Chorionic Tumors

Berkowitz, Ross S.; Goldstein, Donald P.

doi:10.1056/nejm199612053352306

Cited by 267 publications

(172 citation statements)

References 73 publications

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“…Androgenotes (created by the fusion of two sperm nuclei or diplodization of one sperm in the absence of female counterpart) are of purely paternal origin and develop into a structure consisting of a trophoblast and yolk sac (16). These resemble hydatidiform moles (solely trophoblastic tissue), which are formed when a sperm fertilizes an enucleated egg (17).…”

mentioning

confidence: 99%

Nonhuman primate parthenogenetic stem cells

Vrana

Hipp

Goss

et al. 2003

Proc. Natl. Acad. Sci. U.S.A.

176

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Parthenogenesis is the biological phenomenon by which embryonic development is initiated without male contribution. Whereas parthenogenesis is a common mode of reproduction in lower organisms, the mammalian parthenote fails to produce a successful pregnancy. We herein describe in vitro parthenogenetic development of monkey (Macaca fascicularis) eggs to the blastocyst stage, and their use to create a pluripotent line of stem cells. These monkey stem cells (Cyno-1 cells) are positive for telomerase activity and are immunoreactive for alkaline phosphatase, octamer-binding transcription factor 4 (Oct-4), stage-specific embryonic antigen 4 (SSEA-4), tumor rejection antigen 1-60 (TRA 1-60), and tumor rejection antigen 1-81 (TRA 1-81) (traditional markers of human embryonic stem cells). They have a normal chromosome karyotype (40 + 2) and can be maintained in vitro in an undifferentiated state for extended periods of time. Cyno-1 cells can be differentiated in vitro into dopaminergic and serotonergic neurons, contractile cardiomyocyte-like cells, smooth muscle, ciliated epithelia, and adipocytes. When Cyno-1 cells were injected into severe combined immunodeficient mice, teratomas with derivatives from all three embryonic germ layers were obtained. When grown on fibronectin/laminin-coated plates and in neural progenitor medium, Cyno-1 cells assume a neural precursor phenotype (immunoreactive for nestin). However, these cells remain proliferative and express no functional ion channels. When transferred to differentiation conditions, the nestin-positive precursors assume neuronal and epithelial morphologies. Over time, these cells acquire electrophysiological characteristics of functional neurons (appearance of tetrodotoxin-sensitive, voltage-dependent sodium channels). These results suggest that stem cells derived from the parthenogenetically activated nonhuman primate egg provide a potential source for autologous cell therapy in the female and bypass the need for creating a competent embryo

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mentioning

confidence: 99%

Nonhuman primate parthenogenetic stem cells

Vrana

Hipp

Goss

et al. 2003

Proc. Natl. Acad. Sci. U.S.A.

176

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“…A widely used US protocol recommends that if hCG levels increase or plateau over three consecutive weeks, immediate assessment and treatment for post molar disease are indicated (Berkowitz and Goldstein, 1996. In the UK, treatment is expectant and patients may be followed with serial hCG levels for up to 6 months (Gillespie et al, 2000). A recent proposal is that persistent gestational trophoblastic neoplasia should be diagnosed if the plateau of hCG lasts for 4 weeks or more, there is a rise of hCG on three consecutive weekly measurements over a period of 2 weeks or longer, there is a histological diagnosis of choriocarcinoma or the hCG level remains elevated for 6 months or longer (FIGO, 2002).…”

