Current advances in the management of gestational trophoblastic disease

Berkowitz, Ross S.; Goldstein, Donald P.

doi:10.1016/j.ygyno.2012.07.116

Cited by 98 publications

(103 citation statements)

References 42 publications

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“…It is also believed that metalloproteinase's and vascular endothelial growth factors are highly associated with molar pregnancies. 6 …”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

“…1 For low-risk GTN, single agent chemotherapy is recommended, with either Methrotrexate (MTX) or Actinomycin D (Act-D). 6,9,18 For high risk GTN, the most widely used regimens are MAC (methrotrexate, actinomycin D, and cyclophosphamide) or EMA/CO (etoposide, methrotrexate, actinomycin D, cyclophosphamide, and vincristine); the latter is considered the actual standard regimen ( Table 2, 3 and 4). 4,18,19 In refractory cases EMA/EP (EMA with etoposide and platinum (Cisplatin) ) should be used.…”

Section: Managementmentioning

confidence: 99%

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Distinct gestational trophoblastic neoplasia - different entities, specific management

Brandão

Silva-Rocha

Pinto

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Gestational trophoblastic diseases are abnormalities of the trophoblastic tissue development. They have Β-hCG as tumour marker, similar clinical manifestations but different pathological features, management and prognosis. Gestational trophoblastic neoplasia includes all forms of gestational trophoblastic disease that are invasive and/or metastasize and correspond to 10% of this group of diseases. The authors performed a retrospective review of all patients referred to our department between 1st January 2011 and 30th June 2016. Presenting symptoms, Β-hCG levels, obstetric and personal history and microscopic features were reviewed. 4 cases were identified - 2 invasive complete and 1 partial hydatidiform moles and 1 placental site trophoblastic tumour. Management and follow-up were individualized. Neither persistence nor recurrences were diagnosed after primary treatment. These case series highlights the importance of an accurate diagnosis and a long-term follow-up considering the risk of persistency or malignancy, as gestational trophoblastic neoplasia usually have good response to the adequate therapy.

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“…It is also believed that metalloproteinase's and vascular endothelial growth factors are highly associated with molar pregnancies. 6 …”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Distinct gestational trophoblastic neoplasia - different entities, specific management

Brandão

Silva-Rocha

Pinto

et al. 2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

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“…MEASUREMENT OF β-hCG Any woman in the reproductive age group who presents with abnormal bleeding or evidence of metastatic disease should undergo β-hCG screening to rule out choriocarcinoma (Goldstein et al, 2015;Berkowitz, Goldstein, 2009). The serial quantitative measurement of urinary or serum β-hCG is essential for diagnosis, monitoring efficacy of the treatment, and follow-up of the patients.…”

Section: Diagnosismentioning

confidence: 99%

Diagnostic Challenges and Treatment Conflicts for Pure Primary Non Gestational Choriocarcinoma Ovary

2016

European Journal of Medicine

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Pure primary NGCO (non-gestational choriocarcinoma of ovary) is a type of ovarian germ cell tumor with elevated human chorionic gonadotrophin (hCG), posing diagnostic challenges in the patients of reproductive age group. Clinically and histopathologically, NGCO is indistinguishable from GCO. The both are differentiated on the basis of DNA polymorphism analysis and presence of mRNA for BMG (β2-microglobulin) in NGCO. Diagnostic criteria set by Saito et al helps to make a diagnosis of NGCO. It is possible to cure NGCO while preserving fertility, which is an important consideration as most are young age group patients. As these are rare tumors, recommendations for treatment of primary nongestational choriocarcinomas are not available. The principles of surgical management of NGCO are similar to the ovarian epithelial tumors. GCO is treated by methotrexate based chemotherapy, but some studies reported that NGCO is resistant to this chemotherapy, and it requires more aggressive combination chemotherapy as later has bad prognosis as compared to GCO. Various chemotherapy regimens are BEP, EMA/CO, EMA/EP, VAC etc. The serial quantitative measurement of urinary or serum β-hCG is essential for diagnosis, monitoring efficacy of the treatment, and follow-up of the patients. Role of radiation therapy is limited as a palliative setting in metastatic NGCO. In this article, we have tried to conclude the diagnostic methods and best possible treatment protocol.

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“…Common GTNs are invasive mole and choriocarcinoma which respond to chemotherapy. However, ~10% of choriocarcinoma patients have a poor prognosis, particularly when they have metastasis other than pulmonary metastasis (3,4). hCG is a unique reliable marker for monitoring GTD (2,4).…”

Section: Introductionmentioning

confidence: 99%

N-acetylglucosaminyltransferase IVa promotes invasion of choriocarcinoma

et al. 2017

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Abstract. Gestational trophoblastic neoplasia (GTN)results from the malignant transformation of placental trophoblasts which secrete human chorionic gonadotropin (hCG) as do normal placenta or hydatidiform mole. N-acetylglucosaminyltransferase IV (GnT-IV) is a glycosyltransferase which catalyses the formation of β1,4GlcNAc branches on the mannose core of N-glycans. Previous studies reported that β1,4GlcNAc branches on hCG were detected in GTN but not in normal pregnancy or hydatidiform mole. The aim of the present study was to understand the role of GnT-IVa in choriocarcinoma and find the target proteins for GnT-IVa glycosylation which contribute to the malignancy of choriocarcinoma. Immunohistochemistry showed that Griffonia simplicifolia lectin-II staining and GnT-IVa staining were intense in trophoblastic cells of invasive mole and choriocarcinoma. We established a choriocarcinoma cell line with GnT-IVa overexpression (Jar-GnT4a), and examined its malignant potential and target proteins for GnT-IVa glycosylation. GnT-IVa overexpression increased the cell migration and invasion (2.5-and 1.4-fold) as well as the ability to adhere to the extracellular matrix (ECM) components, including fibronectin and collagen type I and IV. The tumour formation potential of Jar-GnT4a in mice was significantly higher than that of control (P= 0.0407), and the cumulative survival rate of mice with Jar-GnT4a was relatively lower than those with control. Immunoprecipitation studies showed that β1,4GlcNAc branches of N-glycans on integrin β1 in choriocarcinoma cells were increased by GnT-IVa overexpression. Nano-LC/MS/MS analysis suggested that lysosome-associated membrane glycoprotein 2 (LAMP-2) was a target protein for glycosylation by GnT-IVa. The increase in β1,4GlcNAc branches on LAMP-2 by GnT-IVa overexpression was confirmed by lectin blot analysis using whole cell lysate and conditioned medium. Our results suggest that highly branched N-glycans generated by the action of GnT-IVa are present in trophoblastic cells of GTN in proportion to GnT-IVa expression level, and that GnT-IVa may contribute to the malignancy of choriocarcinoma by promoting cell adhesion, migration and invasion through glycosylation of integrin β1 and LAMP-2.

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Current advances in the management of gestational trophoblastic disease

Cited by 98 publications

References 42 publications

Distinct gestational trophoblastic neoplasia - different entities, specific management

Distinct gestational trophoblastic neoplasia - different entities, specific management

Diagnostic Challenges and Treatment Conflicts for Pure Primary Non Gestational Choriocarcinoma Ovary

N-acetylglucosaminyltransferase IVa promotes invasion of choriocarcinoma

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