Macrosomia in non-gestational diabetes pregnancy:glucose tolerance test characteristics and feto-maternal complications in tropical Asia Pacific Australia

Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.

Primary ovarian choriocarcinoma occurring in a postmenopausal woman:A case report

BACKGROUND Nongestational ovarian choriocarcinoma(NGOC)is a rare but aggressive neoplasm with limited sensitivity to chemotherapy and a very poor prognosis.Few cases of NGOC have been reported,and there is limited information regarding its clinical features,treatment protocols,or prognosis.CASE SUMMARY A postmenopausal woman in her 5th decade of life visited our clinic because of abnormal vaginal bleeding and an abdominal mass.Although she had been menopausal for more than eight years and her last abortion occurred nine years ago,she had an increased level of serumβ-human chorionic gonadotropin(β-hCG).Thus,an ovarian neoplasm of trophoblastic origin was suspected,and exploratory laparotomy was performed.Based on the patient’s clinical history and the histopathological examination and immunohistochemistry results obtained postoperatively,we concluded that she most likely had primary NGOC.Cytoreductive surgery was performed in combination with adjuvant chemotherapy comprising bleomycin,etoposide,and cisplatin.Serumβ-hCG levels decreased to normal after two cycles,and there was no evidence of recurrence after four cycles of chemotherapy.CONCLUSION Even in postmenopausal women,ovarian choriocarcinoma should be considered in the initial differential diagnosis for an adnexal mass.

Tuberculosis Infected T Lymphocyte Spot as a Differential Diagnosis of Pulmonary Tuberculosis and Choriocarcinoma Recurrence: A Case Report and Review of the Literature

Introduction: Choriocarcinoma is an aggressive tumor, whose incidence is 0.18 per 100,000 women between the ages of 15 and 49 years [1]. Although its prognosis has improved with the development of chemotherapy regimens, the mortality rate of patients with brain metastases is reportedly 29.7% [2]. After chemotherapy, most often, the reappearance of masses in pulmonary is considered to be a sign of relapse. Case presentation: The patient was a 32-year-old Asian Chinese female who delivered a dead male infant at 33 weeks gestation. The placenta appeared to be normal. The major presentation was a haemorrhage of the vagina. The patient received combined treatment with systematic multi-agent chemotherapy and whole-brain radiation therapy at the General Hospital of Hebei Province and achieved complete remission. Two years after remission, a chest CT scan revealed a mass in the right lung that had become larger over 6 months. The patient’s serum β-human chorionic gonadotropin (β-HCG) level was normal, and the tuberculosis infected T lymphocyte spot (T-SPOT.TB) tests were positive. The patient was started on anti-tuberculosis therapy, after which the size of her right lung mass decreased. Conclusion: Lung masses after choriocarcinoma require extensive laboratory and imaging exams to exclude recurrence. This case highlights the importance of differential diagnoses of lung masses in patients with choriocarcinomas. Imaging studies, β-HCG and local lesion resection should be employed to rule out choriocarcinoma recurrence.

