3%) chemotherapy (chemotherapy), 1/30 (3.3%) retroperitoneal lymph node dissection followed by chemotherapy, and 1/30 (3.3%) resection of a distant metastasis. Preoperative serum human chorionic gonadotropin (hCG) levels ranged between 0.1 and 60,715 mIU/mL (mean, 4796; median, 485). One patient had an hCG level of 6367 mIU/mL and another 60,715 mIU/mL with the remaining cases <5000 mIU/mL. In total, 4/30 (13%) patients had elevated serum markers after surgery, 3 of them normalized following chemotherapy while the fourth one continued to have elevated serum alpha fetoprotein levels after chemotherapy. All patients were alive at last follow-up. In total, 7/30 (23.3%) patients subsequently developed metastatic disease to lymph nodes or distal organs, the histology of the metastasis consisted mainly of teratoma and yolk sac tumor. Embryonal carcinoma was present in 2 metastatic sites. One lung metastasis was suggestive for choriocarcinoma. Definitive choriocarcinoma was not present in any of the metastasis. A small component of choriocarcinoma in a MGCT is typically associated with relatively low-level elevations of serum hCG levels, and is not associated with aggressive disease. The presence of limited choriocarcinoma (≤5%) does not add to the prognostic information provided by standard TNM staging, which uses levels of serum markers (hCG, alpha fetoprotein, lactate dehydrogenase) as surrogates for extent of disease.

Different Surgical Approaches to 313 Cesarean Scar Pregnancies

Study ObjectiveTo evaluate the efficacy of different surgical treatments for cesarean scar pregnancy (CSP). DesignRetrospective study (Canadian Task Force classification II-3). SettingAffiliated university hospitals. PatientsWomen (n = 313) with CSP. InterventionsDilation and curettage under ultrasound guidance (DCUS, n = 124), dilation and curettage with hysteroscopic guidance (DCH, n = 103), vaginal excision (n = 55), laparotomy (n = 12), and laparoscopy (n = 19). Measurements and Main ResultsUndetectable serum human chorionic gonadotropin (hCG) levels and thickness of the uterine scar were measured before and after surgery. Success rates of the 5 surgical treatments of CSP (DCUS, DCH, vaginal excision, laparotomy, and laparoscopy) ranged between 89% and 100%. Postoperative treatment was not needed in the vaginal and laparotomy groups, and vaginal treatment was associated with shorter operative time than laparotomy and laparoscopy and shorter time to undetectable hCG levels than DCUS and DCH. Serum hCG levels on day 3 after surgery were significantly lower than baseline levels in all groups of patients, but there was no significant difference between levels on days 3 and 5 postoperatively. Median scar thickness after surgery in the vaginal surgery, laparotomy, and laparoscopy groups was thicker than that in the DCUS and DCH groups. ConclusionIn certain circumstances, CSP can be treated simply by DCH or DCUS. However, time to undetectable hCG levels is prolonged compared with more invasive techniques.

Extra Uterine Choriocarcinoma Mimicking as Ectopic Pregnancy: A Rare Case Report

Choriocarcinomas are germ cell tumours formed by trophoblastic elements (Mundkur et al., J Clin Diagn Res 9(1):QD01–2; 2015). Gestational choriocarcinoma can occur after molar pregnancy, tubal pregnancy or antecedent normal pregnancy. Primary extra-uterine choriocarcinoma is very rare. We report here a case of broad ligament choriocarcinoma who presented with a complaint of pain in lower abdomen off and on. She had a history of dilation and evacuation for spontaneous abortion 3 months back and then she had regular menses. Her transvaginal sonography revealed 42 x 35 mm size right adnexal mass which was more consistent with ectopic pregnancy and her serum human chorionic gonadotropin (β-Hcg) level was 1,76,075 mIU/ ml. Finally, patient was diagnosed as ruptured tubal ectopic pregnancy and thus, she underwent laparotomy. On laparotomy, there was purple colored broad ligament mass of size 5x6 cm with highly increased vascularity in right side which was removed with difficulty and massive bleeding occurred. So, total abdominal hysterectomy was done. Histopathological report showed choriocarcinoma of right broad ligament invading myometrium. The patient was given 6 cycles of EMACO regime. Serum β-Hcg levels of the patient gradually declined and eventually became negative after 2 weeks of 5th EMACO. With this case report, we aim to emphasize that while diagnosing the ectopic pregnancy, even very rare, the tubal choriocarcinoma should be kept in mind. We report a case of primary extra-uterine choriocarcinoma that was mistaken for an ectopic pregnancy.

