Gestational Trophoblastic Disease

Gestational Trophoblastic Neoplasia (GTN) is a rare but highly curable condition arising from abnormal placental tissue. This retrospective study, conducted at Calicut Medical College, Kerala, from 2016 to 2019, evaluated the clinical and demographic profile, treatment outcomes, and fertility impacts in 25 patients diagnosed with GTN. Most patients were aged 20-35 years, with multiparous women showing a higher risk. Complete hydatidiform mole was the most common histopathological finding (60%), and 84% of patients were diagnosed at an early stage. Low-risk GTN cases responded well to single-agent chemotherapy, primarily Methotrexate, with a 100% treatment success rate. High-risk cases required more intensive regimens and occasional surgical interventions. Fertility outcomes were promising, with 72% of patients able to conceive post-treatment, though many experienced anxiety and depression during care. This study highlights the need for early diagnosis, effective treatment, and comprehensive psychosocial support to optimize outcomes for GTN patients. Further research is needed to explore long-term effects and improve awareness of this condition

Background: Objective of current study was to study the demographic details, pattern of presentation and response to the treatment in the patients presenting with Gestational Trophoblastic Disease (GTD). Methods: The present study was conducted in a tertiary teaching institute as a retrospective plus prospective study over a period of 5 years from August 2004 to August 2009. Total 37 cases were studied out of which 16 were studied retrospectively from the case record and 21 were studied prospectively. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy and the treatment received. Results: 37 cases of gestational trophoblastic disease were studied in a period of 5 years from August 2004 to August 2009. The incidence of gestational trophoblastic disease was 1in 600 deliveries with the mean age of patients being 26.9 years. Most common chief complaint at presentation was bleeding per vaginum after a period of amenorrhoea seen in 31 patients (84%) followed by hyperemesis seen in 8 (19%) patients. Out of 37 patients 29 (78%) had complete mole & 8 (22%) had partial mole, the ratio of being 3.6:1. Complete cure rate in present study was seen in 31 out of 37 (84%) patients and mortality was seen in 2.7%. Conclusions: Gestational trophoblastic disease is seen most commonly in reproductive age group. This is a highly curable tumor even in the presence of distant metastasis.

Background: Objective of current study was to study the demographic details, pattern of presentation and response to the treatment in the patients presenting with Gestational Trophoblastic Disease (GTD). Methods: The present study was conducted in a tertiary teaching institute as a retrospective plus prospective study over a period of 5 years from August 2004 to August 2009. Total 37 cases were studied out of which 16 were studied retrospectively from the case record and 21 were studied prospectively. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy and the treatment received. Results: 37 cases of gestational trophoblastic disease were studied in a period of 5 years from August 2004 to August 2009. The incidence of gestational trophoblastic disease was 1in 600 deliveries with the mean age of patients being 26.9 years. Most common chief complaint at presentation was bleeding per vaginum after a period of amenorrhoea seen in 31 patients (84%) followed by hyperemesis seen in 8 (19%) patients. Out of 37 patients 29 (78%) had complete mole & 8 (22%) had partial mole, the ratio of being 3.6:1. Complete cure rate in present study was seen in 31 out of 37 (84%) patients and mortality was seen in 2.7%. Conclusions: Gestational trophoblastic disease is seen most commonly in reproductive age group. This is a highly curable tumor even in the presence of distant metastasis.

Epithelioid trophoblastic tumour (ETT) is a very rare variant of gestational trophoblastic disease, which arises in reproductive-age women with a prior gestational history. Because of its rarity, its biological behaviour, imaging characteristics and therapeutic schedule have not yet been fully established. Here we describe a rare case of metastatic ETT in a premenopausal woman. A 40-year-old, gravida 3, para 2, Portuguese woman was referred to the dermatology department for multiple skin nodules on the scalp measuring between 1 and 6 cm. A skin biopsy was suggestive of metastatic lesions of low differentiated carcinoma in favour of squamous cell carcinoma. Staging cervical-thoracic-abdominal and pelvic CT showed multiple lesions compatible with metastasis (ganglia, lung and kidneys). Since a CT scan was unable to identify the primary tumour, it was decided to perform a PET-CT scan and to take a biopsy of a vulvar nodule which had been clinically identified as ETT. The patient began ...

Background: Gestational trophoblastic disease (GTD) comprises a spectrum of diseases ranging from molar pregnancy to malignant gestational trophoblastic neoplasia (GTN). GTN are highly chemo-sensitive tumours which are treated as per FIGO risk stratification. The rarity of the disease limits the evidence regarding the disease to case series and reports. The objective of this study was to study incidence, baseline characteristics of patients and clinical outcome of GTN patients treated at this centre. Methods: This is a retrospective descriptive study based on medical records of patients of GTD who were registered in department of medical oncology, from January 2015 to December 2018 (4 years). GTN was diagnosed based on serum beta HCG values. Their baseline characteristics, risk score, serum β HCG levels, and treatment regimens were investigated. The incidence of GTD and response to treatment were analysed. Results: Out of 211 GTD patients, 56 developed GTN. The incidence was 3.4 per 10000 deliveries. Low risk cases (n=38) were treated with methotrexate and actinomycin in first line while high risk cases received EMACO and EP followed by EMACO as the first line. A cure rate of 100% for low risk cases and 94.4% (n=17) for high risk cases were recorded. Resistance to MTX was 32.3% while EMACO was resistant in 46.6% as first line. Neutropenia and alopecia were the most common treatment related adverse events. Predictors of resistance to single agent in low risk GTN include higher pre-treatment βHCG values and higher risk scores. Conclusions: GTN exemplifies a rare, highly aggressive but curable malignancy. Serum βHCG is the most reliable diagnostic as well as prognostic marker in management of GTD. EMACO is the preferred regimen for high risk GTN. FIGO staging and risk stratification help in individualizing the treatment to ensure maximum response to therapy thus making GTN a curable malignancy.

