Double trouble in an ectopic pregnancy / Philippine Journal of Obstetrics and Gynecology

@#Gestational trophoblastic diseases are histologically different types of tumors originating from the placenta with an incidence of 0.2–5.8/1000 pregnancies. Ectopic pregnancy is the implantation of the fertilized ovum outside the uterine cavity, and a 0.64% incidence is reported. Ectopic cornual pregnancy and molar pregnancy are rare cases, and a combination of these two rare entities occurring simultaneously is even rare and very few cases have been reported in the literature. A cornual pregnancy refers to the implantation and development of a gestational sac in one of the upper and lateral portions of the uterus, whereas an interstitial pregnancy is a gestational sac that implants within the proximal, intramural portion of the fallopian tube that is enveloped by the myometrium. We present one of the rare combinations of molar pregnancy and cornual/interstitial ectopic pregnancy in a 30‑year‑old G3 P1 who presented with a triad of amenorrhea, vaginal bleeding, and abdominal pain. Laparotomy was done in view of an ultrasound which was suggestive of a well‑defined complex thick‑walled lesion of size 3.2 × 3.3 with a gestational sac and no cardiac activity in the right fallopian tube/adnexa suggesting tubal ectopic pregnancy. Beta‑human chorionic gonadotropin (β‑hCG) levels were done and noted to be as high as 9998 mIU/mL. Intraoperatively, a cornual ectopic pregnancy was found with no hemoperitoneum which was excised. Histopathology showed chorionic villi with variable size and hydropic change, myxoid stromal changes, and cistern formation with polar trophoblastic proliferation, based on which a diagnosis of molar pregnancy was made. Although ultrasonography and higher than usual serum β‑hCG levels are diagnostic of uterine molar pregnancy, they do not yield a proper diagnosis in ectopic molar pregnancy, hence, making it difficult to distinguish between an early ectopic molar pregnancy from a nontrophoblastic tubal pregnancy. The final diagnosis is usually made only after histopathology. A high degree of clinical suspicion of cornual pregnancy followed by histopathological examination of the products of conception is the standard for arriving at an appropriate diagnosis. Serial serum β‑hCG level follow‑up is recommended to rule out its malignant potential.

Association of ultrasound morphological features with serum β subunit human chorionic gonadotrophin and histopathology among sonologically diagnosed cases of gestational trophoblastic neoplasia in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Background@#Gestational trophoblastic neoplasia (GTN) presents as vascular mass of varying morphology on ultrasound and confirmed through quantitative serum β subunit human chorionic gonadotrophin (β‑hCG). In regions with limited access to β‑hCG, ultrasound plays a crucial role in the initial diagnosis for timely management.@*Objectives@#This study aimed to investigate the associations between ultrasound vascular morphologic features, serum β‑hCG levels, and histopathology in GTN cases.@*Methodology@#A cross‑sectional review was conducted on 113 cases with ultrasound impression of GTN over an 8‑year period. The patient data were extracted from case records, and ultrasound images were categorized based on the distinct features. Associations with β‑hCG levels and histopathology were analyzed using the Chi‑square test and Mann–Whitney U‑test. Statistical significance was set at P < 0.05.@*Results@#A significant association was observed between ultrasound category and serum β‑hCG (P < 0.0001). The compact and diffuse types were more prevalent with β‑hCG levels between 104 to <105 mIU/mL, while the lacunar type was common among patients with ≥105 mIU/mL. However, there was no significant association between ultrasound categories and mean β‑hCG levels. Regarding histopathology, the lacunar type was more common in invasive moles, whereas the compact and diffuse types tended to be seen with choriocarcinoma, although these were not statistically significant (P = 0.182).@*Conclusions@#Morphologic types of GTN by gray scale and Doppler ultrasound vary across the different levels of serum β‑hCG and may suggest the histopathological diagnosis. This study provides valuable insights into the ultrasonographic characteristics of GTN, which can aid in its diagnosis and management.

