Gestational trophoblastic disease and the second-birth pregnancy / 西安交通大学学报(医学版)

With the overall implementation of the two-child policy,scar of the uterus and elderly mothers bring a lot of gynecological and obstetric problems.Therefore,we are paying attention and making responses to obstetric challenges.At the same time,we should also attach importance to the gynecological problems caused by the secondbirth pregnancy.Currently,the hot spots include increased incidence of hydatidiform mole,which may lead to gestational trophoblastic tumor,and the second-birth pregnancy of gestational trophoblastic tumor patients after treatment.This paper discusses the issues of gcstational trophoblastic disease and the second-birth pregnancy from the following aspects:relationship between age and development of gestational trophoblastic disease,effect of chemotherapy on ovarian function in gestational trophoblastic tumor patients,protection of ovarian function during chemotherapy,and appropriate time and prognosis of next pregnancy after treatment.

A Case of Trophoblastic Tumor Associated with Papillary Thyroid Cancer / 대한내과학회지

Thyroid cancer is one of the most common endocrine malignancies. It is known that thyroid cancer can develop during reproductive periods, possibly due to the effects of sex hormones and growth factors such human chorionic gonadotrophin (HCG). Some data suggest that elevated HCG levels during pregnancy or gestational trophoblastic disease can stimulate thyroid cellular proliferation and promote cancer formation; however, a case of papillary thyroid cancer accompanied by a gestational trophoblastic tumor has not been reported. Here, we report the case of a 44-year-old woman with papillary thyroid cancer during treatment for a gestational trophoblastic tumor.

Clinical Characteristics and Management of Choriocarcinoma in Postmenopausal Women / 中国医科大学学报

Objective To investigate the clinical characteristics,management and prognosis of choriocarcinorna in postmenopausal women. Methods Six cases of choriocarcinoma in postmenopausal women were reviewed retrospectively. Results Four cases in the 6 patients presented with abnormal vaginal bleeding. All of the six cases received chemotherapy and four cases underwent hysterectomy. Three cases achieved complete remission,one partial remission,one stable condition,and one disease progression.One case died,two cases lost follow-up and three cases survived as follow-up so far. Conclusion The diagnosis of pregnancy-related disease should be considered in the elderly women presenting with abnormal vaginal bleeding.Once diagnosed,chemotherapy should be given as soon as possible. Satisfactory effects can be achieved with a combination therapy of chemotherapy and surgery.

Correlation of P53 expression with proliferation and apoptosis in gestational trophoblastic tumor / 基础医学与临床

Objective To elucidate the features of the expression of P53,proliferation and apoptosis in gestational trophoblastic tumor(GTT).Methods Ten cases of normal placenta,10 cases of complete hydatidiform mole(CM),20 cases of invasive hydatidiform mole(IM)and 19 cases of choriocarcinoma(CCA)paraffin-embedded tissues were studied.P53 and PCNA were detected with immunohistochemistry,apoptosis was detected with terminal deoxy-nucleotidyl transferase-mediated dUTP-biotin nick end labeling(TUNEL).Results In NP,CM,IM and CCA,the P53 indexes(P53-Ⅰ)were 4.12%,21.68%,39.61% and 27.39% respectively with significant differences among them(P

