The role of surgery in the management of women with gestational trophoblastic disease

Lima, Lana; Padrón, Lilian; Câmara, Raphael; Sun, Sue Yazaki; Filho, Jorge Rezende; Braga, Antônio

doi:10.1590/0100-69912017001009

Cited by 9 publications

(9 citation statements)

References 21 publications

(16 reference statements)

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“…However, while salpingotomy is preferred in cases of non-molar ectopic pregnancy, when EMP is suspected, medical professionals have shown a preference for performing salpingectomy, avoiding the possibility of leaving trophoblastic material in the remaining tube. [9][10][11]13,14,25,29 We must insist that because the clinical and ultrasonographic findings of EMP can be non-specific and simulate non-molar ectopic pregnancy, it is extremely important to submit the material obtained during surgery for a histopathological and immunohistochemical study for making an accurate diagnosis. 24 However, as mentioned above, as EMP may mimic nonmolar ectopic pregnancy situations, we must consider that some cases of EMP can be conservatively managed and observe the patient's progress and administer periodic doses of hCG or MTX.…”

Section: Discussionmentioning

confidence: 99%

Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects

López

Lopes

Resende

et al. 2018

Rev Bras Ginecol Obstet

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This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic molar pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic molar pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-molar pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic molar pregnancy must undergo postmolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.

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Section: Discussionmentioning

confidence: 99%

Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects

López

Lopes

Resende

et al. 2018

Rev Bras Ginecol Obstet

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“…The FIGO anatomical staging system is used to appraise the prognosis of patients and predict appropriate therapeutic strategies (15). Lung metastasis occurs in ~70% of patients with GTN, and brain metastasis occurs in 8-15% (37). The brain metastasis of a GTN is characterized by central necrosis and hemorrhage.…”

Section: Current Therapeutic Methods and Research For Gtdmentioning

confidence: 99%

“…The majority of these tests are combined with chemotherapy to minimize metastatic potential by tissue manipulation during the treatment period. Furthermore, this combination therapy has the advantage of reducing the length of the hospitalization period and the number of chemotherapy cycles (37).…”

Section: Current Therapeutic Methods and Research For Gtdmentioning

confidence: 99%

A promising therapeutic strategy for metastatic gestational trophoblastic disease: Engineered anticancer gene‑expressing stem cells to selectively target choriocarcinoma (Review)

2019

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Gestational trophoblastic disease (GTD) is an unusual disease occurring in pregnancy that originates from abnormal trophoblastic cells and comprises a group of diseases with different properties of invasion, metastasis and recurrence. The GTD group includes hydatidiform moles and gestational trophoblastic neoplasms (GTNs), with GTNs being divided into invasive moles, choriocarcinoma, placental site trophoblastic tumors and epithelioid trophoblastic tumors. The present review focuses on current effective treatments for GTD, including conventional and novel promising direct enzyme prodrug therapies (DEPTs). Conventional therapies, such as chemotherapy and hysterectomy, are currently used in a clinical setting; however, the use of diverse DEPTs, including antibody-DEPT and gene-DEPT is also being attempted to cure GTNs. In addition, gene delivery tools using genetically engineered neural stem cells (NSCs) are presently being examined for the treatment of GTNs. The tumor-tropism of NSCs by chemoattractant factors is a unique characteristic of these cells and can serve as a vehicle to deliver anticancer agents. Previous studies have demonstrated that injection with NSC-expressing suicide genes into xenograft animal models has a significant inhibitory effect on tumor growth. Stem cells can be genetically engineered to express anticancer genes, which migrate to the metastatic sites and selectively target cancer cells, and are considered to effectively target metastatic GTNs. However, the safety issue of stem cell therapy, such as tumorigenesis, remains a challenge. Novel therapies comprising a combination of conventional and novel promising treatments are anticipated to be definitive treatments for metastasized and/or recurrent patients with GTNs.

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“…Once the clinical diagnosis of GTN has been made following a histopathological diagnosis of a molar pregnancy, repeat biopsies to confirm malignant progression are unnecessary and nearly always contraindicated because of the risk of promoting life-threatening hemorrhage. Indeed, as samples are usually taken from the uterus in women of reproductive age who can expect to be cured by chemotherapy, a biopsy might result in a hysterectomy or loss of life which is reprehensible[18]. Moreover, biopsies of metastatic sites where bleeding cannot be controlled such as the lungs and abdominal/pelvic organs may precipitate severe hemorrhage, resulting in death[18].…”

Section: Hot Topics On Gtn Diagnosis and Stagingmentioning

confidence: 99%

Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

Braga

Mora

Melo

et al. 2019

WJCO

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Gestational trophoblastic neoplasia (GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma (CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor (PSTT/ETT). GTN presents different degrees of proliferation, invasion and dissemination, but, if treated in reference centers, has high cure rates, even in multi-metastatic cases. The diagnosis of GTN following a hydatidiform molar pregnancy is made according to the International Federation of Gynecology and Obstetrics (FIGO) 2000 criteria: four or more plateaued human chorionic gonadotropin (hCG) concentrations over three weeks; rise in hCG for three consecutive weekly measurements over at least a period of 2 weeks or more; and an elevated but falling hCG concentrations six or more months after molar evacuation. However, the latter reason for treatment is no longer used by many centers. In addition, GTN is diagnosed with a pathological diagnosis of CCA or PSTT/ETT. For staging after a molar pregnancy, FIGO recommends pelvic-transvaginal Doppler ultrasound and chest X-ray. In cases of pulmonary metastases with more than 1 cm, the screening should be complemented with chest computed tomography and brain magnetic resonance image. Single agent chemotherapy, usually Methotrexate (MTX) or Actinomycin-D (Act-D), can cure about 70% of patients with FIGO/World Health Organization (WHO) prognosis risk score ≤ 6 (low risk), reserving multiple agent chemotherapy, such as EMA/CO (Etoposide, MTX, Act-D, Cyclophosphamide and Oncovin) for cases with FIGO/WHO prognosis risk score ≥ 7 (high risk) that is often metastatic. Best overall cure rates for low and high risk disease is close to 100% and > 95%, respectively. The management of PSTT/ETT differs and cure rates tend to be a bit lower. The early diagnosis of this disease and the appropriate treatment avoid maternal death, allow the healing and maintenance of the reproductive potential of these women.

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The role of surgery in the management of women with gestational trophoblastic disease

Cited by 9 publications

References 21 publications

Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects

Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects

A promising therapeutic strategy for metastatic gestational trophoblastic disease: Engineered anticancer gene‑expressing stem cells to selectively target choriocarcinoma (Review)

Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

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