The potential value of red blood cell distribution width in patients with invasive hydatidiform mole.

BACKGROUND: Red blood cell distribution width (RDW) has attracted increasing attention in cancer. The aim of this study was to assess the changes of RDW in patients with invasive hydatidiform mole and analyze the relationship between RDW and invasive hydatidiform mole. METHODS: A retrospective analysis was performed on 102 patients diagnosed as invasive hydatidiform mole in the First Affiliated Hospital of Guangxi Medical University from January 2009 to March 2018. A total of 120 healthy subjects were used as a control group. The Mann-Whitney U test was used for comparison between the invasive hydatidiform mole and control groups. Comparison of RDW with other blood parameters was performed using Spearman's. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) were also determined. RESULTS: The RDW, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and absolute lymphocyte count were significantly elevated in the invasive hydatidiform mole group compared with control group. The hemoglobin (Hb) concentration, mean red blood cell volume (MCV) and platelet count (PLT) were significantly lower in invasive hydatidiform mole group than control group. Grade III and above invasive hydatidiform mole patients had higher levels of RDW than grade I and II patients. Correlation analysis showed that RDW was negatively correlated with Hb, MCV, NLR, and neutrophil count, but positively correlated with PDW and different stages of invasive hydatidiform mole. The ROC curve showed that the AUC of the RDW was 0.660 (95% CI 0.581-0.740; P < 0.01). CONCLUSION: This study reveals the potential value of RDW in invasive hydatidiform mole.

Histopathological and clinical features of molar pregnancy.

OBJECTIVE: To analyse own set of molar pregnancies and to develop clinically relevant procedures. TYPE OF STUDY: Review article with analysis of own data. SETTINGS: Department of Pathology 3rd Faculty of Medicine, Charles University, Faculty Hospital Královské Vinohrady, Prague; Department of Obstetrics and Gynecology 3rd Faculty of Medicine, Charles University, Faculty Hospital Královské Vinohrady, Prague. INTRODUCTION: The study monitors the decrease of laboratory values of beta-subunit of hCG gonadotropin (beta-hCG) after evacuation of partial and complete hydatidiform moles in a set of 45 partial and 46 complete moles. Two case reports of invasive moles. RESULTS: In cases of partial hydatidiform moles there was complete regression of beta-hCG in all cases, 89% regressed in six weeks, none of the women showed no subsequent elevation after reaching negativity. In cases of complete hydatidiform moles the decrease was less gradual, the negativity after six weeks was confirmed in 78%, three complete moles became malignant. CONCLUSION: The decrease of beta-hCG after molar pregnancy termination is variable. Even if in cases of complete hydatidiform moles the risk of malignization after reaching negativity is low, beta-hCG checks are recommended at monthly intervals for 6 months. Correct diagnosis of complete mole and its differentiation from partial mole can be achieved using immunohistochemistry - p57 antibody.

Predictive value of some hematological parameters for non-invasive and invasive mole pregnancies.

AIM: The aim of this study was to discriminate mole pregnancies and invasive forms among cases with first trimester vaginal bleeding by the utilization of some complete blood count parameters conjunct to sonographic findings and beta human chorionic gonadotropin concentration. MATERIALS AND METHODS: Consecutive 257 cases with histopathologically confirmed mole pregnancies and 199 women without mole pregnancy presented with first trimester vaginal bleeding who admitted to Zeynep Kamil Women and Children's Health Training Hospital between January 2012 and January 2016 were included in this cross-sectional study. The serum beta HCG level at presentation, and beta hCG levels at 1st, 2nd and 3rd weeks of postevacuation with some parameters of complete blood count were utilized to discriminate cases with molar pregnancy and cases with invasive mole among first trimester pregnants presented with vaginal bleeding and abnormal sonographic findings. RESULTS: Levels of beta hCG at baseline (AUC = 0.700, p < 0.05) and 1st (AUC = 0.704, p < 0.05), 2nd (AUC = 0.870, p < 0.001) and 3rd (AUC = 0.916, p < 0.001) weeks of postevacuation period were significant predictors for the cases with persistent disease. While area under curve for mean platelet volume is 0.715, it means that mean platelet volume has 21.5% additional diagnostic value for predicting persistency in molar patients. For 8.55 cut-off point for mean platelet volume, sensitivity is 84.6% and specificity is 51.6%. Area under curve for platelet/lymphocyte ratio is 0.683 means that platelet/lymphocyte ratio has additional 18.3% diagnostic value. For 102.25 cut-off point sensitivity is 86.6% and specificity is 46.2. CONCLUSIONS: Simple, widely available complete blood count parameters may be used as an adjunct to other risk factors to diagnose molar pregnancies and predict postevacuation trophoblastic disease.

Laparoscopically diagnosed invasive mole presenting as acute hemoperitoneum.

