Problematic issues of diagnosis of trophoblastic disease

Н. Ю. Педаченко, О. І. Мухомор, К. Л. Аветисьян, Ю. С. Денисенко

Abstract


The article investigates the difficulties of diagnosis of trophoblastic disease in practice. Till nowadays there is no general strategy in the detection and treatment of gestational trophoblastic disease, as there is no clear status. The diagnosis of this pathology is multifactorial in nature, which also presents some difficulties in the timely detection of gestational trophoblastic disease. This shown that the occurrence of this disease depends on many factors, including the important role of pathogenetic predisposition.

In the current study the features of diferrential diagnosis of trophoblastic disease in the early stages of development by ultrasonography and hystologycal analysis were investigated. It was proved that these studies play an important role in the differentiation of uterine molar pregnancy. A clinical case is presented, in which disagreements in diagnoses of a pregnant patient are noted. Also there is a need to respect modern principles of medical ethics and deontology (another device, “other eye” of researcher).

As the authors of the article notes, the interpretation of cases with pathology of small pregnancy terms should implemented by doctors of diagnosts together with gynecologists, who have sufficient experience and special training on the problems of trophoblastic disease. In this case, the ultrasound data in the dynamics and the results of clinical and laboratory studies should be taken into account in the complex. Histological studies should be carried out by doctors in specialized institutions (oncological centers, scientific institutions of the 4th level). This problem continues to be relevant, given the high risk of transformation of the physiological conditions of pregnancy into oncopathology, and radical decisions in such cases should be taken by the consilium.

With the increase in the number of pregnant women after infertility treatment, including methods of assisted reproduction, such cases can happen more often for different reasons.

Therefore doctors who are entrusted to watch and treat such patients should always take into account the significant moral, psychological and possibly additional legal aspects, the occurrence of which can often be foreseen and prevented.


Keywords


trophoblastic disease; mollar pregnancy; malignant tumor pathology; human chorionic gonadotropin; cancer transformation

References


Mangili, G., Lorusso, D., Brown, J., et al. “Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup.” Int J Gynecol Cancer 24 (2014): 9–116.

Lurain, J.R. “Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia.” Am J Obstet Gynecol 204 (2011):11–8.

Ronnett, B.M., DeScipio, C., Murphy, K.M. “Hydatidiform moles: ancillary techniques to refine diagnosis.” Int J Gynecol Pathol 30 (2011): 101–16.

Ngan, H.Y., Bender, H., Benedet, J.L., et al. “Gestational trophoblastic neoplasia, FIGO 2000 staging and classification.” Int J Gynaecol Obstet 83 (2003): 175–7.

Barber, E.L., Schink, J.C., Lurain, J.R. “Hepatic metastasis in gestational trophoblastic neoplasia: patient characteristics, prognostic factors, and outcomes.” J Reprod Med 59 (2014): 199–203.

Meshcheriakova, L.A., Kozachenko, V.P. “Trophoblastic tumors: the possibilities of surgical treatment.” Herald of Rus Oncol Scientific Center 4 (2003): 36–42.

Tsyp, N.P., Vorobyeva, L.I. “Surgical method in the treatment of trophoblastic tumors.” Pract Oncol 3 (2008): 179–85.

Matsui, H., Suzuka, K., Yamazawa, K., et al. “Relapse rate of patients with low-risk gestational trophoblastic tumor initially treated with single-agent chemotherapy.” Gynecol Oncol 96.3 (2005): 616–20.

Behtash, N., Ansari, S., Sarvi, F. “Successful pregnancy after localized resection of perforated uterus in choriocarcinoma and a literature review.” Int J Gynecol Cancer 16 Suppl 1 (2006): 445–8.

Hoekstra, A.V., Keh, P., Lurain, J.R. “Placental site trophoblastic tumor: a review of 7 cases and their implications for prognosis and treatment.” J Reprod Med 49.6 (2004): 447–52.

Papadopoulos, A.J., Foskett, M., Seckl, M.J., et al. “Twenty-five years’ clinical experience with placental site trophoblastic tumors.” J Reprod Med 47.6 (2002): 460–4.

Kohorn, E. “The draft of EOTTD protocol for diagnosis and treatment of trophoblastic disease of pregnancy.” (2012).

Berkowitz, R.S., Goldstein, D.P., Seckl, M.J., et al. “Placental site trophoblastic tumour: clinical features and management.” Clin Obstet Gynecol 50 (2007): 112–22.