Background: Gestational trophoblastic disease (GTD) comprises a spectrum of diseases ranging from molar pregnancy to malignant gestational trophoblastic neoplasia (GTN). GTN are highly chemo-sensitive tumours which are treated as per FIGO risk stratification. The rarity of the disease limits the evidence regarding the disease to case series and reports. The objective of this study was to study incidence, baseline characteristics of patients and clinical outcome of GTN patients treated at this centre.Methods: This is a retrospective descriptive study based on medical records of patients of GTD who were registered in department of medical oncology, from January 2015 to December 2018 (4 years). GTN was diagnosed based on serum beta HCG values. Their baseline characteristics, risk score, serum β HCG levels, and treatment regimens were investigated. The incidence of GTD and response to treatment were analysed.Results: Out of 211 GTD patients, 56 developed GTN. The incidence was 3.4 per 1...

Result(s)* Fifteen patients with PHMCF were extracted from the databases and ninety-four case-reports from literature. Vaginal bleeding and hypertensive disorders occur more often during a PHMCF pregnancy compared to normal pregnancies (27% and 18%), especially the incidence of severe early preeclampsia (PE) was high in case of fetal triploidy (41%). The incidence of progression into gestational trophoblastic neoplasia (GTN) was 13%. High numbers of premature delivery and termination of pregnancy in case of fetal triploidy led to a neonatal survival of only 26%. Conclusion* Fetal triploidy has a poor prognosis and higher chance of maternal complications. Termination of pregnancy is therefore often advisable. In case of normal pregnancy in combination of a partial mole, continuation of pregnancy is possible in combination with close guidance and clinical monitoring preferably in obstretric high care units because of the high maternal and fetal risks. Disclosures None of the authors has a conflict of interest.

Objectives: The objective of this study was to collect information on human chorionic gonadotrophin (hCG) laboratory testing and reporting in women with gestational trophoblastic disease (GTD), to assess the associated challenges, and to offer perspectives on hCG testing harmonisation. Design: Information was collected from laboratories by electronic survey (SurveyMonkey) using a questionnaire designed by members of the European Organisation for the Treatment of Trophoblastic Disease (EOTTD) hCG working party. Participants: The questionnaire was distributed by the EOTTD board to member laboratories and their associated scientists who work within the GTD field. Setting: The questionnaire was distributed and accessed via an online platform. Methods: The questionnaire consisted of 5 main sections. These included methods used for hCG testing, quality procedures, reporting of results, laboratory operational aspects, and non-GTD testing capability. In addition to reporting these survey re...

Introduction: Extrauterine epithelioid trophoblastic tumour is an exceedingly rare and aggressive form of gestational trophoblastic disease that arises outside the uterus and is characterised by the proliferation of intermediate trophoblastic cells. Unlike more common forms of gestational trophoblastic diseases, such as hydatidiform moles and choriocarcinoma, this entity presents unique diagnostic and therapeutic challenges due to its atypical location and clinical features. Thus far, no documented cases of this entity have been reported in the colon. Case presentation: We report the case of a 42-year-old woman who presented with complaints of lower abdominal pain and a palpable mass in the left iliac fossa, initially suspected to be an ectopic pregnancy. On radiological evaluation, a provisional diagnosis of gastrointestinal stromal tumour was made, following which the patient underwent a left colectomy with resection and anastomosis, and the excised specimen on comprehensive histopathological and immunohistochemical analysis was diagnosed as a case of extrauterine epithelioid trophoblastic tumour. However, the patient's condition deteriorated, and she succumbed to the disease one month after the diagnosis. Conclusion: The rarity of extrauterine trophoblastic tumours contributes to limited clinical experience and treatment protocols, resulting in poor prognoses. This case report highlights the importance of histopathological examination for a confirmatory diagnosis, ensuring timely identification and improving patient outcomes.

Doença trofoblástica gestacional é anomalia de gravidez que engloba formas clínicas benignas (mola hidatiforme completa e parcial) e malignas (mola invasora, coriocarcinoma, tumor trofoblástico do sítio placentário e tumor trofoblástico epitelioide). Sua forma mais comum, a mola hidatiforme, acomete 1:200 grávidas brasileiras. No passado era comum a paciente com mola hidatiforme apresentasse sintomatologia exuberante: hemorragia copiosa, cistos teca-luteínicos dos ovários, útero aumentado para a idade gestacional, pré-eclâmpsia precoce, hiperemese e hipertireoidismo. Hoje, com o diagnóstico precoce feito pela ultrassonografia, muitas pacientes são diagnosticadas com gestação molar ainda em fase assintomática. Todavia, este diagnóstico precoce tem dificultado a análise histopatológica do material molar, tornando as técnicas imuno-histoquímica e de biologia molecular importantes para a confirmação diagnóstica. Por seu potencial de evoluir para neoplasia trofoblástica gestacional, as pacientes acometidas por gravidez molar devem ser atendidas em Centros de Referência, onde são inicialmente submetidas ao esvaziamento uterino pela técnica de vácuo-aspiração. Nestes serviços especializados, elas também terão monitorados seus níveis de gonadotrofina coriônica humana a fim de detectar precocemente a persistência da doença e sua progressão maligna. Vale salientar que o uso rigoroso de contracepção hormonal é fundamental para manter fidedigno o marcador tumoral dessa doença. Espera-se que cerca de 20% das pacientes com mola hidatiforme evolvam para neoplasia trofoblástica, cujo tratamento quimioterápico é capaz de curar a grande maioria das pacientes, preservando sua capacidade reprodutiva que, pelo geral, não se altera. O objetivo desse artigo é rever aspectos clínicos, genéticos, patológicos e terapêuticos da doença trofoblástica gestacional, importante causa de hemorragia da gestação.