miR-19b-3p靶向IGF-1参与绒毛膜癌发生发展的机制研究

目的探究miR-19b-3p靶向胰岛素样生长因子-1(IGF-1)参与绒毛膜癌增殖、侵袭和转移的机制。方法以人绒毛膜癌细胞系JEG-3为研究对象,A组:miR-19b-3p mimics组,B组:miR-19b-3p mimics NC组,C组:miR-19b-3p inhibitor组,D组:miR-19b-3p inhibitor NC组,E组:空白对照组。A组、B组、C组、D组按照分组情况进行相应转染,E组不做任何处理。分别用Real-time PCR和Western blot检测五组miR-19b-3p RNA和IGF-1蛋白表达水平,采用CCK-8法测定细胞增殖,采用划痕实验和Transwell小室侵袭实验测定细胞迁移和侵袭能力,并进行比较;采用双荧光素酶(Dualluciferase)报告实验验证miR-19b-3p对IGF-1的靶向关系。结果与E组的(0.98±0.13)相比,A组miR-19b-3p mRNA表达水平(2.23±0.16)明显上调,C组miR-19b-3p mRNA表达水平(0.73±0.08)明显下调(P<0.05)。与E组的(1.03±0.03)nmol/L相比,A组IGF-1蛋白表达水平(1.48±0.12)nmol/L明显上调,C组IGF-1蛋白表达水平(0.76±0.05)nmol/L明显下调(P<0.05)。72 h时,与E组的(5.03±0.14)%相比,A组细胞增殖活力(10.34±0.87)%明显增加,C组细胞增殖活力(2.42±0.13)%明显下调(P<0.05);与E组的(1.09±0.07)mm相比,A组细胞划痕迁移距离(1.45±0.08)mm明显增加,C组细胞划痕迁移距离(0.73±0.07)mm明显减少(P<0.05)。与E组的(103.00±7.00)个相比,A组侵袭细胞数(173.00±4.00)个明显增加,C组侵袭细胞数(82.00±1.00)个明显减少(P<0.05)。双荧光素酶报告实验结果显示:miR-19b-3p转染WT-IGF-1的细胞荧光素酶活性(0.57±0.08)Kat低于miR-NC的(0.95±0.06)Kat(P<0.05);miR-19b-3p转染MUT-IGF-1的细胞荧光素酶活性(0.98±0.05)Kat与miR-NC的(0.96±0.06)Kat比较无明显差异(P>0.05)。结论miR-19b-3p靶向上调IGF-1促进绒毛膜癌JEG-3细胞增殖、侵袭、迁移。

早产剖宫产后发现绒毛膜癌一例

绒毛膜癌是恶性程度极高的一类滋养细胞肿瘤,早产剖宫产后绒毛膜癌的病例较为少见,报告1例早产剖宫产后发现的绒毛膜癌病例情况。患者因胎心监护反应欠佳、胎儿超声脐动脉收缩期最大血流速度与舒张末期血流速度的比值(S/D)异常和甲胎蛋白异常升高行子宫下段剖宫产,新生儿出生后诊断贫血。患者剖宫产后持续异常阴道出血1个月余,复查人绒毛膜促性腺激素β亚单位(β-human chorionic gonadotropin,β-hCG)呈高水平,超声提示宫内异常回声团,除外妊娠物残留及再次妊娠,结合病史、临床表现、专科检查及辅助检查考虑诊断为绒毛膜癌,行氟尿嘧啶+更生霉素第1~8天静脉化疗治疗3个疗程后复查β-hCG为4.13 IU/L。随访至2024年5月母儿结局良好。因此,不论患者是否为足月妊娠,对于产后异常阴道出血、β-hCG水平异常的产妇需要警惕妊娠滋养细胞肿瘤,及时早期诊断、治疗,化疗后定期随访。

男性原发性纵隔绒毛膜癌伴多器官转移1例

绒毛膜癌(choriocarcinoma)是一种滋养层细胞的高度恶性肿瘤,多见于性腺和子宫[1],原发于生殖腺外的绒癌较少见,主要发生在机体中线部位,像腹膜后、松果体、纵隔或胃肠等,其中原发于纵隔的更为罕见,以年轻男性发病为主,组织学上可分为畸胎瘤、精原细胞瘤和非精原细胞瘤[2],本病的主要治疗方法有化疗、放疗和手术,但疗效都较差。本文根据我院收治的1例原发性纵隔绒毛膜癌患者特点进行回顾性总结,以提高临床相关专业医生和影像科医生对本病的认识。

