O papel da ultrassonografia na doença trofoblástica gestacional / The role of ultrasonography in gestational trophoblastic disease

A doença trofoblástica gestacional (DTG) agrupa um conjunto de anomalias do desenvolvimento trofoblástico, que incluem formas clínicas benignas como a mola hidatiforme completa e parcial, o nódulo do sítio placentário atípico e o sítio trofoblástico exagerado, e malignas, caracterizando a neoplasia trofoblástica gestacional (NTG). De modo geral, seu diagnóstico precoce antecipa complicações clínicas que podem estar associadas a near miss obstétrico. Diante da suspeição clínica, é a ultrassonografia (US) precoce o exame de escolha pa ra o diagnóstico, associado à dosagem sérica de gonadotrofina coriônica humana, capaz de minimizar a ocorrência de complicações clínicas associadas à gravidez molar. Nos casos de NTG, é a US também de grande valia para estadiamento, avaliação de prognóstico e acompanhamento da mulher tratada para DTG. Este estudo faz uma revisão sobre o papel da US na DTG, sendo importante para familiarizar os tocoginecologistas com essa doença e salientar o papel da US consoante as melhores práticas clínicas.(AU)

Gestational trophoblastic disease (GTD) includes a set of trophoblastic developmental anomalies, which include benign forms such as complete and partial hydatidiform mole, atypical placental site nodule and exaggerated trophoblastic site, and malignant forms, characterizing gestational trophoblastic neoplasia (GTN). In general, its early diagnosis anticipates clinical complications that could be associated with obstetric near miss. In view of clinical suspicion, early ultrasonography (US) and serum levels of human chorionic gonadotropin are the best diagnostic screening techniques, able to minimizing the occurrence of medical complications associated with molar pregnancy. In cases of GTN, US is also of great value for staging, assessment of prognosis and follow-up of women treated for GTN. This study reviews the role of US in GTD, being important to familiarize tocogynecologists with this disease and highlight the role of US according to best clinical practices to minimize the morbidity of these patients and maximize the remission rates of this disease.(AU)

Doença trofoblástica gestacional: correlação ßhCG sérico quantitativo, ultrassonografia e anatomopatologia em serviço de obstetrícia do Ceará / Gestational trophoblastic disease: ßhCG quantitative serum correlation, ultrasonography and pathology in obstetrics service in Ceará

Doença trofoblástica gestacional (DTG) é uma anomalia que engloba formas clínicas benignas (mola hidatiforme completa e parcial) e malignas (mola invasora, coriocarcinoma, tumor trofoblástico do sítio placentário e tumor trofoblástico epitelioide). O objetivo deste estudo é realizar levantamento epidemiológico retrospectivo de prontuários de 40 pacientes internadas entre abril de 2014 e fevereiro de 2016 com hipótese diagnóstica de DTG atendidas no Hospital Regional Norte/ Centro de Apoio à Saúde Reprodutiva da Mulher em Sobral, no Ceará, traçando o perfil de cada paciente (idade, paridade), além de fazer correlação dos parâmetros clínicos, laboratoriais e anatomopatológico. Entre as pacientes que obtiveram o diagnóstico de DTG, observou-se que em torno de 93,33% possuíam exame ultrassonográfico evidenciando possível mola hidatiforme; o anatomopatológico confirmou doença trofoblástica em aproximadamente 52,5% da população estudada. Este estudo é inédito, por ser o primeiro a realizar um levantamento de dados em pacientes com DTG na cidade de Sobral.(AU)

Gestational trophoblastic disease (GTD) is an anomaly that encompasses benign clinical forms (complete and partial hydatidiform mole) and malignant (invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor). The objective of this study was to carry out a retrospective epidemiological survey of medical records of 40 hospitalized patients between April 2014 and February 2016 with diagnostic hypothesis of GTD attended at the Regional Hospital Norte/Center for Support to Women's Reproductive Health in Sobral, Ceará, drawing the profile of each patient (age, parity), in addition to correlating the clinical, laboratory and anatomopathological parameters. Among the patients who had the diagnosis of GTD, it was observed that about 93.33% had ultrasonographic examination evidencing a possible hydatidiform mole; the anatomopathological confirmed trophoblastic disease in about 52.5% of the study population. This study is unprecedented because it is the first to perform a data collection in patients with GTD in the city of Sobral.(AU)

