Enfermedad trofoblástica gestacional en el posparto tardío

La enfermedad trofoblástica gestacional (ETG) es un término utilizado para un grupo de tumores relacionados con el embarazo que surgen de la proliferación defectuosa del tejido trofoblástico. Su incidencia después de un embarazo a término no es frecuente, siendo diagnosticada en la mayoría de los casos de forma incidental, por síntomas de metástasis. Presentamos un caso de ETG que ocurrió 9 semanas después de un parto vaginal a término. El nivel sérico de gonadotropina coriónica humana beta (hCG-β) fue de 38 084 mUI/mL y una tomografía de tórax mostró múltiples nódulos pulmonares. La paciente recibió actinomicina D durante 3 ciclos. La hCG-β se normalizó después del tercer ciclo y la paciente permaneció libre de enfermedad durante 12 meses después del diagnóstico. Se describe la presentación clínica y los desafíos en el diagnóstico de ETG en el período posparto tardío.

Gestational trophoblastic disease (GTD) is a term used for a group of pregnancyrelated tumors arising from defective proliferation of trophoblastic tissue. Its incidence after term pregnancy is infrequent, being diagnosed in most cases incidentally, due to symptoms of metastasis. We present a case of GTD that occurred 9 weeks after a vaginal delivery at term. The serum beta-human chorionic gonadotropin (β-hCG) level was 38 084 mIU/mL and a chest CT scan showed multiple pulmonary nodules. The patient received actinomycin D for 3 cycles. The β-hCG normalized after the third cycle and the patient remained disease-free for 12 months after diagnosis. The clinical presentation and challenges in diagnosing GTD in the late postpartum period are described.

Gestational Trophoblastic Diseases - A Clinicopathological Study

The term ‘gestational trophoblastic disease’, includes lesions, some of which are categorized as true neoplasms, and others that are representative of placentas that are malformed. It refers to various lesions that accompany the premalignant type, some of which are hydatidiform moles of the partial or the whole variety. The malignant type of lesions (GTD / GTN), include the following: choriocarcinoma, epithelioid trophoblastic tumour, placental site trophoblastic tumour, and invasive moles. METHODSA total number of thirty-four cases of GTD during the last two years at a tertiary care hospital was studied, relevant data was collected, and histological features studied. RESULTS79.41% of GTDs in the present study were complete mole, 58.82% of GTDs occurred in nullipara, 52.94% cases had GTDs seen in the third decade, 14.70% cases had history of previous GTD, 5.88% cases had history of previous abortion, 2.94% cases had a history of previous ectopic pregnancy, and case with choriocarcinoma had the highest HCG levels. In contrast, case with epithelioid trophoblastic tumour had the least HCG levels. CONCLUSIONSIn this particular study, it was found that most of the GTDs occurred in nulliparous women in their thirties and their occurrence increased with risk factors like a previous history of GTD, abortions, or ectopic pregnancy.

Corioangioma placentario: reporte de un caso en la Unidad de Patología del Hospital San Juan de Dios E.S.E. Rionegro-Antioquia / Placental chorioangioma: case report in the Pathology Unit of the San Juan de Dios E.S.E. Hospital in Rionegro-Antioquia

Dentro de las neoplasias no trofoblásticas gestacionales de tipo vascular, el corioangioma es la más común. Se caracteriza por presentar una proliferación exagerada de estructuras vasculares, con células endoteliales y vellosidades coriónicas que generan una alteración de los vasos sanguíneos tanto arteriales como venosos. Tiene una incidencia menor al 1%, con tasas de mortalidad perinatal aproximadas entre 18% a 40%. Se presenta el caso de un corioangioma placentario diagnosticado a las 26 semanas de gestación en una paciente de 21 años de edad sin controles prenatales previos, el cual generó un lóbulo accesorio de 7 cm con tinción positiva en el análisis inmunohistoquímico para anticuerpos antimúsculo liso y CD34, y negativa para Ki67. El corioangioma desencadenó complicaciones en el embarazo, con parto pretérmino, hidropesía fetal y retardo en el crecimiento intrauterino, que llevaron a la muerte fetal. La falta de control prenatal en nuestra paciente impidió que se detectaran las anomalías placentarias oportunamente, con un desenlace fatal para el feto. Un control prenatal adecuado con seguimiento ecográfico puede evitar eventos fatales como el presentado. El análisis macroscópico y microscópico de la placenta puede favorecer la identificación de los casos y el aporte a las estadísticas de incidencia y mortalidad.

