Gestational trophoblastic disease Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo83
, , , Evaluate the risk factors for the development of post-molar gestational trophoblastic neoplasia.
Retrospective cohort study with 320 women with gestational trophoblastic disease (GTD) followed in a tertiary hospital from January 2005 to January 2020. Data referring to the women's sociodemographic profile, clinical, laboratory and treatment aspects and types of GTD were analyzed.
The mean age of women with the benign form was 26.4±8.6 years and with the malignant forms 26.9±8.5 years (p=0.536). Most women with malignant forms came from regions further away from reference center (p=0.012), had vesicle elimination at the time of diagnosis (p=0.028) and needed more than one uterine evacuation (p<0.001) when compared to the benign forms. There was no difference between laboratory tests in both forms. Being between 30 and 39 years old increased the chance of developing invasive mole by 2.5 (p=0.004; 95%CI:1.3–4.9) and coming from regions far from reference center by 4.01 (p=0.020; CI95%: 1.2-12.9). The women with the highest risk of malignant forms were those with the longest time of become normal on human gonadotrophic hormone (hCG) testing (each week the risk increases 1.3 times; p<0.001, 95%CI: 1.2-1.3).
The prolonged hCG fall curve is the main indicator of an increased chance of GTN. Women from regions further away from reference center have a greater chance of developing malignant forms, probably due to the difficulty in accessing the reference center and, therefore, adequate follow-up that would allow early identification of more serious cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo83
, , , Evaluate the risk factors for the development of post-molar gestational trophoblastic neoplasia.
Retrospective cohort study with 320 women with gestational trophoblastic disease (GTD) followed in a tertiary hospital from January 2005 to January 2020. Data referring to the women's sociodemographic profile, clinical, laboratory and treatment aspects and types of GTD were analyzed.
The mean age of women with the benign form was 26.4±8.6 years and with the malignant forms 26.9±8.5 years (p=0.536). Most women with malignant forms came from regions further away from reference center (p=0.012), had vesicle elimination at the time of diagnosis (p=0.028) and needed more than one uterine evacuation (p<0.001) when compared to the benign forms. There was no difference between laboratory tests in both forms. Being between 30 and 39 years old increased the chance of developing invasive mole by 2.5 (p=0.004; 95%CI:1.3–4.9) and coming from regions far from reference center by 4.01 (p=0.020; CI95%: 1.2-12.9). The women with the highest risk of malignant forms were those with the longest time of become normal on human gonadotrophic hormone (hCG) testing (each week the risk increases 1.3 times; p<0.001, 95%CI: 1.2-1.3).
The prolonged hCG fall curve is the main indicator of an increased chance of GTN. Women from regions further away from reference center have a greater chance of developing malignant forms, probably due to the difficulty in accessing the reference center and, therefore, adequate follow-up that would allow early identification of more serious cases.
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(7):384-392
, , , , , , , To assess the potential relationship of clinical status upon admission and distance traveled from geographical health district in women with gestational trophoblastic disease (GTD).
This is a cross-sectional study including women with GTD from the 17 health districts from the São Paulo state (I–XVII), Brazil, referred to the Botucatu Trophoblastic Disease Center (specialized center, district VI), between 1990 and 2018. At admission, hydatidiform mole was assessed according to the risk score system of Berkowitz et al. Gestational trophoblastic neoplasia was evaluated using the International Federation of Gynecology and Obstetrics / World Health Organization (FIGO/WHO) staging/risk score. Data on demographics, clinical status and distance traveled were collected. Multiple regression analyses were performed.
This study included 366 women (335 hydatidiform mole, 31 gestational trophoblastic neoplasia). The clinical status at admission and distance traveled significantly differed between the specialized center district and other districts. Patients referred from health districts IX (β = 2.38 [0.87–3.88], p = 0.002) and XVI (β = 0.78 [0.02–1.55], p = 0.045) had higher hydatidiform mole scores than those from the specialized center district. Gestational trophoblastic neoplasia patients from district XVI showed a 3.32 increase in FIGO risk scores compared with those from the specialized center area (β = 3.32, 95% CI = 0.78–5.87, p = 0.010). Distance traveled by patients from districts IX (200km) and XVI (203.5km) was significantly longer than that traveled by patients from the specialized center district (76km).