A young multipara presented with acute abdominal pain. She had history of dilatation and evacuation for a missed miscarriage 2 months back. The diagnosis of ectopic pregnancy was made on the basis of clinical presentation and laboratory investigations. Laparoscopy was performed which revealed features of invasive mole. The procedure was converted to laparotomy and hysterectomy was performed. Patient recovered well. Histopathology confirmed the diagnosis of invasive mole. Follow-up till 12 weeks reported return to normal ßhCG (beta subunit of human Chorionic Gonadotropin) levels.

Ovarian hyperstimulation syndrome in a spontaneous pregnancy with invasive mole: report of a case.

It is known that most cases of Ovarian Hyperstimulation Syndrome (OHSS) are associated with the therapies for ovulation induction. However, OHSS may rarely be associated with a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism or polycystic ovary syndrome. We report a case of severe OHSS in spontaneous pregnancy with invasive mole in a 34 years old woman. The clinical picture showed abdominal pain, massive ascites, nausea, dyspnea and amenorrhea. After imaging examinations and laboratory tests, the diagnosis was established. The patient was managed expectantly with no complications. Although spontaneous ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious complications, which may develop rapidly.

Differences in total human chorionic gonadotropin immunoassay analytical specificity and ability to measure human chorionic gonadotropin in gestational trophoblastic disease and germ cell tumors.

OBJECTIVE: To determine the ability of several radioimmunoassays and commercial two-site immunoassays to detect the first World Health Organization International Reference Reagents (IRRs) for 6 defined human chorionic gonadotropin (hCG) variants and to compare their performance in measuring hCG in sera from patients with gestational trophoblastic disease (GTD) and germ cell tumors (GCTs) of the testis or ovary. STUDY DESIGN: The reactivity of the different assays with the 6 IRRs together with the current fourth International Standard (IS, 75/589) was tested using 5 commercial two-site assays as well as 2 competitive polyclonal radioimmunoassays (RIAs) and a competitive monoclonal immunoassay. Individual samples from 41 patients (19 GCT and 22 GTD) with high circulating levels of hCG (range, 718-6,055,000 IU/L) were diluted and measured using the various immunoassays. RESULTS: The results of 4 GCT patient samples varied markedly among the assays, including 1 sample that was grossly underestimated by 3 of the commercial assays. CONCLUSION: Comparison of each assay's reactivity to the variant isoforms revealed that recognition of the isoforms was highly variable, particularly for hCGbeta and hCGbeta core fragment (hCGbetacf).

Japanese trial for classification of gestational trophoblastic disease.

OBJECTIVE: To evaluate the clinical usefulness of the Japanese Diagnostic Score to differentiate choriocarcinoma clinically without histologic findings from persistent gestational trophoblastic disease (GTD). STUDY DESIGN: We reviewed the clinical records and histologic reports on all 809 patients with persistent GTD treated with surgery and chemotherapy in Japan. There were 347 cases of choriocarcinoma and 462 cases of invasive mole with histologic confirmation. We retrospectively applied the Japanese Diagnostic Score to all patients for detection of choriocarcinoma in persistent trophoblastic disease. RESULTS: The sensitivity of the score for choriocarcinoma was 92.2%. The specificity was 93.5%. This retrospective study showed that the accuracy of this scoring system to differentiate true malignant choriocarcinoma clinically from both low risk and high risk gestational trophoblastic neoplasia without histologic findings was 92.9%. CONCLUSION: Our trial to differentiate choriocarcinoma clinically from persistent GTD without histologic findings using a unique scoring system was successful. Proper management in the early stages strongly influences the outcome of these diseases. This scoring system should be very useful in comparing the incidence and survival rate of choriocarcinoma between nations.

Invasive mole--case report of massive uterine destruction.

Patient with malignant Gestational Trophoblastic Neoplasm (GTN) was treated by mean of MTX-FA, MAC, EMA-CO and EMA-EP. Changes in serum human chorionic gonadotropine (beta hCG) levels and changes in ultrasonographic findings were checked weekly. Finally transabdominal hysterectomy with ovaries conservation was done and polychemotherapy administrated after the operation until three consecutive serum chorionic gonadotropine values were negative. This is a case report of Invasive mole in 32 years old patient without possibility to preserve reproductive health. GTN developed two months after spontaneous abortion in 13th week gestation. No changes in uterine structure were found during the first ultrasonographic examination. Three months after abortion and one month after GTN confirmed, massive destruction of lateral uterine wall was detected during transvaginal Doppler ultrasound examination. Resistance index of 0,366 was significantly lower than normal, with hypervascularisation in affected tissue. Serum beta hCG confirmed poor effect of polychemotherapy treatment and decision for operative treatment was made. Hystological findings after the operation confirmed malignant GTN- invasive mole. Specific changes in ultrasonographic picture could have an impact in therapy making decision and could not be refereed without the most relevant parameter such is serum human chorionic gonadotropine.

