Pulmonary deportation of hydatidiform mole: a 12-year, single tertiary center experience in China / 中华医学杂志(英文版)

BACKGROUND@#Pulmonary deportation of hydatidiform mole is an exceedingly rare entity. The underlying mechanisms and proper management strategies remain unclear based on sporadic case reports over the past six decades. This study aimed to investigate the clinical features and rational treatment of patients with benign molar pregnancies with pulmonary deportation based on our experience.@*METHODS@#Medical records of 20 cases of hydatidiform mole with pulmonary deportation were retrospectively reviewed at Peking Union Medical College Hospital from November 2006 to May 2019. The detailed information of all patients was recorded and analyzed. Patients were divided into different groups according to their characteristics and Mann-Whitney U test was used to compare the duration to achieve a normal β-human chorionic gonadotrophin (β-hCG) level after the first evacuation among groups.@*RESULTS@#Initial pulmonary computed tomography scans showed suspected bilateral, left and right chest deportation of hydatidiform mole in 12, four, and four patients, respectively, with the maximum nodular diameter ranging from 0.6 to 1.2 cm. Ten patients achieved lesion resolution while the remaining ten patients achieved decreases in the size of their pulmonary lesions. The median duration to achieve a normal β-hCG level after the first evacuation was 15.5 (13.0, 21.9) weeks. There was no significant difference in the duration to achieve a normal β-hCG level after the first evacuation between two groups based on age (≥40 years vs. 0.5 cm vs. ≤0.5 cm: 13.0 [11.3, 17.2] weeks vs. 16.0 [14.5, 23.8] weeks, Z = 1.815, P = 0.070), and number of uterine evacuations (once vs. twice or three times: 15.0 [13.0, 16.3] weeks vs. 16.0 [12.8, 23.9] weeks, Z = 0.832, P = 0.405). The post-molar cohort was followed up for 17 to 139 months, and no gestational trophoblastic neoplasia was observed.@*CONCLUSIONS@#No surgeries other than uterine evacuation and no chemotherapy regimens are recommended for such patients if they achieve satisfactory decreases in the level of hCG and gradual decrease or disappearance of pulmonary deportation nodules. Patients should be informed about the necessity of long-term follow-up. More collaborative international studies on this exceedingly rare condition may guide decisions regarding optimal management strategies.

Combination chemotherapy regimen with floxuridine, dactinomycin, etoposide, and vincristine as primary treatment for gestational trophoblastic neoplasia / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the combination chemotherapy regimen with floxuridine, dactinomycin, etoposide, and vincristine (FAEV) as primary treatment for gestational trophoblastic neoplasia (GTN).</p><p><b>METHODS</b>Clinical data and outcome of the patients with GTN from 1 January 2004 to 31 December 2009 were retrospectively reviewed. Totally 38 eligible patients had received at least one cycle of FAEV chemotherapy as primary treatment. The primary end points were response rate and toxicity of FAEV regimen.</p><p><b>RESULTS</b>Totally 38 patients and 205 cycles of FAEV chemotherapy were included. Twenty-eight of these patients (73.6%) achieved serologic complete remission (SCR). Regimens were changed in 10 patients because of 5 with no response and 5 with intolerable toxicity. The most serious adverse events were greater than or equal to grade 3 neutropenia (31.6%), febrile neutropenia (7.9%), and greater than or equal to grade 3 thrombocytopenia (5.3%). During the follow-up, none relapsed.</p><p><b>CONCLUSION</b>FAEV is an effective regimen with manageable toxicity for patients with GTN as primary treatment, especially for patients with non-metastatic low or high risk GTN.</p>

Pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios do not predict survival in patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A few inflammatory markers were studied to evaluate their possible prognostic roles in various cancers. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are hypothesized to reflect the systemic inflammation. The objective of the present study was to investigate whether or not the pretreatment neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio can predict the survival of patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy.</p><p><b>METHODS</b>We performed a retrospective study on cervical cancer patients (FIGO stage Ib2-IIb) who had undergone neoadjuvant chemotherapy and radical hysterectomy at Peking Union Medical College Hospital between January 1999 and December 2010. Data on demographics, clinical prognostic markers and histopathology were collected and analyzed. Univariate and multivariate analyses for prognostic factors were performed.</p><p><b>RESULTS</b>A total of 111 patients were identified. The median neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were 2.4 and 142.2, respectively. Overall survival and progression-free survival were neither significantly different between patients with high and low neutrophil-to-lymphocyte ratio (P = 0.149 and P = 0.108) nor in high and low platelet-to-lymphocyte ratio (P = 0.336 and P = 0.510). On multivariate analysis, lymph node status (P = 0.000 and P = 0.007) and lymphovascular space involvement (P = 0.001 and P = 0.001) were independent prognostic factors of progression-free survival and overall survival.</p><p><b>CONCLUSIONS</b>Lymph node status and lymphovascular space involvement were found to be independent prognostic factors for patients with cervical cancer who underwent neoadjuvant chemotherapy and radical hysterectomy. The pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios seemed not to predict the survival of patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy.</p>