Gestational trophoblastic disease is disorder of pregnancy that encompasses clinical benign forms (complete and partial hydatidiform mole) and malignant forms (invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor). Its most common form, hydatidiform mole, affects 1:200 pregnant in Brazil. In the past it was common for a patient with hydatidiform mole present exuberant symptoms: copious bleeding, theca lutein cysts of the ovary, enlarged uterus for gestational age, early preeclampsia, hyperemesis and hyperthyroidism. Nowadays, with early diagnosis made by ultrasound, many patients are still diagnosed asymptomatic. However, this situation has hindered early diagnosis histopathological analysis of molecular material, making immunohistochemistry and molecular biology major in the diagnostic. For its potential to develop into gestational trophoblastic neoplasia, patients affected by molar pregnancy should be followed in the Reference Cent...

HCG is composed of two subunits, HCGa and HCGb. During early pregnancy, HCG stimulates progesterone production in the corpus luteum, and injection of HCG is widely used to induce ovulation in assisted reproduction treatment (ART). Under experimental conditions, the free subunits have been shown to exert functions other than those of HCG, but the relevance of these remains to be determined. Intact HCG, free subunits and degraded forms of these occur in biological fluids, and determinations of these are important for diagnosis and monitoring of pregnancy, pregnancy-related disorders and several types of cancer. Development of optimal methods for the various forms has been hampered by lack of appropriate standards and expression of the concentrations of the various forms in units that are not comparable. Furthermore, the nomenclature for HCG assays is confusing and in some cases misleading. These problems can now be solved; a uniform nomenclature has been established, and new standards are available for HCG, its subunits HCGa and HCGb, the partially degraded or nicked forms of HCG and HCGb, and the beta-core fragment. This review describes the biochemical and biological background for the clinical use of determinations of various forms of HCG. The clinical use of HCG and studies on HCG vaccines are briefly reviewed.

Background: An altered amniotic cytokine profile has been reported in inflammatory pregnancy complications with a leading role for IL-6, a marker of the foetal systemic inflammatory response. Up to this date there is no exhaustive information neither on the foetal cytokine balance nor on the best method for its modulation. We aimed to evaluate the influence of vaginal lactoferrin administration on amniotic fluid concentration of 47 cytokines, chemokines and growth factors. Methods: Sixty women undergoing genetic amniocentesis were enrolled in an open-label clinical trial. 300 mg of vaginal lactoferrin (Florence, Italy) were randomly administered to obtain 3 groups: A, 20 untreated patients; B and C (20 patients in each) respectively treated 4 and 12 h before amniocentesis. Cytokines, chemokines and growth factors concentrations were quantified by a magnetic bead Luminex multiplex immunoassays panel technology. Data analysis was performed with the software Stata (v. 13.1) and GraphPad Prism (v. 5). Group comparisons were performed using Kruskal-Wallis followed by Mann-Whitney U tests, with Bonferroni correction for multiple comparisons. A p < 0.05 was considered significant. Results: Among the 47 tested mediators, 24 (51.06%) were influenced by lactoferrin. 11 (23.4%), showed a highly significant difference (p <0.

Placental Site Trophoblastic Tumor (PSTT) is a rare malignancy that often presents with extensive disease and can be resistant to traditional treatments. We present the case of a woman with stage IV PSTT who was initially managed with neoadjuvant chemotherapy followed by tumor debulking. Adjuvant therapy was guided by further pathologic analysis that revealed high levels of staining for PD-L1 as well as the presence of tumor infiltrating lymphocytes (TILs). Subsequently, the patient was treated with traditional chemotherapy with the EP/EMA regimen with the addition of pembrolizumab. The patient's treatment course was complicated by the development of pulmonary arteriovenous malformations, autoimmune thyroiditis thought to be secondary to immunotherapy, and significant tinnitus secondary to platinum agents. Currently the patient is in follow up and remains in a complete remission.

Epithelioid Trophoblastic Tumor (ETT) is a distinct but rare variety of gestational trophoblastic tumors. Misdiagnosis delays effective treatment and affects the survival. The case being reported here involved a 43 years old lady presented with 4 months history of intermenstrual per vaginal bleeding and 6 weeks amenorrhea. Workup has revealed pelvic mass. The patient underwent laparotomy with transabdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathology turned out to be clear cell carcinoma of the ovary. Patient was put on chemotherapy but there was progression of disease. Review of histopathology and immunohistochemistry revealed it as Epithelioid Trophoblastic Tumor; serum b-hCG was also raised. The case was really challenging for histopathologist. By the time final diagnosis was made, patient developed extensive metastases in lungs and liver and expired. Such an uncommon yet distinct trophoblastic tumor should be kept in mind by pathologists and treating physici...