Partial hydatidiform mole.

A case of partial hydatidiform mole is presented, occurring in a young primiparous woman after natural conception. She presented with incomplete miscarriage. Histological diagnosis of partial mole was made. Failure of beta HCG to fall resulted in the start of chemotherapy. WHO scoring placed her in low risk group. In spite of the low risk, she required third line chemotherapy for complete eradication of disease.

[Regression of hCG in various types of molar pregnancies--clinical course and prognosis]. / Regrese hCG u ruzných typu molárních tehotenství--klinický prubeh a prognóza.

OBJECTIVE: To evaluate spontaneous regression curves of hCG serum positivity in patients with surgically treated molar pregnancies. Comparison of complete, partial and invasive mole. The study should result in optimalisation of follow up criteria of molar pregnancies in respect to their potential malignant change. DESIGN: Retrospective comparative clinical study. SETTING: Obst. Gyn. Dpt., Oncogynecology div., 2nd Medical Faculty, FNM, Charles University Prague, Pathology Dpt., 2nd Medical Faculty, Institute of Biology and Medical Genetics. METHODS: Evaluation of spontaneous regression curves of serum hCG levels in 104 molar pregnancies. 46 patients with partial hydatiform mole, 48 patients with complete hydatiform mole, 10 patients with invasive mole. Serum hCG levels were detected by radioimunoassay (RIA) in the first period and imunochemoluminisent assay (LIA) in the second period. Regression curves of hCG positivity in particular moles were statistically evaluated by Fischer test and t-test. RESULTS: There is statistically significant difference in spontaneous regression of hCG positivity in different types of molar pregnancies. Recommended criteria for gestational trofoblastic disease (GTD) diagnosis and follow up are fully applicable in clinical practice. There is exception in partial hydatiform moles, where plateau in hCG regression does not necessarily implicate chemotherapy in patient with good compliance. CONCLUSION: Early diagnosis of GTD predominantly due to the widespread use of ultrasonography changes classical clinical features of molar pregnancies. Spontaneous regression in hCG positivity in serum is more rapid in patients with partial hydatiform mole, slower in complete hydatiform mole and invasive mole. There is no significant change in malignant potential regarding early detection and treatment.

A clinical trial on diagnostic scoring system of choriocarcinoma and invasive mole in Vietnam.

OBJECTIVES: The aim was to discriminate preoperatively invasive mole (IM) and choriocarcinoma (CC) in patients with gestational trophoblastic neoplasm (GTN) for early and satisfactory treatment in Vietnam. METHODS: In 1990, 122 patients with GTN treated at TUDU Hospital were retrospectively analysed to make a differential diagnosis between CC and IM by using the JSOG scoring system and these results were later compared with postoperative histopathological findings. Furthermore, to raise the predictive diagnostic value for CC, the authors modified the JSOG system and devised a scoring system of TUDU hospital which results were compared with that of the JSOG ones. From the end of 1990 to March 1993, in 151 patients with GTN who underwent surgery, preoperative and postoperative diagnoses of CC and IM were prospectively compared using the JSOG and the modified scoring system. The comparative data were statistically analysed using the t-test, chi 2 test and Fisher test. The sensitivity, specificity, and the positive and negative predictive value, and false positive and false negative were calculated and compared. RESULTS RETROSPECTIVE STUDY: In making a predictive diagnosis of 122 patients with findings of trophoblastic tumors, the authors found some differences in possibility of CC of the following subfactors: latent period, primary lesion, pulmonary metastases, metastases except pulmonary metastases and hCG rerise. So, a modified scoring system of TUDU hospital was devised. PROSPECTIVE STUDY: Of 151 Vietnamese patients with GTN using the JSOG scoring system and the modified system, a diagnostic probability in 108 cases predicted choriocarcinoma by JSOG scoring system was 61%, while that of invasive mole in 43 cases was 62.8%. Accordingly, the false positive rate for invasive mole of 64 cases predicted choriocarcinoma was 38.9%. According to the modified scoring system, of 75 patients predicted choriocarcinoma, 69 patients were histologically confirmed choriocarcinoma. Therefore, the diagnostic specificity was high (94.20%) and the false positive rate was low (5.3%), while of 76 patients predicted invasive mole, 13 patients were histologically diagnosed as choriocarcinoma. Accordingly, the false negative rate was low (13.1%). CONCLUSION: The modified JSOG scoring system is of more diagnostic value in the preoperative differentiation between CC and IM in Vietnam.

Usefulness of granulocyte colony-stimulating factor on neutropenia in patients of invasive mole and choriocarcinoma.