侵蚀性葡萄胎与绒毛膜癌应用超声造影的鉴别诊断效能评估

目的探讨侵蚀性葡萄胎与绒毛膜癌应用超声造影的鉴别诊断效能。方法回顾性分析2019年2月至2021年12月上海市东方医院吉安医院收治的117例恶性滋养细胞患者的临床资料。所有患者均行超声造影检查。以病理检查结果为金标准,分析超声造影对侵蚀性葡萄胎、绒毛膜癌诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值;评估超声造影与病理结果的一致性。分别比较侵蚀性葡萄胎与绒毛膜癌的动态增强时间及超声造影特征。结果超声造影对侵蚀性葡萄胎与绒毛膜癌的灵敏度分别为92.45%、92.00%,特异度分别为98.44%、97.01%,准确度分别为95.73%、94.87%,阳性预测值分别为98.00%、95.83%,阴性预测值分别为94.03%、94.20%;超声造影与病理检查均具有一致性(Kappa=0.912、0.895,P<0.05)。侵蚀性葡萄胎与绒毛膜癌患者绒始增时间、增强时间、达峰时间比较差异无统计学意义。侵蚀性葡萄胎患者边界清晰、弥漫型增强、无增强区域<1/3的占比均高于绒毛膜癌患者,差异有统计学意义(P<0.05);绒毛膜癌患者边界不清晰、环状型增强、无增强区域>2/3的占比均高于侵蚀性葡萄胎患者,差异有统计学意义(P<0.05);侵蚀性葡萄胎与绒毛膜癌患者增强顺序、网状型增强、区域型增强、无增强区域为1/3~1/2、无增强区域为1/2~2/3占比比较差异无统计学意义。结论超声造影对侵蚀性葡萄胎与绒毛膜癌的诊断效能较好,有利于鉴别侵蚀性葡萄胎、绒毛膜癌,可在临床推广应用。

A rare case of primary choriocarcinoma in the sigmoid colon

Primary colorectal choriocarcinoma is an extremely rare neoplasm and is usually associated with a poor prognosis.Only 13 cases of colorectal choriocarcinoma have previously been reported.There is no standard chemotherapeutic regimen for this tumor type.A 68-year-old man presented with melena and was diagnosed with sigmoid colonic adenocarcinoma with multiple liver metastases.He underwent a laparoscopic sigmoidectomy.Pathology revealed choriocarcinoma with a focal component of moderately differentiated adenocarcinoma of colon origin.Based on the collagen gel droplet-embedded culture drug sensitivity test(CD-DST)results,mFOLFOX6 and bevacizumab were administered,which suppressed aggressive tumor growth for 4 mo.The patient died 9 mo after the initial diagnosis.Our study results suggest that the standard chemotherapy regimen for colorectal cancer might have suppressive effects against primary colorectal choriocarcinoma.Moreover,CD-DST may provide,at least in part,therapeutic insight for the selection of appropriate antitumor agents for such patients.

Complete response to multidisciplinary therapy in a patient with primary gastric choriocarcinoma

Primary gastric choriocarcinoma is a rapidly growing neoplasm with an average survival of several months in untreated patients.Gastrectomy with lymph node dissection followed by chemotherapy is the treatment of choice.Regimens used for gastric adenocarcinoma are usually selected.However,median survival remains less than six months.In this case report,we describe a case of primary gastric choriocarcinoma with a clinical complete response to multidisciplinary treatment including surgery,chemotherapy,and radiofrequency ablation(RFA).The patient was originally referred for general malaise.Esophagogastroduodenoscopy demonstrated a large tumor occupying the fornix,and total gastrectomy with lymph node dissection was performed.Seven days later,multiple liver metastatic recurrences with high serum levels of beta-human chorionic gonadotropin(β-hCG) were recognized.Chemotherapy with a gonadal choriocarcinoma regimen consisting of etoposide,methotrexate,actinomycin D,cyclophosphamide,and vincristine(EMA/CO),was initiated.After three cycles,serum β-hCG decreased markedly and the tumors disappeared.Six months later,multiple lung metastatic recurrences were found.After one cycle of EMA/CO,only one nodule remained.Computed tomography-guided RFA was performed for this oligometastatic tumor.The patient has been alive with no evidence of disease for 10 years after the initial diagnosis.To the best of our knowledge,this patient with recurrent primary gastric choriocarcinoma has achieved the longest survival.The present case is the first report of choriocarcinoma metastatic to the lung successfully treated with RFA.From our retrospective analysis of recurrent or unresectable primary gastric choriocarcinoma,we propose that gonadal choriocarcinoma regimens can be considered as first-line for primary gastric choriocarcinoma.