Placenta accreta is a condition characterized by the abnormal invasion of the placenta into the uterine wall, leading to torrential hemorrhage. This case series, highlights the importance of accurate diagnosis and early detection of this life-threatening complication. The incidence of this iatrogenic complication is rising due to increased caesarean deliveries. While in advance stages of pregnancy the chances of missing accreta are less but in early pregnancy the diagnosis may be elusive. Timely detection by using imaging modalities like ultrasound both 2D and colour Doppler, provide valuable clues. Misdiagnosis may be fatal, especially in the first trimester. The present case series presents 3 cases where initial diagnosis of missed abortion followed by repeated curettage and gestational trophoblastic disease (GTD) was made respectively. The agony of suffering leads the patient to our tertiary care center where the diagnosis of accreta was made. Accurate diagnosis and early detecti...

I d e n t i f y i n g which c h i l d r e n with sex chromosome abnormalities a r e a t r i s k f o r a b e r r a n t development i s important. To t h i s end t h e following were i d e n t i f i e d a t b i r t h : 1 6 47.XXY ( a g e s 2-12),

I d e n t i f y i n g which c h i l d r e n with sex chromosome abnormalities a r e a t r i s k f o r a b e r r a n t development i s important. To t h i s end t h e following were i d e n t i f i e d a t b i r t h : 1 6 47.XXY ( a g e s 2-12),

The populations, infrastructure and ecology of cities are at risk from the impacts of climate change which affect urban ventilation and cooling, urban drainage and flood risk and water resources. Built areas exert considerable influence over their local climate and environment, and urban populations are already facing a range of weather-related risks such as heat waves, water pollution and flooding. Although climate change is expected to compound these problems, building designers and spatial planners are responding through improved building design and layout of cities. There is also a need for weather data for testing future performance of urban drainage and water supply systems. Urban forestry and associated Indexed African Journals Online: www.ajol.info programmes are expected to play leading roles in the built environment too. This paper x-rayed significant climate change impacts expected to shape the future character and functioning of urban systems, in Nigeria, people's attitude to the change, the findings have serious implications for how hazards are managed. The paper also highlighted strategies for managing and preventing climate change on built environment. The importance of public awareness through effective hazard education was also suggested.

Resumen ANTECEDENTES: El embarazo molar parcial, con feto vivo sano coexistente, es una forma rara de las molas hidatiformes. Debido a los pocos casos reportados se carece de guías que marquen la pauta para la atención médica de estas pacientes. Si bien el riesgo de complicaciones obstétricas en estos casos es alto, un gran porcentaje de las pacientes puede llegar a tener un recién nacido sano. CASO CLÍNICO: Paciente de 29 años, primigesta, con embarazo espontáneo. A las 23.3 semanas se detectó, por ultrasonido, que la placenta tenía múltiples imágenes anecoicas en su interior, un patrón en "racimo de uvas" que sugería un posible embarazo molar. La paciente decidió continuar con el embarazo a pesar de haberle explicado los riesgos obstétricos. Durante el resto del embarazo cursó con hipertensión gestacional y trombocitopenia, quizá gestacional. Se decidió la finalización del embarazo por vía abdominal a las 38 semanas. El reporte histopatológico corroboró el diagnóstico de mola hidatiforme parcial. CONCLUSIÓN: El momento de finalización del embarazo se determina con base en las complicaciones de la madre o el feto. Es importante la adecuada comunicación con la paciente.

These guidelines reflect emerging clinical and scientific advances as of the date issued and are subject to change.The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions.They should be well documented if modified at the local level. None of the contents may be reproduced in any form without prior written permission of SOGC.

Abnormal trophoblast differentiation is the main cause of gestational trophoblast diseases in the case of hydatidiform moles and choriocarcinomas. Here we investigated the expression patterns of two gene products, p16 and Bcl-2, implicated in cell cycle regulation and apoptosis, respectively, using immunohistochemistry during normal placenta differentiation, hydatidiform moles (partial, complete and invasive) and post-molar choriocarcinomas. The p16 protein shows a gradual expression in cytotrophoblast of normal villous, from a p16 weak proliferative phenotype to a p16 strong invasive phenotype reaching a maximum around 17 weeks of gestation. The expression pattern in cytotrophoblast was similar in moles in contrast to the villous mesenchyme of invasive moles where p16 was strongly expressed. Bcl-2 expression was syncytiotrophoblast specific in normal placenta and moles and increased gradually during normal differentiation. The results explain the persistence of normal and molar vil...

Hydatiform mole is an important disease, with a high incidence, many risk factors, and equity spreading. To know and compareb-hCG levels among patients with hydatiform mole before and after curretage was investigated. A retrospective study from January2002 to December 2005 at Dr. Wahidin Sudirohusodo Public Hospital was performed comprising b-hCG levels of hydatiform molepatients before and after curettage. b-hCG level (Elisa&#39;s method) were grouped by age of pregnancy. Among 72 patients, 43 patients withhydatiform mole were found. At trimester I among 10 patients (23.3%), b-hCG level was higher 3 (7.0%), normally 4 (9.3%) and lower3 (7.0%). At trimester II, among 33 patients (76.7%), b-hCG level was higher 12 (27.9%), normal 13 (30.2%) and lower 3 (7.0%).After curretage, b-hCG level was decreased in 35 (81.4%), and increased in 7 (16.3%). Diagnosis of hydatiform mole was establishedin 36 (83.7%) and Gestational Trophoblastic Tumours (GTT) 7 (16.3%). Patients with hydatiform mole...