Among vascular gestational nontrophoblastic tumors, chorioangioma is the most common. It is characterized by an exaggerated proliferation of vascular structures, with endothelial cells and chorionic villi that generate abnormalities of both arterial and venous blood vessels. It has an incidence of less than 1%, with perinatal mortality rates between 18% to 40%. We present the case of a 21-year-old patient without previous prenatal controls, with a placental chorioangioma diagnosed at 26 weeks of gestation that formed a 7 cm accessory lobe, with positive staining during immunohistochemical analysis for smooth anti-muscle antibodies and CD34, and negative for Ki67. The placental chorioangioma triggered complications during pregnancy, with preterm delivery, hydrops fetalis, and intrauterine growth retardation leading to fetal death. The lack of prenatal control in our patient prevented an early detection of placental abnormalities with a fatal outcome for the fetus. Adequate prenatal control with ultrasound monitoring can avoid fatal events such as the one presented. Macroscopic and microscopic analysis of the placenta can help identify cases and contribute to incidence and mortality statistics.

Atypical epithelioid trophoblastic lesions after a cesarean section with cyst and fistula formation:a clinicopathological analysis of 4 cases / 中华病理学杂志

Objective@#To elucidate the clinicopathologic characteristics of atypical epithelioid trophoblastic lesions with cyst and fistula formation after cesarean section.@*Methods@#The clinical and pathological data of 4 cases of post-cesarean atypical epithelioid trophoblastic lesions with cyst and fistula formation diagnosed at Women′s Hospital, School of Medicine, Zhejiang University during April 2007 to June 2018 were evaluated by hematoxylin and eosin stain and EnVision two-step immunohistochemical staining technique.@*Results@#The age of the 4 patients ranged from 32 to 41 years, with a mean age of 36.5 years. Three patients recieved cystectomy and one underwent subtotal hysterectomy. Histologically, the lesions were well circumscribed and consisted of uniform cells of medium size, irregularly enlarged with hyperchromatic nuclei and 1 to 2 inconspicuous nucleoli embedded in abundant hyalinized matrix with fibrinoid material in the center. The cells exhibited immunohistochemical feature of chorionic-type intermediate trophoblastic cells (CK18+, p63+ and CD146-). All patients were alive without recurrence during follow-up of 1 to 40 months (mean=22 months).@*Conclusion@#Atypical epithelioid trophoblastic lesion with cyst and fistula formation after cesarean section has unique histological features, and its biological behavior and prognosis are still unclear, which need further exploration.

Coriocarcinoma: reporte de 3 casos / Choriocarcinoma: report of 3 cases

La enfermedad trofoblástica gestacional (ETG) es un trastorno proliferativo de las células del trofoblasto. La ETG más agresiva es el coriocarcinoma, debido a su rápida invasión vascular y formación de múltiples metástasis. Presentamos tres casos de coriocarcinoma poco frecuentes. Tres mujeres de 30, 47 y 44 años, respectivamente, acudieron a Emergencia por ginecorragia y tumoración vaginal con variaciones de presentación y antecedentes significativos, encontrándose en todas ellas metástasis diversas y raras. Se presenta estos casos, por ser una patología poco frecuente pero extremadamente agresiva, con amplio espectro clínico, presentaciones inusuales y necesidad de un diagnóstico precoz para su óptimo tratamiento.

