Persistent trophoblastic neoplasia in the broad ligament, a case report / The Health Sciences Journal

@#Gestational trophoblastic neoplasia (GTN), a malignancy arising from trophoblastic tissue of pregnancy, is an aggressive disease process with a high probability of metastasis if left untreated. This is a case report on metastatic invasive mole arising from a molar pregnancy. Four months after suction curettage, a mass was noted in the left broad ligament on exploratory laparotomy with intact uterine serosa. Clinical presentation, biochemical, and radiological parameters led to a diagnosis of persistent trophoblastic disease. Histopathological findings also confirmed the diagnosis. Prompt chemotherapy was given after removal of the left intraligamentary mass, and subsequent response to treatment was documented. We report a case demonstrating a different clinical presentation of invasive mole and its potential to metastasize to the broad ligament without uterine perforation or direct extension.

Prospective observation of early diagnosis and accurate diagnosis of invasive mole by transvaginal ultrasound / 中华医学超声杂志（电子版）

Objective To explore the characteristics of sonographic patterns of invasive mole (IM),observe specific ultrasonic signs and provide more evidences for early and precise diagnosis of IM.Methods Twenty patients diagnosed with IM at the PUMC Hospital from 2014 January to 2016 January were evaluated by transvaginal ultrasonography.These sonographic dynamic images were observed comprehensively and carefully in order to discover the early ultrasound characteristics and specific ultrasonic representations of IM.Results It was indicated by transvaginal ultrasonography that there were myometrial lesions in 4 patients with diameters less than 2.0 cm,performing as heteroechoic lesions in myometrium with obviously increased and disorder blood flow signals after the curettage of uterine cavity.Meanwhile,the myometrial lesions of 8 patients showed hydropic fluid-filled molar vesicles,representing swollen villi.Conclusions After the curettage of uterine cavity,presentations of the myometrial lesions with abnormally rich blood flow contribute to early diagnosis of IM.And the patterns of myometrial hydropic fluid-filled molar vesicles can play an important role in the accurate diagnosis of IM,and may distinguish it from choriocarcinoma.

Effects of prophylactic chemotherapy on outcomes and prognosis of patients older than 40 years with invasive mole / 中华妇产科杂志

Objective To discuss the effects of prophylactic chemotherapy on the outcomes and prognosis of invasive mole patients.Methods One hundred and fifteen invasive mole (IM) patients older than 40 years were registered in Peking Union Medical Collage Hospital.Eleven of them were treated with prophylactic chemotherapy before diagnosed as IM prophylactic chemotherapy group,while the other 104 cases received therapeutic chemotherapy after diagnosed as IM (non-prophylactic chemotherapy group).The general clinical data (including age,clinical stage,risk factor score),treatment,outcomes and relapse of patients were retrospectively compared between two groups.Results (1) The age of prophylactic chemotherapy group and non-prophylactic chemotherapy group were (47±5) versus (46±4) years old.Ratio of clinical stage Ⅰ-Ⅱ were 3/11 versus 29.8％ (31/104),clinical stage Ⅲ-Ⅳ were 8/11 versus 70.2％ (73/104).Ratio of risk factor score 0-6 were 11/11 versus 84.6％ (88/104),risk factor score ＞6 were 0 versus 15.4％(16/104).There were no significant statistical differences between two groups in age,clinical stage or risk factor score (all P＞0.05).(2) Treatment:the total chemotherapy courses between prophylactic chemotherapy group and non-prophylactic chemotherapy group (median 7 versus 5) were significantly different (Z=3.071,P=0.002).There were no significant statistical differences between two groups in the chemotherapy courses until negative conversion of β-hCG,consolidation chemotherapy courses,total therapeutic chemotherapy courses or ratio of hysterectomy (all P＞0.05).(3) Outcomes and relapse:between the prophylactic chemotherapy group and the non-prophylactic chemotherapy group,the complete remission rate were 11/11 versus 98.1％(102/104),the relapse rate were 0 versus 1.0％(1/102).There were no significant difference between the two groups in outcomes or relapse rate (P＞0.05).Conclusions Prophylactic chemotherapy does not substantially benefit the IM patients older than 40 years.Prophylactic chemotherapy may not significantly improve patients' prognosis,in which increased sample size is required in further study.

Giant invasive mole presenting as a cause of abdominopelvic mass in a perimenopausal woman: An unusual presentation of a rare pathology

Invasive mole is a benign gestational trophoblastic disease that arises from the myometrial invasion of any gestational event via direct extension through tissue or vascular structures. Invasive mole (and other gestational trophoblastic diseases) may present with life-threatening complications including uterine perforation, excessive bleeding, acute hemoperitoneum, and abdominal pain. We report a case of invasive mole presenting as abdominal distention in a 51-year-old perimenopausal woman (gravida 12, para 12, abortion 0). The patient was admitted to the gynecology clinic with a giant uterine mass filling the pelvic and abdominal cavity. To our knowledge, this is the first case in the literature of a gestational trophoblastic neoplasia presenting with uterine mass of 28 weeks' gestational size in this age group. Interestingly, complications such as uterine rupture or invasion of the adjacent structures (such as parametrial tissues or blood vessels) had not developed in our patient despite the considerable enlargement of the uterus.

CT diagnosis of invasive hydatidiform mole / 中华放射学杂志

Objective To investigate the CT features and the diagnostic value in invasive mole. Methods Eleven cases (age, 30 to 53 years, mean 40 years)with invasive mole proved by operation and pathology were studied, including 3 cases during peri menopausal period of eight months, ten months and twelve months respectively. All cases were scanned by CT and enhanced study was done. Results All cases showed enlargement of uterus of varying degrees. On CT, the density of uterine cavity was similar to that of water, intermingled with spotty patchy and hazzy circular isodense shadows. High density stripe like bleeding foci were found in 3 cases.The outline of uterine cavity was locally disrupted in all case and the muscle layer was thickened in 3 cases. On enhanced CT scan, the lesions in the uterine cavity appeared markedly hyperdense, just like “the crater” and the “mole sign” .The muscle layers at the site of disruption showed inhomogeneous enhancement after contrast injection. Conclusion The CT features of invasive mole are characteristic, with important diagnostic value, especially for those during peri menopausal period.