Hui, P., Maesta, I., et al. “Placental site trophoblastic tumour: clinical features and management.” Gynecol Oncol 99.3 (2005): 603–7.

Zeng, X., Liu, X., Tian, Q., et al. “Placental site trophoblastic tumor: A case report and literature review.” Intractable Rare Dis Res 4.3 (2015): 147–51.

Janni, W., Hantschmann, P., Rehbock, J., et al. “Successful treatment of malignant placental site trophoblastic tumor with combined cytostaticsurgical approach: case report and review of literature.” Gynecol Oncol 75.1 (1999): 164–9.

Metindir, J., Pak, I., Ozdilekcan, C., Eren, E. “Chemoresistant placental site trophoblastic tumor with hilar lymph node metastasis: an unusual site of involvement.” Gynecol Oncol 96.2 (2005): 552–5.

Eysbouts, Y.K., Massuger, L., Thomas, C., et al. “Dutch Risk Classification and FIGO 2000 for Gestational Trophoblastic Neoplasia Compared.” Int J Gynecol Cancer 26.9 (2016): 1712–16.

Brown, J., Naumann, R.W., Seckl, M.J., Schink, J. “15 years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage.” Gynecol Oncol 144.1 (2017): 200–7.

Yamada, Y., Ohira, S., Yamazaki, T., Shiozawa, T. “Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature.” Case Rep Obstet Gynecol (2016): 7618631.

Niknejadi, M., Ahmadi, F., Akhbari, F. “Imaging and Clinical Data of Placental Site Trophoblastic Tumor: A Case Report.” Iran J Radiol 13.2 (2016): e18480.

Manthati, S., Pratumvinit, B., Hanyongyuth, R., et al. “Circulating free soluble fms-like tyrosine kinase-1 during late first trimester in relation with placental volume as a surrogate for trophoblastic production: A physiology study in low-risk cohort.” J Matern Fetal Neonatal Med Online Feb 5 (2017): 1–8, DOI: 10.1080/14767058.2016.1235697.

Begum, J., Palai, P., Ghose, S. “Complete molar pregnancy in postmenopausal women.” J Midlife Health 7.2 (2016): 91–3.

Mohamed, S.A., Al-Hendy, A., Ghamande, S., et al. “Atypical Presentations of Molar Pregnancy: Diagnostic Roles of Imaging, β-Human Chorionic Gonadotropin Measurement, and p57 Immunostaining.” J Ultrasound Med 35.3 (2016): 643–9.

Order of the MOH of Ukraine No 641/84 from 31.12.2003. “On the improvement of medical-genetics care in Ukraine.”

Site of Dr. Urvashi Surti, Department of Pathology of University of Pittsburgh, USA. Available from: [http://path.upmc.edu/personnel/faculty/Surti.htm], last accessed Apr 1, 2017.

Steinberg, K.M., Schneider, V.A., Graves-Lindsay, T., et al. “Single Haplotype Assembly of the Human Genome From a Hydatidiform Mole.” Genome Research 12.24 (2014): 2066–76.


GOST Style Citations


1. Mangili, G., Lorusso, D., Brown, J., et al. “Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup.” Int J Gynecol Cancer 24 (2014): 9–116.

2. Lurain, J.R. “Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia.” Am J Obstet Gynecol 204 (2011):11–8.

3. Ronnett, B.M., DeScipio, C., Murphy, K.M. “Hydatidiform moles: ancillary techniques to refine diagnosis.” Int J Gynecol Pathol 30 (2011): 101–16.

4. Ngan, H.Y., Bender, H., Benedet, J.L., et al. “Gestational trophoblastic neoplasia, FIGO 2000 staging and classification.” Int J Gynaecol Obstet 83 (2003): 175–7.

5. Barber, E.L., Schink, J.C., Lurain, J.R. “Hepatic metastasis in gestational trophoblastic neoplasia: patient characteristics, prognostic factors, and outcomes.” J Reprod Med 59 (2014): 199–203.

6. Мещерякова, Л.А. Трофобластические опухоли: возможности хирургического лечения / Л.А. Мещерякова, В.П. Козаченко // Вестн. Рос. онкол. науч. Центра. – 2003. – №4. – С. 36–42.

7. Цип, Н.П. Хирургический метод в лечении трофобластических опухолей / Н.П. Цип, Л.И. Воробьева // Практ. Онкол. – 2008. – №3. – С. 179–185.