Enfermedad trofoblastica gestacional / Gestational trophoblastic disease

Resumen La enfermedad trofoblástica gestacional engloba un conjunto de patologías con potencial maligno y neoplásicas propiamente, las cuales pueden ser adquiridas tras la gestación. Aunque estos tumores abarcan menos del 1% de los tumores ginecológicos, representan una amenaza para la vida de las mujeres en edad reproductiva. Es importante que los médicos comprendan su etiología, evolución natural y manejo, debido a su alto potencial de curación con la posibilidad de preservar la función reproductiva si se diagnostica a tiempo y se trata adecuadamente según sus criterios de riesgo y pronóstico.

Abstract The gestational trophoblastic disease englobes a set of neoplastic pathologies and pathologies with malignant potential, which can be acquired after gestation. Even though these tumors include less than 1% of gynecological tumors, they represent a threat to the life of women in reproductive age. It is important that physicians understand its etiology, natural evolution and control. If it is diagnosed on time and treated appropriately according to its risk and prognosis criteria, there's a high healing potential including the ability of preserving reproductive function.

Caso Clínico: Mola Hidatiforme Parcial. Resolución Obstétrica / Case Report: Partial Hydatiform Mole Obstetric Resolution

INTRODUCCIÓN: La mola hidatiforme parcial es una enfermedad del tejido trofoblástico que se caracteriza por presentar sobrecrecimiento del mismo, con feto presente, sus manifestaciones tanto clínicas como de laboratorio indican que puede transformarse en tumor de características malignas. CASO CLÍNICO: Paciente de 28 años de edad de 17.1 Semanas de Gestación (SG) por fecha de última menstruación (FUM), con presencia de sangrado rojo rutilante hace 9 horas, vómitos postprandiales durante todo embarazo, niveles de hormona gonadotropina coriónica fracción B (BHCG) 90000 mUI/ml, ecografía que reporta placenta multiquística en patrón de racimo de uvas con presencia de feto vivo. EVOLUCIÓN: Paciente es sometida a un aborto terapéutico modo parto y legrado, presenta un valor de BHCG 25000 mUI/ml, se realiza evaluación periódica de BHCG, a los 15 días después del procedimiento presenta un nivel de BHCG de 470 mUI/ml, al mes presenta un valor de BHCG de 183 mUI/ml. Se optó por administrar manejo anticonceptivo mediante Drospirenona + Etinilestradiol mínimo por 6 meses, al segundo mes de BHCG disminuye a 86 mUI/ml, ecografía de control con reporte normal, a los 4 meses el valor de BHCG reportado es < 1 mUI/ml por lo cual oncología decide el alta médica definitiva. CONCLUSIONES: Según datos bibliográficos la presentación de la enfermedad es muy similar a la del caso expuesto, siendo una rara afección del tejido trofoblástico, que mediante un pronto diagnóstico y manejo, tuvo un desenlace y evolución favorable, llegando a una resolución completa de la enfermedad. (au)

BACKGROUND: The partial hydatidmole is a disease oftrophoblastic tissue characterized by trophoblastic overgrowth with a fetus present, both clinical and laboratory manifestations that indicate being able to transforminto a tumor ofmalignant characteristics. CASE REPORT A 28-year-old patient 17.1 gestation weeks, with red bleeding 9 hours ago, postprandial vomiting throughout pregnancy, BHCG 90000mUI/ml levels, ultrasound thatreports amulticystic placenta in the formof a honeycomb of bees with presence of vivid fetus. EVOLUTION: Patientis submitted to therapeutic abortion in themode of delivery and curettage presents a BHCG value of 25000 mUI/ml, a periodic evaluation of BHCG is performed, 15 days after the procedure has aBHCGlevel of 470mUI/ml, amonthlyBHCGvalue of 183 , it was decided to administer contraceptive management by means of Drospirenona + Etinilestradiol minimum for 6 months, the second month of BHCG decreases to 86 mUI/ml, control ultrasound with normal report, at 4 months the value of BHCG reported is < 1mUI/ml for which oncology decides high definitivemedical. CONCLUSIONS: According to bibliographical data the presentation of the disease is very similar to that of the exposed case, being a rare affection of the trophoblastic tissue, which through a prompt diagnosis and management had a favorable outcome and evolution, reaching a complete resolution ofthe disease.(au)

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.

