Chemotherapy is not needed when complete evacuation of gestational choriocarcinoma leads to hCG normalization.

BACKGROUND: The standard treatment for gestational choriocarcinoma is chemotherapy. OBJECTIVE: To describe the risk of recurrence with expectant management of gestational choriocarcinoma that has reached a normal human chorionic gonadotropin level after tumor removal without adjuvant chemotherapy. METHODS: A retrospective multicenter international cohort study was conducted from 1981 to 2017 involving 11 gestational trophoblastic disease reference centers with patient's follow-up extended until 2023. Clinical and biological data of included patients were extracted from each center's database. The inclusion criteria were i) histological diagnosis of gestational choriocarcinoma in any kind of placental tissue retrieved, ii) spontaneous normalization of human chorionic gonadotropin level following choriocarcinoma retrieval, iii) patient did not receive any oncological treatment for the choriocarcinoma, iv) and at least 6 months of follow-up after the first human chorionic gonadotropin level normalization. RESULTS: Among 80 patients with retrieved gestational choriocarcinoma and whose human chorionic gonadotropin level normalized without any other oncological therapy, none had a recurrence of choriocarcinoma after a median follow-up of 50 months. The median interval between choriocarcinoma excision and human chorionic gonadotropin level normalization was 48 days. The International Federation of Gynecology and Obstetrics/World Health Organization risk score was ≤6 in 93.7% of the cases. CONCLUSIONS: This multicenter international study reports that selected patients with gestational choriocarcinoma managed in gestational trophoblastic disease reference centers did not experience any relapse when the initial tumor evacuation is followed by human chorionic gonadotropin level normalization without any additional treatment. Expectant management may be a safe approach for highly selected patients.

Guideline No. 408: management of gestational trophoblastic diseases

This guideline reviews the clinical evaluation and management of gestational trophoblastic diseases, including surgical and medical management of benign, premalignant, and malignant entities. The objective of this guideline is to assist health care providers in promptly diagnosing gestational trophoblastic diseases, to standardize treatment and follow-up, and to ensure early specialized care of patients with malignant or metastatic disease. General gynaecologists, obstetricians, family physicians, midwives, emergency department physicians, anaesthesiologists, radiologists, pathologists, registered nurses, nurse practitioners, residents, gynaecologic oncologists, medical oncologists, radiation oncologists, surgeons, general practitioners in oncology, oncology nurses, pharmacists, physician assistants, and other health care providers who treat patients with gestational trophoblastic diseases. This guideline is also intended to provide information for interested parties who provide follow-up care for these patients following treatment. Women of reproductive age with gestational trophoblastic diseases. Women diagnosed with a gestational trophoblastic disease should be referred to a gynaecologist for initial evaluation and consideration for primary surgery (uterine evacuation or hysterectomy) and follow-up. Women diagnosed with gestational trophoblastic neoplasia should be referred to a gynaecologic oncologist for staging, risk scoring, and consideration for primary surgery or systemic therapy (single- or multi-agent chemotherapy) with the potential need for additional therapies. All cases of gestational trophoblastic neoplasia should be discussed at a multidisciplinary cancer case conference and registered in a centralized (regional and/or national) database. Relevant studies from 2002 onwards were searched in Embase, MEDLINE, the Cochrane Central Register of Controlled Trials, and Cochrane Systematic Reviews using the following terms, either alone or in combination: trophoblastic neoplasms, choriocarcinoma, trophoblastic tumor, placental site, gestational trophoblastic disease, hydatidiform mole, drug therapy, surgical therapy, radiotherapy, cure, complications, recurrence, survival, prognosis, pregnancy outcome, disease outcome, treatment outcome, and remission. The initial search was performed in April 2017 and updated in May 2019. Relevant evidence was selected for inclusion in the following order: meta-analyses, systematic reviews, guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional significant articles were identified through cross-referencing the identified reviews. The total number of studies identified was 673, with 79 studies cited in this review. The content and recommendations were drafted and agreed upon by the authors. The Executive and Board of Directors of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration, and the Board of Directors for the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. See the online appendix tables for key to grading and interpretation of recommendations. These guidelines will assist physicians in promptly diagnosing gestational trophoblastic diseases and urgently referring patients diagnosed with gestational trophoblastic neoplasia to gynaecologic oncology for specialized management. Treating gestational trophoblastic neoplasia in specialized centres with the use of centralized databases allows for capturing and comparing data on treatment outcomes of patients with these rare tumours and for optimizing patient care.

[Cervical cancer screening: current status and perspectives]. / Dépistage du cancer du cot utérin: situation actuelle et perspectives.

Cervical cancer screening with Pap cytology has effectively reduced the incidence of morbidity and mortality from invasive cervical cancer. However, Pap cytology has important limitation and is not completely protective. Invasive cervical cancers are still diagnosed and main reasons are an insufficient coverage rate and presence of false-negative results. HPV testing has greater sensitivity than Pap cytology for detecting high-grade lesions and cancer and is clearly one of the most promising new screening tools. It has the potential to improve cervical cancer screening effectiveness. The aim of our study was to discuss the current situation of cervical cancer screening in Switzerland, limitations of Pap cytology as well as the benefice expected with HPV testing and vaccienes.