Effective component from verbena officinalis L.inhibits proliferation and induces apoptosis of human choriocarcinoma JAR cells

Objective:To examine the action of the effective component,4'-methylether-scutellarein,from Verbena officinalis L.(VOL)on the proliferation and apoptosis of human choriocarcinomaJAR cells.Methods:Cell proliferation was measured by MTT[3-(4,5-dimethylthiazol-2-yl)-2,5-di-phenyl tetrasodium bromide,MTT]assay and the incorporation of tritiated thymidine(~3H-TdR).Apoptosis of cell was evaluated by flow cytometry(FCM)and the characteristic apoptoticDNA ladder by agarose gel electrophoresis,and the morphological changes of apoptotic JAR cellswere observed under fluorescence microscopy and electron microscopy(EM).Expressions of ap-optosis proteins,poly(ADP-ribose)polymerase(PARP)and caspase-3,-8,and -9 were deter-mined with Western blot.Results:The effective component from VOL inhibited the proliferation of JAR cells in a dose-and time-dependent manner.The treated cell cycle was arrested in S phase and an apoptotic peakwas found in S phase using FCM analysis.A typical DNA ladder appeared in the treatment groupwhen analyzed by agarose gel electrophoresis.Using fluorescence microscopy,the percentage ofapoptotic cell was 0.9%,6%,and 14% after treatments of 10,20,and 40 mg·L^(-1) of the effec-tive component,respectively,for 48 h.Typical apoptotic changes,such as condensed chromatinand presence of apoptotic bodies,were observed under EM.Treatment with effective componentfor 48 h and 72 h also induced protein expression of PARP and caspase-3,-8,and -9 as seen byWestern blot.Conclusions:The effective component from VOL inhibits cell proliferation and induces apop-tosis in human choriocarcinoma JAR cells.

Primary gastric choriocarcinoma-a rare and aggressive tumor with multilineage differentiation: A case report

BACKGROUND Primary choriocarcinoma of the stomach (PCCS) is a rare tumor, with fewer than 60 cases published in the English-language literature up to December 2018. In this paper, we present the complex immunoprofile of one PCCS and a hypothesis regarding its histogenesis. CASE SUMMARY A 66-year-old previously healthy male underwent an emergency palliative gastrectomy for a gastric obstructive tumor. The histologic examination and immunoprofile of tumor cells showed a mixed tumor that consisted of choriocarcinoma (90%) and moderate differentiated adenocarcinoma (10%), with hepatic metastases (Stage pT2NxM1L1V1R0) and microsatelite stable status. The patient died one month after surgery. The tumor cells showed focal positivity for CDX2 (adenocarcinoma component), HCG (choriocarcinoma) and CD138 (plasmacytoid carcinoma component) and were negative for HER-2,α- fetoprotein, VEGF, maspin and markers of epithelial-mesenchymal transition. The gastric mucosa cells displayed positivity for CDX2, Hepar A and CD138. The complex immunoprofile and literature data synthesis prove that the gastric mucosa cells can present a multilineage differentiation. CONCLUSION PCCS should be considered as an aggressive variant of microsatellite stable gastric adenocarcinoma of an epithelial type, and not a germ cell tumor.