Comparison of beta‑human chorionic gonadotropin‑based prognostic models on the clinical outcomes of gestational trophoblastic disease patients in the Philippines / Philippine Journal of Obstetrics and Gynecology

Objective@#Despite the widespread use and measurement of beta‑human chorionic gonadotropin (β‑HCG) among hydatidiform mole (HM) patients, models derived from this biomarker to predict the remission or postmolar gestational trophoblastic neoplasia (GTN) rarely perform well. The study aimed to generate cutoff points for postevacuation β‑HCG levels and evaluate their performance among women with complete molar pregnancies@*Methods@#A retrospective cohort study composed of women with complete HM underwent bivariate procedures comparing characteristics between the comparison groups. Cut points using Liu’s and Youden’s indices were estimated, and their performance was evaluated using receiver operating characteristic curve analysis. Cox regression to compare time‑to‑progression across these proposed β‑HCG cutoffs was also performed.@*Results@#The incidence of postmolar GTN among the 155 women in the study was 15.5% (95% confidence interval: 10.2%–22.2%). Postevacuation HCG levels had a better prediction of disease status than preevacuation and HCG ratio models (χ2 : 163.07, P < 0.01). A cutoff at 508 mIU/mL the 3rd‑week postevacuation (area under the curve [AUC]: 0.89, sensitivity: 87.5%, specificity: 90.1%) was comparable with the 185 mIU/mL cutoff at the 5th‑week postevacuation (AUC: 0.89, sensitivity: 91.7%, specificity: 87%). The hazards ratio of postmolar GTN was 29.74 (8.53–103.71) and 39.89 (8.82–180.38) for the 3rd and 5th weeks HCG after evacuation adjusting for clinically relevant variables@*Conclusion@#The first 3rd‑ and 5th‑week postevacuation levels of β‑HCG demonstrated potential in predicting postmolar GTN. However, further refinement and adjustment for clinically relevant risk factors are still needed.

Beta-human chorionic Gonadotropin levels as early predictor for progression to Gestational Trophoblastic Neoplasia after molar pregnancy evacuation at a Philippine tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Objective@#This study aimed to determine if the beta-human chorionic gonadotropin (hCG) levels during the first 5 weeks after a molar evacuation predict progression to gestational trophoblastic neoplasia (GTN).@*Materials and Methods@#This was a retrospective cohort study of complete mole cases managed at a Philippine tertiary hospital from January 2009 to December 2018. Extracted data were analyzed using applicable statistical tools. The level of significance was set at a P < 0.05 using two-tailed comparisons. @*Results@#One hundred and fifty-five complete patient records were available for review. Disease progression in 15.48% of cases while regression in 84.52% were noted. Uterine size was larger in those who eventually had postmolar GTN (t: −3.12, df: 32.64, P: 0.01). Analysis of the receiver operating characteristic curve showed that optimum cut-off levels for predicting GTN at 1, 3, and 5 weeks after evacuation were 4,152 mIU/ml (sensitivity: 50%, specificity: 94.7%, area under the curve [AUC]: 0.75), 804 mIU/ml (sensitivity: 62.5, specificity: 96.9%, AUC: 0.94), and 541 mIU/ml (70.8%, specificity: 97.7%, AUC: 0.96), respectively. @*Conclusion@#The level of hCG within the first 5 weeks after molar pregnancy evacuation is predictive of progression to GTN.

The Spectrum of Clinical Presentations of Gestational Trophoblastic Disease from a Tertiary Care Center

