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NCI CANCERLIT^® Search: Gestational Trophoblastic Neoplasms - March 2002

Imprima English

National Cancer Institute^®
Ultima Vez Modificado: 1 de marzo del 2002

False diagnosis and needless therapy of presumed malignant disease in women with false-positive human chorionic gonadotropin concentrations.

The diagnostic implications of routine ultrasound examination in histologically confirmed early molar pregnancies.

Cytotoxic chemotherapy in the treatment of nonmalignant disease.

Expression of CDKI p27Kip1 in trophoblastic neoplasm.

The effect of early pregnancy following chemotherapy on disease relapse and foetal outcome in women treated for gestational trophoblastic

Falsely elevated human chorionic gonadotropin leading to unnecessary therapy.

Forceps delivery after molar malignancy in a woman with arteriovenous malformation. A case report.

Molecular analysis of a gestation consisting of a complete hydatidiform mole and normal dizygotic twin.

Placental site trophoblastic tumor (PSTT) in mother and child: first report of PSTT in infancy.

Table of Contents

1
UI - 10703803
AU - Rotmensch S; Cole LA
TI - False diagnosis and needless therapy of presumed malignant disease in women with false-positive human chorionic gonadotropin concentrations.
SO - Lancet 2000 Feb 26;355(9205):712-5
AD - Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, USA.
BACKGROUND: 12 women were diagnosed of having postgestational choriocarcinoma on the basis of persistently positive human chorionic gonadotropin (hCG) test results in the absence of pregnancy. Most of the women had extirpative surgery or chemotherapy, or both, without significant diminution in hCG titre. Our aim was to assess whether the hCG concentrations were false-positive test results. METHODS: Samples were tested for hCG, hCG free beta subunit, and hCG beta-core fragment. Assay kinetics were also assessed, and samples were tested independently by competitive RIA. False-positive hCG concentrations were identified by two criteria: detection of hCG in serum and lack of detection of hCG and its degradation products in urine; and wide variations in results for different hCG assays. We corroborated false-positive hCG values by the lack of parallel changes in hCG results when serum was diluted, by false detection of other antigens, and by failure to detect hCG with in-house assays. FINDINGS: All 12 women met both criteria for false-positive hCG, and all had corroborating findings. In all 12 cases, a false diagnosis had been made, and most of the women had been subjected to needless surgery or chemotherapy. Assay kinetics indicated that heterophilic antibodies were responsible for the false-positive results. As a result of our findings all further therapy was stopped. INTERPRETATION: Current protocols for the diagnosis and treatment of choriocarcinoma should be modified to include a compulsory test for hCG in urine.

2
UI - 11844211
AU - Sebire NJ; Rees H; Paradinas F; Seckl M; Newlands E
TI - The diagnostic implications of routine ultrasound examination in histologically confirmed early molar pregnancies.
SO - Ultrasound Obstet Gynecol 2001 Dec;18(6):662-5
AD - Department of Histopathology, Imperial College School of Medicine at Charing Cross Hospital, Fulham Palace Road, London, UK. njs@fetalpathology.co.uk
OBJECTIVE: Early ultrasound examination is being used increasingly in the diagnosis of molar pregnancy. The aim of this study was to examine the diagnostic implications of routine ultrasound examination for histologically confirmed molar pregnancies. METHODS: This was a retrospective review of sonographic and histological findings in a series of consecutive cases referred to the National Trophoblastic Disease Surveillance Centre with suspected molar pregnancies. In 194 cases referred to the center over a 6-month period in whom results of a preceding ultrasound examination were documented, review of ultrasound findings and final histological diagnosis was carried out. RESULTS: There were 155 cases with a reviewed histological diagnosis of complete or partial hydatidiform mole. In 131 (67%) cases, the sonographic diagnosis was that of a missed miscarriage/anembryonic pregnancy with no documented suspicion of molar pregnancy, referral being on the basis of histological examination of products of conception. In 63 cases, ultrasound examination suggested molar pregnancy; in 53 (84%) of these, the diagnosis of molar pregnancy was correct. Overall, 37 of 64 (58%) complete moles had sonographic evidence of molar pregnancy compared to 16 of 91 (17%) partial moles. Of 155 histologically confirmed complete or partial hydatidiform moles, only 53 (34%) were suspected as molar sonographically. CONCLUSION: The majority of cases of molar pregnancy now present as missed miscarriage/anembryonic pregnancy sonographically, highlighting the importance of histological examination to diagnose gestational trophoblastic disease.

