Low-risk gestational trophoblastic neoplasia: evaluating the need for initial inpatient treatment during low-dose methotrexate chemotherapy.

OBJECTIVE: To evaluate the need for initial inpatient treatment for patients being treated with low-dose intramuscular methotrexate for low-risk gestational trophoblastic neoplasia (GTN). STUDY DESIGN: Clinical notes of all patients treated with low-dose intramuscular methotrexate for low-risk GTN were analyzed and side effects noted. RESULTS: There were no episodes of increased uterine bleeding requiring extra medical intervention. There were 7 cases of chest pain; none required a change from methotrexate chemotherapy. CONCLUSION: Patients being treated with low-dose intramuscular methotrexate for low-risk GTN do not need to be treated routinely in the hospital for their first treatment cycle.

Persistent gestational trophoblastic neoplasia after partial hydatidiform mole incidence and outcome.

OBJECTIVE: To report the Sheffield experience with persistent gestational trophoblastic neoplasia (GTN) after partial hydatidiform mole (PHM) and to review worldwide experience. METHODS: All PHMs registered at the Sheffield Trophoblast Centre between 1991 and 2004 were included in this retrospective study. Any case of PHM leading to persistent GTN was reviewed centrally by an expert gynecologic pathologist. Clinical features, treatment and outcome were recorded. RESULTS: During the 14-year study period 3189 PHMs were registered. Forty-one developed persistent GTN. Central histopathology review confirmed PHM in only 14 cases (0.91% of all those registered). Twelve scored low and 2 high risk according to International Federation of Gynecology and Obstetrics 2000 criteria. During the same period, 271 cases of persistent GTN originally registered as complete hydatidiform mole were reviewed; 3 were found to be PHMs (2 low, 1 high risk). In all, 15 of 17 persistent PHMs required chemotherapy. CONCLUSION: Persistent GTN requiring chemotherapy can occasionally occur after PHM; surveillance of all cases continues to be recommended.

Twin mole and viable fetus: The case for misdiagnosis.

OBJECTIVE: To report the Sheffield Trophoblast Centre experience of twin molar gestations and review this in the light of international experience. CASE: Thirty patients with possible twin molar gestations were registered from 1986 to 2004 (during which period 7,200 cases of mole were seen). The accuracy of suspected clinical and histologic diagnoses was investigated. RESULTS: In 10 cases twin mole/fetus had been suspected clinically but not confirmed when products of conception were examined. In 3 of these cases the pregnancy had been therapeutically terminated because of clinical (ultrasound) suspicion of coexisting molar pregnancy. In the 19 cases where twin mole/fetus was suspected, central histopathology review was possible in 14 cases. Only 7 were confirmed. In 2 further cases twin molar gestation was diagnosed on specimens referred for central review as partial mole singleton pregnancies. For confirmed cases the pregnancy outcome was term delivery in 5 cases and miscarriage in 4. CONCLUSION: Clinical and histopathologic diagnosis of twin molar pregnancies is inaccurate in many suspected cases; therefore, a second (expert) opinion should be sought. When the diagnosis is accurate, maternal and fetal complications are common. However, in suspected cases the pregnancy may be allowed to proceed, with caution, if the mother wishes.