Introduction: Gestational trophoblastic disease (GTD) is a disease of pregnancy and therefore a disease of women. GTDcomprises the heterogeneous group of related lesions arising from abnormal proliferation of trophoblast of the placenta witha spectrum of disorders ranging from benign to malignant disease. The malignant form of GTD collectively called gestationaltrophoblastic neoplasia (GTN).Aim: The aim of this study was to analyze the clinical characteristics, outcomes, and factors affecting response to treatment.Materials and Methods: We undertook a retrospective review of GTD cases treated at our center from 2017 to 2019, inwhich patients demographic profile and clinical information were identified including age, gravidity, symptoms, gestational age,consanguinity, pathologic diagnosis, investigations, treatment, and follow-up data, and subsequently, statistical analysis was done.Results: During the 3-year period, 78 cases of GTD were reviewed. Complete and partial molar pregnancies were diagnosed in49 (68%) and 29 (32%) cases, respectively. According to the International Federation of Gynecology and Obstetrics anatomicalstaging, the most GTN patients were assessed as Stage I and Stage III, at 80.0% and 11.4%, respectively. Post-molar GTNdeveloped more frequently in women who had a pathologic diagnosis of complete mole, uterus larger than 14-week size, andpretreatment human chorionic gonadotropin levels more than 150,000 mIU/mL. Our study demonstrated a superior responseto single-agent actinomycin D (90%). The overall cure rate at our center approached 96% during the study period.Conclusion: GTD results in significant maternal morbidity, which leads to mortality if not detected early. The patients shouldbe risk stratified for proper management and referred to experienced centers that have capabilities for adequate supportivecare and consequent treatment.

A Study on the Clinicopathological, Molecular (Beta-hCG), Sonological Study, and Correlation in Breast Diseases

Introduction: Breast is important organ of female as a symbol of womanhood and fertility. This study is done to know utility ofultrasonography in identifying breast diseases as mammography not routinely available in all treating centres. Role of BetahCGin breast diseases.Materials and Methods: This is a prospective observational study consisting of 112 patients with breast diseases plannedfor surgical management from June 2016 to June 2018 and a cyto-sono-histopathological correlation done. Pre-operativeevaluation included history, clinical examination, ultrasonography (USG) breast, serum beta-human chorionic gonadotropin(hCG), and post-operative histopathology.Results: The most common benign lesion was fibroadenoma (62 cases) followed by gynecomastia disease – 5 cases (7.33%).The most common malignant lesion reported in the study was invasive ductal carcinoma – 53 cases. In this study, sensitivityand specificity of breast fine-needle aspiration cytology (FNAC) were 87.5% and 100%, respectively. The diagnostic accuracy ofFNAC in our study was reported to be 96.5%. Sensitivity and specificity of breast USG were 84.8.5% and 96.5%, respectively.The diagnostic accuracy of USG in our study was reported to be 93.3%. In our study, a 98.9% cyto-histopathological correlationwas observed for benign lesions and 100% for cases suspicious of malignancy. A cyto-histopathological correlation was 100%.Conclusion: Study concludes that sonography should be the first investigation to be done after the clinical examination becauseif USG says the disease is benign then the patient can be assured without any invasive procedure, i.e., FNAC and biopsy. IfUSG says abnormality then the patient should go for an invasive procedure. As far as for early definitive diagnosis, FNAC issuperior to Sonology. Serum beta-hCG has no correlation with breast diseases.

Successful live birth after heterotopic ruptured cornual pregnancy with twin intrauterine gestation in an in vitro fertilization conception

Heterotopic pregnancies, especially in the cornual region which were a rarity till recent times, have become a more common occurrence due to increasing practice of assisted reproduction. Optimal management of such cases is imperative to manage the risk of hypotension and shock in case of rupture and to judiciously preserve the intrauterine pregnancy. Here we are reporting a case of IVF conception of twin intrauterine pregnancy with a cornual heterotopic pregnancy. Patient presented to the emergency department with features of acute abdomen, haemoperitoneum and shock. Ultrasound findings were suggestive of rupture of cornual heterotopic pregnancy, 1500 ml haemoperitoneum with live twin intrauterine gestation. Patient was resuscitated with iv fluids blood transfusion. Immediate laparotomy was done and cornual site repaired and covered with an omental patch while preserving the intrauterine gestations. Thereafter, pregnancy was carefully monitored with a high index of suspicion for rupture of site of cornual repair with advancing gestational age. Patient was readmitted at 24 weeks with pain abdomen and cornual site was found to be 4mm in thickness. She was managed conservatively till 27 weeks when she had preterm rupture of membranes and emergency LSCS was done. She delivered healthy twin male babies, 780 gmb and 795 gm respectively. This case demonstrates that cornual heterotopic pregnancy is a diagnosis which may be easily missed and can present as a life-threatening complication if it ruptures and significant intraperitoneal bleeding occurs. However, it is possible to successfully manage these cases with timely intervention, proper uterine reconstruction and monitoring of intrauterine gestation.