3
UI - 11847707
AU - Parra SA
TI - Cytotoxic chemotherapy in the treatment of nonmalignant disease.
SO - J Intraven Nurs 2000 Nov-Dec;23(6):359-65
AD - Division of Medical Oncology/Hematology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA.
The term chemotherapy refers to an ever-increasing number of drugs that work with varying specificity against the malignant cells of tumors. These drugs work in several different ways, including direct and indirect cytotoxicity and immunosuppression. This diversity of mechanisms of action has led to the use of cancer chemotherapeutic agents in the treatment of several nonmalignant diseases. The use of cytotoxic drugs in nonmalignant disease is reviewed, and recommendations are provided for safe handling, administration, and the management of expected toxicities.

4
UI - 11776123
AU - Wang G; Wang S; Wang J
TI - Expression of CDKI p27Kip1 in trophoblastic neoplasm.
SO - Chin Med J (Engl) 2000 Nov;113(11):1046-8
AD - Department of Obstetrics and Gynecology, West China University of Medical Sciences, Chengdu 610041, China.
OBJECTIVE: To evaluate the role of p27Kip1 in tumorigenesis and the development of trophoblastic cell disease. METHODS: Using immunohistochemistry, the expression of p27-protein was investigated in 10 normal chorionic villi in the first trimester of pregnancy, 15 complete hydatidiform moles (HM), 7 invasive moles (IM) and 7 choriocarcinomas (CC). RESULTS: In all cases, immunohistochemical staining localized p27-protein in the plasma. Decreased expression of p27Kip1 was observed in malignant trophoblastic neoplasms with a positive rate of 21.43%, which is significantly less than that in normal chorionic villi (80%) and in complete HM (73.33%) (P < 0.05). The positive rate of p27Kip1 in those complete HM with large uterine size for gestational age was lower than that in those with normal or small uterus (42.86% vs 100%, P < 0.05). CONCLUSION: p27Kip1 may be involved in the tumorigenesis of gestational trophoblastic neoplasm as a negative regulator of the cell cycle. The expression level of p27Kip1 in trophoblastic cells may be a prognostic factor for complete HM.

5
UI - 11857007
AU - Blagden SP; Foskett MA; Fisher RA; Short D; Fuller S; Newlands ES; Seckl
TI - MJ The effect of early pregnancy following chemotherapy on disease relapse and foetal outcome in women treated for gestational trophoblastic tumours.
SO - Br J Cancer 2002 Jan 7;86(1):26-30
AD - Department of Medical Oncology, Charing Cross Hospital, London W6 8RF, UK.
Little literature exists on the safety of early pregnancy following chemotherapy. Here we assess the rate of relapse and foetal outcome in women who have completed single and multi-agent chemotherapy for gestational trophoblastic tumours. The records of 1532 patients treated for persistent gestational trophoblastic tumours at Charing Cross Hospital between 1969 and 1998 were reviewed. Patients were defined as receiving single agent or multi-agent treatment. Relapse rates and foetal outcome were reviewed in the 230 patients who became pregnant within 12 months of completing chemotherapy. In the single agent group 153 (22%) of 691 patients conceived early. Three subsequently relapsed. In the multi-agent group, 77 (10%) of 779 patients conceived early, two then relapsed. Relapse rates were 2% (3 out of 153) and 2.5% (2 out of 77) for each group compared to 5% and 5.6% in the comparative non-pregnant groups. Outcomes of 230 early pregnancies: 164 (71%) delivered at full term, 35 (15%) terminations, 26 (11%) spontaneous abortions, three (1.3%) new hydatidiform moles and two (1%) stillbirths. Early pregnancies were more common in the single agent group (P<0.001), but spontaneous miscarriages and terminations were more likely to occur in the multi-agent group (P=0.04 and 0.03, respectively). Of the full-term pregnancies, three (1.8%) babies were born with congenital abnormalities. Patients in either group who conceive within 12 months of completing chemotherapy are not at increased risk of relapse. Though, we still advise avoiding pregnancy within 12 months of completing chemotherapy, those that do conceive can be reassured of a likely favourable outcome. DOI: 10.1038/sj/bjc/6600041 www.bjcancer.comCopyright 2002 The Cancer Research Campaign

