Temporal trends in incidence and outcome of hydatidiform mole: a retrospective cohort study (original) (raw)
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Guidelines following hydatidiform mole: A reappraisal
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 2006
Objective: The aim of this study was to determine how often patients with complete hydatidiform mole (CHM) who spontaneously achieve normal human chorionic gonadotrophin (hCG) levels subsequently develop persistent or recurrent gestational trophoblast disease. Methods: Four hundred and fourteen cases of CHM registered at the Hydatidiform Mole Registry of Victoria were reviewed retrospectively after molar evacuation. Maternal age, gestational age, gravidity and parity were determined for each patient, as well as the need for chemotherapy. Results: Among the 414 patients, 55 (13.3%) required chemotherapy for persistent trophoblastic disease. None of the patients whose hCG levels spontaneously fell to normal subsequently developed persistent molar disease. Conclusion: Weekly hCG measurements are recommended for all patients until normal levels are achieved. For patients who attain normal hCG levels within 2 months after evacuation, it seems safe to discontinue monitoring once normal levels are achieved. Patients who fail to achieve normal hCG levels by 2 months after evacuation should be monitored with monthly hCG measurements for 1 year after normalisation to assure sustained remission.
Persistent trophoblast disease following partial molar pregnancy
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 2006
Objective: Human chorionic gonadotrophin (hCG) follow-up data were analysed retrospectively in all patients registered in the Hydatidiform Mole Registry at the Royal Women's Hospital, Melbourne from January 1992 to January 2001 to determine the risk of persistent trophoblast disease following partial molar pregnancy and to review the present follow-up protocol of patients suffering from partial hydatidiform molar pregnancy (PHM). Methods: Demographic factors were determined for all 344 cases with a review diagnosis of PHM, included age, history of previous hydatidiform mole, gestation length, hCG levels and compliance with follow-up. Findings: Six of the 344 patients diagnosed with PHM required treatment with single-agent methotrexate and folinic acid rescue. All six patients achieved and maintained a complete biochemical remission after chemotherapy. hCG regression assays were analysed for 235 patients: 225 patients had at least one normal hCG measurement during follow-up, of whom 152 (64.7%) patients obtained normal values within 2 months after evacuation. All patients obtained normal levels within 32 weeks after evacuation of the partial hydatidiform mole. Only 63 (25.6%) patients completed the recommended follow-up program. No patient who achieved normal hCG levels required chemotherapy because of a recurrent gestational trophoblastic tumour. Recommendations: This study indicates that 1.7% of all partial mole pregnancy patients needed treatment for malignant sequelae. In contrast, no patient diagnosed with partial mole had a biochemical or clinical relapse after achieving normal levels of hCG, consistent with previous studies. Patients who have had a partial hydatidiform mole should be followed by hCG assays until normal levels are achieved and then follow-up can be safely discontinued.
Modern Pathology, 2019
Hydatidiform mole (HM) is an aberrant human pregnancy characterized by excessive trophoblastic proliferation and abnormal embryonic development. HM has two morphological types, complete (CHM) and partial (PHM), and nonrecurrent ones have three genotypic types, androgenetic monospermic, androgenetic dispermic, and triploid dispermic. Most available studies on risk factors predisposing to different types of HM and their malignant transformation mainly suffer from the lack of comprehensive genotypic analysis of large cohorts of molar tissues combined with accurate postmolar hCG follow-up. Moreover, 10-20% of patients with one HM have at least one non-molar miscarriage, which is higher than the frequency of two pregnancy losses in the general population (2-5%), suggesting a common genetic susceptibility to HM and miscarriages. However, the underlying causes of the miscarriages in these patients are unknown. Here, we comprehensively analyzed 204 HM, mostly from patients referred to the Quebec Registry of Trophoblastic Diseases and for which postmolar hCG monitoring is available, and 30 of their non-molar miscarriages. We revisited the risk of maternal age and neoplastic transformation across the different HM genotypic categories and investigated the presence of chromosomal abnormalities in their non-molar miscarriages. We confirm that androgenetic CHM is more prone to gestational trophoblastic neoplasia (GTN) than triploid dispermic PHM, and androgenetic dispermic CHM is more prone to high-risk GTN and choriocarcinoma (CC) than androgenetic monospermic CHM. We also confirm the association between increased maternal age and androgenetic CHM and their malignancies. Most importantly, we demonstrate for the first time that patients with an HM and miscarriages are at higher risk for aneuploid miscarriages [83.3%, 95% confidence interval (CI): 0.653-0.944] than women with sporadic (51.5%, 95% CI: 50.3-52.7%, p value = 0.0003828) or recurrent miscarriages (43.8%, 95% CI: 40.7-47.0%, p value = 0.00002). Our data suggest common genetic female germline defects predisposing to HM and aneuploid non-molar miscarriages in some patients.
Journal of gynecology and womens health, 2017
Hydatidiform mole (HM) is a complication of pregnancy, genetically abnormal, characterized by several degrees of trophoblastic proliferation and hydropic degeneration of chorionic villi with potential for malignant transformation. The HM is classified as complete hydatidiform mole (CHM) and partial hydatiform mole (PHM). The distinction between CHM and PHM and non-molar abortions (NM) is very important since the risk for the development of postmolar gestational trophoblastic neoplasia is higher in CHM. This article is a brief review of relevant topics about genetic, histological and clinical features of molar pregnancy.