Human chorionic gonadotropin serum levels following ovulation triggering and IVF cycle outcome.

The clinical significance of serum hCG levels after ovulation triggering was studied previously with conflicting results. Our aim was to study the correlation of hCG levels on the day after ovulation triggering using recombinant hCG (r-hCG) with treatment outcome. A prospective observational study of all fresh IVF/ICSI cycles in a single medical center, between January 2015 and June 2016, was performed. hCG serum levels were obtained 10-12h following ovulation triggering with 250mcg r-hCG. Clinical and laboratory outcome parameters were compared between cycles with serum hCG above and below median level. A multivariate regression analysis was performed in order to study the association between hCG levels and live birth rate, after controlling for confounders. Overall, 326 cycles were included. Median serum hCG level was 91.35IU/L. hCG levels were lower as age and BMI were higher (p = 0.004, p < 0.001, respectively). The study groups did not differ with regard to clinical pregnancy rate (p = 0.14), live birth rate (p = 0.09), fertilization rate (p = 0.45), or metaphase II oocyte rate (p = 0.68). On multivariate regression analysis, hCG level was not associated with live birth (aOR 0.99, 95% CI 0.98-1.005), after controlling for patient's age and BMI. hCG levels on the day after ovulation triggering with 250mcg r-hCG are inversely correlated with patient age and BMI. However, they are not correlated with any clinical or laboratory outcome parameter. Therefore, testing for hCG levels after ovulation induction seems futile and cannot be recommended.

Metastases of Urothelial Carcinoma with Trophoblastic Differentiation that Responded to Combination Chemotherapy with Gemcitabine and Oxaliplatin : A Case Report

A 70-year-old man was admitted with complaint of gross hematuria. Cystoscopy and computed tomography (CT) revealed a 2.5 cm nodular tumor in the urinary bladder. Pathological diagnosis after the transurethral resection of bladder tumor (TURBT) was invasive urothelial cancer with trophoblastic differentiation of pT1. The tumor was positively stained with human chorionic gonadotropin (HCG). The serum HCG level was 12.8 IU/l in the fourth week after TURBT, and it increased to 35.7 IU/l in the 20th week after TURBT. However, radiological examination at this point did not reveal tumor recurrence or metastases. Three months later, the patient coughed up bloody sputum. Lung metastases (up to 2.4 cm) were identified, and they were surgically removed. The pathological specimen consisted of syncytiotrophoblastic giant cells with hemorrhage and necrosis, but no urothelial cancer element. Because the lung and lymph node metastases developed soon after surgery, chemotherapy was planned. Because the patient had impaired renal function with a creatinine clearance of 33.7 ml/min, we selected combination chemotherapy with gemcitabine and oxaliplatin (GEMOX) rather than cisplatin -based chemotherapy. CT after two courses of GEMOX showed stable disease, but HCG levels markedly decreased from 1,240 IU/l to 7.9 IU/l. This marker of response continued through six courses of GEMOX. Then, the chemotherapy was discontinued due to grade 2 neuropathy. He died of cancer 12 months after development of metastases. Autopsy revealed only tumor cells with trophoblastic differentiation, but no urothelial carcinoma in multiple metastatic sites.

Trends in serum human chorionic gonadotropin levels 0-4days after methotrexate administration for predicting tubal ectopic pregnancy treatment success.

To evaluate serum human chorionic gonadotropin (HCG) levels 0-4days after single-dose methotrexate administration for tubal ectopic pregnancy. The present retrospective study included women with tubal ectopic pregnancy treated by methotrexate at a tertiary hospital in Hong Kong, China, between January 1, 2007, and December 31, 2016. Patients were stratified serum HCG levels rose or fell from day 0-4 post-administration. Trends in day 0-4 serum HCG to predict treatment success were compared with that of day 4-7 serum HCG. The optimal drop in HCG was identified by receiver operating characteristic curve analysis. There were 102 patients included. The positive predictive value (PPV) of day 0-4 serum HCG for treatment success was 91% (95% confidence interval [CI] 82-96), which is comparable to the current criterion of a 15% drop in day 4-7 serum HCG (PPV 91%, 95% CI 84-95). A 6% drop in day 0-4 serum HCG was the best predictor of treatment success (PPV 96%, 95% CI 86-99). A drop in day 0-4 serum HCG provided earlier prognostic information and was not inferior to the current criterion.