Patients from health districts outside the specialized center area had higher risk scores for both hydatidiform mole and gestational trophoblastic neoplasia at admission. Long distances (>80 km) seemed to adversely influence gestational trophoblastic disease clinical status at admission, indicating barriers to accessing specialized centers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(7):384-392
, , , , , , , To assess the potential relationship of clinical status upon admission and distance traveled from geographical health district in women with gestational trophoblastic disease (GTD).
This is a cross-sectional study including women with GTD from the 17 health districts from the São Paulo state (I–XVII), Brazil, referred to the Botucatu Trophoblastic Disease Center (specialized center, district VI), between 1990 and 2018. At admission, hydatidiform mole was assessed according to the risk score system of Berkowitz et al. Gestational trophoblastic neoplasia was evaluated using the International Federation of Gynecology and Obstetrics / World Health Organization (FIGO/WHO) staging/risk score. Data on demographics, clinical status and distance traveled were collected. Multiple regression analyses were performed.
This study included 366 women (335 hydatidiform mole, 31 gestational trophoblastic neoplasia). The clinical status at admission and distance traveled significantly differed between the specialized center district and other districts. Patients referred from health districts IX (β = 2.38 [0.87–3.88], p = 0.002) and XVI (β = 0.78 [0.02–1.55], p = 0.045) had higher hydatidiform mole scores than those from the specialized center district. Gestational trophoblastic neoplasia patients from district XVI showed a 3.32 increase in FIGO risk scores compared with those from the specialized center area (β = 3.32, 95% CI = 0.78–5.87, p = 0.010). Distance traveled by patients from districts IX (200km) and XVI (203.5km) was significantly longer than that traveled by patients from the specialized center district (76km).
Patients from health districts outside the specialized center area had higher risk scores for both hydatidiform mole and gestational trophoblastic neoplasia at admission. Long distances (>80 km) seemed to adversely influence gestational trophoblastic disease clinical status at admission, indicating barriers to accessing specialized centers.
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):343-351
, , , , , , To evaluate the emotional and clinical aspects observed in women with gestational trophoblastic disease (GTD) followed-up in a reference center (RC) by a multidisciplinary team.
Retrospective cohort study of the clinical records of 186 women with GTD and of the emotional aspects (EA) observed in these women by a teamof psychologists and reported by the 389 support groups conducted from 2014 to 2018.
The women were young (mean age: 31.2 years), 47% had no living child, 60% had planned the pregnancy, and 50% participated in two or more SG. Most women (n=137; 73.6%) reached spontaneous remission ofmolar gestation in a median time of 10 weeks and had a total follow-up time of seven months. In the group of 49 women (26.3%) who progressed to gestational trophoblastic neoplasia (GTN), time to remission after chemotherapy was 18 weeks, and total follow-up time was 36 months. EA included different levels of anxiety and depression,more evident in 9.1% of the women; these symptoms tended to occur more frequently in women older than 40 years (p=0.067), less educated (p=0.054), and whose disease progressed to GTN (p=0.018), as well as in those who had to undergo multi-agent chemotherapy (p=0.028) or hysterectomy (p=0.001) adjuvant to clinical treatment.
This study found several EA in association with all types of GTD. It also highlights the importance of specialized care only found in a RC, essential to support the recovery of the mental health of these women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):343-351
, , , , , , To evaluate the emotional and clinical aspects observed in women with gestational trophoblastic disease (GTD) followed-up in a reference center (RC) by a multidisciplinary team.
Retrospective cohort study of the clinical records of 186 women with GTD and of the emotional aspects (EA) observed in these women by a teamof psychologists and reported by the 389 support groups conducted from 2014 to 2018.