To study the current status of gestational trophoblastic neoplasms (GTN) . The records of cases of GTN managed over a period of 10 years from 1994 to 2003 were analyzed retrospectively. During the study period there were 99 histopathologically proved cases of GTN, constituting 0.27% of the obstetric admissions and 0.29% of births; 88 (88.88%) were cases of hydatidiform mole, eight (8.7%) of invasive mole, and three (3.03%) of choriocarcinoma. Case fatality was 2.02%. Most of the cases who were given chemotherapy responded well to methotrexate alone, but in cases of persistant disease (2.2%) etoposide and actinomycin were added and a good response was obtained. Of the 11 cases in whom chemotherapy was given only two (18.18%) needed multidrug therapy. If recognized in time and treated appropriately GTN is amenable to treatment with good cure rates. However there are inherent problems and high risk factors which lead to fatality.

METHOD(S) : The records of cases of GTN managed over a period of 10 years from 1994 to 2003 were analyzed retrospectively. RESULT(S) : During the study period there were 99 histopathologically proved cases of GTN, constituting 0.27% of the obstetric admissions and 0.29% of births; 88 (88.88%) were cases of hydatidiform mole, eight (8.7%) of invasive mole, and three (3.03%) of choriocarcino ma. Case fatality was 2.02%. Most of the cases who were given chemotherapy responded well to methotrexate alone, but in cases of persistant disease (2.2%) etoposide and actinomycin were added and a good response was obtained. Of the 11 cases in whom chemotherapy was given only two (18.18%) needed multidrug therapy. CONCLUSION(S) : If recognized in time and treated appropriately GTN is amenable to treatment with good cure rates. However there are inherent problems and high risk factors which lead to fatality.

BACKGROUND: Metabolic diseases are a group of disorders characterized by abnormalities in the body's metabolism. Sedentary lifestyles and lack of regular exercise are key risk factors for metabolic diseases, as they lead to decreased insulin sensitivity and increased obesity. The study aimed to find the prevalence of lifestyle risk factors for metabolic diseases among adult women and to find the association of risk factors with the selected demographic variable at P < 0.001. MATERIALS AND METHODS: A community-based cross-sectional descriptive design was used. A total of 1200 adult women between 20 and 59 years were selected using a nonprobability convenient sampling method. A Standardized WHO STEPS survey tool was used to survey the participants. RESULTS: The present study survey revealed that about 1.08% and 0.42% have habits of tobacco usage and alcohol usage, respectively. A total of 86.08% and 95.25% of the adult women had inadequate fruit and vegetable intake per day in the study. 72.75% of the participants had not followed the recommended physical activity per week. Age and family income are found associated with inadequate fruit intake and occupational and family income is found associated with inadequate vegetable intake of the participants at the 0.001 level of significance. Similarly, age and family income are found associated with decreased physical activity. CONCLUSION: The study has shown the presence of lifestyle risk factors for metabolic diseases among women in the community. The rising burden of chronic diseases can be curtailed with the appropriate health promotional interventions among women.

Introduction: Gestational trophoblastic disease (GTD) is a group of
neoplastic disorders that arise from placental trophoblast cells following
abnormal fertilization. Persistent Gestational Trophoblastic Neoplasia
(PGTN) is a severe complication that can occur following a hydatidiform
mole, requiring the early identification of high-risk patients. This study
aimed to analyze the risk factors associated with PGTN in patients with
hydatidiform moles using multivariate analysis.
Methods: A retrospective analysis was conducted on 50 patients
diagnosed with hydatidiform moles, categorized into GTN-positive
(n=7) and GTN-negative (n=43) groups at the Gynecological Oncology
Outpatient Department of Bangabandhu Sheikh Mujib Medical University
(BSMMU), Dhaka, Bangladesh from January 2021 to December 2021.
Result: Age and BMI were significantly associated with GTN positivity
(p=0.024 and p=0.012, respectively). GTN-positive patients were
predominantly under 20 years old (71.4%) and underweight (100%). A
history of abortion was absent in all GTN-positive cases, while the presence
of grape-like vesicles (100%), larger vesicle size (>2 cm), and a history of
molar pregnancy (71.4%) were significantly more common in the GTNpositive group (p<0.05). Ultrasound findings showed a higher prevalence
of cystic vesicles and theca lutein cysts >6 cm in GTN-positive patients
(p<0.05). Initial post-evacuation β-hCG levels were significantly higher in
GTN-positive cases (p<0.05), with levels in weeks 5 to 8 demonstrating
the strongest predictive power for GTN development (AUC = 99.7%).
Multivariate analysis identified younger age as a significant independent
risk factor for PGTN (OR: 1.17, 95% CI: 1.02–16.3, p<0.05), while the
history of molar pregnancy, thyrotoxic features, and uterine size were not
significantly associated.

Introduction: Gestational trophoblastic neoplasia (GTN), is recognized as the most curable gynaecolo-gic malignancy. However, many cases are resistant to first line chemotherapy. Objective: The aim of the study is to report our 5 years experience in the ma-

Gestational trophoblastic neoplasia (GTN) is a disease of women in reproductive age. It is one of the most chemotherapy responsive and highly curable cancer. It is diagnosed when there is clinical, radiologic, pathologic, and/or hormonal evidence of persistent or relapsed gestational trophoblastic disease. In most instances, it is cured by surgical evacuation of the uterus. If persistent, it is treated with chemotherapy which provides response in &gt;90% of the cases. In the unresponsive persistent cases and if the women has completed her child bearing, hysterectomy is generally recommended. Here, we report a rare case of chemoresistant GTN which was confirmed to be placental-site trophoblastic tumour (PSTT) on biopsy.