Emergency irradiation with 3.4 Gy/2f in sellar/suprasellar germinoma patients with rapid visual acuity decline / 中华医学杂志(英文版)

Background@#Rapid visual acuity (VA) decline was a common complaint in patients with sellar/suprasellar germinoma. In our hospital, 3.4 Gy/2f of emergency irradiation was applied to save patient VA and enable subsequent chemoradiotherapy. This study aimed to investigate the efficacy of emergency irradiation with 3.4 Gy/2f in patients with sellar/suprasellar germinoma who had rapid VA decline.@*Methods@#From January 2014 to December 2017, 33 patients with sellar/suprasellar germinoma who complained of VA decline within 3 months received 3.4 Gy/2f of emergency irradiation in Beijing Tiantan Hospital. The best-corrected VA (BCVA) and mean deviation (MD) were measured. Correlations between visual function change and clinical factors, including age at diagnosis, duration of VA decline, extent of tumor regression, serum level of tumor markers, were analyzed.@*Results@#Among 33 patients with sellar/suprasellar germinoma, the median diameter and volume of sellar/suprasellar lesions were 32 mm (range: 5–55 mm) and 12.9 cm3 (range 0.6–58.5 cm3), respectively. Data on pre- and post-emergency-irradiation BCVA were obtained in 32 patients. For the right eyes, BCVA was improved in 23 patients (71.9%), unchanged in 7 (21.9%), and worsened in 2 (6.2%); and for the left eyes, these numbers were 27 (84.4%), 4 (12.5%), and 1 (3.1%), respectively. In terms of the logarithm of the minimum angle of resolution (logarithm of the minimum angle of resolution = Log (1/BCVA) score, the improvement was significant in both eyes (P < 0.001). In terms of MD, six patients had paired data and the improvement was marginal in the right eyes (P = 0.068) and significant in the left eyes (P = 0.043). However, no clinical factor was found to have correlation with visual function improvement.@*Conclusion@#In sellar/suprasellar germinoma patients with VA decline, 3.4 Gy/2f of emergency irradiation was effective in improving visual function.

Multivariate analysis of laparoscopic conservative surgery for persistent ectopic pregnancy after tubal pregnancy / 中国综合临床

Objective To investigate the influencing factors of persistent ectopic pregnancy (PEP) after laparoscopic conservative surgery for tubal pregnancy.Methods Three hundred and one cases of tubal pregnancy treated by laparoscopic conservative surgery in Jizhong energy Fengfeng Group Hospital from October 2007 to October 2017 were divided into PEP group ( 21 cases) and non PEP group ( 280 cases) according to whether PEP occurred after operation.The age,menopause time and preoperative serum of the two groups were analyzed.The levels of beta?human chorionic gonadotropin (beta?hCG),surgical methods, corpus luteum exfoliation, methotrexate and mass diameter were analyzed.Logistic regression was used to analyze the multiple factors.Results There was no significant difference in age between the two groups.There were significant differences in the time of menopause, preoperative serum beta?hCG level, operative methods,corpus luteum exfoliation, methotrexate application and mass diameter between the two groups (P＜0.05 or P＜0.01).Multivariate logistic regression analysis showed that short menopause time, high preoperative serum beta?hCG concentration, sac extrusion at the umbrella end of fallopian tube, no corpus luteum exfoliation, no intraoperative methotrexate and small mass diameter were risk factors for persistent ectopic pregnancy (OR(95%CI) were 1.476 ( 1.035～3.961),1.513 (1.391～3.017),5.301 (1.304～19.570),1.104 (1.015～2.769),1.180 (1.020～2.543),1.540 (1.181～5.120),respectively, all P＜0.05).Conclusion PEP is prone to occur in patients with tubal pregnancy treated by laparoscopic conservative surgery,such as short menopause time,small size of mass,high preoperative serum beta?hCG concentration,no corpus luteum exfoliation,no local methotrexate and umbrella sac extrusion.Therefore,the key measures to reduce the occurrence of PEP in clinic are to choose the right operation time,appropriate operation method,corpus luteum exfoliation and local injection of methotrexate.