8. Matsui, H., Suzuka, K., Yamazawa, K., et al. “Relapse rate of patients with low-risk gestational trophoblastic tumor initially treated with single-agent chemotherapy.” Gynecol Oncol 96.3 (2005): 616–20.

9. Behtash, N., Ansari, S., Sarvi, F. “Successful pregnancy after localized resection of perforated uterus in choriocarcinoma and a literature review.” Int J Gynecol Cancer 16 Suppl 1 (2006): 445–8.

10. Hoekstra, A.V., Keh, P., Lurain, J.R. “Placental site trophoblastic tumor: a review of 7 cases and their implications for prognosis and treatment.” J Reprod Med 49.6 (2004): 447–52.

11. Papadopoulos, A.J., Foskett, M., Seckl, M.J., et al. “Twenty-five years’ clinical experience with placental site trophoblastic tumors.” J Reprod Med 47.6 (2002): 460–4.

12. Kohorn, E. “The draft of EOTTD protocol for diagnosis and treatment of trophoblastic disease of pregnancy.” (2012).

13. Berkowitz, R.S., Goldstein, D.P., Seckl, M.J., et al. “Placental site trophoblastic tumour: clinical features and management.” Clin Obstet Gynecol 50 (2007): 112–22.

14. Hui, P., Maesta, I., et al. “Placental site trophoblastic tumour: clinical features and management.” Gynecol Oncol 99.3 (2005): 603–7.

15. Zeng, X., Liu, X., Tian, Q., et al. “Placental site trophoblastic tumor: A case report and literature review.” Intractable Rare Dis Res 4.3 (2015): 147–51.

16. Janni, W., Hantschmann, P., Rehbock, J., et al. “Successful treatment of malignant placental site trophoblastic tumor with combined cytostaticsurgical approach: case report and review of literature.” Gynecol Oncol 75.1 (1999): 164–9.

17. Metindir, J., Pak, I., Ozdilekcan, C., Eren, E. “Chemoresistant placental site trophoblastic tumor with hilar lymph node metastasis: an unusual site of involvement.” Gynecol Oncol 96.2 (2005): 552–5.

18. Eysbouts, Y.K., Massuger, L., Thomas, C., et al. “Dutch Risk Classification and FIGO 2000 for Gestational Trophoblastic Neoplasia Compared.” Int J Gynecol Cancer 26.9 (2016): 1712–16.

19. Brown, J., Naumann, R.W., Seckl, M.J., Schink, J. “15 years of progress in gestational trophoblastic disease: Scoring, standardization, and salvage.” Gynecol Oncol 144.1 (2017): 200–7.

20. Yamada, Y., Ohira, S., Yamazaki, T., Shiozawa, T. “Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature.” Case Rep Obstet Gynecol (2016): 7618631.

21. Niknejadi, M., Ahmadi, F., Akhbari, F. “Imaging and Clinical Data of Placental Site Trophoblastic Tumor: A Case Report.” Iran J Radiol 13.2 (2016): e18480.

22. Manthati, S., Pratumvinit, B., Hanyongyuth, R., et al. “Circulating free soluble fms-like tyrosine kinase-1 during late first trimester in relation with placental volume as a surrogate for trophoblastic production: A physiology study in low-risk cohort.” J Matern Fetal Neonatal Med Online Feb 5 (2017): 1–8, DOI: 10.1080/14767058.2016.1235697.

24. Begum, J., Palai, P., Ghose, S. “Complete molar pregnancy in postmenopausal women.” J Midlife Health 7.2 (2016): 91–3.

25. Mohamed, S.A., Al-Hendy, A., Ghamande, S., et al. “Atypical Presentations of Molar Pregnancy: Diagnostic Roles of Imaging, β-Human Chorionic Gonadotropin Measurement, and p57 Immunostaining.” J Ultrasound Med 35.3 (2016): 643–9.

26. Наказ МОЗ України № 641/84 від 31.12.2003. «Про вдосконалення медико-генетичної допомоги в Україні».

27. Site of Dr. Urvashi Surti, Department of Pathology of University of Pittsburgh, USA. Available from: [http://path.upmc.edu/personnel/faculty/Surti.htm], last accessed Apr 1, 2017.

28. Steinberg, K.M., Schneider, V.A., Graves-Lindsay, T., et al. “Single Haplotype Assembly of the Human Genome From a Hydatidiform Mole.” Genome Research 12.24 (2014): 2066–76.





DOI: http://dx.doi.org/10.18370/2309-4117.2017.34.68-76

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