It is thought that the time interval between the antecedent pregnancy and diagnosis of gestational trophoblastic tumours (GTTs) may influence the outcome of these patients. In this study, we investigate the significance of this time interval. Multivariate analysis was used to investigate if the time interval was of prognostic significance from our cohort of 241 high-risk patients with GTT. Subsequent cutpoint analysis was used to determine an optimal cutpoint for the interval covariate. The outcome of these patients was plotted according to the Kaplan -Meier method. The time interval was of prognostic significance on multivariate analysis. A period of greater than 2.8 years after pregnancy was found to be of most significance. The 5-year overall survival was 62.0% (95% CI: 47 -76%) for greater than 2.8 years vs 94% (95% CI: 91 -97%) for less than 2.8 years (Po0.001). Multivariate analysis showed the presence of liver metastasis and the number of metastasis was also of prognostic importance. The interval between antecedent pregnancy and diagnosis in high-risk GTT is of prognostic significance. This gives some insight into the pathogenesis of the disease.

The significance of residual lung metastasis from malignant gestational trophoblastic neoplasm (GTN) after the completion of chemotherapy is unknown. We currently do not advocate resection of these masses. Here, we investigate the outcome of these patients. Patients with residual lung abnormalities after the completion of treatment for GTN were compared to those who had a complete radiological resolution of the disease. None of the residual masses post-treatment were surgically removed. In all, 76 patients were identified. Overall 53 (70%) patients had no radiological abnormality on CXR or CT after completion of treatment. Eight (11%) patients had residual disease on CXR alone 15 patients had residual disease on CT (19%). During follow-up, two patients (2.6%) relapsed. One of these had had a complete radiological response post-treatment whereas the other had residual disease on CT. Patients with residual lung lesions after completing treatment for GTN do not appear to have an increased chance of relapse compared to those with no residual abnormality. We continue to recommend that these patients do not require pulmonary surgery for these lesions.

BACKGROUND: Neo-angiogenesis is a hallmark of cancer. The aim of this study was to test the hypothesis, in a prospective patient cohort, that in low-risk gestational trophoblastic neoplasia (LR-GTN) the uterine artery pulsatility index (UAPI), a measure of tumour vascularity, can predict resistance to methotrexate chemotherapy (MTX-R). METHODS: 286 LR-GTN patients (Charing Cross Hospital (CXH) score 0 -8, or FIGO score 0 -6) were treated with methotrexate between January 2008 and June 2011 at CXH. During staging investigations, patients underwent a Doppler ultrasound to assess the UAPI. RESULTS: 239 patients were assessable for both UAPI and MTX-R. The median UAPI was lower (higher vascularity) in MTX-R compared with MTX-sensitive patients (0.8 vs 1.4, Po0.0001). In multivariate logistic regression, UAPIp1 predicted MTX-R, independent of both CXH and FIGO scores. The risk of MTX-R in patients with a FIGO score of 6 and UAPIp1 was 100% vs 20% in patients with UAPI41 (w 2 Po0.0001). CONCLUSION: UAPI represents an independently validated clinically useful predictor of MTX-R in LR-GTN. Further, consideration of whether to incorporate UAPI into the FIGO scoring system is now warranted so that patients with a score of 6 and a UAPI p1 might be upstaged and offered combination chemotherapy rather than MTX.

The majority of women requiring chemotherapy for gestational trophoblastic disease (GTN) are cured with their initial chemotherapy treatment. However, a small percentage either become refractory to treatment, or relapse after the completion of treatment. This study investigates the characteristics and outcome of these patients. Patients were identified from the Charing Cross Hospital GTD database. The outcome of these patients with relapsed disease was compared to those with refractory disease. Between 1980 and 2004, 1708 patients were treated with chemotherapy for GTN. Sixty (3.5%) patents relapsed following completion of initial therapy. The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86 -100%). The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n ¼ 35), and 84% (n ¼ 25) (95% CI: 66 -96%: Po0.05), respectively. Eleven patients were identified who failed to enter remission and had refractory disease. These patients had a worse outcome compared to patients with relapsed disease (5-year survival 43% (95% CI:12 -73% Po0.01)). The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients.

To quantify the risk of developing post-molar gestational trophoblastic neoplasia (pGTN) beyond the first normal human chorionic gonadotrophin (hCG) in women who have had a complete (CHM) or partial molar pregnancy (PHM) and to re-evaluate the current UK Hydatidiform mole hCG surveillance guidelines. The Charing Cross Hospital Trophoblast Disease Centre database was screened to identify all registered cases of hydatidiform mole (HM) between 1980 and 2009. We identified 20,144 cases of HM, comprising 8400 CHM, 9586 PHM, and 2158 cases of unclassified hydatidiform mole (UHM). Twenty-nine cases (20 CHM, 3 PHM and 6 UHM) developed pGTN after the first normal hCG. For CHM the risk of pGTN at the point of hCG normalisation was 1 in 406, and fell rapidly in the first six months of monitoring. For PHM the risk of pGTN at the point of hCG normalisation was 1 in 3195. Women with CHM where hCG normalisation occurred beyond 56days after uterine evacuation of molar tissue were found to have a 3....