A clinical study on gestational trophoblastic disease / 부인종양

OBJECTIVE: To evaluate the clinical characteristics and the outcome of the management for gestational trophoblastic disease (GTD) patients diagnosed at our hospital and to report the current situation of GTD in Korea. METHODS: Between January, 1991, and December, 2000, One hundred and eleven women were diagnosed as GTD and managed in our hospital. Patients were classified according to clinical diagnosis and their medical records were investigated. RESULTS: Cases of benign, malignant nonmetastatic, malignant metastatic low risk and malignant metastatic high risk GTDs were 62, 36, 2 and 11 respectively. The mean age (year), gravidity and parity (number) of GTD patients were 33.3+/-9.9 (range: 19-54), 3.2+/-3.0 (range: 0-16) and 1.7+/-1.8 (range: 0-7) overall. About 75% of GTD patients were women in their 20s and 30s, and 85% occurred in patients with parity of 3 or less. The most common prior gestational event was abortion (37.1%) for molar pregnancy and molar pregnancy (61.2%) for persistent gestational trophoblastic tumor (PGTT). The progression rate of molar pregnancies to PGTT was 38.0%. MTX (16.3%) was mainly used as a single agent, and EMACO (28.6%) or MAC (22.4%) were primarily used for multidrug chemotherapy for the treatment of PGTT. In the treatment of PGTT, overall remission rate was 95.9% (n=47/49). CONCLUSION: The trends for GTD in Korea revealed significant changes, not only a decrease in the incidence of GTD, but also an improvement in the outcome of the management. There is a necessity of further community-based surveys for GTD.

Efficacy of NETDC (New England Trophoblastic Disease Center) prognostic index score to predict gestational trophoblastic tumor from hydatidiform mole.

A prospective longitudinal analytic study assessing the efficacy of NETDC (New England Trophoblastic Disease Center) prognostic index score in predicting malignancy after hydatidiform mole had been performed. Of the parameter evaluated; age of patients, type of hydatidiform mole, uterine enlargement, serum hCG level, lutein cyst, and presence of complicating factors were significant risk factors for malignancy after hydatidiform mole were evacuated (p<0.032). The study were done on 50 women diagnosed with hydatidiform mole with 1 year observation (January 2001-December 2002) at the Department of Obstetrics and Gynecology, Mohammad Hoesin Hospital, Palembang. The results showed that the NETDC prognostic index score predicted malignancy in 50% of high risk group and 10% in low risk group (p<0.05). This showed a higher number than that found by the WHO (19%-30%). The risk for incidence of malignancy after hydatidiform mole in the high risk group is 9.0 times higher compared to that of the low risk group (CI: 1.769-45.786).

The Role of Clinical and Biololgical Parameters to Predict Malignant Gestational Trophoblastic Tumor in Patients with Hydatidiform Mole / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study is to reevaluate the prognostic factors by investigating the clinical and biological parameters concerned malignant gestational trophoblastic tumor in patients with hydatidiform mole. METHODS: From March 1995 to February 2000, 41 patients admitted to department of the Obstetrics and Gynecology, Yonsei University College of Medicine who were diagnosed with pathologically-proven gestational trophoblastic disease were selected. Parameters such as age, gravida, parity, presence of theca lutein cyst, ratio of uterine size to gestational age, hCG level, DNA ploidy, S-phase fraction were compared between malignant gestational trophoblastic tumor group and spontaneous remission group. RESULTS: Considering the clinical prognostic factors, the patients were divided into two age groups; the first group consisted of those older than 40 years of age and the second control group consisted of those under 40. The number of patients older than 40 in the spontaneous remission group and malignant gestational trophoblastic tumor group were 4(15.4%) and 7(46.7%), respectively, showing a significantly higher number in the group over 40years. Other parameters such as gravida, parity, presence of theca lutein cyst, ratio of uterine size to gestational age, hCG level, DNA ploidy, S-phase fraction showed no statistically significant difference between the two groups. CONCLUSION: The progression rate from hydatidiform mole to malignant gestational trophoblastic tumor was significantly higher in patients over 40 years of age. Therefore, more aggressive therapeutic approach should be considered in such patients.