Gestational trophoblastic disease is a proliferative disorder of trophoblast cells. Choriocarcinoma is the most aggressive type due to its rapid vascular invasion and metastasis formation. We present three rare cases of choriocarcinoma. Three women 30, 47, and 44 years old respectively were admitted for vaginal bleeding and vaginal tumor as main complaints with different presentations of the disease and past medical history; various and rare metastases were found. We report these cases because of their rarity and aggressive pathology, showing a wide clinical spectrum, unusual presentations and the need for early diagnostic and optimal treatment.

Diagnosis and management of recurrent or resistant gestational trophoblastic neoplasia / 中国医师杂志

With the application of chemotherapy,gestational trophoblastic neoplasia (GTN) has been the first of malignant tumors which can be cured by chemotherapy.However,the resistance and relapse still is the difficulty of treatment and the leading cause of death in patients.Approximately 20％ ～ 30％ of GTN tumor will be resistant to,or will relapse after cure.These resistant and relapsed lesions will require salvage therapy,which be treated with multi-agent chemotherapy with or without surgery and/or adjuvant radiation therapy.Various salvage regimens are used worldwide.It is unclear to determine which of the various salvage combinations,if any,was the most effect and the least toxic for the treatment of resistant or relapsed GTN.

Is Doppler ultrasound useful for evaluating gestational trophoblastic disease?

Doppler ultrasound is a non-invasive method for evaluating vascularization and is widely used in clinical practice. Gestational trophoblastic neoplasia includes a group of highly vascularized malignancies derived from placental cells. This review summarizes data found in the literature regarding the applications of Doppler ultrasound in managing patients with gestational trophoblastic neoplasia. The PubMed/Medline, Web of Science, Cochrane and LILACS databases were searched for articles published in English until 2014 using the following keywords: “Gestational trophoblastic disease AND Ultrasonography, Doppler.” Twenty-eight articles met the inclusion criteria and were separated into the 4 following groups according to the aim of the study. (1) Doppler ultrasound does not seem to be capable of differentiating partial from complete moles, but it might be useful when evaluating pregnancies in which a complete mole coexists with a normal fetus. (2) There is controversy in the role of uterine artery Doppler velocimetry in the prediction of development of gestational trophoblastic neoplasia. (3) Doppler ultrasound is a useful tool in the diagnosis of gestational trophoblastic neoplasia because abnormal myometrial vascularization and lower uterine artery Doppler indices seem to be correlated with invasive disease. (4) Lower uterine artery Doppler indices in the diagnosis of gestational trophoblastic neoplasia are associated with methotrexate resistance and might play a role in prognosis. CONCLUSION: Several studies support the importance of Doppler ultrasound in the management of patients with gestational trophoblastic neoplasia, particularly the role of Doppler velocimetry in the prediction of trophoblastic neoplasia and the chemoresistance of trophoblastic tumors. Doppler findings should be used as ancillary tools, along with human chorionic gonadotropin assessment, in the diagnosis of gestational trophoblastic neoplasia.

Analysis of the treatment and prognosis for gestational trophoblastic neoplasia patients with urinary system and adrenal glands metastasis / 中华妇产科杂志

Objective To analyze the treatment and prognosis of patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis.Methods The treatment and prognoses of 32 patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis from Dec.1990 to Dec.2010 at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences were respectively reviewed.Results Treatment methods:all 32 patients received 9 courses(in average) of a multi-drug chemotherapy in our hospital (range 1-24 coures).Among them,3 patients with bladder metastasis received intravesical chemotherapy of fluorouracil.9 patients received surgical treatments in other hospital and 15 patients received surgical treatments while undergoing chemotherapy in our hospital.Treatment results:after the treatments,of the 32 patients,21 (66％) patients achieved complete remission,3(9％) exhibited partial remission and 8 (25％) progressed.Seven patients with renal metastasis achieved complete remission.Two patients with adrenal glands metastasis achieved complete remission.Nine patients with urinary bladder metastasis achieved complete remission.Seven patients with ureters metastasis achieved complete remission.Two (10％) of 21 patients with complete remission relapsed.Conclusions Multidrug and muhiroute chemotherapy is the main strategy for patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis.The prognoses of patients with renal or adrenal glands metastasis are much worse than those in patients with bladder and ureters metastasis because of concomitant multiogran metastasis.Adequate attention should be given to patients with renal or adrenal glands metastasis.Individual treatment,assisted by surgery when necessary,may be carried out for these patients to achieve a better outcome.