Teratoma tímico productor de beta-HCG: una causa infrecuente de pubertad precoz periférica / Beta-hCG-producing thymic teratoma: an uncommon cause of peripheral precocious puberty

INTRODUCCIÓN: Entre las causas de pubertad precoz periférica en el varón están los tumores secretores de betagonadotrofina coriónica humana (Β-HCG), como hepatoblastomas, disgerminomas, corio-carcinomas y teratomas inmaduros. En pediatría los teratomas mediastínicos son raros, representan el 7-10% de los teratomas extragonadales. OBJETIVO: Describir caso de un paciente que cursa con pubertad precoz periférica debida a teratoma tímico secretor de Β-HCG. CASO CLÍNICO: Escolar masculino de 7 años 10 meses consultó por cuadro de 3 meses de cambios de la voz, ginecomastia, aparición de vello pubiano y aumento de volumen genital. En exámenes destacaba edad ósea de 9 años, testosterona total 9,33ng/ml (< 0,4ng/ml), dehidroepiandrosterona sulfato (DHEAS), 17-hidroxi-progesterona (17-OH-P) y prueba de hormona adrenocorticotrofina (ACTH) normales, hormona luteinizante (LH) y hormona folículo estimulante (FSH) basales bajas, Β-HCG 39,5mU/ml (< 2,5 mUI/ml), alfa fetoproteína (α-FP) 11,2ng/ml (0,6-2,0 ng/ml). Estudio de imágenes para determinar origen de secreción de Β-HCG incluye: ecografía testicular y tomografla axial computarizada (TAC) torácica, abdominal y pelviana normales; resonancia cerebral y selar sin hallazgos significativos. Tomografía por emisión de positrones/tomografía computada (PET SCAN) evidenció imagen de tumor en mediastino antero-superior. Se resecó el tumor, cuya biopsia evidenció teratoma quístico inmaduro en timo. Evolución postoperatoria fue satisfactoria, con normalización de niveles hormonales. CONCLUSIÓN: La presentación de un teratoma en paciente pediátrico es infrecuente, aún más, si es inmaduro, su localización es tímica y es secretor de Β-HCG. Es relevante considerarlo dentro de diagnósticos diferenciales frente a pubertad precoz, de modo que pueda efectuarse un manejo oportuno.

INTRODUCTION: Among the causes of peripheral precocious puberty in men are the beta- human cho rionic gonadotropin (Β-HCG)-secreting tumors, such as hepatoblastomas, dysgerminomas, chorio carcinomas, and immature teratomas. In pediatrics, the mediastinal teratomas are rare, representing the 7-10% of extragonadal teratomas. OBJECTIVE: To describe the case of a patient with peripheral precocious puberty due to a Β-HCG -secreting thymic teratoma. CLINICAL CASE: A seven-years-old schoolboy presents a three-months history of voice changes, gynecomastia, pubic hair appearance, and increased genital volume. In the exams, bone age of nine years, total testosterone 9.33ng/ml (< 0.4ng/ml), dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone (17-OHP), and normal adrenocorticotropic hormone (ACTH) test stand out; luteinizing hormone (LH) and follicle stimulating hormone (FSH) with low basal levels, P-HCG 39.5mU/ml (< 2.5 mUI/ml), alpha feto protein (Α-FP) 11,2ng/ml (0.6-2.0 ng/ml). Imaging study to determine the origin of P-HCG secretion shows normal testicular ultrasound and thoracic, abdominal, and pelvic computerized axial tomo graphy (CAT); brain and sellar resonance without significant findings. The positron emission tomography/computed scan (PET SCAN) shows a tumor image in the anterosuperior mediastinum. The tumor is resected, and the biopsy shows an immature cystic teratoma in the thymus. Post-operatory evolution was satisfactory, with normalization of hormonal levels. CONCLUSION: The appearance of a teratoma in a pediatric patient is rare, even more if it is immature, with thymic location and Β-HCG- secretor. It is important to consider it within the differential diagnosis facing precocious puberty, as a better way to handle appropriately.