Embarazo gemelar bicorial, uno con mola completa y el otro con feto vivo con displasia septo-óptica / Bichorial twin pregnancy with one mole complete and the other with alive fetus with septo-optic dysplasia

La gestación gemelar bicorial uno con transformación molar completa y el otro con feto vivo, es un caso extremadamente raro. Se presenta el caso de una paciente de sexo femenino de 24 años de edad, derivada de consulta particular con Diagnostico de Mola Parcial con feto vivo de 16 semanas. Los nuevos estudios determinan que se trata de embarazo gemelar bicorial uno con mola completa y el otro con feto vivo Displasia Septo-óptica. Se realizó cariotipo por amniocentesis a las 16 semanas cuyo resultado informa: feto Masculino 46 XY. Se determinó realizar control estricto del embarazo. A las 32 semanas de gestación, la paciente presenta rotura prematura de membranas; se concluye el embarazo tras la maduración pulmonar, obteniéndose recién nacido peso 1350 grs, APGAR 8 -9. La paciente tuvo evolución favorable y alta médica con controles y seguimiento por consulta externa, sin datos clínicos o bioquímicos de persistencia o recurrencia. El estudio de imágenes posnatal del neonato confirma el diagnóstico prenatal. El niño cursa actualmente con 23 meses de vida, fenotípicamente normal, no demostrándose alteraciones psicomotrices hasta el momento.

Bichorial twin pregnancy with one molar transformation and the other with alive fetus is an extremely rare case. The case of a female patient of 24 years, derived from private practice with a diagnosis of Partial Mola with alive fetus 16 weeks. A new study finds that pregnancy is bichorial twin pregnancy with complete mole and alive fetus with Septo-optict dysplasia. The genetic diagnosis was made by amniocentesis informing: karyotype 46, XY male fetus. It was decided to carry out strict control of pregnancy. At 32 weeks gestation, the patient has spontaneous rupture of the fetal membranes. Pregnancy is concluded after administration of corticosteroids to induce pulmonary maduration; obtaining newborn with 1350 grs at birth, the APGAR score was 8 - 9. The patient had a favorable evolution, without clinical or biochemical evidence of recurrence or persistence. Postnatal study confirms prenatal diagnosis The infant has at the moment 23 months of life, not demonstrating psychomotor disturbances.

Hypotensive Response Magnitude and Duration in Hypertensives: Continuous and Interval Exercise / Magnitude e Duração da Resposta Hipotensora em Hipertensos: Exercício Contínuo e Intervalado

Background: Although exercise training is known to promote post-exercise hypotension, there is currently no consistent argument about the effects of manipulating its various components (intensity, duration, rest periods, types of exercise, training methods) on the magnitude and duration of hypotensive response. Objective: To compare the effect of continuous and interval exercises on hypotensive response magnitude and duration in hypertensive patients by using ambulatory blood pressure monitoring (ABPM). Methods: The sample consisted of 20 elderly hypertensives. Each participant underwent three ABPM sessions: one control ABPM, without exercise; one ABPM after continuous exercise; and one ABPM after interval exercise. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and double product (DP) were monitored to check post-exercise hypotension and for comparison between each ABPM. Results: ABPM after continuous exercise and after interval exercise showed post-exercise hypotension and a significant reduction (p < 0.05) in SBP, DBP, MAP and DP for 20 hours as compared with control ABPM. Comparing ABPM after continuous and ABPM after interval exercise, a significant reduction (p < 0.05) in SBP, DBP, MAP and DP was observed in the latter. Conclusion: Continuous and interval exercise trainings promote post-exercise hypotension with reduction in SBP, DBP, MAP and DP in the 20 hours following exercise. Interval exercise training causes greater post-exercise hypotension and lower cardiovascular overload as compared with continuous exercise. .