Clinical study on 39 cases with caesarean scar pregnancy with sonographic mass / 中华妇产科杂志

Objective To study the clinical features,differential diagnosis and treatment of caesarean scar pregnancy (CSP) with sonographic mass.Methods A retrospective analysis was performed on 39 patients of CSP with sonographic mass undergoing treatment in Peking Union Medical College Hospital from 2005 to 2012.14 cases with misdiagnosis of gestational trophoblastic neoplasm,among 4 cases were administered by chemotherapy with methotrexate (MTX),cisplatin,fluorouracil (5-FU) and dactinomycin.According to treatment methods,39 cases were divided into five groups: 3 cases in methotrexate,16 cases in dilation and curettage,15 cases in excision of CSP lesion via laparoscopy,6 cases in excision of CSP lesion via laparotomy,and 4 cases in transabdominal hysterectomy (TAH).Results (1)Clinical characteristics: the mean age was (33 ± 5) years old.Five patients had undergone two prior caesarean sections.The median interval from the last caesarean delivery to CSP was 4 years.Thirty-five cases presented vaginal bleeding or abnormal serum β-hCG level from 5 cases with medical abortion,9 cases with artificial abortion and 21 cases with dilation and curettage.The sonography showed cystic-solid or solid mass with mixed echoes in the lower segment of anterior uterine wall,surrounded by peritrophoblastic vasculature.(2) Treatment outcome: diagnosis of gestational trophoblastic neoplasm was suspected or made in 20 patients,four of whom were even treated by chemotherapy.MTX therapy was given to 3 patients,2 of whom were cured.Dilation and curettages were given to 16 patients,11 of whom were cured.8 patients underwent curettage with sonographic guidance after uterine artery embolism,and 8 patients with laparoscopic or hysteroscopic guidance.All of 15 patients underwent excision of CSP lesion via laparoscopy were cured.4 patients were treated by TAH.(3) Time of in hospital and operation:in laparoscopy group,the average hospitalization days were (3.5 ± 1.6) days,the average operation duration was (54 ± 16)minutes.In laparotomy group,the average hospitalization days were (9.7 ± 5.8) days,and the average surgical duration was (87 ± 15) minutes.It reached significant difference (P ＜ 0.05).Conclusions CSP with sonographic mass was the consequence of continued growth of residual pregnancy mass after incomplete abortion or curettage of CSP with gestation sac.The similar sonographic image might lead to misdiagnosis.Individual therapy was recommended.Excision of CSP lesion via laparoscopy might be the primary option for its advantages in differential diagnosis,caesarean scar defect repair and successful ratio.

Ultrasonographic analysis of mass-type cornual pregnancy / 中华医学超声杂志（电子版）

Objective To summarize the sonographic features and differential diagnosis points of mass-type cornual pregnancy. Methods The sonographic ifndings of 23 pathological proven mass-type cornual pregnancy cases enrolled in PUMCH from 2011 January to 2013 January were retrospectively analyzed. Results All pathological proven mass-type cornual pregnancy were located at one corner of the uterus presenting as a heterogenous outward mass. Well-deifned margins were found in 20 cases, and interstitial-line signs were found in 15 cases. The surrounding muscle thickness is 0.1-0.3 cm. Typical hyperechoic villi were found on sonography in cases with bloodβ-hCG>20 000 IU/L. On Doppler, the lesion showed abundant peripheral vascularity with low resistance in 22 cases, 9 lesions also showed abundant internal vascularity. Among 23 mass-type cornual pregnancy cases, 7 cases were misdiagnosed as gestational trophoblastic neoplasia (GTN) due to the similar sonographic characteristics including mixed-echo and abundant vascularity with low resistance. Sixteen cases were diagnosed by ultrasound preoperatively, with featured sonographic signs including mass located in the endometrial extension line;clear margin;peripheral vascularity;or detection of interstitial-line sign and typical villus. Conclusions Mass-type cornual pregnancy may be correctly diagnosed according to the location, boundary of the mass and the distribution of blood flow combining with clinical manifestation and bloodβ-hCG level. Transvaginal sonography could play an important role in diagnosis of cornual pregnancy.