6
UI - 11864687
AU - Butler SA; Cole LA
TI - Falsely elevated human chorionic gonadotropin leading to unnecessary therapy.
SO - Obstet Gynecol 2002 Mar;99(3):516-7

7
UI - 11762145
AU - Kelly FW
TI - Forceps delivery after molar malignancy in a woman with arteriovenous malformation. A case report.
SO - J Reprod Med 2001 Nov;46(11):1013-6
AD - Wyoming County Department of Health, Warsaw, New York, USA.
BACKGROUND: An arteriovenous (AV) fistula in the female pelvis is a rare finding. This report describes a successful pregnancy after selective embolization of a postmolar vascular malformation. CASE: At 5 weeks of pregnancy, a 27-year-old, white female, gravida 3, para 0, was discovered on ultrasound examination to have an AV malformation along with a fetal pole. The patient was asymptomatic and had previously received two courses of chemotherapy for a previous nonmetastasized malignant molar pregnancy. Doppler ultrasonography uncovered a vascular malformation extending from the margin of the fetal pole to the margin of the uterus. The pregnancy ended at 8 weeks with a spontaneous abortion. The patient underwent angiography and embolization of extensive right-sided uterine vessels. She resumed normal menstrual periods six weeks after the embolization and became pregnant. The pregnancy concluded in low forceps vaginal delivery of a healthy, female infant at 34 weeks. CONCLUSION: Vaginal delivery following postmolar pregnancy and a uterine AV malformation may be considered a viable delivery option.

8
UI - 11789083
AU - Ruiz-Casares E; Henriques-Gil N; Orera M; Fernandez-Pacheco RP; Aguaron
TI - A Molecular analysis of a gestation consisting of a complete hydatidiform mole and normal dizygotic twin.
SO - J Reprod Med 2001 Dec;46(12):1041-5
AD - Section of Genetics, Faculty of Experimental and Health Sciences, University of San Pablo, Centro De Estudios Universitarios, Madrid 28668, Spain.
OBJECTIVE: To identify a twin pregnancy consisting of a complete mole and coexistent fetus by means of molecular cytogenetics and DNA polymorphisms. STUDY DESIGN: Seven highly polymorphic DNA markers were used to establish the androgenetic origin of a complete hydatidiform mole that coexisted with a normal 46,XY fetus. Cytogenetic analysis of mole nuclei was performed with centromeric probes, demonstrating a 46,XX constitution. RESULTS: Molar tissue was diploid with two X chromosomes, possibly due to chromosome doubling after monospermic fertilization of an ovum with inactivated or absent nucleus. CONCLUSION: Although contamination with maternal tissue may be difficult to avoid, molecular markers provide the possibility of distinguishing between a complete hydatidiform mole and coexisting normal fetus versus a partial mole, with methods that can be performed antenatally. This distinction is important since in the first case up to 24% of fetuses described in the literature have been viable, and the risk of subsequent development of persistent trophoblastic tumor in patients with a complete mole and a coexisting fetus is considerably higher than in patients with a single, complete hydatidiform mole.

9
UI - 11836719
AU - Monclair T; Abeler VM; Kaern J; Walaas L; Zeller B; Hilstrom C
TI - Placental site trophoblastic tumor (PSTT) in mother and child: first report of PSTT in infancy.
SO - Med Pediatr Oncol 2002 Mar;38(3):187-91; discussion 192
AD - Pediatric Surgical Service, Department of Surgery, The National Hospital, Rikshospitalet, Oslo, Norway. tom.monclair@rikshospitalet.no
BACKGROUND: To the authors' knowledge, placental site trophoblastic tumors occurring simultaneously in mother and infant have not previously been reported. PROCEDURE: The clinicopathologic features of metastatic placental site trophoblastic tumor in a mother and her 4-month-old son are described. RESULTS: The disease in the infant was aggressive, and he died in multiorgan failure within 5 weeks of hospital admission. Autopsy showed widespread metastases to liver, lungs, pleura, kidney, mesentery and lymph nodes. The mother, who had a uterine tumor and lung metastases, was treated with chemotherapy and hysterectomy and has no evidence of disease 26 months post-treatment. CONCLUSIONS: This report shows that placental site trophoblastic tumors can metastasize in both mother and child. Copyright 2002 Wiley-Liss, Inc.

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