Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

Braga, Antônio; Mora, Paulo Alexandre Ribeiro; Melo, Andréia Cristina de; Nogueira-Rodrigues, Angélica; Amim-Júnior, Joffre; Filho, Jorge Fonte de Rezende; Seckl, Michael J.

doi:10.5306/wjco.v10.i2.28

Cited by 74 publications

(69 citation statements)

References 52 publications

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“…The clinical features of PSTT are usually benign, but a few of them can relapse and metastasize, demonstrating the malignant biological behavior. The early diagnosis of PSTT remains uncertain, and it is difficult to distinguish the benign and malignant forms of PSTT in the early stage (14). The present obstacles in managing PSTT include malignancy prediction, fertility preservation, recurrence and chemotherapy resistance, and identification of possible treatment targets.…”

Section: Introductionmentioning

confidence: 99%

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

et al. 2019

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Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease originating from the intermediate trophoblast. Compared with hydatidiform mole, invasive hydatidiform mole and choriocarcinoma, the diagnosis of PSTT is more complicated and lacks specific and sensitive tumor markers. Most PSTT patients demonstrate malignant potential, and the primary treatment of PSTT is hysterectomy. However, metastasis occasionally occurs and even causes death in a small number of PSTT patients. Most PSTT patients are young women hence fertility preservation is an important consideration. The major obstacle for PSTT patient prognosis is chemotherapy resistance. However, the current understanding of the pathogenesis of PSTT and clinical treatment remains elusive. In this review, we summarized the research progress of PSTT in recent years from three aspects: mechanism, clinical presentation, and treatment and prognosis. Well-conducted multi-center studies with sufficient sample sizes are of great importance to better examine the pathological progress and evaluate the prognosis of PSTT patients, so as to develop prevention and early detection programs, as well as novel treatment strategies, and finally improve prognosis for PSTT patients.

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Section: Introductionmentioning

confidence: 99%

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

et al. 2019

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“…Although chest CT scans are recommended in the diagnosis of lung metastasis owing to its superior sensitivity for detecting lung lesions, [ 4 ] the clinical significance of so-called “micrometastases” on CT scans, which may be too small to be detected on chest X-rays, remains uncertain. [ 5 ] It has long been debated whether these are truly malignant pulmonary metastases or whether they represent only lung granulomata that are the results of deportation. The concept of benign metastases or the deportation of hydatidiform moles has been discussed for over 50 years, beginning in 1959 when Jacobson and Enzer reported the first case in the scientific literature.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary deportation of hydatidiform mole: a 12-year, single tertiary center experience in China

Dai

Xiang

Feng

et al. 2020

Chinese Medical Journal

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Background Pulmonary deportation of hydatidiform mole is an exceedingly rare entity. The underlying mechanisms and proper management strategies remain unclear based on sporadic case reports over the past six decades. This study aimed to investigate the clinical features and rational treatment of patients with benign molar pregnancies with pulmonary deportation based on our experience. Methods Medical records of 20 cases of hydatidiform mole with pulmonary deportation were retrospectively reviewed at Peking Union Medical College Hospital from November 2006 to May 2019. The detailed information of all patients was recorded and analyzed. Patients were divided into different groups according to their characteristics and Mann-Whitney U test was used to compare the duration to achieve a normal β-human chorionic gonadotrophin (β-hCG) level after the first evacuation among groups. Results Initial pulmonary computed tomography scans showed suspected bilateral, left and right chest deportation of hydatidiform mole in 12, four, and four patients, respectively, with the maximum nodular diameter ranging from 0.6 to 1.2 cm. Ten patients achieved lesion resolution while the remaining ten patients achieved decreases in the size of their pulmonary lesions. The median duration to achieve a normal β-hCG level after the first evacuation was 15.5 (13.0, 21.9) weeks. There was no significant difference in the duration to achieve a normal β-hCG level after the first evacuation between two groups based on age (≥40 years vs . < 40 years: 15.8 [12.2, 21.5] weeks vs . 15.5 [12.9, 23.0] weeks, Z = 0.094, P = 0.925), type of antecedent mole (partial mole vs . complete mole: 15.2 [12.5, 27.4] weeks vs . 15.9 [12.9, 21.5] weeks, Z = 0.165, P = 0.869), distribution of pulmonary nodules (bilateral lungs vs . unilateral lung: 15.2 [12.8, 22.5] weeks vs . 15.9 [13.2, 22.2] weeks, Z = 0.386, P = 0.700), maximum size of pulmonary nodules (>0.5 cm vs . ≤0.5 cm: 13.0 [11.3, 17.2] weeks vs . 16.0 [14.5, 23.8] weeks, Z = 1.815, P = 0.070), and number of uterine evacuations (once vs . twice or three times: 15.0 [13.0, 16.3] weeks vs . 16.0 [12.8, 23.9] weeks, Z = 0.832, P = 0.405). The post-molar cohort was followed up for 17 to 139 months, and no gestational trophoblastic neoplasia was observed. Conclusions No surgeries other than uterine evacuation and no chemotherapy regim...

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“…(2) Preoperative planning: the 3D model of coronary arteries facilitates the planning of preoperative planning for vascular implantation [26]. e manifested vascular model can accommodate the visual touch of the cardiologist and measure the vascular segment of the lesion, so as to determine the key steps of the operation, select the appropriate size of the blood vessel branch, develop the best surgical scheme, reduce the possibility of stent adherence unevenness, and greatly improve the effectiveness of interventional surgery [27]. At the same time, due to the stability of the printing material, the solid model can also be viewed and carried by doctors at any time [28].…”

Section: Cad Modelsmentioning

confidence: 99%

Patient-Specific Coronary Artery 3D Printing Based on Intravascular Optical Coherence Tomography and Coronary Angiography

et al. 2019

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Despite the new ideas were inspired in medical treatment by the rapid advancement of three-dimensional (3D) printing technology, there is still rare research work reported on 3D printing of coronary arteries being documented in the literature. In this work, the application value of 3D printing technology in the treatment of cardiovascular diseases has been explored via comparison study between the 3D printed vascular solid model and the computer aided design (CAD) model. In this paper, a new framework is proposed to achieve a 3D printing vascular model with high simulation. e patient-speci c 3D reconstruction of the coronary arteries is performed by the detailed morphological information abstracted from the contour of the vessel lumen. In the process of reconstruction which has 5 steps, the morphological details of the contour view of the vessel lumen are merged along with the curvature and length information provided by the coronary angiography. After comparing with the diameter of the narrow section and the diameter of the normal section in CAD models and 3D printing model, it can be concluded that there is a high correlation between the diameter of vascular stenosis measured in 3D printing models and computer aided design models. e 3D printing model has high-modeling ability and high precision, which can represent the original coronary artery appearance accurately. It can be adapted for prevascularization planning to support doctors in determining the surgical procedures.

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Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

Cited by 74 publications

References 52 publications

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

Pulmonary deportation of hydatidiform mole: a 12-year, single tertiary center experience in China

Patient-Specific Coronary Artery 3D Printing Based on Intravascular Optical Coherence Tomography and Coronary Angiography

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