Patient: Female, 19-year-old Final Diagnosis: Gestational thropoblastic neoplasia Symptoms: Bleeding Medication:— Clinical Procedure: Curettage Specialty: Obstetrics and Gynecology • Oncology Objective: Rare disease Background: Gestational trophoblastic disease (GTD) encompasses a group of disorders that arise from abnormal growth of trophoblastic tissue. The spectrum of GTD includes 2 major groups: benign and malignant. The benign form is a hydatidiform mole, either complete or partial; the malignant forms, referred to as gestational trophoblastic neoplasia (GTN), consist of invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Most patients who undergo evacuation of a hydatidiform mole by curettage have a disease-free period before a new tumor develops that can be considered malignant. In rare cases, metastasis occurs rapidly and manifests coincidentally before the hydatidiform mole can be evacuated. Case Report: A 19-year-old woman in Bandung City, West Java, Indonesia, was diagnosed with a molar pregnancy with early evidence of a mass in her vagina that was suspicious for stage II GTN. The early emergence of a vaginal mass was a rare case of early transformation of a molar pregnancy into GTN. Conclusions: Careful evaluation is warranted of patients with characteristics typical of an intrauterine molar pregnancy who have an early presentation of a vaginal mass because of the possibility that the diagnosis could be GTN.
Background:Placenta accreta spectrum (PAS) is a complex obstetric complication that poses a major risk for life-threatening hemorrhage. The pathogenesis of PAS is known to be related to placentogenesis, trophoblastic cells invasion, and previous obstetrical procedures that cause uterine wall defects. However, the precise mechanism of this disease has not been fully explained. This study aimed to evaluate the differences in maximum depth of invasion and distribution pattern of implantation site intermediate trophoblasts between PAS and non-accreta cases. Material/methods:This was an observational, analytic, cross-sectional study that utilized paraffin block specimen of peripartum hysterectomy performed in Hasan Sadikin General Hospital Bandung from 2018 to 2020. Sixty-four samples were obtained, then classified as PAS and non-accreta (normal placenta). Implantation site-intermediate trophoblasts were identified using CD-146 staining. Maximum invasion depth of intermediate trophoblasts was measured in micrometers, while the distribution pattern was assessed and classified into 2 groups: confluent and scattered. Results:We found that the maximum invasion depth of the intermediate trophoblasts was significantly higher in the PAS group compared to that of the non-accreta group (2453.52±1172.122 µm vs 1613.59±822.588 µm, P=0.009).The confluent distribution pattern was significantly more common in the PAS group compared to that of the non-accreta group (87.2% vs 17.6%, P=0.0001). Conclusions:The findings of our study suggested that implantation site intermediate trophoblasts play a role in the pathophysiology of placenta accreta. Further studies are needed to determine factors that affect trophoblast invasion leading to placenta accreta spectrum.
Tujuan: Penelitian ini bertujuan untuk mengevaluasi dan membandingkan penerapan dua metode diagnostik yang telah digunakan di RSHS, yaitu skor RMI dan Klasifikasi IOTA Rules untuk memprediksi keganasan suatu tumor ovarium selama periode 2017−2018 Metode: Penelitian ini merupakan penelitian komparatif dengan pengambilan data secara retrospektif. Sumber data diperoleh dari rekam medis pasien yang menjalani operasi pengangkatan dan pemeriksaan histopalogis tumor ovarium. Dilakukan pengumpulan informasi mengenai data USG, kadar CA125, skor RMI, klasifikasi IOTA Simple Rules, dan membandingkannya dengan luaran histopatologis. Hasil: 190 kasus tumor ovarium diteliti. 156 kasus (82,1%) memiliki luaran histopatologis ganas dan 34 kasus lainnya (17.9%) jinak. 178 kasus (93,68%) memiliki skor RMI ≥200 dan 12 kasus (6,32%) <200. sebanyak 78 kasus diklasifikasikan sebagai Malignant, 42 kasus Benign, dan 70 kasus lainnya Inconclusive dengan kriteria IOTA Simple Rules. Distribusi CA125 dan Skor RMI pada kedua kelompok luaran histopatologis berbeda secara bermakna (P<0,05). Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules di RSHS masing-masing 94,23% dan 97,06%, dengan menggabungkan kelompok IOTA inkonklusif dengan kelompok ganas. Penghitungan sensitivitas dan spesifisitas skor RMI memberikan nilai 95,51% dan 14,71% dengan menggunakan cut-off-point skor RMI 200. Kesimpulan: Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules lebih baik dibandingkan dengan skor RMI dalam memprediksi keganasan suatu tumor ovarium.
Tujuan: Penelitian ini bertujuan untuk mengevaluasi dan membandingkan penerapan dua metode diagnostik yang telah digunakan di RSHS, yaitu skor RMI dan Klasifikasi IOTA Rules untuk memprediksi keganasan suatu tumor ovarium selama periode 2017−2018 Metode: Penelitian ini merupakan penelitian komparatif dengan pengambilan data secara retrospektif. Sumber data diperoleh dari rekam medis pasien yang menjalani operasi pengangkatan dan pemeriksaan histopalogis tumor ovarium. Dilakukan pengumpulan informasi mengenai data USG, kadar CA125, skor RMI, klasifikasi IOTA Simple Rules, dan membandingkannya dengan luaran histopatologis. Hasil: 190 kasus tumor ovarium diteliti. 156 kasus (82,1%) memiliki luaran histopatologis ganas dan 34 kasus lainnya (17.9%) jinak. 178 kasus (93,68%) memiliki skor RMI ≥200 dan 12 kasus (6,32%) <200. sebanyak 78 kasus diklasifikasikan sebagai Malignant, 42 kasus Benign, dan 70 kasus lainnya Inconclusive dengan kriteria IOTA Simple Rules. Distribusi CA125 dan Skor RMI pada kedua kelompok luaran histopatologis berbeda secara bermakna (P<0,05). Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules di RSHS masing-masing 94,23% dan 97,06%, dengan menggabungkan kelompok IOTA inkonklusif dengan kelompok ganas. Penghitungan sensitivitas dan spesifisitas skor RMI memberikan nilai 95,51% dan 14,71% dengan menggunakan cut-off-point skor RMI 200. Kesimpulan: Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules lebih baik dibandingkan dengan skor RMI dalam memprediksi keganasan suatu tumor ovarium.
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