Three Cases of FDG-FET Scan Application in Patients with Metastatic Gestational Trophoblastic Tumor / 대한부인종양콜포스코피학회잡지

Positron emission tomography(PET) is an imaging technique that produces images reflective of tissue biochemistry rather anatomy. The great versatility of PET and its potential of direct noninvasive study of tumor function will make it a very important clinical and research tool in oncology. Recently, whole body PET techniques have been developed which permit imaging of the entire body during a single scanning session promising both in determining the nature of a localized lesion and in defining the systemic extent of malignant disease. FDG-PET scan seems valuable in evaluating patients with GTT resistant to chemotherapy with persistent elevation of beta-hCG levels and localizing the site of a viable tumor. We present three cases of FDG-PET scan in patients with metastatic gestational trophoblastic tumor with a brief review of literatures.

p53 and bcl-2 Gene Expression in Gastational Trophoblastic Disease / 대한암학회지

PURPOSE: p53 and bcl-2 expressions are known as important cell survival factors and their levels of expression are related with patients prognosis in various human malignancies. But there are few data about p53 and bcl-2 expression and their role in the genesis of gestational trophoblastic disease (GTD). The aims of this study are to describe p53 and bcl-2 expression in normal trophoblast and hydatidifonn mole (HM), and to identify the role of p53 and bcl-2 in the genesis of gestational trophoblastic tumor (GlTI from HM. MATERIALS AND METHODS: Paraffin-embedded tissue sections from 32 cases of HM and 9 cases of normal early pregnancy placentas were obtained. Of 32 HM patients, 15 cases were cured after molar evacuation (group A), and 17 cases progressed to GT1' (group B). p53 and bcl-2 immunohistochemical stainings were done and their reactivity were graded. The positive rates of p53 and bcl-2 overexpression among normal placenta, group A, and group B were compared and analyzed. RESULTS: p53 mutant gene overexpression was more frequently detected in HM (68%) than in normal placentas (22%)(p 0.05). The difference in bcl-2 and p53 expression between group A and group B was not observed (P>0.05). There was no inverse relationship between p53 and bcl-2 expression in group A, and group B (P>0.05). CONCLUSIONS: p53 gene mutation may play a mle in the process of HM development, but p53 and bcl-2 were not associated with the genesis of GTI' from H-mole. More studies are needed to identify the molecular process in the progression of the GTD.

Telomerase Activity in Gestational Trophoblastic Disease / 대한산부인과학회잡지

The purpose of this study was to evaluate the significance of telomerase activity in gestational trophoblastic disease and the association of telomerase activity in complete hydatidiform mole and subsequent development of persistent gestational trophoblastic tumor. By using the standard telomerase repeat assay, we examined telomerase activity in 2 normal placentas, 31 complete hydatidiform moles, 7 invasive moles, 5 choriocarcinoma tissues and choriocarcinoma cell line (JEG-3). Telomerase activity was detected in 13 of 15 (86.7%) complete hydatidiform mole patients who eventually had chemotherapy for the treatment of persistent gestational trophoblastic tumor. All of the 9 patients with metastatic disease (FIGO Stage III) had telomerase activity in their initial molar tissue. In contrast, telomerase activity was evident in only two of 16 (12.5%) complete hydatidiform mole patients with spontaneous remission. While telomerase activity was not detected in normal placentas, high level of telomerase activity was detected in all of 7 invasive moles, 5 choriocarcinoma tissues and choriocarcinoma cell line (JEG-3). The presence of telomerase activity in a complete hydatidiform mole is associated with the development of persistent gestational trophoblastic tumor, such as invasive mole and choriocarcinoma.

Clinical Significance of Zygosity as a Prognostic Factor in Complete Hydatidiform Mole / 대한산부인과학회잡지