Section: Discussionmentioning

confidence: 99%

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

et al. 2003

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The aim of this study was to evaluate the efficacy and toxicity of low-dose methotrexate with folinic acid rescue in a large series of consecutively treated patients with low-risk persistent gestational trophoblastic disease. Between January 1987 and December 2000, 250 patients were treated with intramuscular methotrexate (50 mg on alternate days 1, 3, 5, 7) with folinic acid (7.5 mg orally on alternate days 2, 4, 6, 8) rescue. The overall complete response rate without recurrence was 72% for first-line treatment and 95% for those who required second-line chemotherapy. Eight women (3.2%) had recurrence following remission and two (0.8%) had new moles. Two women (0.8%) died of their disease giving an overall cure of 99%. Only 10 women (4%) experienced grade III/IV toxicity during the first course of treatment and 13 women (5.2%) subsequently. Toxicity included mucositis and stomatitis, pleuritic chest pain, thrombocytopenia, uterine bleeding, abdominal pain, liver function changes, rash and pericardial effusion. A total of 59 women (23.6%) required second-line chemotherapy; 48 women had methotrexate resistance, eight had methotrexate toxicity and an empirical decision to change therapy was made in three. In all, 11 women (4.4%) had a hysterectomy before, during or after treatment; 141 women (56.4%) became pregnant following treatment: in 128 (90.7%), the outcome was successful. Methotrexate with folinic acid rescue is an effective treatment for low-risk persistent trophoblastic disease. It has minimal severe toxicity, excellent cure rates and does not appear to affect fertility.

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“…Clinical symptoms similar to those of an ectopic pregnancy, including abdominal pain and intra-abdominal bleeding, may develop when a primary lesion is present in the abdominal cavity outside the uterus (1,2,4,5). Conversely, the lung, liver, brain, vagina and digestive tract are frequently metastasized by gestational choriocarcinoma that primarily developed in the uterus (6). In the current patient, the primary lesion was present in the uterus and metastasized to the uterine serosa, which is a very rare metastatic site.…”

Section: Introductionmentioning

confidence: 59%

“…The lungs, liver, brain, vagina and digestive tract are common sites of metastasis (6). Three mechanisms have been proposed for uterine serosal metastasis.…”

Section: Discussionmentioning

confidence: 99%

Gestational choriocarcinoma with uterine serosal metastasis mimicking ruptured ectopic pregnancy: A case report

et al. 2015

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Abstract. Primary gestational choriocarcinoma is commonly present in the uterus in cases of atypical genital bleeding. Symptoms similar to those of an ectopic pregnancy develop when an extra-uterine lesion is present in the abdominal cavity, and lesions have been detected in the ovaries and fallopian tubes in a number of cases. In the present study, we describe a patient with choriocarcinoma that metastasized to the uterine serosa and caused symptoms similar to those of an ectopic pregnancy. The patient was a 30-year-old female who presented to our hospital with atypical genital bleeding and a positive pregnancy test 3 months after missed abortion at 10 weeks of gestation. Transvaginal ultrasonography revealed the absence of a gestational sac in or outside the uterus, and intra-abdominal bleeding was noted. An ectopic pregnancy was suspected based on these findings, and emergency laparotomy was performed. A hemorrhagic mass was present on the uterine serosa, and was subsequently resected. Trophoblastic disease was suspected following histopathological examination, for which intra-uterine curettage was performed and choriocarcinoma was diagnosed. Lung metastasis was detected on computed tomography, and a high serum human chorionic gonadotropin (hCG) level persisted following surgery. The lesion disappeared following five cycles of methotrexate+ etoposide+actinomycin D therapy, which was performed as postoperative chemotherapy, and the patient's serum hCG level decreased to below the detection limit. In this case of choriocarcinoma, the primary lesion was present in the uterus and had metastasized to the uterine serosa, which is a very rare metastatic site. This uterine serosal metastatic lesion bled and caused symptoms similar to those of an ectopic pregnancy. Certain patients who undergo surgery for a suspected peritoneal pregnancy may have gestational choriocarcinoma, similar to this case.

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Chorionic Tumors

Cited by 267 publications

References 73 publications

Nonhuman primate parthenogenetic stem cells

Nonhuman primate parthenogenetic stem cells

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

Gestational choriocarcinoma with uterine serosal metastasis mimicking ruptured ectopic pregnancy: A case report

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