Extrauterine epithelioid trophoblastic tumor in hysterectomized woman

Epithelioid trophoblastic tumor (ETT) is a very rare variant of gestational trophoblastic disease (GTD) which arises in reproductive age women with prior gestational history. Although abnormal vaginal bleeding is the most common symptom of ETT, there are no reported pathognomonic symptoms of ETT because of its rarity. ETT is similar to placental site trophoblastic tumor in terms of its slow growing characteristic and microscopic findings. Therefore, it could be misdiagnosed as placental site trophoblastic tumor or other types of GTD. Unlike other types of GTD, primary treatment of ETT is surgical resection because of its chemo-resistant nature. Accordingly, immunohistochemical staining is essential for accurate diagnosis and appropriate treatment. Here, we report a case of a 42-year-old hysterectomized woman with pelvic masses who suffered from abdominal pain. Through laparotomy, tumors were resected completely and they were diagnosed as ETT through immunohistochemical stain. This report provides more evidence about its clinical features, diagnosis, and treatment including a brief review of the literature.

Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin: Embolization of both uterine arteries and extra-uterine feeding arteries

The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.

Concomitant ultrasound-guided intra-gestational sac methotrexate-potassium chloride and systemic methotrexate injection in the recurrent cesarean scar pregnancy

Recurrent ectopic pregnancy of cesarean scar is very rare and its therapeutic management is still not established. We reported the first case of recurrent cesarean scar pregnancy that was successfully treated with concomitant intra-gestational sac methotrexate-potassium chloride injection and systemic methotrexate injection. This case study provides physicians with a safe and effective minimally invasive treatment option for recurrent cesarean scar pregnancy.

Study on combined detection of serum β-HCG, estradiol, progesterone and antiphospholipid antibodies in predicting the outcome of threatened abortion in early pregnancy / 中国基层医药

Objective To explore the clinical value of combined detection of serum beta human chorionic gonadotropin (β-hCG),estradiol (E2),progesterone (P) and antiphospholipid antibodies (ACA) in predicting the outcomes of early threatened abortion.Methods 80 pregnant women were chosen from six to eight weeks singleton pregnancies,50 cases of threatened abortion and 30 cases of normal pregnancy.The serum levels of β-HCG,estradiol,progesterone and ACA-IgG,ACA-IgM and ACA-IgA were detected.The threatened abortion patients were given intramuscular progesterone 20 mg/day/time for 1 week,then,the pregnancy outcomes were analyzed and the serum levels of β-HCG,estradiol and progesterone were explored.Results The serum β-HCG,estradiol and progesterone of the threatened abortion group [(5 140.77 ± 2 365.47) IU/L,(680.28 ± 306.06) pg/mL,(15.59 ± 3.65) pg/L]were lower than those of the normal pregnant women [(14 520.4 ± 11 016.24) IU/L,(1 142.81 ± 670.57) pg/mL,(27.6 ± 4.78) pg/L] (t =3.224,P =0.003 ; t =2.43,P =0.022 ; t =7.72,P =0.001).According to pregnancy outcome,patients with threatened miscarriages were divided into the two groups,including 45 patients with continuing pregnancies and 5 patients with inevitable miscarriages.The serum levels of β-HCG,estradiol and progesterone in ongoing pregnancies group [(10 829.42 ± 6 926.28) IU/L,(832.9 ± 397.91) pg/mL,(25.62 ± 4.51) pg/L] were higher than those in inevitable miscarriages [(6 310.14 ± 2 593.19) IU/L,(487.14 ± 275.47) pg/mL,(13.6 ±4.84) pg/L] (P ＜ 0.05) ;The serum levels of ACA-IgG,ACA-IgM and ACA-IgA in 80 cases tested,only 2 cases who appeared in the threatened abortion group were detected with the positive of serum ACA-IgG,accounted for 4％ (2/50) (x2 =68.05,P =0.000),occurred spontaneous abortion in the end.Conclusion Combined detection of serum ACA,β-HCG,estradiol and progesterone may be helpful for prognosis of threatened abortion.However,the clinical predictive value of ACA needs further study in the early threatened abortion.