The majority of women requiring chemotherapy for gestational trophoblastic disease (GTN) are cured with their initial chemotherapy treatment. However, a small percentage either become refractory to treatment, or relapse after the completion of treatment. This study investigates the characteristics and outcome of these patients. Patients were identified from the Charing Cross Hospital GTD database. The outcome of these patients with relapsed disease was compared to those with refractory disease. Between 1980 and 2004, 1708 patients were treated with chemotherapy for GTN. Sixty (3.5%) patents relapsed following completion of initial therapy. The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86 -100%). The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n ¼ 35), and 84% (n ¼ 25) (95% CI: 66 -96%: Po0.05), respectively. Eleven patients were identified who failed to enter remission and had refractory disease. These patients had a worse outcome compared to patients with relapsed disease (5-year survival 43% (95% CI:12 -73% Po0.01)). The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients.

Little literature exists on the safety of early pregnancy following chemotherapy. Here we assess the rate of relapse and foetal outcome in women who have completed single and multi-agent chemotherapy for gestational trophoblastic tumours. The records of 1532 patients treated for persistent gestational trophoblastic tumours at Charing Cross Hospital between 1969 and 1998 were reviewed. Patients were defined as receiving single agent or multi-agent treatment. Relapse rates and foetal outcome were reviewed in the 230 patients who became pregnant within 12 months of completing chemotherapy. In the single agent group 153 (22%) of 691 patients conceived early. Three subsequently relapsed. In the multi-agent group, 77 (10%) of 779 patients conceived early, two then relapsed. Relapse rates were 2% (3 out of 153) and 2.5% (2 out of 77) for each group compared to 5% and 5.6% in the comparative non-pregnant groups. Outcomes of 230 early pregnancies: 164 (71%) delivered at full term, 35 (15%) terminations, 26 (11%) spontaneous abortions, three (1.3%) new hydatidiform moles and two (1%) stillbirths. Early pregnancies were more common in the single agent group (P50.001), but spontaneous miscarriages and terminations were more likely to occur in the multi-agent group (P=0.04 and 0.03, respectively). Of the fullterm pregnancies, three (1.8%) babies were born with congenital abnormalities. Patients in either group who conceive within 12 months of completing chemotherapy are not at increased risk of relapse. Though, we still advise avoiding pregnancy within 12 months of completing chemotherapy, those that do conceive can be reassured of a likely favourable outcome.

The significance of residual lung metastasis from malignant gestational trophoblastic neoplasm (GTN) after the completion of chemotherapy is unknown. We currently do not advocate resection of these masses. Here, we investigate the outcome of these patients. Patients with residual lung abnormalities after the completion of treatment for GTN were compared to those who had a complete radiological resolution of the disease. None of the residual masses post-treatment were surgically removed. In all, 76 patients were identified. Overall 53 (70%) patients had no radiological abnormality on CXR or CT after completion of treatment. Eight (11%) patients had residual disease on CXR alone 15 patients had residual disease on CT (19%). During follow-up, two patients (2.6%) relapsed. One of these had had a complete radiological response post-treatment whereas the other had residual disease on CT. Patients with residual lung lesions after completing treatment for GTN do not appear to have an increased chance of relapse compared to those with no residual abnormality. We continue to recommend that these patients do not require pulmonary surgery for these lesions.

It is thought that the time interval between the antecedent pregnancy and diagnosis of gestational trophoblastic tumours (GTTs) may influence the outcome of these patients. In this study, we investigate the significance of this time interval. Multivariate analysis was used to investigate if the time interval was of prognostic significance from our cohort of 241 high-risk patients with GTT. Subsequent cutpoint analysis was used to determine an optimal cutpoint for the interval covariate. The outcome of these patients was plotted according to the Kaplan -Meier method. The time interval was of prognostic significance on multivariate analysis. A period of greater than 2.8 years after pregnancy was found to be of most significance. The 5-year overall survival was 62.0% (95% CI: 47 -76%) for greater than 2.8 years vs 94% (95% CI: 91 -97%) for less than 2.8 years (Po0.001). Multivariate analysis showed the presence of liver metastasis and the number of metastasis was also of prognostic importance. The interval between antecedent pregnancy and diagnosis in high-risk GTT is of prognostic significance. This gives some insight into the pathogenesis of the disease.

To assess the risks of second malignancy and early menopause in a large cohort of patients with gestational trophoblastic tumor who were treated with chemotherapy. A survey of patients treated at Charing Cross Hospital between 1958 and 2000 was performed in 2006 to assemble incidence data for subsequent malignancies and the age at menopause. Treatment records were reviewed for the regimens and durations, and the incidence of subsequent malignancies was compared with that in the national age-matched population. Data were obtained for 1,903 patients, with a mean follow-up of 16.9 years. Eighty-six patients developed a subsequent malignancy compared with an expected number of 79 (standardized incidence ratio [SIR], 1.1; 95% CI, 0.9 to 1.3). The overall risk was low for patients treated with single-agent methotrexate and folinic acid (MTX-FA; SIR, 0.7; 95% CI, 0.5 to 1.1) and also for patients treated with etoposide, methotrexate, and dactinomycin followed by cyclophosphamide and vincri...

Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. Because of the rarity of the diagnosis, detailed structured information on prognosis, treatment escalations and outcome is limited. We have reviewed the demographics, prognostic variables, treatment course and clinical outcomes for the post-mole GTT patients treated at Charing Cross Hospital between 2000 and 2009. Of the 618 women studied, 547 had a diagnosis of complete mole, 13 complete mole with a twin conception and 58 partial moles. At the commencement of treatment, 94% of patients were in the FIGO low-risk group (score 0-6). For patients treated with single-agent methotrexate, the primary cure rate ranged from 75% for a FIGO score of 0-1 through to 31% for those with a FIGO score of 6. In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. Prompt treatment and diagnosis should limit the exp...

