Trophoblastic neoplasms Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):506-510
DOI 10.1590/S0100-72032007001000003
PURPOSE: to evaluate the usefulness of the normal human chorionic gonadotropin (hCG) regression curve in the early diagnosis of post-molar trophoblastic neoplasia (GTN). METHODS: a longitudinal study including 105 patients with complete hydatidiform mole (CHM) followed up at the Botucatu Center of Trophoblastic Diseases from 1998 to 2005. Serial serum hCG titers were measured fortnightly in all patients. Individual curves of the 105 patients were built. Comparison between the normal regression curve established at our center with individual hCG curves was used to screen and diagnose (plateau/rise) GTN. The number of weeks postevacuation when hCG levels exceeded the normal limits was compared with the number of weeks when hCG reached plateau/rise. RESULTS: among the 105 patients with CHM, 80 reached spontaneous remission (SR) and 25 developed GTN. Among the 80 SR patients, 7 (8.7%) initially showed hCG concentrations above normal but eventually achieved remission. All the 25 GTN patients showed deviation from the normal hCG curve at 3.84±2.57 weeks and reached plateau or rise at 8.40±2.94 weeks (p<0.001). CONCLUSIONS: the normal regression curve of post-molar hCG is useful in the early diagnosis of GTN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):506-510
DOI 10.1590/S0100-72032007001000003
PURPOSE: to evaluate the usefulness of the normal human chorionic gonadotropin (hCG) regression curve in the early diagnosis of post-molar trophoblastic neoplasia (GTN). METHODS: a longitudinal study including 105 patients with complete hydatidiform mole (CHM) followed up at the Botucatu Center of Trophoblastic Diseases from 1998 to 2005. Serial serum hCG titers were measured fortnightly in all patients. Individual curves of the 105 patients were built. Comparison between the normal regression curve established at our center with individual hCG curves was used to screen and diagnose (plateau/rise) GTN. The number of weeks postevacuation when hCG levels exceeded the normal limits was compared with the number of weeks when hCG reached plateau/rise. RESULTS: among the 105 patients with CHM, 80 reached spontaneous remission (SR) and 25 developed GTN. Among the 80 SR patients, 7 (8.7%) initially showed hCG concentrations above normal but eventually achieved remission. All the 25 GTN patients showed deviation from the normal hCG curve at 3.84±2.57 weeks and reached plateau or rise at 8.40±2.94 weeks (p<0.001). CONCLUSIONS: the normal regression curve of post-molar hCG is useful in the early diagnosis of GTN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(2):112-121
DOI 10.1590/S0100-72032006000200007
PURPOSE: to investigate the presence and outcome of uterinevascular malformations (UVAM) after gestational trophoblastic disease (GTD). METHODS: retrospective study of 2764 patients with GTD diagnosed from 1987 to 2004. All patients were followed up annually at the "Santa Casa da Misericórdia" Trophoblastic Disease Center (Rio de Janeiro, RJ, Brazil) with transvaginal ultrasonography (US) and color Doppler imaging. Seven patients had a final diagnosis of UVAM based on ultrasonographic analysis - pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV) - and pelvic magnetic nuclear resonance (MNR) findings. Negative beta-hCG values were of utmost importance to establish differential diagnosis with persistent GTD. RESULTS: the incidence of UVAM after GTD was 0.2% (7/2764). US features of UVAM: PI mean 0.44±0,058 (extremes: 0.38-0.52); RI mean 0.36±0.072 (extremes: 0.29-0.50); PSV mean 64.6±23.99 cm/s (extremes: 37-96). MNR image showed a bulky uterus, myometrial inhomogeneity, serpiginous flow-related signal voids, and prominent parametrial vessels. The most common UVAM clinical presentation was vaginal hemorrhage, present in 52.7% (4/7). Pharmacological management with 150 mg medroxyprogesterone acetate was employed to control bleeding, after hemodynamic stabilization. These patients are still being followed and remain asymptomatic nowadays. Two patients with persistent UVAM became pregnant and had successful outcomes. CONCLUSION: patients with antecedent of GTD presenting transvaginal bleeding and negative beta-hCG may be considered to have UVAM and should be investigated through US with Doppler velocimetry. Conservative management is a valuable option in many of the acquired UVAM after GTD.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(2):112-121
DOI 10.1590/S0100-72032006000200007
PURPOSE: to investigate the presence and outcome of uterinevascular malformations (UVAM) after gestational trophoblastic disease (GTD). METHODS: retrospective study of 2764 patients with GTD diagnosed from 1987 to 2004. All patients were followed up annually at the "Santa Casa da Misericórdia" Trophoblastic Disease Center (Rio de Janeiro, RJ, Brazil) with transvaginal ultrasonography (US) and color Doppler imaging. Seven patients had a final diagnosis of UVAM based on ultrasonographic analysis - pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV) - and pelvic magnetic nuclear resonance (MNR) findings. Negative beta-hCG values were of utmost importance to establish differential diagnosis with persistent GTD. RESULTS: the incidence of UVAM after GTD was 0.2% (7/2764). US features of UVAM: PI mean 0.44±0,058 (extremes: 0.38-0.52); RI mean 0.36±0.072 (extremes: 0.29-0.50); PSV mean 64.6±23.99 cm/s (extremes: 37-96). MNR image showed a bulky uterus, myometrial inhomogeneity, serpiginous flow-related signal voids, and prominent parametrial vessels. The most common UVAM clinical presentation was vaginal hemorrhage, present in 52.7% (4/7). Pharmacological management with 150 mg medroxyprogesterone acetate was employed to control bleeding, after hemodynamic stabilization. These patients are still being followed and remain asymptomatic nowadays. Two patients with persistent UVAM became pregnant and had successful outcomes. CONCLUSION: patients with antecedent of GTD presenting transvaginal bleeding and negative beta-hCG may be considered to have UVAM and should be investigated through US with Doppler velocimetry. Conservative management is a valuable option in many of the acquired UVAM after GTD.