Fundamento: Embora se saiba que o exercício promova hipotensão pós-exercício, até o momento não há argumentações consistentes sobre os efeitos da manipulação de seus diversos componentes (intensidade, duração, intervalos de descanso, tipos de exercício, métodos de treinamento) na magnitude e duração da resposta hipotensora. Objetivo: Comparar os efeitos dos exercícios dinâmicos, contínuo e intervalado, sobre a magnitude e duração da resposta hipotensora em hipertensos por meio da monitorização ambulatorial da pressão arterial (MAPA). Métodos: A amostra foi composta por 20 idosos hipertensos. Cada participante realizou três sessões de MAPA, sendo uma controle (sem exercício), uma após exercício contínuo e uma após exercício intervalado. O monitoramento de pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), frequência cardíaca (FC) e duplo produto (DP) foi realizado para verificação da hipotensão pós-exercício e comparação entre cada MAPA. Resultados: As MAPAs após exercício contínuo e intervalado demonstraram hipotensão pós-exercício e redução significativa (p < 0,05) de PAS, PAD, PAM e DP por 20 horas, na comparação com a MAPA controle. Na comparação entre as MAPAs após exercício contínuo e intervalado, verificou-se redução significativa (p < 0,05) de PAS, PAD, PAM e DP após exercício intervalado. Conclusão: Os exercícios contínuo e intervalado promovem hipotensão pós-exercício, com redução significativa de PAS, PAD, PAM e DP ao longo das 20 horas subsequentes à atividade. O exercício intervalado gera maior magnitude de hipotensão pós-exercício e menor sobrecarga cardiovascular, medida por menor DP. .

Spontaneous renal hemorrhage caused by invasive mole: a case report / 南方医科大学学报

Gestational trophoblastic tumors (GTTs) are malignant lesions that often cause abnormal genital bleeding and may present with hemoptysis, intraperitoneal bleeding or acute neurologic deficits. GTTs are generally highly chemosensitive with more favorable outcomes than other comparable malignancies. Here we report a rare case of invasive mole (FIGO stage IV, WHO score16) presenting with renal subcapsular hematoma due to bleeding renal metastasis. The patient had a pretreatment β-human chorionic gonadotrophin (β-HCG) level of 462 047 mIU/ml and received combined chemotherapy with etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine with also adjuvant surgeries including hysterectomy and nephrectomy. The patient recovered well and the tumor has remained in complete remission for one year and a half.

Bullae-Forming Pulmonary Metastasis from Choriocarcinoma Presenting as Pneumothorax

Gestational trophoblastic disease (GTD) is a condition of uncertain etiology, choriocarcioma, or placental-site hydatidiform moles, invasive moles, choriocarcinoma, and placental-site trophoblastic tumors. It arises from the abnormal proliferation of trophoblastic tissue and spreads beyond the uterus hematogenously. The early diagnosis of GTD is important to ensure timely and successful management and the preservation of fertility. We report the unusual case of a metastatic choriocarcinoma that formed bullae on the lung surface and presented as recurrent pneumothorax in a 38-year-old woman with elevated beta-human chorionic gonadotropin (hCG) levels. She underwent thoracoscopic wedge resection of the involved lung and four subsequent cycles of consolidation chemotherapy. No other evidence of metastatic disease or recurrent pneumothorax was noted during 22 months of follow-up. GTD should be considered in the differential diagnosis of spontaneous pneumothorax in reproductive-age women with an antecedent pregnancy and abnormal beta-hCG levels.

Histopathological review of partial and complete hydatidiform moles in a tertiary care hospital, Lahore - Pakistan

Hydatidiform mole is an abnormal gestation characterized by trophoblastic hyperplasia and overgrowth of placental villi. Hydatidiform mole is classified as complete [CHM] and partial hydatidiform mole [PHM]. The diagnosis is based on histopathology and genetic origin. The incidence of molar pregnancy varies in different parts of the world. The malignant potential of this disease is higher in south East Asia as compared to western countries. Objective of the present study was to determine the frequency, clinical presentation and morphological features of hydatidiform mole. This retrospective, descriptive case series was conducted in the Department of Pathology Postgraduate Medical Institute and Lahore General Hospital, from 1st Jan 2009 to 31st Dec 2010. The case records of all the molar pregnancy specimens during the study period were analysed regarding patient's history, clinical examination, morphological features and laboratory investigations. The main outcomes were measured in terms of duration, gestational age, morphological features and investigations. A total of 60 cases were examined during the study period, which included 40 cases of complete hydatidiform mole and 20 cases of partial hydatidiform mole. Frequency of CHM was higher as compared to PHM. The disease was common at extremes of ages. Morphological findings of CHM differ from PHM on the basis of degree of trophoblastic hyperplasia, villous contours and scalloping, presence of distinct cisterns and nucleated Red Blood Cells [RBC] in fetal vessels. We concluded that there is no single criterion for the differentiate CHM and PHM. P57[kip2] expression can be used in association with the histological findings for a definite diagnosis