The women were young (mean age: 31.2 years), 47% had no living child, 60% had planned the pregnancy, and 50% participated in two or more SG. Most women (n=137; 73.6%) reached spontaneous remission ofmolar gestation in a median time of 10 weeks and had a total follow-up time of seven months. In the group of 49 women (26.3%) who progressed to gestational trophoblastic neoplasia (GTN), time to remission after chemotherapy was 18 weeks, and total follow-up time was 36 months. EA included different levels of anxiety and depression,more evident in 9.1% of the women; these symptoms tended to occur more frequently in women older than 40 years (p=0.067), less educated (p=0.054), and whose disease progressed to GTN (p=0.018), as well as in those who had to undergo multi-agent chemotherapy (p=0.028) or hysterectomy (p=0.001) adjuvant to clinical treatment.
This study found several EA in association with all types of GTD. It also highlights the importance of specialized care only found in a RC, essential to support the recovery of the mental health of these women.
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(4):323-328
, , , , , Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation.We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(4):323-328
, , , , , Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation.We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(5):240-247
To compare the effect of high-dose vitamin A (HD Vit-A) use during postmolar follow-up of patients with low and plateauing (L&P) serum human chorionic gonadotropin (hCG) levels, from the moment serum hCG plateaued (P-hCG) to the first normal serum hCG value (< 5IU/L).
The present retrospective series case study compared two nonconcurrent cohorts of patients. Control group (CG): 34 patients with L&P serum hCG levels who underwent expectant management for 6 months after uterine evacuation, from 1992 to 2010; study group (SG): 32 patients in similar conditions who received 200,000 IU of Vit-A daily, from the identification of a P-hCG level to the first normal hCG value or the diagnosis of progression to gestational trophoblastic neoplasia (GTN), from 2011 to 2017. The present study was approved by the Ethics Committee of the institution where it was conducted.
In both groups, the prevalence of persistent L&P serum hCG levels was < 5%. In the SG, hCG levels at plateau were higher (CG = 85.5 versus SG = 195 IU/L; p = 0.028), the rate of postmolar GTN was lower (CG = 29.4% versus SG = 6.3%, p = 0.034) and follow-up was shorter (CG = 14 versus SG = 10 months, p < 0.001). During GTN follow-up, there were no differences in GTN staging or treatment aggressiveness in both groups. High-dose Vit-A use did not have any relevant toxic effect. There were no GTN relapses or deaths.
The limited use of HD Vit-A seems to have a safe and significant effect on the treatment of postmolar patients with L&P serum hCG levels and may decrease the development of postmolar GTN in this population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(5):240-247
To compare the effect of high-dose vitamin A (HD Vit-A) use during postmolar follow-up of patients with low and plateauing (L&P) serum human chorionic gonadotropin (hCG) levels, from the moment serum hCG plateaued (P-hCG) to the first normal serum hCG value (< 5IU/L).
The present retrospective series case study compared two nonconcurrent cohorts of patients. Control group (CG): 34 patients with L&P serum hCG levels who underwent expectant management for 6 months after uterine evacuation, from 1992 to 2010; study group (SG): 32 patients in similar conditions who received 200,000 IU of Vit-A daily, from the identification of a P-hCG level to the first normal hCG value or the diagnosis of progression to gestational trophoblastic neoplasia (GTN), from 2011 to 2017. The present study was approved by the Ethics Committee of the institution where it was conducted.
In both groups, the prevalence of persistent L&P serum hCG levels was < 5%. In the SG, hCG levels at plateau were higher (CG = 85.5 versus SG = 195 IU/L; p = 0.028), the rate of postmolar GTN was lower (CG = 29.4% versus SG = 6.3%, p = 0.034) and follow-up was shorter (CG = 14 versus SG = 10 months, p < 0.001). During GTN follow-up, there were no differences in GTN staging or treatment aggressiveness in both groups. High-dose Vit-A use did not have any relevant toxic effect. There were no GTN relapses or deaths.