Prevalence of molar pregnancy (a three year retrospective study) in a tertiary care ho
2016
Hydatidiform mole is an abnormal gestation characterized by trophoblastic hyperplasia and overgrowth of placental villi. H. mole is classified as complete (CHM) and partial (PHM). The diagnosis is based on histopathology and genetic origin. In our set up, we used only histopathological diagnostic criteria. The incidence of molar pregnancy varies in different parts of the world. The malignant potential of the disease is higher in South East Asia as compared to western countries. Objective of the present study was to determine the frequency, clinical presentation and morphological features of H. mole and compare them with those of other studies. This is a 3 year retrospective descriptive case series conducted in the Department of Pathology, SKIMS Medical College, Bemina from 31 st December 2011 to 31 st December 2014. The case records of all the molar pregnancies during the study period were analysed regarding patient’s history, clinical presentation and morphological features. A to...
Clinicopathological Study of Gestational Trophoblastic Disease (GTD) in a Tertiary Care Hospital
Indian Journal of Gynecologic Oncology, 2023
Purpose This is a prospective observational study from November 2020 to 2022 over 104 cases with an objective (a) to determine the incidence along with the clinicopathologic characteristics, (b) to find risk factors associated and its management (c) to evaluate the outcome of GTD after follow-up. Methods After detailed clinical and laboratory investigation, all cases of molar pregnancy were subjected for suction and evacuation followed by histopathological study and serum b-hCG. During its follow up visit, detailed history for signs and patterns of serum b-hCG was noted, categorized as high risk or low risk GTN and treated accordingly. Results The incidence was found to be 4.6/1000 pregnancies. A maximum of 66 cases (63.4%) were of O?ve, mostly presenting with amenorrhea. 84 cases (80.8%) were hydatidiform mole and 20 cases (19.2%) were of pGTT with 80 cases (76.9%) complete mole, 04 cases (3.8%) partial mole, 15 cases (14.4%) invasive mole and 5 cases (4.8%) choriocarcinoma. Suction & evacuation was done in all 86 cases (82.6%) of hydatidiform mole, hysterectomy in 12 cases (11.5%) and chemotherapy in 45 cases (43.2%) of GTN among which 40 cases (88.9%) completed follow up of 6 months with remission and only 5 cases (11.1%) developed resistant. FIGO scoring system showed 20 cases (44.4%) of low risk, 16 cases (35.5%) of medium risk and 9 cases (20%) of high risk. Conclusion Routine ultrasonography, appropriate diagnosis, treatment and follow up leads to near 100% cure. A multicentered study and proper counseling is essential to determine the true incidence and overall outcome of molar pregnancy. Keywords GTD b-hCG Chemotherapy Hydatidiform mole
Indian Journal of Gynecologic Oncology, 2019
Objective The objective of this study is to estimate the prevalence, management and follow-up of gestational trophoblastic disease (GTD) in a tertiary care center, Royal Hospital, in Oman over the last 11 years from January 2007 till December 2017. This study also looked into the reproductive outcome after trophoblastic disease treatment. Methods This retrospective, descriptive study was carried out at Royal Hospital from Jan. 2007 to Dec. 2017. All cases with a histopathological report of hydatidiform molar disease were included. Demographic characteristics, clinical presentation physical signs, treatment and follow-up including reproductive outcome and recurrence rate were included. Results Two hundred and thirty-six women with GTD were included in the study. Mean maternal age was 35 years, mean gravidity 5 and parity 3. Prevalence of complete mole was 83 cases (35.1%), partial mole 144 cases (61%), choriocarcinoma (0.42%), placental site (0.42%) and invasive mole (1.27%). Thyrotoxicosis, preeclampsia and anemia were 3.8%, 7.2% and 0.8%, respectively. Mean gestational age was 10.57 ± 3.2 weeks at presentation. Persistent disease was observed in 12.3%. About 5% received chemotherapy. Metastasis was reported in 4.7% of cases, 81.8% to the lung. About 38% conceived later. Conclusion This study highlights the importance of proper assessment and follow-up of histopathology diagnosis. GTD usually has a good prognosis and reproductive outcome if properly followed up and treated.
Nagoya Journal of Medical Science, 2020
The management of hydatidiform mole (HM) and the incidence of post-molar gestational trophoblastic neoplasia (GTN) in Vietnam has not been reported to date. This study aimed to study the incidence of HM and post-molar GTN and identify factors associated with post-molar GTN at a tertiary hospital in Vietnam. Five hundred and eighty-four patients who were treated for HM at Tu Du Hospital between January and December 2010 were included in this study. The mean age and gestational age at the first evacuation were 28.8 years old and 11.0 weeks, respectively. After the initial evacuation and pathological examination, 87 patients who were older than 40 or did not wish to have children underwent a hysterectomy, while the others underwent second curettage. All 472 patients who had human chorionic gonadotropin (hCG) ≥ 100,000 IU/L before treatment received one cycle of methotrexate with folinic acid as prophylactic chemotherapy. The incidence of HM was 11.1 per 1,000 deliveries; 47 patients (8...
Gynecologic oncology, 2016
To compare complete hydatidiform mole (CHM) clinical presentation and risk factors associated with GTN development between North American and South American adolescents. This non-concurrent cohort study was undertaken including adolescents with CHM referred to centers in North America (New England Trophoblastic Disease Center, Harvard University, USA), and South America (Botucatu Trophoblastic Disease Center-São Paulo State University, Brazil; Trophoblastic Unit of Central University of Venezuela and Maternidad Concepcion Palacios of Caracas, Venezuela) between 1990 and 2012. Data were obtained from medical records and pathology reports. Study participants were allocated into 2 groups: North America (NA) and South America (SA). In NA and SA, 13.1% and 30.9% of patients with hydatidiform mole were adolescents, respectively. Of these, 77.6% in NA and 86.1% in SA had pathologic diagnosis of CHM (p=0.121). Vaginal bleeding (SA=69% vs NA=51%; p=0.020), anemia (SA=48% vs NA=18%; p<0.00...