study of gestational trophoblastic disease

To study the frequency, type of mole and follow-up of patients of gestational trophoblastic disease. Descriptive study. Military Hospital Rawalpindi [Tertiary Care hospital] from Jan 2001 to Dec 2006. Ninety patients both primigravida and multigravida were recruited by convenience sampling. They did not have any associated disease. The frequency regarding age, parity, blood group and antecedent pregnancy was calculated. They were managed initially by suction curettage and later either expectantly or actively. Type of mole was confirmed by histopathology report. Follow-up of these patients was done by clinical symptoms, beta-hCG level, x-ray chest and ultrasound abdomen and pelvis. GTD included 31.11% patients aged <40 years and 68.88% patients aged >40 years. 55.55% of patients had blood group O and only 33.33% patient with other blood groups. In 64.44% patients previous pregnancy was miscarriage while only 6.66% patients had term pregnancy before. 77.77% patients presented with vaginal bleeding, while cough, gastro-intestinal symptoms and hemorrhage 65.55% patients within 6 months while 34.44% patients had persistently raised serum beta- hCG level. Histopathological reports of 80% patient revealed complete mole while 20% patients had partial mole. Frequency of malignancy was found mostly in patients of complete mole. Chemotherapy was given to 38.88% patients among them 24.44% treated with single agent and 14.44% patients were given multi-drug therapy. GTD is more common in multigravida than primigravida. High frequency was observed in extremes of reproductive life and with blood group O. Irregular vaginal bleeding is the most common clinical feature. The frequency of complete mole is more than partial mole

Function of F10 gene, a novel hydatidiform mole-related gene: a preliminary study / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the function of F10 gene, a novel hydaditiform mole-related gene.</p><p><b>METHODS</b>A549 cell line was transfected with the F10 gene of forward or reverse sequence or with the empty vector, respectively. The cellular mRNA was extracted after 24 h of transfection to screen for the differentially expressed genes among the 3 transfected and the control cells using differential display-polymerase chain reaction (ddPCR).</p><p><b>RESULTS</b>The bands representing differentially expressed genes were amplified from the cells, and the products were linked to T-Vector for sequence analysis. Several genes were screened by Blasting and their expressions were confirmed by fluorescent quantitative PCR.</p><p><b>CONCLUSION</b>F10 gene is functionally related to cell proliferation and apoptosis.</p>

Expression of TM4SF9 in human trophoblasts / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the expression of TM4SF9 in the villi of early pregnancy, hydatidiform mole, invasive hydatidiform mole and chorionic carcinoma tissue.</p><p><b>METHODS</b>Immunohistochemistry was used to detect the expression of TM4SF9 in normal villi of early pregnancy, hydatidiform mole, invasive hydatidiform mole and chorionic carcinoma tissues.</p><p><b>RESULTS</b>TM4SF9 was expressed in the cytotroblasts but not in the syncytiotrophoblast of normal villi. The intensity of TM4SF9 expression increased in the order of normal villi, hydatidiform mole, invasive hydatidiform mole and chorionic carcinoma, with strong positivity rates of 0, 10%, 36.4% and 100%, respectively, showing significant differences between the samples (P<0.001).</p><p><b>CONCLUSION</b>TM4SF9 expression in the trophoblasts may relate to their invasiveness and play an important role in the metastasis of trophoblastic tumor.</p>

