Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Abu‐Rustum, Nadeem R.; Yashar, Catheryn M.; Bean, Sarah; Bradley, Kristin; Campos, Susana M.; Chon, Hye Sook; Chu, Christina; Cohn, David E.; Crispens, Marta A.; Damast, Shari; Dorigo, Oliver; Eifel, Patricia J.; Fisher, Christine M.; Frederick, Peter J.; Gaffney, David K.; Han, Ernest; Huh, Warner K.; Lurain, John R.; Mariani, Andrea; Mutch, David G.; Nagel, Christa; Nekhlyudov, Larissa; Fader, Amanda N.; Remmenga, Steven W.; Reynolds, R. Kevin; Sisodia, Rachel; Tillmanns, Todd; Ueda, Stefanie; Wyse, Emily; McMillian, Nicole R.; Scavone, Jillian L.

doi:10.6004/jnccn.2019.0053

Cited by 101 publications

(108 citation statements)

References 118 publications

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“…Hysterectomy with salpingectomy may be considered as initial treatment for molar pregnancies in women who are older and do not wish to retain fertility [ 21 ]. It can be performed via laparotomy, laparoscopic or vaginal approach, depending on uterine size and the surgeon’s expertise with the techniques.…”

Section: Surgery For Hydatidiform Molementioning

confidence: 99%

“…Four deaths in stage I disease occurred in patients with an interval of ≥48 months since the antecedent pregnancy (1 interval unknown) which is a poor prognostic factor of ETT. In PSTT and ETT, the incidence of pelvic lymph node metastasis is approximately 5% to 15% in clinical stage I tumours [ 21 , 57 ]. Hence, pelvic lymph node biopsy should be considered during hysterectomy for localised PSTT and ETT, particularly with large or deeply invasive tumour.…”

Section: Surgery For Malignant Gestational Trophoblastic Neoplasiamentioning

confidence: 99%

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Surgery including fertility-sparing treatment of GTD

Ngu

Ngan

2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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Gestational trophoblastic disease (GTD) consist of a spectrum of diseases, including hydatidiform moles, invasive mole, metastatic mole, choriocarcinoma, placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). GTD are relatively uncommon disease occurring in women of reproductive age, with high cure rates. Primary treatment of hydatidiform moles includes uterine evacuation, followed by close monitoring of serial hCG levels to detect for post-molar gestational trophoblastic neoplasia (GTN). In patients with GTN, the main therapy consists of chemotherapy, although some surgical procedures are important in selected patients in order to achieve cure. Hysterectomy is the mainstay treatment for PSTT or ETT, and may be considered in selected patients for management of hydatidiform mole and malignant GTN especially in chemoresistant disease. Resection of metastatic lesions such as in the lung or brain can be considered in selected patients with isolated chemoresistant tumour. Surgical treatment of GTD will be discussed in this chapter.

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Section: Surgery For Hydatidiform Molementioning

confidence: 99%

Section: Surgery For Malignant Gestational Trophoblastic Neoplasiamentioning

confidence: 99%

Surgery including fertility-sparing treatment of GTD

Ngu

Ngan

2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…Repeat laboratory tests showed continued increase in β-hCG to 916,335 mIU/ml. In light of the confirmed pathology and continued rise in β-hCG, the decision was made to modify therapy to a choriocarcinoma-targeted EMA/CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) [32,33].…”

Section: Case Presentationmentioning

confidence: 99%

Primary colon adenocarcinoma with choriocarcinoma differentiation: a case report and review of the literature

