Gestational trophoblastic tumor Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2000;22(6):373-380
DOI 10.1590/S0100-72032000000600008
Purpose: to construct a b-human chorionic gonadotropin (b-hCG) regression curve following complete hydatidiform mole (CHM) of patients with spontaneous remission, and then compare it to that of CHM patients with gestational trophoblastic tumor (GTT). Also, to compare the b-hCG regression curve of CHM patients followed-up at the Service to the regression curve of other authors1-3. Methods: clinical and laboratory evaluations (serum determinations of b-hCG) were performed on admission and during post-molar follow-up of CHM patients treated at the University Hospital of Botucatu between 1990 and 1998. The result of the serial b-hCG determinations was analyzed using log regression curves. The evolution of the b-hCG regression curve was analyzed and compared between cases of CHM with spontaneous remission and with GTT using a log regression curve, with 95% confidence interval. The log regression curve of the spontaneous remission group was compared to those of other authors1,2. Individual log curves for each patient were constructed and classified according to the four curve types (I, II, III, and IV) proposed by Goldstein³ for post-molar follow-up. Results: sixty-one patients received complete post-molar follow-up, 50 (82%) showing spontaneous remission and 11 (18%) developing GTT. In the group of patients with CHM and spontaneous remission, the time to return to normal b-hCG levels after mole emptying was 20 weeks. The patients who developed GTT showed early deviation from normal b-hCG regression curve 4 to 6 weeks after mole emptying. These patients received chemotherapy normally starting during the 9th post-mole emptying week. Conclusions: the regression curve of post-CHM b-hCG in patients with spontaneous remission showed a log-exponential decline similar to that observed by other authors1,2, but different from that of CHM patients who developed GTT. Three types of b-hCG regression curves similar to Goldstein's³, I, II, and IV, were identified, as well as two other different types: V (normal regression) and VI (abnormal regression).
Summary
Rev Bras Ginecol Obstet. 2000;22(6):373-380
DOI 10.1590/S0100-72032000000600008
Purpose: to construct a b-human chorionic gonadotropin (b-hCG) regression curve following complete hydatidiform mole (CHM) of patients with spontaneous remission, and then compare it to that of CHM patients with gestational trophoblastic tumor (GTT). Also, to compare the b-hCG regression curve of CHM patients followed-up at the Service to the regression curve of other authors1-3. Methods: clinical and laboratory evaluations (serum determinations of b-hCG) were performed on admission and during post-molar follow-up of CHM patients treated at the University Hospital of Botucatu between 1990 and 1998. The result of the serial b-hCG determinations was analyzed using log regression curves. The evolution of the b-hCG regression curve was analyzed and compared between cases of CHM with spontaneous remission and with GTT using a log regression curve, with 95% confidence interval. The log regression curve of the spontaneous remission group was compared to those of other authors1,2. Individual log curves for each patient were constructed and classified according to the four curve types (I, II, III, and IV) proposed by Goldstein³ for post-molar follow-up. Results: sixty-one patients received complete post-molar follow-up, 50 (82%) showing spontaneous remission and 11 (18%) developing GTT. In the group of patients with CHM and spontaneous remission, the time to return to normal b-hCG levels after mole emptying was 20 weeks. The patients who developed GTT showed early deviation from normal b-hCG regression curve 4 to 6 weeks after mole emptying. These patients received chemotherapy normally starting during the 9th post-mole emptying week. Conclusions: the regression curve of post-CHM b-hCG in patients with spontaneous remission showed a log-exponential decline similar to that observed by other authors1,2, but different from that of CHM patients who developed GTT. Three types of b-hCG regression curves similar to Goldstein's³, I, II, and IV, were identified, as well as two other different types: V (normal regression) and VI (abnormal regression).
Summary
Rev Bras Ginecol Obstet. 2003;25(6):445-448
DOI 10.1590/S0100-72032003000600010
Development of preeclampsia/eclampsia prior to 20 weeks of pregnancy should raise the suspicion of hydatidiform mole. We report a case of complete hydatidiform mole (CHM) concurrent with eclampsia in a 20-year-old patient with vaginal bleeding, anemia, large uterine size, and ovary cysts associated with hypertension and proteinuria. Plasmatic b-hCG levels were high and there was abnormal thyroid function. The ultrasonographic findings were compatible with CHM. After uterine evacuation, the patient had headache and visual alterations, followed by tonic-clonic seizures, which ceased with the administration of 50% magnesium sulfate. At post-molar follow-up, a gestational trophoblastic tumor (GTT) was diagnosed and promptly treated with chemotherapy. Association between CHM and eclampsia requires immediate uterine evacuation and strict post-molar follow-up, due to increased risk of GTT development.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):445-448
DOI 10.1590/S0100-72032003000600010
Development of preeclampsia/eclampsia prior to 20 weeks of pregnancy should raise the suspicion of hydatidiform mole. We report a case of complete hydatidiform mole (CHM) concurrent with eclampsia in a 20-year-old patient with vaginal bleeding, anemia, large uterine size, and ovary cysts associated with hypertension and proteinuria. Plasmatic b-hCG levels were high and there was abnormal thyroid function. The ultrasonographic findings were compatible with CHM. After uterine evacuation, the patient had headache and visual alterations, followed by tonic-clonic seizures, which ceased with the administration of 50% magnesium sulfate. At post-molar follow-up, a gestational trophoblastic tumor (GTT) was diagnosed and promptly treated with chemotherapy. Association between CHM and eclampsia requires immediate uterine evacuation and strict post-molar follow-up, due to increased risk of GTT development.