ABSTRACT
La mola invasiva es poco frecuente y se caracteriza por la excesiva proliferación trofoblástica y penetración del trofoblasto dentro del miometrio, pero sin tendencia hacia la diseminación metastásica. El objetivo del trabajo es presentar un caso diagnosticado de neoplasia trofoblástica gestacional, tipo mola invasiva. Se realizaron estudios complementarios como: ecografía transabdominal, determinaciones de la fracción beta de la gonadotropina coriónica humana y una biopsia endometrial por legrado uterino. El resultado fue embarazo molar. Al ingreso le fue administrado metotrexato sistémico 25 mg intramuscular y ácido folínico un ámpula intramuscular de 15 mg diariamente, ambos durante cinco días. Posteriormente, a los 20 días se realizó histerectomía total abdominal sin anexectomía. La evolución clínica fue por consulta externa. Además, se realizó: radiografía de tórax, ultrasonografía de pelvis, dosificación de gonadotropina coriónica humana en su fracción beta, hemograma completo, tiempo de coagulación, sangramiento y transaminasa glutámico pirúvica evolutivas. En el manejo de la mola invasiva el tratamiento médico combinado con el quirúrgico fue efectivo y bien tolerado por la paciente.
Invasive mole is an infrequent condition characterized by excessive trophoblastic proliferation and trophoblast penetration into the myometrium, without a tendency to metastatic dissemination. The purpose of the study is to present a case diagnosed with gestational trophoblastic neoplasia of the invasive mole type. The following complementary tests were performed: transabdominal echography, human chorionic gonadotropin beta subunit determinations, and endometrial biopsy by uterine curettage. The result was molar pregnancy. Upon admission the patient was administered systemic methotrexate 25 mg intramuscularly, as well as an intramuscular ampoule of folinic acid 15 mg daily, both during five days. Total abdominal hysterectomy without anexectomy was performed 20 days later. Clinical evolution was followed up on an outpatient basis. The following tests were also performed: chest radiography, pelvic ultrasonography, human chorionic gonadotropin beta dosage, complete blood count, clotting time, bleeding and evolutive glutamic-pyruvic transaminase. During management of the invasive mole, the combination of clinical and surgical treatments proved effective and was well assimilated by the patient.
Subject(s)
Humans , Female , Pregnancy , Adult , Hydatidiform Mole/surgery , Hydatidiform Mole/drug therapy , Hydatidiform Mole/diagnostic imaging , Gestational Trophoblastic Disease/epidemiologyABSTRACT
This study included fifty-five patients with complete hydatidiform mole aiming to assess the value of U/S, transabdominal [TAS], transvaginal [TVS] and serial B HCG assay in the selection of cases of complete hydatidiform mole for the use of chemotherapy. All patients were diagnosed by ultrasonography and B HCG assay and managed by suction evacuation under continuous ultrasonic monitoring and then were followed up with serial B HCG assay and ultrasonography. The results concluded that the use of ultrasound, B HCG assay in conjunction with suction evacuation under continues US monitoring in the management of complete molar pregnancy is invaluable to select cases of persistent gestational trophoblastic disease for chemotherapy and helps together with careful follow up to give the standard care in such cases
Subject(s)
Humans , Female , Hydatidiform Mole/diagnostic imaging , Hydatidiform Mole/drug therapy , /analysisABSTRACT
Se realizó una revisión de 6 casos de mola hidatiforme entre 1985 y 1994, se determinó una incidencia del 0,03 por ciento o sea; 1 por cada 2.831 embarazos. La edad de las pacientes más afectadas osciló entre 31 y 40 años, en un 83,3 por ciento se presentó en pacientes II gestas, más quimioterapia con un 66,61 y ninguno de los casos reportó malignización
Subject(s)
Humans , Female , Adult , Pregnancy , Dilatation and Curettage/methods , Hydatidiform Mole/diagnosis , Hydatidiform Mole/drug therapy , Hydatidiform Mole/pathology , PregnancySubject(s)
Humans , Female , Pregnancy , Hydatidiform Mole/diagnosis , Hyperplasia/genetics , Hysterectomy , Trophoblastic Neoplasms/classification , Hydatidiform Mole , Hydatidiform Mole/drug therapy , Hydatidiform Mole/epidemiology , Hydatidiform Mole/pathology , Hydatidiform Mole/therapy , Hyperplasia/pathology , Trophoblastic Neoplasms/diagnosis , Trophoblastic Neoplasms/pathology , Trophoblastic Neoplasms/drug therapy , Trophoblastic NeoplasmsABSTRACT
Com o objetivo de avaliar o desempenho reprodutivo de 80 mulheres que tiveram neoplasia trofoblástica gestacional (NTG), analisou-se a primeira gestaçäo após o episódio molar. Dois grupos foram estabelecidos: aquelas submetidas a qumioterapia, rotuladas como "tratadas", e as que alcançaram remissäo espontânea, "controle". O diagnóstico de NTG baseou-se nos achados clínicos peculiares a doença, dosagen de gonadotrofinas coriônicas plasmáticas e ultra-sonografia pélvica. No seguimento pós-molar, mereceram quimioterapia as pacientes que näo alcançaram remissäo espontânea após o prazo regulamentar de acompanhamento. A quimioterapia interferiu no futuro reprodutivo das pacientes "tratadas", tornando maior a freqüência de abortamento espontâneo de primeiro trimestre. Ultrapassada a fase de abortamento de primeiro trimestre (12ª semana), nenhuma repercussäo relevante sobre o curso da prenhez foi consignada. Toda paciente portadora de neoplasia trofoblástica gestacional (NTG), independente do estadiamento clínico da doença, sofre, por definiçäo, grave frustraçäo da perda reprodutiva temporária, necessitando, quase sempre, recompensar-se com futura gestaçäo. A exceçäodaquelas tratadas cirurgicamente mediante histerctomia, quase todas alcançaram remissäo espontânea ou após quimioterapia. É indispensável poder oferecer a tais pacietnes perspectivas reprodutivas que lhes assegurem pré-natal bem acompanhado, parto adequado e prole hígida. É o que visa o presente trabalho