ABSTRACT
@#Gestational trophoblastic neoplasia is a group of tumors which includes invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor, all of which develop after a recognized pregnancy. Choriocarcinoma is a highly invasive and metastatic neoplasm which arises in women of reproductive age. Local spread is reported at 15% while distant metastasis at 4%. Of the 4% of cases having distant metastasis, 60% goes to the lungs, 30% to the vagina, and 10% to other sites. Less than 5% of patients with metastatic gestational trophoblastic neoplasia have involvement of the gastrointestinal tract. This is the case of a 47-year-old multigravid patient who came in with an enlarging abdomen 8 years after she had a hydatidiform mole. Work-ups were done which revealed metastases to the colon, liver and lungs. The plan of management was to give multiple agent chemotherapy.
Subject(s)
Pregnancy , Female , Hydatidiform Mole , Gestational Trophoblastic Disease , ChoriocarcinomaABSTRACT
@#The co-existence of a hydatidiform mole with a living fetus during the third trimester is extremely rare. The optimal management of such a case is controversial especially when medical and obstetric complications set in before term. The aim of management is towards avoidance of complications and planning the delivery at the most appropriate time to ensure good maternal and fetal outcome. We report the case of a 27-year-old Gravida 2 Para 1, who was diagnosed with a complete mole with co-existing live fetus at around 12 weeks age of gestation. She was referred to our institution at 31 weeks and 1 day age of gestation due to vaginal bleeding for which an emergency cesarean section was done. She delivered a live baby boy weighing 1.5 kg, with Apgar Score of 4,6,6. Chemoprophylaxis was administered and her serum beta human chorionic gonadotropin was monitored post-partum.
Subject(s)
Pregnancy , Female , Hydatidiform MoleABSTRACT
Background@#Administration of chemotherapy to prevent postmolar gestational trophoblastic neoplasia was first implemented in the 1960’s. However, its use has remained controversial.@*Objectives@#This study aimed to describe the effect of chemoprophylaxis in preventing progression of hydatidiform mole to gestational trophoblastic neoplasia among patients managed in a tertiary hospital in Davao City from 2011 to 2015.@*Materials & Method@#This retrospective cross-sectional study evaluated 123 cases of hydatidiform mole who were managed at a tertiary hospital in Davao City from the years 2011 to 2015. The patients’ charts were retrieved to get the clinicodemographic profile, progression to gestational trophoblastic neoplasia, and occurrence of adverse effects secondary to chemoprophylaxis. Patients with rising or plateauing beta human chorionic gonadotropin titer were identified within the 3-year period from molar evacuation. Collected data were analyzed using frequency and percentage distribution.@*Results@#The mean age of the patients was 30.5 years, 24% of whom were noted in women more than 40 years of age. The average age of gestation on admission was 14.89 weeks. All patients had a histopathologic diagnosis of complete mole and at least one risk factor for developing postmolar gestational trophoblastic neoplasia. Patients did not experience any significant side effect to chemoprophylaxis. None of the patients developed gestational trophoblastic neoplasia within the 3-year period of monitoring.@*Conclusion@#The administration of chemoprophylaxis to patients diagnosed with hydatidiform mole may be effective against the development of postmolar gestational trophoblastic neoplasia.