Clinical Presentation of Complete Hydatidiform Mole and Partial Hydatidiform Mole at a Regional Trophoblastic Disease Center in the United States Over the Past 2 Decades.

OBJECTIVE: The aim of this study was to compare the clinical presentation and incidence of postmolar gestational trophoblastic neoplasia (GTN) among cases of complete mole (CM) and partial mole (PM) from 1994 to 2013. METHODS: This study included all cases of patients with CM and PM from our trophoblastic disease center between 1994 and 2013. Their clinical and pathologic reports were reviewed. Gestational age at evacuation, features of clinical presentation, human chorionic gonadotropin levels, and the rate of progression to GTN were compared. RESULTS: The median gestational age at evacuation was 9 weeks for CM and 12 weeks for PM (P < 0.001). Patients with PM had lower pre-evacuation serum human chorionic gonadotropin levels (P < 0.001), and they were also less likely to present with vaginal bleeding (P < 0.001), biochemical hyperthyroidism (P < 0.001), anemia (P < 0.001), uterine size greater than dates (P < 0.001), and hyperemesis (P = 0.002). Consequently, patients with PM were less likely to have been clinically diagnosed as moles compared with CM prior to uterine evacuation (P < 0.001). The development of GTN occurred in 17.7% (33/186) and 4.1% (7/169) of patients with CM and PM, respectively (P < 0.001). CONCLUSIONS: This study indicates that, at our center over the past 20 years, both CM and PM were usually evacuated in the first trimester of pregnancy. Because CM more commonly presents with the signs and symptoms of molar disease than PM, CM is more commonly diagnosed prior to evacuation.

Current management of gestational trophoblastic neoplasia.

Gestational trophoblastic neoplasms are malignant lesions that arise from placental villous and extravillous trophoblast. Four clinicopathologic conditions make up this entity: invasive mole (IM), choriocarcinoma (CCA), placental-site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). IM and CCA, which make up the majority of these tumors, are highly responsive to chemotherapy with an overall cure rate exceeding 90%, making it usually possible to achieve cure while preserving reproductive function. PSTT and ETT, which rarely occur, are relatively resistant to chemotherapy, making surgery the primary treatment modality, chemotherapy being used only when the disease has metastasized.

Choriocarcinoma and epithelial trophoblastic tumor: successful treatment of relapse with hysterectomy and high-dose chemotherapy with peripheral stem cell support: a case report.

BACKGROUND: Post-termchoriocarcinoma is a rare complication of pregnancy. The presence of epithelioid trophoblastic elements may lead to the persistence of locally invasive disease which is unresponsive to multiagent chemotherapy. Relapse is associated with an estimated mortality rate of 30%. CASE: We present a case of Stage IC post-term choriocarcinoma and epithelioid trophoblastic tumor. While the metastatic sites in the lungs responded to multiagent chemotherapy, a hysterectomy was required to treat persistent disease in the uterus. The patient relapsed within 4 months of completion of chemotherapy. Relapse was treated with high-dose chemotherapy with peripheral stem cell support. The patient is alive with no evidence of disease 23 months posttransplant. CONCLUSIONS: The application of multimodality treatment and high-dose chemotherapy resulted in a successful outcome for this patient, indicating a potential role for high-dose therapy in patients who suffer a relapse of choriocarcinoma.

Padecimientos ginecológicos en la adolescencia: sangrado uterino disfuncional y nódulos mamarios; segunda parte / Gynecological diseases in the adolescence: disfunctional uterine bleeding and breast nodules; 2

Los periodos menstruales anovulatorios durante el primer año de posmenarquia o más, y los factores relacionados con la maduración sexual, además de los procesos patológicos, pueden producir sangramientos uterinos. Los nódulos mamarios son menos frecuentes, pero pueden provocar angustia, sobre todo entre jóvenes con antecedentes familiares de cáncer de mama