Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women

Abstract

Early diagnosis of complete hydatidiform mole has altered the natural history of molar pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.

Type I interferons modulate methotrexate resistance in gestational trophoblastic neoplasia

“…30 Accumulating significant amounts of clinical material is difficult given the low prevalence of these diseases in the general population. 32,33 Still, specialized referral centers for GTD such as our centers continue to see patients with chemotherapy resistance, some of whom die from what is conventionally considered a curable disease. 32,33 Still, specialized referral centers for GTD such as our centers continue to see patients with chemotherapy resistance, some of whom die from what is conventionally considered a curable disease.…”

“…8,31 Furthermore, most women with molar pregnancies do not develop GTN, and among those that do, only a minority will have chemotherapy resistance or high-risk disease. 32,33 Still, specialized referral centers for GTD such as our centers continue to see patients with chemotherapy resistance, some of whom die from what is conventionally considered a curable disease. Consequently, we undertook the present study to develop a simple in vitro model which could be used to spur discovery for novel biomarkers and treatments for GTN.…”

Complete molar pregnancy in adolescents from North and South America: Clinical presentation and risk of gestational trophoblastic neoplasia

“…This decreased rate, may be explained by the fact that in the U.S., CHM has been diagnosed progressively earlier by pelvic ultrasound and hCG measurement in the first trimester. With earlier diagnosis, CHM signs and symptoms, such as vaginal bleeding, are less frequently observed [18,24,26].…”

Does hormonal contraception during molar pregnancy follow-up influence the risk and clinical aggressiveness of gestational trophoblastic neoplasia after controlling for risk factors?

“…The following patient variables were collected: age (in years), gravidity, parity, gestational age at diagnosis of molar pregnancy (in weeks), clinical symptomatology at presentation (anemia -defined as hemoglobin b9 g/dL, hemorrhage, enlarged uterus for gestational age -defined as the uterine size N4 cm greater than expected for gestational age, theca lutein cysts -defined as a cystic ovarian mass N 6 cm evaluated by pelvic-transvaginal ultrasonography, pre-eclampsiadefined as blood pressure levels higher than a systolic of 140 mm Hg and/or diastolic of 90 mm Hg in the presence of proteinuria, hyperemesis, hyperthyroidism -defined as the serum thyroid stimulating hormone b0.03 mU/L and serum free T4 N 1.6 ng/dL) [30], the hCG preevacuation level (IU/L), the mode of uterine evacuation (vacuum aspiration, curettage or misoprostol for cases of PHM with fetus of gestational age over 12 weeks), the histology of the molar pregnancy (CHM or PHM), and the time for remission (in weeks) after molar pregnancy and GTN.…”