Invasive mole as acute abdomen

The disease spectrum in gestational trophoblastic disease [GTD] varies from benign to malignant. In most cases it can be treated successfully but sometimes even a hydatidiform mole can be fatal if it remains unattended. It is an important condition that can be diagnosed and cured with chemotherapy. The gestational trophoblastic disease [GTD is a proliferative anddegenerative disorder of placental elements and includes complete and partial mole [90%] invasive mole [5-8%] choriocarcinoma [1-2%] and placental site tumour [1-2%].[1] World Health Organization classification divides GTD into the premalignant disorders which include partial and complete hydatidiform moles and the malignant disorders of invasive mole which, include choriocarcinoma and placental site tumours. Incidence is higher in Africa and Asia with geographical and racial variations.[2] The reported incidence of molar pregnancies in Europe and North America is 0.2-1.5per 1000 live births

Metastatic gestational trophoblastic neoplasms and no gynecological symptoms: Report of five cases

Early recognition of Gestational Trophoblastic Neoplasm [GTN] will maximize the chances of cure with chemotherapy but some patients present with many different symptoms months or even years after the causative pregnancy making diagnosis difficult. Clinicians should be aware of the possibility of GTN in any reproductive age woman with bizarre central nervous system, gastrointestinal, pulmonary symptoms or radiographic evidence of metastatic tumor of unknown primary origin. We reported five cases of metastatic gestational trophoblastic neoplasms with bizarre pulmonary symptoms, acute abdomen, neurologic symptoms presenting without gynecological symptoms

Diagnostico clínico e histopatológico: embarazo molar: presentación de un caso clínico / Clinical and histopatológical diagnostics: molar pregnancy: presentation clinical of a case

La ETG es el término general utilizado para identificar distintos procesos donde existe una hiperplasia de diferentes tipos de epitelio trofoblástico, según la OMS puede clasificarse en 4 tipos: 1) Mola hidatiforme: completa o parcial, más común la primera en un 67 por ciento, 2) Mola invasora (corioadenoma destruens) 3) Coricarcinoma 4)Tumor trofoblástico del lecho placentario, su incidencia varia, pero en países desarrollados se estima sea 1.1/1000 embarazos, siendo esta mas alta en países subdesarrollados se presenta caso clìnico de una paciente la cual se le hace diagnóstico clínico e histopatológico y procedimientos para evacuación uterina por embarazo molar.

MMP-2/TIMP-2 expression in the trophoblasts of patients with gestational trophoblastic disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the role of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of MMP-2 (TIMP-2) in the pathogenesis, development and prognosis of gestational trophoblastic disease (GTD).</p><p><b>METHODS</b>In situ hybridization and immunohistochemistry were utilized for MMP-2/TIMP-2 mRNA and protein detection in normal chorion of women with early gestation, hydatidiform mole, invasive mole, or choricarcinoma.</p><p><b>RESULTS</b>The results revealed that specific staining for mRNA and protein of MMP-2 and the expression of TIMP-2 was reduced in normal chorion of early gestation. In GTD ranging from hydatidiform mole, invasive mole to choricarcinoma, MMP-2 expression tended to increase while TIMP-2 expression underwent an invert change. The positivity rate of MMP-2 and TIMP-2 in gestational trophoblastic tumor group was higher than that of the normal chorion of early gestation group and hydatiform mole group (P<0.05 and P<0.001, respectively).</p><p><b>CONCLUSION</b>A disrupted balance between the activation and inhibition of MMP-2 plays a critical role in the pathogenesis, progression and metastasis of GTD.</p>

Malignant gestational trophobalstic tumor with markedly elevated serum hCG levels and negative urine hCG level / 대한산부인과학회지

Gestational trophoblastic disease comprises a spectrum of interrelated conditions originating from the placenta. Malignant gestational trophoblastic disease refers to lesions that have the potential for local invasion and metastasis. This compromises many histological entities including hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site trophoblastic tumors. Before the advent of sensitive assays for human chorionic gonadotropin (hCG) and efficacious chemotherapy, the morbidity and mortality from gestational trophoblastic disease were substantial. Currently, with sensitive quantitative assays for beta-hCG and current approaches to chemotherapy, most women with malignant trophoblastic disease can be cured. We present a case of malignant gestational trophobalstic tumor with serum beta-hCG concentration over 1million IU/L that metastaze to the lungs and have a hyperthyroidism, but negative urine hCG testing. We report a case with a brief review of literatures.