Contrast of efficacy between floxuridine and 5-fluorouracil for gestational trophoblastic tumor / 肿瘤研究与临床

Objective To compare the efficacy and adverse reactions between floxuridine (FUDR) and 5-fluorouracil (5-Fu) treatment of gestational trophoblastic tumor.Methods 111 trophoblastic tumor patients of Ⅱ-Ⅲ stage including 62 cases of in vasive mole and 49 cases of choriocarcinoma were analyzed retrospectinely.The patients were divided into FUDR+KSM group (55 cases) and 5-Fu+KSM group (56 cases).FUDR was according to 23 mg/kg·d phleb instillation,keeping 8 hours,KSM was according to 6 μg/kg·d phleb instillation,keeping 4 hours.5-Fu was according to 26 mg/kg·d phleb instillation,keeping 8 hours.KSM was according to 6 μg/kg·d phleb instillation,keeping 4 hours.Both the two programs were 8 days.Results The cure rate was 98 ％ (54/55) in FUDR+DSM group,and that was 96 ％ (54/56) in 5-Fu+KSM group.The incidence rates of phlebophlogosis,dental ulcer and alopecie in the FUDR+KSM group were obviously lower than those in 5-Fu+KSM group [29.1％ (16/55) vs 85.7 ％ (48/56),54.5 ％ (30/55) vs 98.2 ％(55/56),21.8 ％ (12/55) vs 89.3 ％ (50/56),all P ＜ 0.05].Both the FUDR+KSM group and the 5-Fu+KSM group bad significant differences at phlebophlogosis dental ulcer and alopecie in Ⅲ stages.Conclusion The curative effect of the FUDR is aimilar with the 5-Fu,but the drug consumption of the FUDR is less.The incidence rates of dental ulcer,alopecie,and phlebophlogosis are less,but myelosuppression and alvi profluvium are rcscmble between the two sets.

Neoplasia blástica de células dendríticas plasmocitoides: Caso clínico / Blastic plasmocytoid dendritic cell neoplasm: Report of one case

Background: We report a 74 years old male consulting for multiple painless non pruriginous pink plaques and nodules of truncal distribution that appeared 15 days earlier. A skin biopsy disclosed a blastic plasmocytoid dendritic cell neoplasm. A staging CAT scan showed lymphadenopathies located around the trachea and its bifurcation. A bone marrow biopsy did not show tumor infiltration. The patient has been treated with four cycles of cyclophosphamide-doxorubicin-vincristine-prednisone, obtaining a partial remission of the lesions.

Therapeutic evaluation of cisplatin, etoposide, and bleomycin chemotherapy regimen in high-risk gestational trophoblastic neoplasia / 中华妇产科杂志