A new vaginal extractor for laparoscopic surgery.

We developed a new instrument specifically designed to facilitate the removal of large tissue masses through a vaginal incision during laparoscopic surgery without any loss of gas. It consists of a cannula fitted with a ball-shaped head at one end. After laparoscopic culpotomy, tissue is seized with a grasping forceps introduced vaginally through the cannula. To prevent dissemination and to facilitate passage through the incision, tissue masses may be placed in a tied plastic pouch prior to extraction. The entire procedure is safe because of continual endoscopic control. It was performed in 57 women to extract cysts, tubal pregnancies, adnexa, myomas, and ovaries. It took an average of 10 minutes, and no intraoperative or postoperative complications were observed. Preliminary experience suggests that this technique is safe, fast, inexpensive, and easy to perform under continuous endoscopic control.

[Liver transplantation and pregnancy: 1994 perspectives]. / Transplantation hépatique et grossesse: perspectives en 1994.

The authors report a case of pregnancy in a 24-year-old, gravida-3, para-1 patient who had previously undergone liver transplantation for alveolar echinococcosis. Pregnancy and delivery were uneventful with no obstetrical or liver complications. Pregnancy seems to have little effect on liver transplants and rejection is seldom observed. Primary maternal complications are hypertension, preeclampsia, anemia and hyperbilirubinemia. Primary fetal complications include premature delivery and growth retardation. The mode of delivery depends on the obstetrical situation. Cyclosporin may be used during pregnancy. The risk of breastfeeding has not been clearly established. Pregnancy after liver transplantation is possible after 9 to 12 months but requires strict multidisciplinary surveillance. Barrier methods remain the preferred method of contraception for liver transplant patients.

[Value of penis endoscopy in sexual partners of women with condylomatous or dysplastic lesions]. / Intérêt de la péniscopie lors de lésions condylomateuses ou dysplasiques chez la femme.

TYPE OF STUDY: A retrospective study of 532 male sexual partners of patients who were examined for condylomatous or dysplasic lesions of the lower genital tract between January 1990 and June 1993. AIM: To evaluate the balanoscopy examination. The value of this examination for the follow-up of papilloma virus and dysplasic lesions in women. METHOD: Balanoscopy was performed after application of acetic acid (5%). Lesions were treated with viralytic agents or by CO2 laser destruction. Computer analysis of the data from the microscopic examination and treatment in partners was performed. MAIN RESULTS: Globally, peniscopy revealed a papilloma virus lesion in 43.3% of the cases. Nevertheless, for infectious lesions (condylomas) in women, 63% of the women had a papilloma virus lesions. CONCLUSION: Severe dysplasia of the penis is rare in our geographical area and balanoscopy is useful for the eradication of sexually transmitted diseases, sometimes for oncological examinations and to decrease the incidence of recurrent condylomatous or dysplasic lesions in women partners. Globally, the results are disappointing since the rate of recurrence was similar whether or not the male partner had been examined. The only difference was in case of rapid effective treatment in the partner which was obtained in 27% of the partners.

[Current indications for colposcopic examination]. / Indications actuelles de l'examen colposcopique.

OBJECTIVE: It has become necessary to set out exactly the indications for colposcopic examination and to improve out-patient therapy. A response has been made to the ever increasing pre-cancerous pathological conditions of the lower genital tract. TYPE OF STUDY: A review of the pathological conditions of the lower genital tract has led to colposcopic examinations being carried out to work out how far grounded its indications are. The authors particularly lead to the future for colposcopy and histology of so called "atypical" cytology. MATERIAL: A review of the literature and a retrospective study of the agreement between the cytology and the histology in 1,454 patients who were examined and followed up at the centre for laparoscopy and colposcopy between 1.1.1987 and 31.12.1991. THE PRINCIPLE: A study of the information is being gathered about the cytological, colposcopic and histological diagnoses. PRINCIPLES RESULTS: Dysplasias diagnosed cytologically were confirmed in 95% of cases by colposcopic examination and by the results of directed biopsy. In over 90% cases of smears showing "atypical" cells the colposcopy confirmed the pathology that was found and in more than 85% of cases the histological examination confirmed a papillomavirus lesion or a dysplasia of the cervix or elsewhere in the lower genital tract. CONCLUSION: Over and above the indication for colposcopic examination, cytological dysplasias were found and to were condylomata of the lower genital tract or leukoplakia of the vulva, and one has to add "atypical" smears. Furthermore repeating a smear in cases of atypical cytology is useless, and can be deceptive. Systemic control of the vulva and vagina has to be carried out when the cervix is examined because there is a frequent association of dysplasic lesions and there is a possible presence of isolated extracervical lesions when cytologically pathological smears are found.