Treatment of respiratory failure in metastatic pulmonary choriocarcinoma: an experience at Peking Union Medical College Hospital, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Respiratory failure caused by metastatic pulmonary choriocarcinoma usually develops rapidly and is associated with a high mortality. The clinical management strategy is important in choriocarcinoma patients with acute respiratory failure. The objective of this study was to evaluate the clinical characteristics, treatment outcome and potential risk factors in patients with acute respiratory failure from metastatic pulmonary choriocarcinoma.</p><p><b>METHODS</b>Sixteen patients with acute respiratory failure from pulmonary metastases choriocarcinoma were enrolled and treated at Peking Union Medical College Hospital from 1995 to 2010. Clinical characteristics, causes of pulmonary failure, treatment profiles and outcomes were analyzed retrospectively.</p><p><b>RESULTS</b>The presence of respiratory infection or hemorrhage was associated with acute respiratory failure in patients with metastatic choriocarcinoma. Fifteen (93.8%) patients presented with pulmonary infection, 8 (50.0%) patients with pulmonary hemorrhage. All patients were treated with face mask or mechanical ventilation. Fourteen (87.5%) patients received initial chemotherapy at a low dosage or with modified regimens, with a median of 2 cycles (range 1 to 4). Seven patients achieved a complete remission (CR), two had a partial remission. Six CR patients remained alive with a median follow-up of 59 months (range 16 to 120). Seven patients developed progressive diseases and subsequently died.</p><p><b>CONCLUSIONS</b>Respiratory infection and hemorrhage were associated with acute respiratory failure in metastatic pulmonary choriocarcinoma. The initial administration of gentle chemotherapy regimens, accompanied with mechanical ventilation, is feasible and effective in attenuating respiratory failure in patients with metastatic pulmonary choriocarcinoma.</p>

Diagnosis and treatment of cesarean scar pregnancy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the early diagnosis and treatment of cesarean scar pregnancy (CSP).</p><p><b>METHODS</b>Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, including age, interval from the last cesarean delivery to diagnosis, clinical presentation, location of the lesion, process of diagnosis and treatment, outcome, and follow-up, were retrospectively analyzed.</p><p><b>RESULTS</b>CSP constituted 1.05% of all ectopic pregnancies, and the ratio of CSP to pregnancy was 1:1221. The mean age of the group was 31.4 years. Twenty-six women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years. The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding. Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 were misdiagnosed as gestational trophoblastic tumor. The other 9 were diagnosed definitely before treatment The diagnosis was made based on cesarean delivery history, gynecologic examination, ultrasound, and magnetic resonance imaging (MRI). The treatment of CSP included systemic or local methotrexate administration, conservative surgery, and hysterectomy. The conservative treatment was successful in 24 cases. All of the 28 women were cured through individual therapies.</p><p><b>CONCLUSIONS</b>CSP is rare and usually misdiagnosed as other diseases. Ultrasound is valuable for diagnosing CSP, and MRI can be used as an adjunct to ultrasound scan. Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients. Individual therapy is strongly recommended.</p>

