Early detection of persistent trophoblastic tumour by serum human chorionic gonadotrophin monitoring after molar pregnancy

Objective To study the outcome of a multi centred post molar pregnancy serum human chorionic gonadotrophin (hCG) surveillance programme. Methods Patients recruited into the multi centred post molar serum hCG surveillance programme between 1988 and 1996 were studied. The clinical data were obtained from medical records and computer database. Results There were 616 patients in the study. Twenty five (11%) of 224 patients with molar pregnancy and 28 (7%) of 392 patients with partial molar pregnancy were diagnosed to have persistent trophoblastic tumour (PTT) requiring chemotherapy. Of the 53 patients treated for PTT, 58.5% received intravenous methotrexate (MTX), 22.6% received both MTX and actinomycin D, and 19% received CHAMOC, a multiple chemotherapeutic regimen. Four patients receiving single drug had to change the regimen because of poor response, and all recovered and remained well. There were 3 cases of recurrence, one in each group of patients receiving single, dual or multiple agents. One patient died because of treatment complication. The rest were well with a mean follow up of 42 months. Conclusions Post molar serum hCG surveillance is important to detecting persistent trophoblastic activity. Early treatment of PTT by the appropriate chemotherapy has a near hundred percent cure and prevents the progression of PTT into more advanced trophoblastic malignancy such as choriocarcinoma.

Serum β-hCG level on day 7 of frozen-thawed embryo transfer: association with the clinical pregnancy outcomes in artificial cycles

Objective:The relationship between serum beta human chorionic gonadotropin(β-hCG)levels of patients(7 days after the transplantation of frozen-thawed embryos)and the pregnancy outcomes was investigated.Methods:This study was designed as a retrospective clinical trial of 366 women who underwent frozen-thawed embryo transfers(FETs)in artificial cycles.Patients were divided into three groups:clinical pregnancy group,biochemical pregnancy group,and non-pregnant group according to their pregnancy outcomes.Serumβ-hCG levels were tested on day 4,7,9,11 and 14 after FET.Results:In the clinical pregnancy group,the serumβ-hCG levels after 7-day post-transplantation were significantly elevated(16.20 IU/L vs.3.07 vs.0.1 IU/L;P<0.05)compared with the other two groups.Furthermore,it was found that Area Under Curve(AUC=0.96)was significant with cut-off value higher than 4.26 IU/L(sensitivity=92.3%,specificity=90.2%)to predict the clinical pregnancy outcomes in the receiver operating characteristic(ROC)analysis ofβ-hCG concentrations on day 7 of post-transplantation.Conclusion:Our results suggested that the elevated serumβ-hCG levels on day 7 of post-transplantation could predict the positive clinical pregnancy outcomes in artificial FET cycles.

Pulmonary deportation of hydatidiform mole:a 12-year,single tertiary center experience in China

Background:Pulmonary deportation of hydatidiform mole is an exceedingly rare entity.The underlying mechanisms and proper management strategies remain unclear based on sporadic case reports over the past six decades.This study aimed to investigate the clinical features and rational treatment of patients with benign molar pregnancies with pulmonary deportation based on our experience.Methods:Medical records of 20 cases of hydatidiform mole with pulmonary deportation were retrospectively reviewed at Peking Union Medical College Hospital from November 2006 to May 2019.The detailed information of all patients was recorded and analyzed.Patients were divided into different groups according to their characteristics and Mann-Whitney U test was used to compare the duration to achieve a normal b-human chorionic gonadotrophin(b-hCG)level after the first evacuation among groups.Results:Initial pulmonary computed tomography scans showed suspected bilateral,left and right chest deportation of hydatidiform mole in 12,four,and four patients,respectively,with the maximum nodular diameter ranging from 0.6 to 1.2 cm.Ten patients achieved lesion resolution while the remaining ten patients achieved decreases in the size of their pulmonary lesions.The median duration to achieve a normal b-hCG level after the first evacuation was 15.5(13.0,21.9)weeks.There was no significant difference in the duration to achieve a normal b-hCG level after the first evacuation between two groups based on age(≥40 years vs.<40 years:15.8[12.2,21.5]weeks vs.15.5[12.9,23.0]weeks,Z=0.094,P=0.925),type of antecedent mole(partial mole vs.complete mole:15.2[12.5,27.4]weeks vs.15.9[12.9,21.5]weeks,Z=0.165,P=0.869),distribution of pulmonary nodules(bilateral lungs vs.unilateral lung:15.2[12.8,22.5]weeks vs.15.9[13.2,22.2]weeks,Z=0.386,P=0.700),maximum size of pulmonary nodules(>0.5 cm vs.0.5 cm:13.0[11.3,17.2]weeks vs.16.0[14.5,23.8]weeks,Z=1.815,P=0.070),and number of uterine evacuations(once vs.twice or three times:15.0[13.0,16.3]weeks vs.16.0[12.8,23.9]weeks,Z=0.832,P=0.405).The post-molar cohort was followed up for 17 to 139 months,and no gestational trophoblastic neoplasia was observed.Conclusions:No surgeries other than uterine evacuation and no chemotherapy regimens are recommended for such patients if they achieve satisfactory decreases in the level of hCG and gradual decrease or disappearance of pulmonary deportation nodules.Patients should be informed about the necessity of long-term follow-up.More collaborative international studies on this exceedingly rare condition may guide decisions regarding optimal management strategies.