The effect of human granulocyte colony stimulating factor (hG-CSF) was investigated on the proliferation of choriocarcinoma cells in vitro. No growth-stimulating effect was observed. Then, 22 patients with invasive mole and 9 patients with choriocarcinoma who received combination chemotherapy were treated with hG-CSF when white blood cell counts decreased below 2,000/mm3. The duration of neutropenia was reduced significantly by 3-4 days with the use of hG-CSF. No side effects were observed. These results indicate safety and usefulness of hG-CSF as an adjunct to chemotherapy in the treatment of gestational trophoblastic disease.

[Clinical evaluation of ultrasonography in diagnosis of the early invasive hydatidiform mole].

The consecutive uterine changes of the B ultrasonic scan were observed in 41 cases with invasive hydatidiform mole, which compared with the uterine changes in 10 controls who had induction of labor in second trimester. It was found that B ultrasonic scan was very useful technic in diagnosis of invasive mole. The time when the serum hCG titers fell to normal was earlier than the time of B scan reversed during treatment. Therefore, the B scan of uterus is of value in early diagnosis and therapeutic quide of invasive mole.

Serum SP1, hPL and beta-hCG levels in trophoblastic diseases.

Serum SP1 (pregnancy specific beta 1 glycoprotein), hPL (human placental lactogen) and beta-hCG (beta-human chorionic gonadotropin) in patients with choriocarcinoma, invasive mole, and hydati-diform mole were determined by radioimmunoassay (RIA), and compared with those in normal males, non-pregnant women and normal pregnant women in order to evaluate the clinical significance of SP1, hPL and beta-hCG determinations. Serum SP1 levels at the time of admission were highest in hydatidiform mole (5.1 +/- 0.6 micrograms/L) and lowest in choriocarcinoma (0.5 +/- 0.3 micrograms/L). Serum hPL levels were 68.2 +/- 9.7 ng/L in hydatidiform mole and 26.4 +/- 8.3 ng/L in choriocarcinoma. Serum SP1 and hPL levels in trophoblastic diseases were lower than in normal pregnancies (SP1 11.5 +/- 5.1 micrograms/L, hPL 216.8 +/- 48.1 ng/L). SP1/beta-hCG ratios were less than 1.5 in 4/43 (9.3%) cases of hydatidiform mole and 17/19 (89.5%) cases of invasive mole and choriocarcinoma. The beta-hCG/hPL ratios were below 15 in 35/43 (81.4%) cases of hydatidiform mole and 4/19 (21.1%) malignant trophoblastic diseases. The prognosis after operation and chemotherapy was favourable if patient's SP1 and beta-hCG levels gradually decreased.

[Evaluation of serum ferritin in female genital neoplasms].

Serum ferritin concentrations of 50 normal women and 90 patients with neoplasms of female genital tract were determined by radioimmunoassay. The mean value of serum ferritin in 23 cases of ovarian carcinoma was 402.04 micrograms/L, significantly higher than that of normal subjects and patients with benign genital neoplasms. Serum ferritin levels in patients with endometrial carcinoma, endometrial stromal sarcoma, and benign genital neoplasms were significantly higher than that of the normal subjects. There was a positive correlation between the serum ferritin level and the clinical stage of ovarian carcinoma. The serum ferritin determination is useful in the diagnosis, differential diagnosis and prognosis of ovarian cancers.

Study and treatment of gestational trophoblastic diseases at the John I. Brewer Trophoblastic Disease Center, 1962-1990.

From 1962 through 1989, 5063 patients were referred to the John I. Brewer Trophoblastic Disease Center of the Northwestern University Medical School. Among these were 564 patients treated with chemotherapy for gestational trophoblastic tumors (choriocarcinoma and invasive mole). The overall cure rate was 94%, 100% for 323 patients without evidence of metastases and 85% for 241 patients with metastatic disease. Four factors were determined to significantly influence treatment response: (1) clinicopathologic diagnosis of choriocarcinoma, (2) metastases to sites other than the lung or vagina, (3) number of metastases, and (4) previous failed chemotherapy.

Gestational trophoblastic tumours following initial diagnosis of partial hydatidiform mole.

11 patients registered with an initial diagnosis of partial hydatidiform mole (PHM) subsequently required chemotherapy for a gestational trophoblastic tumour. In a retrospective review by histopathological examination and measurement of DNA ploidy, the diagnosis was confirmed as PHM in 5 cases and revised to complete hydatidiform mole in 4; in 2 cases there was no evidence of a molar pregnancy. 4 of the patients with PHM had no other known pregnancy before the gestational trophoblastic tumour and in 2 of these patients the tumour was diagnosed histologically as choriocarcinoma. Not all patients in whom PHM was diagnosed at referring hospitals proved to have the condition. Although the risk of a patient with PHM requiring chemotherapy for gestational trophoblastic tumour is of the order of 1 in 200, compared with 1 in 12 after a complete mole, there is no justification for excluding a patient from follow-up after the evacuation of a PHM.