2020

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Background Choriocarcinoma is an aggressive malignancy of trophoblastic tissue, typically of gestational etiology. Sporadic, nongestational cases are rarely found outside of the gonads. There are only 31 cases of primary choriocarcinoma of the colon reported in the literature. As a consequence of their rarity and aggressive nature, timely diagnosis and effective treatment have proved challenging, and prognosis is very poor. For that reason, we present a rare case with prolonged survival in the youngest reported patient . Case presentation A 26-year-old Caucasian woman presented with abdominal cramping and rectal and vaginal bleeding. Elevated serum human chorionic gonadotropin and an 8-cm right-sided mass seen on ultrasound suggested ectopic pregnancy. The patient was treated with methotrexate; however, her symptoms persisted, and her human chorionic gonadotropin levels continued to rise. Further workup showed a large mass of the sigmoid colon with multiple hepatic lesions suggestive of metastases. Preliminary pathology showed adenocarcinoma. Despite surgical resection and initiation of FOLFOX chemotherapy (folinic acid, fluorouracil, oxaliplatin), the patient had significant clinical deterioration, and her human chorionic gonadotropin increased exponentially. Further pathological review showed two distinct phenotypes: adenocarcinoma merging with choriocarcinoma. The result of evaluation of the metastatic lesions was also positive for choriocarcinoma. Treatment was promptly changed to a choriocarcinoma-targeting chemotherapy regimen of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine), resulting in rapid and dramatic response. The patient had mild progression after 1 year and was switched back to FOLFOX with bevacizumab. After five cycles, scans showed further progression, and the patient was started on third-line therapy with FOLFIRI (folinic acid, fluorouracil, irinotecan) and bevacizumab. Eighteen months after her diagnosis, the patient was alive and maintaining an overall response. Conclusions Our patient achieved a marked response and prolonged survival. Although a comprehensive review of the literature showed that survival with these tumors has improved over the past 10 years, prognosis remains poor. Currently, there is no established algorithm for the management of these rare tumors, but both the literature and our patient’s case indicate that a choriocarcinoma-targeted regimen is critical for survival. Further evaluation of these rare tumors is warranted in order to identify pathological patterns that may help in the diagnosis, management, and survival of these malignancies.

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“…Choriocarcinoma (CC) is a pregnancy-associated tumor characterized by massive hemorrhage and earlier hematogenous metastasis compared with other female genital tumors (1). According to National Comprehensive Cancer Network guidelines, with the development of chemotherapy, the overall cure rate of patients with high-risk CC has reached ~90% worldwide (2). However, multi-drug resistant CC still remains to be a challenge in the clinical setting (3).…”

Section: Introductionmentioning

confidence: 99%

Forskolin promotes vasculogenic mimicry and invasion via Notch‑1‑activated epithelial‑to‑mesenchymal transition in syncytiolization of trophoblast cells in choriocarcinoma

et al. 2020

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Choriocarcinoma (CC) is characterized by earlier blood metastasis compared with other female genital tumors and a high incidence of massive hemorrhage. Vasculogenic mimicry (VM) is highly associated with metastasis, and syncytiotrophoblast is involved in the formation of VM in CC. Forskolin is a typical activator of the cAMP pathway, which is involved in the syncytiolization of trophoblastic cells. In the present study, to determine the effects and mechanism of forskolin on cell invasion and VM during syncytiolization in vitro and in vivo, JEG-3 and JAR cell lines were treated with 100 µM forskolin for 48 h, and wound healing and invasion assays were used to verify cell migratory and invasive capacities. A 3D culture and tube formation assays were established to detect VM. Variation of morphology and markers of the epithelial-to-mesenchymal transition (EMT) were assessed, and the role of the Notch signaling pathway was investigated in CC cells treated with forskolin. The results of the present study demonstrated that 100 µM forskolin induced syncytiolization of trophoblastic cells and enhanced the migratory and invasive abilities of JEG-3 and JAR cell lines. In addition, the capacity of VM was significantly increased, whereas tube formation ability was decreased by forskolin in vitro and in vivo compared with the respective control groups. The cellular morphology exhibited EMT during the syncytiolization process, which was further supported by the changes in EMT marker expression, including downregulation of E-cadherin and cytokeratin and upregulation of N-cadherin, vimentin and zinc finger E-box-binding homeobox 1. The Notch-1 signaling pathway was activated to induce EMT in forskolin-induced VM process in CC cells, and VM and EMT could be reversed by using the γ-secretase inhibitor DAPT to block the Notch-1 pathway. Overall, the results of the present study demonstrated that forskolin enhanced the capacity of VM formation and metastasis through Notch-1-activated EMT in the syncytiolization of trophoblastic cells.

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Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Cited by 101 publications

References 118 publications

Surgery including fertility-sparing treatment of GTD

Surgery including fertility-sparing treatment of GTD

Primary colon adenocarcinoma with choriocarcinoma differentiation: a case report and review of the literature

Forskolin promotes vasculogenic mimicry and invasion via Notch‑1‑activated epithelial‑to‑mesenchymal transition in syncytiolization of trophoblast cells in choriocarcinoma

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