Gastric choriocarcinoma admixed with an α-fetoprotein-producing adenocarcinoma and separated adenocarcinoma

We report a case of gastric choriocarcinoma admixed with an α-fetoprotein (AFP)-producing adeno-carcinoma. A 70-year-old man was hospitalized for gastric cancer that was detected during screening by esophagogastroduodenoscopy (EGD). Initial laboratory data showed the increased serum level of AFP and EGD revealed a 5-cm ulcerofungating mass in the greater curvature of the gastric antrum. The patient underwent radical subtotal gastrectomywith D2 lymph node dissection and Billroth gastrojejunostomy. Histopathological evaluation confirmed double primary gastric cancer: gastric choriocarcinoma admixed with an AFP-producing adenocarcinoma and separated adenocarcinoma. At 2 wk postoperatively, his human chorionic gonadotropin and AFP levels had reduced and six cycles of adjuvant chemotherapy were initiated. No recurrence or distant metastasis was observed at 4 years postoperatively.

Primary hepatic choriocarcinoma in a 49-year-old man:Report of a case

We report a case of hepatic choriocarcinoma in a man diagnosed at autopsy after a rapid downhill clinical course.The patient was a 49-year-old man who presented with acute right-sided abdominal pain.There were no masses palpable on physical examination.Radiographic findings showed large multi-nodular tumors mainly in the right lobe of the liver.Fludeoxyglucosepositron emission tomography scan showed uptake only in the liver,and no uptake in the testes.We initially planned to perform a liver resection for the presumed diagnosis of intra-hepatic cholangiocarcinoma.However,the tumors grew rapidly and ruptured.Multiple lung metastases rapidly developed resulting in respiratory failure,preventing liver resection or even biopsy.He died 60 d after initial presentation with no pathological diagnosis.Postmortem studies included histopathological and immunohistological examinations which diagnosed a primary choriocarcinoma of the liver.Primary hepatic choriocarcinoma is very rare but should be considered in the differential diagnosis of a liver tumor in a middle aged man.Establishing this diagnosis may enable treatment of the choriocarcinoma.Liver biopsy and evaluation of serum human chorionic gonadotropin are recommended in these patients.

Combined choriocarcinoma, neuroendocrine cell carcinoma and tubular adenocarcinoma in the stomach

We described a patient with adenocarcinoma of the stomach combined with choriocarcinoma and neuroendocrine cell carcinoma. An 85-year-old man visited our hospital because of appetite loss. Gastric fiberscopy revealed a large tumor occupying the cardial region and anterior wall of the gastric body. The patient underwent total gastrectomy with lymphnode dissection and partial resection of the liver. Choriocarcinoma, small cell carcinoma and tubular adenocarcinoma existed in the gastric tumor. The choriocarcinomatous foci contained cells positive for beta-subunit of human chorionic gonadotropin （B-hCG） and human placental lactogen mainly in syncytiotrophoblastic cells. The small cell carcinomatous loci contained cells positive for synaptophysin, neuron-specific enolase （NSE）, and chromogranin A. The prognosis for gastric adenocarcinoma with choriocarcinoma and neuroendocrine cell carcinoma is exceedingly poor. This patient died about 2 mo after the first complaint from hepatic failure. This is the first reported case of gastric cancer with these three pathological features.

Choriocarcinoma-associated pulmonary thromboembolism and pulmonary hypertension： a case report

Cases of pulmonary embolism and pulmonary artery hypertension caused by choriocarcinoma represent a rare clinical emergency. We report a case of a 25-year-old woman who presented with pulmonary embolism and hyper- tension and died soon after complete pulmonary embolectomy. A related literature review revealed that almost all of these patients had previously experienced a spontaneous abortion （average, 6 months） and were not pregnant.

