[Diagnostic image (224). A pregnant woman with vaginal blood loss]. / Diagnose in beeld (224). Een zwangere met vaginaal bloedverlies.

In a pregnant woman presenting with vaginal bleeding and a vaginal tumour, vaginal metastasis ofa trophoblast tumour from a mola pregnancy was diagnosed.

Floxuridine-containing regimens in the treatment of gestational trophoblastic tumor.

OBJECTIVE: To analyze the efficacy of floxuridine (FUDR)-containing regimens in the treatment of gestational trophoblastic tumor (GTT). STUDY DESIGN: Seventy-four patients with GTT, 47 with invasive mole and 27 with choriocarcinoma were treated with FUDR-containing regimens. Clinical staging of the disease was: 33 cases of stage I, 3 cases of stage II, 31 cases of stage IIIa, 6 cases of stage IIIb and 1 case of stage IV. RESULTS: The complete response rate of FUDR-containing regimens in the treatment of GTT was 91.9% (68 of 74 cases). Six patients, of whom 3 showed signs of drug resistance and 3 showed myelosuppression, had their regimens changed to non-FUDR-containing regimens, and all achieved a complete response. All 7 patients with advanced disease (>IIIb) achieved a complete response. The major adverse event with FUDR-containing regimens was myelosuppression and gastrointestinal toxicity: third- and fourth-degree neutropenia in 26% and thrombocytopenia in 6.2%, third-degree vomiting in 57.1% and third-degree diarrhea in 4.3%. CONCLUSION: FUDR-containing regimens are efficient for the treatment of GTT even for patients with advanced or drug-resistant disease.

Trichosanthin in the treatment of hydatidiform mole. Clinical analysis of 52 cases.

During 1972-1986, 44 of 52 patients (84.6%) with hydatidiform mole were treated successfully with trichosanthin. Of these, 38 (73.1%) had complete spontaneous evacuation and 6 (11.5%) incomplete evacuation. The average time for evacuation of hydatidiform mole was 4.5 +/- 1.64 days. The amount of bleeding was less than 100 ml in 33 patients (75%), while that in 2 of the patients with incomplete evacuation was more than 300 ml. Malignant changes occurred in two of the 44 patients (4.5%). The malignant rate was similar to that (4-12.5, P greater than 0.05) of prophylactic chemotherapy. We consider that thrichosanthin is a better approach to the treatment of hydatidiform mole.

Gestational trophoblastic disease.

BACKGROUND: Gestational trophoblastic disease consists of a group of interrelated diseases, including molar pregnancy, placental site trophoblastic tumor, and choriocarcinoma. METHODS: Advances in the diagnosis and management of gestational trophoblastic diseases over the past 5 years were reviewed. RESULTS: Molar pregnancy is now categorized as complete or partial on the basis of gross and microscopic histopathologic and karyotypic findings. Early detection of persistent gestational trophoblastic tumor (GTT) depends on careful postmolar gonadotropin follow-up and consideration of the diagnosis for any woman of reproductive age with unexplained gynecologic and/or systemic symptoms. Triple therapy with methotrexate, actinomycin D, and cyclophosphamide was once the preferred treatment for patients with high risk metastatic GTT but induced remission in only about 50%. Treatment with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine is now the preferred regimen for treatment of high risk metastatic GTT and has been shown to induce remission in about 70% of patients. CONCLUSIONS: Important advances have been made in the diagnosis and treatment of patients with gestational trophoblastic disease, and patients can be reassured that they can anticipate normal reproductive functioning.