To evaluate the possible correlation between the origin of complete hydatidiform mole(CHM) and subsequent persistent gestational trophoblastic tumor(GTT) after molar evacua-tion, we have studied genetic origin patterns against conventional clinical parameters -pati-ent's age, gestational age, uterine size for gestational age, serum beta-hCG levels before mol-ar evacuation- in 69 patients with CHM. In our study, each of large uterine size for gesta-tional age, serum beta-hCG levels before molar evacuation, and genetic origin of CHM had a prognostic significance of subsequent persistent GTT. However, each of gestational age and patient's age is not a good prognostic indicator for subsequent persistent GTT. Among the patients with persistent GTT, there are no differences in clinical parameters- patient's age, gestational age, tumor age(the interval between evacuation of CHM and initiation of chem-otherapy), serum beta-hCG levels before molar evacuation and before initiation of chemother-apy- according to the origin of CHM. There are no differences in the analysis of sex-chr-omosome and variable number tandem repeat sequence YNZ22 and APOB gene in the extr-acted DNA from frozen tissues and paraffin blocks and from EDTA treated peripheral blood and dried blood specimen on Wartman paper. It is suggested that analysis of sex-chromo-some and polymorphism of YNZ22 and APOB gene from the extracted DNA of paraffin bl-ock and dried blood specimen on Wartman paper is the valauble experiment to evaluate the origin and the classification of hydatidiform mole and seems to be the sensitive molecular genetic method in predicting subsequent persistent GTT.

Three Cases of Local Excision of Uterine Choriocarcinoma Lesion / 대한산부인과학회잡지

In treating young women for gestational trophoblastic tumor ( G.T.T. ), all efforts are made to preserve fertility and hysterectomy is avoided unless absolutely essential. However, in some cases the operation may be lifesaving. During the last 20 years among the 310 cases of G.T.T. treated at Il Sin Christian Hospital, there were 3 cases in which hysterectomy was avoided by the excision of a localized uterine lesion thus preserving fertility.

Clinical Profiles of Gestational Trophoblastic Tumor with High-Risk Site Metastases / 대한산부인과학회잡지

Gestational trophoblastic tumor(GTT) is one of the most curable malignancies, but metastatic GTT involving high-risk sites(brain, liver, kidney etc.) have been recognized as an adverse prognostic factor. Most centers have treated these patients using multiagent chemotherapy with radiotherapy and/or surgery, but there is still no consensus concerning the optimal treatment strategies. We present our clinical experience in GTT patients with high-risk sites metastases with review of the literatures. We retrospectively reviewed the records of GTT patients treated at the Seoul National University Hospital between 1980 and 1994, and identified 22 GTT patients with high-risk site metastases and analysed prognostic factors which influence the survival. The patients ranged in age from 19 to 57 years(mean, 32 years). All 22 patients had concurrent lung involvement and 15 patients with brain metastases presented with neurologic symptoms. There was 9 cases with metastases to brain only, 5 with metastases to liver only, 3 to metastases to brain and liver, and 5 cases with metastases to multiple sites respectively, All Patients received chemotherapy with MAC(methotrexate, actinomycin D, chlorambucil) or etopodside-based regimens, A radiotherapy to the whole brain was given to patients with brain metastases, and splenic artery embolization was done to control the bleeding from the spleen metastasis in on case. With the use of multimodal therapy, 66.7%(6/9) of patients with brain metastases only, and 60%(3/5) of patients with hepatic metastases only achieved one year survival. Overall l year survival rate was 54%. Patients with high-risk sites metastases did not exhibit any statistically significant relationship between known prognostic factors and survival. Unitl now, combination chemotherapy with adjuvant therapy is the standard treatment approach in GTT patients with high-risk site metastases. A search for more effective treatment modality in this group of patients should be continued.

Relationship between the prognosis and expression of estrogen receptor and progesterone receptor in gestational trophoblastic tumor / 西安交通大学学报(医学版)

Objective To explore the expression of estrogen receptor(ER) and progesterone receptor(PR) in gestational trophoblastic tumor(GTT) and their significance.Methods The expression of ER and PR in 34 cases of GTT was detected by immunohistochemical method;20 cases of normal villi and 30 cases of hydatiform mole served as controls.Results The positive expression rate of ER in normal villi,hydatiform mole and GTT was 85.00%,83.33% and 44.12%,respectively,and had positive correlation with the malignance degree of GTT.The positive expression rate of PR in normal villi,hydatiform mole and GTT was little.The expression of ER was closely related to these clinicopathological features of GTT(P