Role of laparoscopy in the diagnosis and treatment of adnexal masses / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopy has been accepted for years as a management of benign ovarian tumors. The aim of this study was to estimate the feasibility and safety of laparoscopy in diagnosis and management of adnexal masses.</p><p><b>METHODS</b>A total of 2083 patients with benign adnexal mass were treated by laparoscopy at Peking Union Medical College Hospital from January 2000 to December 2003. Their clinical data were reviewed retrospectively. All the adnexal masses suspicious of malignancy at the time of laparoscopy were sent for frozen section evaluation intraoperatively. The rates of unexpected intracystic vegetation and low malignant potential (LMP) tumor or malignancy were investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of laparoscopic diagnosis for LMP or ovarian malignancies were calculated. The ratios were compared by Chi-square test and the continuous variables were tested using two-tailed t test.</p><p><b>RESULTS</b>Of the 2083 patients, 16 had LMP or invasive tumors (0.77%), among which 14 were diagnosed histologically intraoperatively and 2 postoperatively. Fifty-five (2.6%) of the 2083 patients had unexpected intracystic vegetations. Their frozen sections showed benign tumors in 41 (74.5%), LMP tumors in 8 (14.5%), and focal invasive ovarian cancers (stage Ic) in 6 (10.9%). The final pathological diagnosis were benign tumors in 41 (74.5%), LMP tumors 7 (12.7%), and focal invasive ovarian cancers (stage Ic) in 7 (12.7%). Laparoscopy achieved a sensitivity of 87.5%, specificity of 98%, positive predictive value of 25.5%, and negative predictive value of 99.9% in the diagnosis of ovarian malignancies. 2067 cases with benign adnexal masses underwent laparoscopy successfully. No conversion to laparotomy, or intra- and postoperative complications in this series. Of the 16 patients with LMP or invasive ovarian cancer, seven underwent laparoscopic surgery including immediate staging laparoscopy in 3. The mean follow-up was 17.3 months for the 16 patients. Among them, 1 developed a recurrent LMP tumor in the contralateral ovary 36 months after laparoscopic salpingo-oophorectomy, and received subsequent laparoscopic cystectomy and pelvic lymph node sampling; the others had no evidence of recurrent tumor during the follow-up.</p><p><b>CONCLUSION</b>Laparoscopy is feasible for diagnosis of adnexal masses, and the surgery is safe for patients with benign ovarian tumors.</p>

Role of hysteroscopy in the diagnosis of endometrial carcinoma / 中国医学科学院学报

With the apparently increasing incidence of endometrial carcinoma, much importance has been attached to the early and exact diagnosis of endometrial carcinoma. This article mainly focuses on diagnostic techniques of endometrial carcinoma, especially diagnostic hysteroscopy and its assessment of myometrial invasion as well as stage of endometrial carcinoma. Whether hysteroscopy increases the risk of microscopic extrauterine spread is also discussed in this article.

Value of hysteroscopy and laparoscopy in differential diagnosis of gestational trophoblastic neoplasia / 中华妇产科杂志

Objective To determine the efficacy of hysteroscopy and laparoscopy in differential diagnosis of pregnancy-related diseases,including gestational trophoblastic neoplasia(GTN),incomplete abortion and ectopic pregnancy.Methods Twenty-seven patients with a suspected diagnosis of GTN were transferred to Peking Union Medical College Hospital from September 2003 to March 2006,and underwent hysteroscopy and laparoseopy.Clinical data of patients were reviewed retrospectively.Most patients had abnormal vaginal bleeding and persistently elevated plasma beta human chorionic gonadotropin(?-hCG) level for a median(53?37)days(range,15-125 days)after evacuation.Ultrasound revealed a lesion with affluent blood flow in intrauterine,unilateral horn of uterus,or myometrium.No positive findings were revealed by computerized tomography or X-ray of the chest in all patients.Eleven patients underwent evacuation under hysteroscope,10 patients were diagnosed and treated by laparoscopy,and 6 by hysteruscopy and laparoseopy.Results Choriocarcinoma was diagnosed in 4 patients,who achieved complete remission by chemotherapy later.The diagnosis of GTN was ruled out in the other 23 patients, including cornual pregnancy in 12,pregnancy in rudimentary horn in 1,and incomplete abortion in 10,who were cured by hysteroscopic and laparoscopic surgery and postoperative adjuvant single dose methotrexate.Conclusions The major causes of pregnancy-related abnormal bleeding include incomplete abortion,eetopic pregnancy,and GTN.Hysteroscopy and laparoseopy are effective alternative of diagnosis for differentiation of GTN from non-GTN and can also offer therapeutic treatment.

Clinical analysis of patients with lung metastasis of invasive mole before evacuation of hydatidiform mole / 中华妇产科杂志

0.05).Compared with control group,significant decrease in positive group was found in the interval from first evacuation of HM to resolution of serum ?-hCG level,(83?18) days versus(126?31)days(P0.05).Conclusions Once HM is diagnosed,evacuation should be performed as soon as possible,the later the evacuation begins,the higher the risks of lung metastasis and chemotherapy are.It is not necessary to worry about lung metastasis before evacuation of HM,the outcome of post- chemotherapy is very good.