Development of a novel nomogram for predicting ongoing pregnancy after in vitro fertilization and embryo transfer.

ObjectiveThis study aimed to develop a nomogram that predicts ongoing pregnancy after in vitro fertilization and embryo transfer (IVF-ET) using patient age and serum hormonal markers.MethodsA total of 284 IVF-ET cycles were retrospectively analyzed. At 14 days post-oocyte pick-up (OPU), the serum human chorionic gonadotropin (HCG) and progesterone levels were measured. The main predicted outcome was ongoing pregnancy.ResultsPatient age and serum of HCG and progesterone levels at 14 days post-OPU were good predictors of ongoing pregnancy. The cut-off value and area under the curve (AUC) (95% confidence interval) were 36.5 years and 0.666 (0.599–0.733), respectively, for patient age; 67.8 mIU/mL and 0.969 (0.951–0.987), respectively, for serum HCG level; and 29.8 ng/mL and 0.883 (0.840–0.925), respectively, for serum progesterone level. When the prediction model was constructed using these three parameters, the addition of serum progesterone level to the prediction model did not increase its overall predictability. Furthermore, a high linear co-relationship was found between serum HCG and progesterone levels. Therefore, we developed a new nomogram using patient age and HCG serum level only. The AUC of the newly developed nomogram for predicting ongoing pregnancy after IVF-ET cycles using patient age and serum HCG level was as high as 0.975.ConclusionWe showed that ongoing pregnancy may be predicted using only patient age and HCG serum level. Our nomogram could help clinicians and patients predict ongoing pregnancy after IVF-ET if the serum JCG level was ≥5 IU/L at 14 days post-OPU.

WITHDRAWN: The role of tumor size, ultrasonographic findings, and serum tumor markers to predict the likelihood of malignant testicular histology

// Gang Song 1, * , Yu Fan 1, * , Gengyan Xiong 1 , Guangjie Ji 1 , Cong Huang 1 , Yongming Kang 1, 2 , Jinchao Chen 1 , Da Ren 1 , Qun He 1 , He Wang 1 , Gangzhi Shan 1 , Shuqing Li 1 , Zhisong He 1 and Liqun Zhou 1 1 Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China 2 Department of Urology, Suining Central Hospital, Sichuan, China * These authors contributed equally to this work Correspondence to: Gengyan Xiong, email: xgy13537221@163.com Liqun Zhou, email: zhoulqmail@sina.com Keywords: testicular tumor, malignant likelihood, predictive model, urological oncology Received: August 03, 2017 Accepted: November 19, 2017 Published: January 02, 2018 ABSTRACT Background: The clinical predictive factors for malignant testicular histology remain unclear because of the low prevalence. We initiated this study to predict the likelihood of malignant histology for testicular masses and decide more testis-sparing surgeries prior to surgery. Materials and Methods: 325 consecutive testicular mass patients who underwent radical orchiectomy or testicular preserving surgery (15/325) from January, 2001 to June, 2016 were enrolled in our study. We evaluated the predictive role of tumor diameter, cryptorchidism history, ultrasound findings, serum alpha fetoprotein (AFP) and human chorionic gonadotropin (HCG) levels to assess the likelihood of malignant testicular histology. A predictive nomogram was also generated to evaluate the quantitative probability. Results: There were 78 (24.0%) benign and 247 (76.0%) malignant testicular tumor patients in our study cohort. Larger tumor diameter (per centimeter increased, hazard ratio [HR] = 1.284, p = 0.036), lower ultrasound echo (HR = 3.191, p = 0.001), higher ultrasound blood flow (HR = 3.320, p < 0.001) and abnormal blood HCG (HR = 10.550, p < 0.001) were significant predictive factors for malignant disease in all testicular mass patients. In general, the nomogram was well calibrated for all predictions of malignant probability, and the accuracy of the model nomogram measured by Harrell's C statistic (c-index) was 0.92. The main limitation of the study was the retrospective design. Conclusions: According to our data, the proportion of patients who underwent radical orchiectomy for benign tumors (24%) was much larger than generally believed (10%). Our results suggest that the diameter, ultrasonic echo, ultrasonic blood flow and serum HCG levels could predict the malignancy in testicular mass patients.