Objective To evaluate the effectiveness and safety of combination chemotherapy with bleomycin,etoposide and cisplatin (BEP) regimen on the patients with high-risk gestational trophoblastic neoplasia (GTN).Methods Forty-two patients with high-risk GTN admitted in Sichuan Cancer Hospital between Jan.1997 and Oct.2011 were analyzed retrospectively.The International Federation of Gynecology and Obstetrics (FIGO) prognostic score of all patients was more than 7.The mean age of patients was 30.2years (range 20 -49 years).All patients were treated with more than two cycles BEP regimen and followed up to the patients' death or at the end of Feb.2012.The clinical response,toxicity and the occurrence of secondary tumors were investigated.Results Forty-two high-risk GTN patients received the total of 251courses of the BEP regimen,the average number of courses for each patient was 6.0 courses.Thirty-seven patients achieved complete remission and 5 patients showed drug-resistant.The total complete remission rate of BEP regimen was 88％ ( 37/42 ).Among the complete remission patients,the total courses of BEP regimen of cases getting normal serum β-hCG level was 129 courses ( average 3.5 courses),and the total courses of cases achieving complete remission was 227 courses (average 6.1 courses ).Among the 37 complete remission patients,31 cases were treated with BEP regimen chemotherapy alone,4 patients with BEP regimen chemotherapy combined with surgical treatment (1 case had no cancer after surgery) and 2 cases with BEP regimen chemotherapy combined with radiation therapy.Therefore,the complete remission rate of BEP regimen chemotherapy alone was 74％ (31/42 ).There were 5 patients who showed drug-resistance after 24 courses of BEP regimen chemotherapy (average 4.8 courses),then received etoposide,methotrexate and dactinomycin( EMA )/cyclophosphamide and vincristine sulfate ( CO ) regimen chemotherapy after drugresistance,2 cases combined with radiation therapy,1 case combined with surgical treatment.Ultimately,4cases achieved complete remission,1 case died of cancer.The major toxicities of BEP regimen were included bone marrow suppression,digestive tract side effect and alopecic,followed by mild peripheral neuritis and abnormal liver function,rare cases of mild pulmonary toxicity.There were no severe anaphylaxis and obvious impairment of cardiac,liver,pulmonary and kidney function,except 1 patient (49 years old) had grade Ⅳbone marrow suppression and pulmonary fibrosis worsened after chemotherapy.The bone marrow suppression was mainly Ⅰ - Ⅲ degree neutropenia,and Incidence rate was 66.5％ ( 167/251 ).All the survival patients without secondary tumor.Conclusion For young high-risk GTN patients,BEP regimen chemotherapy may be safe and effective.

Expression and significance of LMP2 and PPM1A in gestational trophoblastic disease / 中华妇产科杂志

Objective To investigate the expression of low molecular mass polypeptide-2 (LMP2)and protein phosphatase 1A (PPM1A) in gestational trophoblastic disease and elucidate their predictive value in malignant transformation of hydatidiform mole. Methods The expressions of LMP2 and PPM1A protein in 196 complete hydatidiform moles (in which 28 cases with malignant transformation) , 7 invasive moles, 5 choriocarcinomas and 20 normal chorionic villus were detected with the method of En Vision immunohistochemistry. Their clinicopathologic data were retrospectively analyzed. Results LMP2 and PPM1A protein expressed in cytotrophocytes, syncytiotrophoblast and extravillous trophoblast. The level of LMP2 expression in deteriorative hydatidiform mole was significantly higher than that in non-deteriorative hydatidiform mole or normal chorionic villus (6. 79 ±2. 38, 5.26 ±2.63 and 3. 10 ±1.65, all P 0. 05). Conclusions High expression of LMP2 and low expression of PPM1A might play an important role in the motility and invasiveness of trophohlast cells and malignant transformation of hydatidiform mole. Testing the expression of LMP2 and PPM1A in hydatidiform mole tissues of initial uterine evacuation might be have some reference significance in judging outcomes of hydatidiform mole.

