Identification of patients with persistent trophoblastic disease after complete hydatidiform mole by using a normal 24-hour urine hCG regression curve

Cromvoirt, Suzanne M.E. van; Thomas, Chris M.G.; Quinn, Michael; McNally, Orla; Bekkers, Ruud L.M.

doi:10.1016/j.ygyno.2014.03.018

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Eight cases of these were diagnosed as CHM (18% of total CHM). Similar results were found in a study performed by Van Cromvoirt et al [23] to identify cases the developed PGTD after CHM; 89 cases (20%) of their total 448 CHM cases developed PGTD and required chemotherapy [24-26]. …”

Section: Discussionsupporting

confidence: 87%

Morphological Features and Immunohistochemical Expression of p57Kip2 in Early Molar Pregnancies and Their Relations to the Progression to Persistent Trophoblastic Disease

Khashaba

Arafa²,

Elsalkh

et al. 2017

J Pathol Transl Med

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BackgroundAlthough the morphological features characteristic of products of conception specimens including molar pregnancies are well described, substantial histopathological similarities are observed between the different entities, especially in cases of early pregnancies. Furthermore, there are no current solid criteria that could predict cases with progression to persistent gestational trophoblastic disease. In this study, we aimed to determine the most specific histopathological and immunohistochemical features required for accurate diagnosis that can reliably predict the clinical behavior.MethodsSixty-five cases of products of conception were reviewed clinically and pathologically, and any progression to persistent gestational trophoblastic disease (GTD), if present, was noted. Pathological assessment of the archival material included re-cut sections of 5 μm in thickness, routine staining with hematoxylin and eosin and immunohistochemical staining of p57Kip2.ResultsCertain histopathological criteria were found to be significant in differentiation between complete hydatidiform mole (CHM) and partial hydatidiform mole including villous shape and outline, villous trophoblast hyperplasia, and atypia in extravillous trophoblasts. There were no significant differences in any morphological or immunohistochemical features between cases with or without subsequent development of GTD.ConclusionsHistopathological diagnosis of molar pregnancy remains problematic especially in early gestation. Their diagnosis should be stated after a constellation of specific histopathological criteria in order not to miss CHM. p57Kip2 immunohistochemistry is of great value in diagnosis of cases that had equivocal morphology by histopathological examination. However, there were no significant features to predict cases that subsequently developed persistent GTD.

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Section: Discussionsupporting

confidence: 87%

Morphological Features and Immunohistochemical Expression of p57Kip2 in Early Molar Pregnancies and Their Relations to the Progression to Persistent Trophoblastic Disease

Khashaba

Arafa²,

Elsalkh

et al. 2017

J Pathol Transl Med

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“…Molar pregnancy studies have found a logarithmic decline in β-hCG levels after evacuation [ 5 , 17 , 18 ]. The pattern typically follows an initial rapid reduction followed by a slower decline, as was seen in our patient.…”

Section: Discussionmentioning

confidence: 99%

Severe Thyrotoxicosis Caused by Molar Pregnancy: A Case Report and Review of the Literature

Frasik¹,

Luong²,

Chang³

et al. 2023

Cureus

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Severe thyrotoxicosis is an acute and life-threatening state of hyperthyroidism. While it is a rare presentation of hyperthyroidism, it is clinically significant because of its high mortality and necessitates early identification and treatment to reduce the incidence of poor outcomes. The most common causes of this hypermetabolic state are Graves' disease, toxic thyroid adenoma or multinodular goiter, thyroiditis, iodine-induced hyperthyroidism, and excessive intake of levothyroxine. The less common causes include trauma, medications (i.e., amiodarone), discontinuation of anti-thyroid medications, and interactions with sympathomimetic medications such as ketamine that may be administered during general anesthesia. Regardless of etiology, thyrotoxicosis management should be coordinated using an interdisciplinary team-based approach to optimize outcomes.We discuss a molar pregnancy requiring emergency surgery as an uncommon cause of thyrotoxicosis and highlight appropriate management steps. The patient's symptoms resolved post-operatively, and her postoperative laboratory results (thyroid function and beta-human chorionic gonadotropin {β-hCG}) were followed until they normalized. The patient's preoperative presentation and preparation with a multidisciplinary team discussion, intraoperative anesthetic considerations and course, and post-operative management and follow-up are described.

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“…Furthermore, a comparison of 2 commercially available hCG immunoassays made by Matsui et al [16] , though none of those are used in our laboratories, showed a good correlation with a few discrepancies at the lower levels. A recent publication of van Cromvoirt et al [19] showed the creation of a 24-h urine hCG regression curve used as a tool in the follow-up of CM after evacuation. This is more patient friendly and, therefore, fewer patients will be lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

Human Chorionic Gonadotropin Regression Curves after Partial or Complete Molar Pregnancy in Flanders: Are They Different from Regression Curves from the Eighties?

Delattre

Han²,

Moerman³

et al. 2017

Gynecol Obstet Invest

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Background/Aims: We updated human chorionic gonadotropin (hCG) regression curves created in the eighties after evacuation of complete and partial molar (CM and PM, respectively) pregnancies using modern hCG assays. We created similar curves for patients in need of chemotherapy (gestational trophoblastic neoplasia [GTN]). Methods: A total of 126 patients who were diagnosed with gestational trophoblastic disease from 1990 to 2014 were included. We compared curves from 2 groups, CM and PM, with historical ones. The third group was a comparison of GTN patients receiving first-line chemotherapy and patients in need of a switch of chemotherapy. Results: The regression curves were comparable to historical ones. According to the latter, mean time to normalization was 14-15 weeks after evacuation. We observed a normalization within 12 (CM) and 12.7 (PM) weeks. In addition, a remarkable but not statistically significant vertical shift (20 IU/L higher) was observed prior to day 60 compared with historical curves. The comparison in GTN patients showed a statistical significant difference, even at day 7. Conclusion: The presented hCG regression curves in the Flemish region were comparable with the ones of the eighties but with a vertical shift, hypothetically due to more sensitive assays. In addition, regression curves in GTN patients receiving chemotherapy can be used to evaluate response.

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Identification of patients with persistent trophoblastic disease after complete hydatidiform mole by using a normal 24-hour urine hCG regression curve

Cited by 5 publications

References 9 publications

Morphological Features and Immunohistochemical Expression of p57Kip2 in Early Molar Pregnancies and Their Relations to the Progression to Persistent Trophoblastic Disease

Morphological Features and Immunohistochemical Expression of p57Kip2 in Early Molar Pregnancies and Their Relations to the Progression to Persistent Trophoblastic Disease

Severe Thyrotoxicosis Caused by Molar Pregnancy: A Case Report and Review of the Literature

Human Chorionic Gonadotropin Regression Curves after Partial or Complete Molar Pregnancy in Flanders: Are They Different from Regression Curves from the Eighties?

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