Estudio inmunocitoquímico y molecular de cultivo primario de tejido molar / Immunocytochemical and molecular studies with primary cultures of molar tissue

Introducción. La enfermedad trofoblástica gestacional comprende un conjunto de patologías caracterizadas por crecimiento e invasión anómalos del trofoblasto. Las bases moleculares de esta patología son desconocidas, en parte por la dificultad para disponer de modelos biológicos adecuados. Se plantea que el sistema de factores de crecimiento similares a la insulina puede tener un papel fundamental en el desarrollo de la enfermedad. Objetivo. Caracterizar cultivos primarios de placentas de primer trimestre provenientes de pacientes con mola hidatidiforme completa y aborto espontáneo no molar mediante morfología, inmunocitoquímica y expresión diferencial de algunos genes del sistema de factores de crecimiento similares a la insulina. Materiales y métodos. Se empleó inmunocitoquímica para determinar células trofoblásticas y detección por transcripción reversa y reacción en cadena de la polimerasa de genes del sistema de factores de crecimiento similares a la insulina asociados al tipo celular. Resultados. La morfología evidenció heterogeneidad de los cultivos, incluidas células mesenquimales, trofoblásticas y de decidua. El contenido de células de trofoblasto con citoqueratina-7 (marcador específico) estuvo entre 16 y 37 por ciento. La expresión de genes corroboró la presencia de trofoblasto por medio del ARNm del factor II de crecimiento similar a la insulina, en tanto que los transcritos de la hormona de crecimiento variante evidenciaron la presencia de sincitiotrofoblasto. El factor I de crecimiento similar a la insulina y la proteína de unión tipo 1 se relacionaron con células mesenquimales y de decidua. Se observó una mayor expresión del factor II de crecimiento similar a la insulina en tejidos molares en comparación con aborto no molar. Conclusiones. Los resultados mostraron la utilidad de combinar tres metodologías, morfología, inmunocitoquímica y expresión de genes, como herramientas para la caracterización y seguimiento de cultivos placentarios a partir....

Introduction. Gestational trophoblastic disease includes a group of pathologies characterized by abnormal trophoblast growth and invasion. The molecular bases of the disease are largely unknown, due in part to the lack of appropriate biological models. The insulin-like growth factor (IGF) system plays a fundamental role in the growth and development of many tissues and is involved in the progression of several diseases. Objectives. Primary cell cultures derived from first trimester placenta were characterized from patients with complete hydatidiform mole and spontaneous non molar abortion by immunocytochemical and molecular methods. Materials and Methods. The immunocytochemical method used specific markers for trophoblastic cells, whereas RT-PCR was used to identify insulin-like growth factor gene expression. Results. Histochemical staining with hematoxilin-eosin revealed that the cultures contained heterogeneous cell types, including trophoblast and endometrial decidual cells. The ratio of trophoblast cells in the cultures varied between 16% and 37%, as detected by cytokeratine-7 as the specific trophoblast marker. Gene expression analysis corroborated the presence of trophoblasts by detecting insulin-like growth factor II mRNA, whereas GH-V transcripts were correlated with the presence of syncitiotrophoblasts. Insulin-like growth factor I and insulin-like growth factor binding protein 1 mRNAs were related to mesenchyimal and decidual cells, respectively. Higher insulin-like growth factor II expression levels were found in molar tissues in comparison with non-molar abortions. Conclusion. By combining three methodologies—morphology, immunocytochemistry and gene expression, characterization and follow-up of placenta cultures from abnormal tissues is found to facilitate diagnosis.

Estudio anatomopatológico de un caso de mola parcial / Anathomopathologycal study of a parcial molar case

Se realizó el estudio de un feto masculino y su placenta, producto de una paciente de 38 años y 24 semanas de gestación. El feto mostró retraso en el crecimiento intrauterino. La placenta presentó macroscópicamente una zona normal y otra en forma de "racimos de uvas". El estudio histopatológico de las vesículas molares presentó: cambios hidrópicos de las vellosidades, ausencia de capilares, inclusiones trofoblásticas en el estroma, vellosidades de bordes festoneados e hiperplasia trofoblástica moderada. La degeneración hidrópica de las vellosidades coriales y la hipertrofia trofoblástica moderada observadaen las vesículas molares, es típica de la mola parcial