Correlative factors of the hydatidiform mole deterioration and clinical significance of matrix metalloproteinase 9 in gestational trophoblastic disease / 中国医师进修杂志

Objective To discuss the possibility of prognosing the hydatidiform mole deterioration and metastasis by detecting the expression of matrix metalloproteinase 9(MMP-9)in different type of trophoblastic disease,and analyze the correlative factors of the hydatidiform mole deterioration,so as to improve the criterion of hydatidiform mole prognosis.Methods The expression of MMP-9 in 30 cases of normal human(Iess than 12 weeks)cytotrophoblast cells,32 cases of partial hydatidiform mole,93 cases of complete hydatidiform mole,30 cages of invasive mole and 5 cases of choriocarcinoma were detected by immunohistochemical streptavidin-pemxidase.The factors as the age of onset,uterine size,luteinizing cyst,β-human chorionic gonadotropin hCG of 7 cases of the hydatidiform mole deterioration were analyzed.Results The expression of MMP-9 was detected in all types of trophoblastic cells,with the development of the malignant transformation the stainning Was markedly increased in the invasion of the normal human cytotrophoblast cells(X2=23.49,P＜0.05).Conclusion The difference of MMP-9 expressin gestational trophoblasts is helpful to predict the hydatidiform mole deterioration and metastagis,the hydatidiform mole deterioration correlates with the age of onset,β-hCG,uterine size,luteinizing cyst.

Pregnancy outcome after treatment of gestational trophoblastic tumor / 国际肿瘤学杂志

Chemotherapy cure rate of gestational trophoblastic tumor patients is high, and subsequent preghancy outcomes deserves attention. The gestational trophoblastic tumor parients after chemotherapy is recommended at least 1 year of contraception befor pregnancy, and their pregnancy outcomes are similar to those of general population. Recent siudies find that the interval between chemotherapy and the subsequent pregnancy affects preghancy outcomes. Careful prenatal monitoring is recommended in those patients who are pregnant within 6 months after chemotherapy. So, the gestational trophoblastic tumor patients after chemotherapy is recommended at least 1 year of contraception before pregnancy.

Factors associated with quality of life in survivors of gestational trophoblastic neoplasm after chemotherapy / 中华妇产科杂志

Objective To measure the quality of life (QoL) of gestational trophoblastic neoplasia ( GTN ) survivors after chemotherapy by using a self-invented scale, and to explore the factors associated with QoL Methods The design of questionnaire was based on a series of internationally valid QoL scales,which was tested by epidemiology and showed good reliability and validity. A total of 100 survivors of GTN patients from Peking Union Medical College Hospital participated in this survey from December 2008 to May 2009. Results Patients with disease-free more than three months after chemotherapy enjoys a good QoL,while only 16% (16/100) of survivors feel general overall QoL, but no one feels bad Qol. As refer to sexual function, more than half of these patients (70%, 70/100) satisfied with their sexual life, while there were still 47% (47/100) and 45% (45/100) of the patients complaining of decreased sexual desire and dryness of vagina. 66% (66/100) of the GTN survivors expressed depression, and 50% (50/100) of patients complained anxiety, which were potential factors influencing QoL of GTN survivors. Relevant analysis explored the possible predictors of QoL for GTN patients, including physical function ( r = 0. 609,P ＜0. 01 ), sexual function ( r = 0. 473, P ＜ 0. 01 ), and social psychology ( r = 0. 294, P ＜ 0. 01 ).Conclusions GTN survivors have an overall good QoL after chemotherapy, the possible predictors of QoL for GTN patients include physical function, sexual function and social psychology. The sexual dysfunctions mostly present with short of sexual desire and dryness of vagina. Fear of recurrence may be a potential factor influencing QoL a long term after remission.

Clinical analysis of patients with relapsed and chemo-resistant gestational trophoblastic neoplasia / 中华妇产科杂志

