11/25. Surveillance of hydatidiform mole with the Milan-Markley helix. A case of complicated trophoblastic disease followed by quantitative radioimmunoassay and endometrial cytology is presented. Despite the fall of the postevacuation hCG titer to zero, trophoblastic elements were still detected cytologically with the helix technic. A second curettage performed 60 days postevacuation because of a rising serum hCG titer and persistent trophoblastic elements on the endometrial smears was histologically negative. Subsequent helix cytologic studies continued to reveal trophoblastic cells. Chemotherapy with methotrexate and hysterectomy were carried out. A solitary 7-mm lesion was found deep in the myometrium. Titers dropped abruptly postoperatively. Photomicrographs of the cytologic findings are presented. ( info) |
| A report on a patient with clinical hyperthyroidism associated with hydatidiform mole is presented. Some biochemical characteristics of the thyroid stimulator isolated from the tumour are discussed. ( info) |
13/25. Doppler color flow mapping of an invasive mole. We report here Doppler color flow mapping carried out before and after chemotherapy for an invasive mole. This mapping revealed an abnormal color blood flow within the echo-free space in the uterine myometrium, and pulsed Doppler ultrasound showed a prominent arteriovenous shunt flow. Similar features were obtained by pelvic angiography (PAG). After 4 courses of chemotherapy, the area of abnormal colored flow was reduced and findings on the PAG were supportive. The patient is being closely followed, using Doppler color flow mapping. ( info) |
14/25. Toxicity of vincristine overdose in a patient with invasive mole. A few reports have documented overdoses of vincristine sulfate. The present report describes our experience with serious complications of a vincristine overdose in an 18-year-old female who had methotrexate-resistant invasive mole. The patient received VAC therapy as the second line chemotherapy after 2 courses of MTX therapy. In the 6th course of VAC therapy, she was given 5 consecutive daily doses of VCR by mistake. On the 5th day of this VAC therapy, she showed the following toxic symptoms: abdominal pain, lumbago, insomnia, bleeding tendency, absence of motor reflex, leukopenia, and paralytic ileus. These symptoms led to realization of the VCR overdose. leucovorin calcium administration and supportive treatment were carried out. Although it was difficult to evaluate the efficacy of leucovorin calcium on the vincristine toxic symptoms, she recovered and was discharged on the 36th hospital day. ( info) |
15/25. Long-dormant invasive mole associated with multiple malignancies. A 65-year-old previously healthy housewife, gravida 3, para 3, was first diagnosed as Stage Ib carcinoma of the uterine cervix (poorly differentiated squamous cell carcinoma) and admitted. The external radiation of 5400 rad by telecobalt source was performed. No intracavitary radiation was added. After about 7 1/2 years the patient noticed a tumor of fist size on her buttocks, but she did not present in our clinic regularly. Because of enlarging tumor and general malaise she was readmitted a year later. On the fifth hospital day she died with ileus. autopsy revealed osteosarcoma of buttocks in the radiation field, stomach cancer (tubular adenocarcinoma) with perforated peritonitis, and invasive mole of the uterine corpus. The patient's last pregnancy terminated as a full-term delivery at 26 years of age and she was 43 years at her menopause. The dormant period of invasive mole was 47 years after her last pregnancy, 30 years after her menopause, and at least 8 years after pelvic radiation. ( info) |
16/25. Invasive mole. A case of persistent trophoblastic disease with resistance to chemotherapy is presented. The value of continued and frequent serum hCG measurements in such cases is discussed as well as the indications for performing hysterectomy. ( info) |
17/25. Invasive partial mole. A case of invasive partial hydatidiform mole requiring chemotherapy and hysterectomy in a 30-year-old white woman is presented. This is the first histologically and cytogenetically documented partial mole with persistent elevation of human chorionic gonadotropin (hCG) level and invasion of myometrium. There was no evidence of distant spread. ( info) |
| Human chorionic gonadotropin (hCG) is considered to be one of the factors which regulate relaxin secretion in humans. serum immunoreactive relaxin levels are increased and are detectable by radioimmunoassay both in normal and molar pregnancy. Circulating hCG levels are increased in trophoblastic disease. In the present study, relaxin and hCG levels were sequentially measured in patients with invasive mole, choriocarcinoma and persistent trophoblastic disease. serum relaxin levels were detectable by radioimmunoassay in these patients before treatment, though they were significantly lower than in normal pregnancy. The corpus luteum of pregnancy is the main source of circulating relaxin in normal pregnancy. The existence of a corpus luteum was confirmed in the 2 patients who underwent laparotomy. Consequently, the corpus luteum may also be the main source of circulating relaxin in trophoblastic disease. Parallel changes in hCG and relaxin levels were observed during the courses of trophoblastic disease. The finding suggests that relaxin secretion is dependent on hCG stimulation in trophoblastic disease in the presence of corpus luteum. ( info) |
| A 10-year retrospective study was carried out of cases diagnosed as hydatidiform mole at the University of hong kong. Strict morphologic criteria established in a previous report were used to study the association of the partial mole syndrome with residual trophoblastic disease. Of the total of 138 cases available, 13 were found to be partial moles, 1 of which was followed by trophoblastic disease that required chemotherapy. This subsequently proved to be an invasive (partial) mole, the first example of its kind to be verified by pathology. The extent of the association between partial mole and subsequent trophoblastic disease and the spectrum of the pathologic lesions actually underlying the latter remain to be determined by further retrospective and prospective studies. ( info) |
20/25. No increase in second tumors after cytotoxic chemotherapy for gestational trophoblastic tumors. We investigated the incidence of second tumors after cytotoxic chemotherapy in 457 long-term survivors treated for choriocarcinoma or an invasive mole between 1958 and 1978. Treatment was given according to regular intermittent schedules and over a mean period of four months, with no maintenance. methotrexate was given to all but two patients, and 261 (57 per cent) also received other cytotoxic drugs, most commonly dactinomycin, vincristine, cyclophosphamide, mercaptopurine, and 6-azauridine. After a mean period of 7.8 years since the beginning of treatment and a total of 3522 patient-years of risk, second neoplasms had developed in only two women (acute leukemia in one and carcinoma of the breast in the other). This figure is less than the number of cases of cancer that would have been expected (3.5) in this group and suggests that the use of methotrexate as chemotherapy for choriocarcinoma is not carcinogenic in the medium term. ( info) |