A Case of Primary Choriocarcinoma of the Lung / 결핵및호흡기질환

A primary choriocarcinoma of the lung is extremely rare, and difficult to distinguish from a metastatic choriocarcinoma considering that the lung is also one of the most frequent sites of metastasis. We report a 28-year-old woman patient who was initially misdiagnosed with an ectopic pregnancy and was operated on under the impression of an unidentified malignancy of the lung, which was finally proven to be a choriocarcinoma of the lung. A pelvic examination by a gynecologist, pelvic magnetic resonance imaging and whole body fluorodeoxyglucose positron emission tomography-computed tomography was performed in order to rule out a metastatic choriocarcinoma of the lung. After a curative operation, her serum beta-human chorionic gonadotropin (HCG) level, which was highly elevated in the initial evaluation, had decreased dramatically to the normal range. She is currently being followed up regularly without any evidence of recurrence or elevation of her beta-HCG level.

The Predictive Value of a Single Serum Beta Human Chorionic Gonadotropin Level in Pregnancies Achieved by Intrauterine Insemination and In Vitro Fertilization-Embryo Transfer Program / 대한산부인과학회잡지

OBJECTIVE: To clarify specific serum beta-human chorionic gonadotropin (beta-hCG) levels on 11 days after intrauterine insemination (IUI) and in vitro fertilization-embryo transfer (IVF-ET) that could predict live birth. METHODS: Three hundred ninety-two pregnancies resulting from IUI and IVF-ET procedures between January 1, 1997 and December 31, 2000 were evaluated. Serum quantitative beta-hCG levels were measured 11 days after IUI or ET using standard immunoradiometric assays. Pregnancy outcomes were categorized as spontaneous abortion, biochemical pregnancy, ectopic pregnancy, singleton live birth, or multiple live birth. Statistical analyses were performed by analysis of variances, and Student's t-test. The sensitivity and specificity of serum beta-hCG level for predicting live birth were plotted using receiver-operator-characteristic (ROC) curve. RESULTS: The multiple live birth group has significantly higher serum beta-hCG level among the different pregnancy outcome groups. The beta-hCG level on the eleventh day after IUI and IVF-ET was significantly higher in the live birth group than the non viable pregnancy group. At a threshold level of 65 mIU/ml, the serum beta-hCG level on the eleventh day after IUI had a positive predictive value of 78.9% in predicting live birth with 95% specificity. At a threshold level of 115 mIU/ml, the serum beta human chorionic gonadotropin level on the eleventh day after ET had a positive predictive value of 92.1% with 95% specificity. CONCLUSION: These data suggest that serum beta-hCG level on 11 days after IVF-ET could be a reliable indicator predicting pregnancy outcome.

The association between unexplained elevation of second trimester maternal serum beta-hCG and pregnancy outcomes / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine whether unexplained elevation of second-trimester maternal serum beta-human chorionic gonadotropin (beta-hCG) is associated with adverse pregnancy outcomes. METHOD: Between January 1998 and December 1999, we evaluated 2112 pregnant women undergoing second trimester triple marker screening test who delivered at our hospital. Inclusion criteria were singleton pregnancy, confirmed gestational age, and hCG level greater than 2.0 MoM. The exclusion criteria were fetal anomaly, abnormal karyotype, MSAFP level greater than 2.0 MoM, uE3 level less than 0.4 MoM, and referred patients with pregnancy-induced hypertension (PIH). A group of randomly selected women with normal maternal serum hCG and AFP levels served as control. RESULTS: Women with unexplained elevation of hCG level showed increased risks for PIH (p<0.001) and preterm delivery (p<0.003). There were no significant diffrences between study and control groups with respect to placental abruption, fetal distress, PROM, intrauterine fetal death, and apgar score. CONCLUSION: Pregnancies with unexplained elevation of hCG levels should be regarded as high-risk pregnancies and managed accordingly. The combination with these biomarkers such as VEGF, plasminogen activating factor I and AT-III as a screening test for PIH may be useful.