Objective To analyze and compare the clinical characteristics and the treatment outcome of the patients with chemo-resistant and relapsed gestational trophoblastic neoplasia (GTN).Methods The clinical records of the patients with refractory GTN treated at the Peking Union Medical College Hospital (PUMCH) from Jan 2005 to Dec 2007 were retrospectively reviewed.According to the reasons for referral, all cases were classified as chemo-resistant GTN group who had never a normal serum human chorionic gonadotropin-beta subunit (β-hCG) level during their previous treatment, relapsed GTN group who had elevated serum β-hCG levels in the absence of the pregnancy after finished treatment 3 months or more, and undetermined GTN group who had elevated serum β-hCG levels in the absence of the pregnancy less than 3 months after completed treatment.The clinical features and treatment outcomes were compared between undetermined GTN group and chemo-resistant GTN group and also between undetermined GTN group and relapsed GTN group, respectively.Results Of 81 patients with refractory GTN, 32 cases were defined as undetermined GTN, 38 cases as chemo-resistant GTN and 11 cases as relapsed GTN.The median number of previous chemotherapy regimens, the rate of serologic complete remission ( SCR), the patients who needed to change regimens due to resistance, and the patients who needed to change regimens in the undetermined GTN group and the chemo-resistant GTN group were 2.3 versus 3.1 ( P = 0.010),100% (32/32) versus 66% (25/38, P ＜ 0.01 ), 22% (7/32) versus 58% (22/38, P = 0.002) and 28% (9/32) versus 63% (24/38, P = 0.003 ), respectively.No significant difference were observed between undetermined GTN group and relapsed GTN group in clinical features, previous and current treatment or treatment outcome ( all P ＞0.05 ).Conclusions In order to evaluate accurately the treatment outcome of refractory GTN, it seems more appropriate for the patients who had reached the normal value of serum β-hCG when completed treatment to be defined as patients with relapsed GTN, while whose serum β-hCG levels elevated in the absence of the pregnancy after the completion of treatment, irrespectively of duration of stopping treatment.Comparing with the patients with chemo-resistant GTN, the outcome of patients with relapsed GTN is better.

Epitheilioid Trophoblastic Tumor of the Lung: A Case Report

Epithelioid trophoblastic tumor is a rare type of gestational trophoblastic disease that is distinct from placental site trophoblastic tumor and choriocarcinoma, and epithelioid trophoblastic tumor has features resembling a carcinoma. We report here on an epithelioid trophoblastic tumor that was discovered as a solitary pulmonary nodule in the lung of a 50-year-old woman. The patient had suffered from a hydatidiform mole 20 years previously. Wedge resection of the lung was done and this showed a 1.9x1.5 cm sized, relatively well defined mass composed of mononuclear tumor cells admixed with hyaline-like material and necrosis. The tumor cells were positive for EMA, Cam5.2, alpha-inhibin, PLAP and hCG. After consulting the gynecologic department, a 7.5x6.5 cm sized mass was discovered in the uterine fundus. Hysterectomy was then done. The tumor cells were same to those of the lung mass. The lung mass is considered to be metastasis from the epithelioid trophoblastic tumor of the uterus. She has been an uneventful clinical course for three years.

Case report and literature review of epithelioid trophoblastic tumor / 中华妇产科杂志

Objective To evaluate the clinical characteristics of epithelioid trophoblastic tumor (ETT).Methods Six cases of ETT treated in Women's Hospital,School of Medicine,Zhejiang University from 2005 to 2007 were retrospectively analyzed,together with a literature review.Results Six cases of ETT were diagnosed pathologically after surgery.The age of patients ranged from 27 to 46 years.The most common presentation was abnormal vaginal bleeding(5/6).The preceding gestational events were hydatidiform mole in 1 case,abortion in 2 cases,and term delivery in 3 cases.The interval between the preceding gestation and the diagnosis of ETT ranged from 15-48 months.The serum human chorionic gonadotropin(hCG)level was 46-121 147 IU/L.Four cases presented with metastasis,including lung metastasis in all of the 4 cases,liver metastasis in 1 case,and pancreas metastasis in another 1 case.The main therapies were surgery combined with chemotherapy.All of the 6 cases received total abdominal hysterectomy.and 1 case also had lung lobectomy.One ease had a recurrence but refused any treatment again,and was lost to follow up;the therapy of 1 case unfinished;another 4 cases were without evidence of disease 9 to 19 months after surgery.Condusions The confirmation of ETF diagnosis is difficult before surgery.Surgical management is mostly recommended in ETT. The role of chemotherapy in ETT is not clear yet.