Introduction: Gestational trophoblastic tumours are a rare form of malignancy, which in the majority of cases arise from abnormal trophoblast cells formed in a complete molar pregnancy. These tumours are extremely sensitive to chemotherapy and high cure rates approaching 100% can be expected. The disease is usually limited to the uterus where the abnormal trophoblast proliferation and human chorionic production can lead to vascular changes including the formation of arteriovenous malformations. Case presentation: We describe the case of a 28-year-old Caucasian woman who presented to the United Kingdom's Gestational Trophoblast Tumour Service with rising human chorionic gonadotropin levels following a uterine evacuation for a complete molar pregnancy. She was commenced on chemotherapy but subsequently reported two episodes of haemoptysis. Computed tomography imaging demonstrated findings consistent with a pulmonary arteriovenous malformation, probably due to a small pulmonary metastasis, complicated by recent haemorrhage. These findings were confirmed on emergency pulmonary arteriography, and the pulmonary arteriovenous malformation was successfully embolised. Conclusions: Arteriovenous malformations secondary to gestational trophoblastic tumours at metastatic sites have only been reported in a very limited number of cases. When significant bleeding occurs, as in this case of a pulmonary lesion, urgent referral for embolisation is indicated.

To evaluate the efficacy and toxicity of paclitaxel and cisplatin alternating with paclitaxel and etoposide doublet regimen (TP/TE), for salvage of patients with high-risk gestational trophoblastic neoplasia (GTN). Patients and methods: Twenty-four patients with GTN received TP/TE. Sixteen had failed previous chemotherapy including six with cisplatin-based regimens (group A) and eight changed to TP/TE because of prior treatment-induced toxic effects (group B). Results: In group A, three patients (19%) achieved a complete response (CR) and five (31%) a partial response (PR). All CR and four PR patients remain alive with a median follow-up of 25 months (range 9-48). The eight patients failing TP/TE subsequently died. Thus, the overall survival of the 16 patients in group A was 44% (seven of 16), rising to 70% (seven of 10) if the six patients who had failed prior cisplatin-based chemotherapy were excluded. In group B, four patients were assessable for response (two CR, two PR) and six remain alive (median follow-up 19 months) giving an overall survival of 75%. TP/TE was well tolerated, with only one patient discontinuing therapy because of toxic effects. Conclusion: TP/TE is an effective, well-tolerated, salvage treatment for relapsed patients who are heavily pretreated for GTN. Further studies of this regimen are warranted.

Objective: To evaluate the psychological repercussions of gestational trophoblastic disease. Methods: A cross-sectional study including 100 women (50 with gestational trophoblastic disease and 50 without) was conducted between September 2020 and October 2021. Socio-demographic characteristics, quality of life, depression, and anxiety were evaluated and follow-up was performed at a referral center. Results: Women with gestational trophoblastic disease had a mean age and body mass index of 28.8±6.4 years and 24.7±5.0kg/m2, respectively; the corresponding values for the Control Group were 30.1±6.9 years (p=0.27) and 28.9±4.6kg/m2 (p<0.001). The Gestational Trophoblastic Disease Group presented a better general health status (p=0.04) than the Control Group. Among women with gestational trophoblastic disease, 62% and 46% had anxiety and depression, respectively; the corresponding percentages for women without gestational trophoblastic disease were 52% and 24% (p=0.64 and 0.08, respectively). Conclusion: Multidisciplinary follow-up at a referral center may improve the mental health and quality of life scores of women with gestational trophoblastic disease.

We investigate learning feature-to-feature translator networks by alternating back-propagation as a generalpurpose solution to zero-shot learning (ZSL) problems. It is a generative model-based ZSL framework. In contrast to models based on generative adversarial networks (GAN) or variational autoencoders (VAE) that require auxiliary networks to assist the training, our model consists of a single conditional generator that maps class-level semantic features and Gaussian white noise vector accounting for instance-level latent factors to visual features, and is trained by maximum likelihood estimation. The training process is a simple yet effective alternating backpropagation process that iterates the following two steps: (i) the inferential back-propagation to infer the latent factors of each observed example, and (ii) the learning backpropagation to update the model parameters. We show that, with slight modifications, our model is capable of learning from incomplete visual features for ZSL. We conduct extensive comparisons with existing generative ZSL methods on five benchmarks, demonstrating the superiority of our method in not only ZSL performance but also convergence speed and computational cost. Specifically, our model outperforms the existing state-of-the-art methods by a remarkable margin up to 3.1% and 4.0% in ZSL and generalized ZSL settings, respectively.

Background Gestational trophoblastic disease (GTD) defines a heterogenenous group of interrelated lesions that arise from the trophoblastic epithelium of the placenta. There are several histologically distinct types of GTD: hydatiform mole (complete or partial), persistant/invasive gestational trophoblastic neoplasia (GTN), choriocarcinoma and placenta site trophoblastic tumors. The aim of this study was to determine the frequency and risk factors of GTD among women admitted to Imam Khomeini Hospital in Ahvaz, Iran. Materials and methods This was a cross-sectional study conducted at Imam Khomeini Hospital in Ahvaz, Iran. All hospital records related to GTD (132) from 1996 until 2006 were reviewed. Demographic and histo-pathologic characteristics were extracted. Chi-square and Fisher-exact tests were used to analyze all variables. P ≤ 0.05 was considered statistically significant. SPSS, version 11 was used for statistical analysis. Results The mean age of patients was 27.6 years. Mos...