Prognosis of gestational choriocarcinoma diagnosed incidentally during laparoscopy for a presumed cornual pregnancy:a report of five cases

The clinical presentations of gestational choriocarcinoma vary markedly, and a misdiagnosis could be made in atypical patients if simply relying on clinical features. Laparoscopic resection of uterine mass lesion is rarely used in gestational choriocarcinoma diagnosis because of the fear of heavy blood loss and distant metastasis. Five patients who were preoperatively diagnosed as having cornual pregnancy underwent laparoscopic resection of mass lesion and then proved to have gestational choriocarcinoma based on pathological examinations. Chemotherapy was started within two days after surgery, and the rate of complete remission was 100%. The mean follow-up time was 29.8±19.1 months, and no patient showed signs of relapse. Laparoscopic resection of uterine mass followed by timely postoperative chemotherapy may be an effective and safe way to obtain pathologic results in patients with suspected gestational choriocarcinoma.

Choriocarcinoma misdiagnosed as cerebral hemangioma:A case report

BACKGROUND Choriocarcinoma is a subtype of gestational trophoblastic disease,gestational trophoblastic neoplasia.Patients with brain metastasis are rare and information on the optimal treatment and patient outcome is limited.In order to improve the prognosis of this disease,accurate and timely treatments are very important for the patient of brain metastasis by choriocarcinoma.CASE SUMMARY A 17-year-old unmarried girl was misdiagnosed with a cerebral hemangioma with intracranial hemorrhage in a local hospital after presentation with severe head pain.She underwent craniotomy three times for treatment.The pathological results of posterior intracranial hematoma showed choriocarcinoma,and the patient was diagnosed as choriocarcinoma(21 points in stage IV).After uterine artery embolization,etoposide,methotrexate,actinomycin D,cyclophosphamide,and vincristine chemotherapy for 7 cycles,and whole brain radiotherapy,the patient achieved remission.She has been followed for 2 years with no signs of tumor recurrence.CONCLUSION For female patients of childbearing age with an intracranial hematoma,the possibility of brain metastasis by choriocarcinoma should be considered.It is necessary to obtain a detailed history,including menstruation,beginning age of first sex,contraception,etc.The level ofβ-human chorionic gonadotropin should be tested at the beginning,and a stratified treatment should be administered according to the International Federation of Gynecology and Obstetrics staging and World Health Organization prognostic scoring systems.

Radioimmunodetection of human choriocarcinoma xenograft in nude mouse

Objective: To study the efficiency of radioimmuno-detection in locating the xenograft of human chorio-carcinoma in nude mouse. Methods: Radioimmuno-detection was performed using cocktail antibodies of 131I-labeled mouse anti-human chorionic gonadotropin monoclonal antibodies to locate the xenograft of human choriocarcinoma in nude mouse. Radioactivity in different tissues was measured and the tumor/non-tumor ratio was calculated. Normal mouse IgG was used as control IgG. Results: The accumulation of radioactivity in the xenograft area could be recognized as early as 24 h after the injection of the radiolabelled antibodies. 72-96 h after the injection, the xenograft could be clearly shown. The minimal shown xenograft was 0.8 cm in diameter. The tumor/non-tumor ratio increased with the time and was obviously higher than that in control group. Conclusion: Radioimmunodetection can efficiently locate human choriocarcinoma xenograft in nude mouse.

Rapid Evolution of a Case of Choriocarcinoma Following Normal Delivery at Term Pregnancy

We report a case of postpartum choriocarcinoma with rapid evolution. The patient died 6 months after diagnosis. We underline the interest of the systematic histological examination of any pregnancy tissue, particulary the placenta full term.

Rare tumor of the ovary: Primitive choriocarcinoma

We report the case of a patient of 30 years with primary choriocarcinoma of the ovary. This patient referred for abdomino-pelvic mass suspected clinically and sonographically. Exploratory laparotomy was performed with the presence of two latero-uterine mass adherents to the highly vascularised uterus and difficult to resects deep plane with a mass left hepatic bleeding. A biopsy of both masses was performed and histological examination with immunehistochemical study returned for a primary ovarian non-gestational choriocarcinoma and the patient received 4 cycles of chemotherapy after hepatic artery embolization with good clinical, biological and radiological evaluation.