The limited use of HD Vit-A seems to have a safe and significant effect on the treatment of postmolar patients with L&P serum hCG levels and may decrease the development of postmolar GTN in this population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(11):529-529
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(11):529-529
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):415-419
DOI 10.1590/S0100-72031998000700008
Twin pregnancy in which a normal fetus and a complete mole develop at the same time is a rare event. Clinical complications and malignancy are frequent in this type of disease.This report is about a case of a late diagnosis due to the presence of the fetus. The diagnosis was made when the pregnancy was interrupted and then confirmed by histopathological study and flow cytometry. The pregnancy was terminated transpelvically due to massive uterine hemorrhage. The post-molar follow-up showed the persistence of high levels of bhCG. The patient's complete recovery was achieved after the administration of methotrexate. The diagnosis, natural history, and procedures for this rare disease are discussed in view of this case.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):415-419
DOI 10.1590/S0100-72031998000700008
Twin pregnancy in which a normal fetus and a complete mole develop at the same time is a rare event. Clinical complications and malignancy are frequent in this type of disease.This report is about a case of a late diagnosis due to the presence of the fetus. The diagnosis was made when the pregnancy was interrupted and then confirmed by histopathological study and flow cytometry. The pregnancy was terminated transpelvically due to massive uterine hemorrhage. The post-molar follow-up showed the persistence of high levels of bhCG. The patient's complete recovery was achieved after the administration of methotrexate. The diagnosis, natural history, and procedures for this rare disease are discussed in view of this case.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(3):167-173
DOI 10.1590/S0100-72032000000300008
Purpose: to determine the most efficient clinical and histopathological predictors of complete hydatidiform mole (CHM) after gestational trophoblastic tumors (GTT). Methods: a prospective clinical and histopathological study was performed on all patients with CHM treated at the University Hospital of Botucatu between 1990 and 1998. Preevacuation clinical evaluation allowed the classification of molar pregnancy into high risk and low risk CHM. The author analyzed the clinical predictors of GTT established by Goldstein et al.¹ and by other authors2--10. The histopathological evaluation included the confirmation of CHM diagnosis based on the criteria by Szulman and Surti11 and the understanding of risk factors for GTT by Ayhan et al.8. The clinical and histopathological predictors were correlated with the postmolar GTT. Results: ovarian cysts larger than 6 cm and uterus size larger than 16 cm were the most efficient clinical predictors of GTT in 65 patients with CHM. Trophoblastic proliferation, nuclear atypia, necrosis/hemorrhage, trophoblastic maturation, and the ratio cytotrophoblast to syncytiotrophoblast were not significant predictors of GTT. The correlation between the clinical and histopathological predictors for the development of GTT was not possible, as no histopathological parameter was significant. Conclusion: additional investigations could evaluate other predictors for persistent disease, and its usefulness in a clinical context. The sequential determination of plasmatic beta-hCG remains the only safe predictor for persistent disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(3):167-173
DOI 10.1590/S0100-72032000000300008
Purpose: to determine the most efficient clinical and histopathological predictors of complete hydatidiform mole (CHM) after gestational trophoblastic tumors (GTT). Methods: a prospective clinical and histopathological study was performed on all patients with CHM treated at the University Hospital of Botucatu between 1990 and 1998. Preevacuation clinical evaluation allowed the classification of molar pregnancy into high risk and low risk CHM. The author analyzed the clinical predictors of GTT established by Goldstein et al.¹ and by other authors2--10. The histopathological evaluation included the confirmation of CHM diagnosis based on the criteria by Szulman and Surti11 and the understanding of risk factors for GTT by Ayhan et al.8. The clinical and histopathological predictors were correlated with the postmolar GTT. Results: ovarian cysts larger than 6 cm and uterus size larger than 16 cm were the most efficient clinical predictors of GTT in 65 patients with CHM. Trophoblastic proliferation, nuclear atypia, necrosis/hemorrhage, trophoblastic maturation, and the ratio cytotrophoblast to syncytiotrophoblast were not significant predictors of GTT. The correlation between the clinical and histopathological predictors for the development of GTT was not possible, as no histopathological parameter was significant. Conclusion: additional investigations could evaluate other predictors for persistent disease, and its usefulness in a clinical context. The sequential determination of plasmatic beta-hCG remains the only safe predictor for persistent disease.
