The authors analyzed ultrasonographic findings of 112 cases of trophoblastic disases which were confirmed byD&E or hysterectomy at Wallace Memorial Baptist Hospital from September 1980 to December 1984. The results were asfollows; 1. Of all 112 cases, hydatidiform moles were 99 cases, invasive moles were 3 cases and choriocarcinomas were 10 cases. 2. 81 cases (72%) occurred in 3rd decades. 3. The sized of uterus was large for gestational weeksin 65 cases(56%) and smaller in 13 cases(13%). 4. The contour of uterus was globular in 59 cases(53%), diffuse in49 cases(44%) and nodular in 4 cases(3%). 5. The internal echopatterns of uterus revealed numerous small vesicular snowstorm patterns in all cases, and revealed internal degeneration in 67 cases(60%). 6. Uterine walls in 89 cases(79%) were well delineated but uterine walls in 23 cases(21%) were poor delineated. 7. Multiseptated ovarian thecalutein cysts were seen in 36 cases (32%). 8. Invasive trophoblastic disease(invasive moles 3 cases andchoriocarcinomas 10 cases) revealed similiar ultrasonographic findings with H-mole, but more irregular internalechoes and irregular echoes in uterine wall. 9. Diagnostic accuracy was diagnostic in 98 cases (88%) , nonspecificin 11 cases (10%) and error in 3 cases(2%).
Choriocarcinoma ; Female ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Hysterectomy ; Pregnancy ; Protestantism ; Trophoblasts ; Uterus

social resistance ; Chemotherapy-Oncologic Procedure ; Singular ; Etoposide ; Hydatidiform Mole, Invasive

Invasive mole is a malignant form of hydatidiform mole and can be seen occasionally. It invades the myometrium, adjacent structures and metastasizes distantly. It can initially appear with symptoms of the respiratory, genitourinary system, or rarely intraperitoneal hemorrhage. However, reports of invasive mole initially presenting symptom of brain metastasis is rare and is occasionally found at autopsy. We report a case of invasive mole which had metastasized to the brain and lung and initially presented with symptoms of brain metastasis.
Animals ; Autopsy ; Brain* ; Female ; Hemorrhage ; Hydatidiform Mole ; Hydatidiform Mole, Invasive* ; Lung ; Mice ; Myometrium ; Neoplasm Metastasis* ; Pregnancy ; Urogenital System

PURPOSE: To evaluate the MR findings of gestational trophoblastic tumor(GTT) in correlation with pathological results. MATERIALS AND METHODS: Nine patients who confirmed the diagnosis (four choriocarcinomas and five invasive moles) constituted the basis of our study. Pathologic specimens were taken from the tumors corresponding to the regions of interest on MR images. The MR images were analyzed in respect of the morphology and signal intensity of the tumors, uterine and adnexal vascularity, and the adnexal lesion. RESULTS: The MR findings of four choriocarcinomas were well-defined, hemorrhagic masses with central necrosis;the masses were hyperintense on Tl-weighted images. In contrast, the five invasive moles showed irregular and permeative masses with densely enhanced solid components and tiny cystic lesions. The trophoblastic proliferation, coagulation necrosis, and molar villi had variable signal intensities on Tl-and T2-weighted images. CONCLUSION: Our results suggest that MR imaging is a promising tool for noninvasive morphologic analysis of GTTS.
Choriocarcinoma ; Diagnosis ; Female ; Humans ; Hydatidiform Mole, Invasive ; Magnetic Resonance Imaging* ; Molar ; Necrosis ; Pregnancy ; Trophoblastic Neoplasms* ; Trophoblasts*

The purpose of this study was to evaluate the significance of telomerase activity in gestational trophoblastic disease and the association of telomerase activity in complete hydatidiform mole and subsequent development of persistent gestational trophoblastic tumor. By using the standard telomerase repeat assay, we examined telomerase activity in 2 normal placentas, 31 complete hydatidiform moles, 7 invasive moles, 5 choriocarcinoma tissues and choriocarcinoma cell line (JEG-3). Telomerase activity was detected in 13 of 15 (86.7%) complete hydatidiform mole patients who eventually had chemotherapy for the treatment of persistent gestational trophoblastic tumor. All of the 9 patients with metastatic disease (FIGO Stage III) had telomerase activity in their initial molar tissue. In contrast, telomerase activity was evident in only two of 16 (12.5%) complete hydatidiform mole patients with spontaneous remission. While telomerase activity was not detected in normal placentas, high level of telomerase activity was detected in all of 7 invasive moles, 5 choriocarcinoma tissues and choriocarcinoma cell line (JEG-3). The presence of telomerase activity in a complete hydatidiform mole is associated with the development of persistent gestational trophoblastic tumor, such as invasive mole and choriocarcinoma.
Cell Line ; Choriocarcinoma ; Drug Therapy ; Female ; Gestational Trophoblastic Disease* ; Humans ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Molar ; Placenta ; Pregnancy ; Remission, Spontaneous ; Telomerase* ; Telomere ; Trophoblastic Neoplasms

For the clinical analysis and evaluation on the patients with gestational trophoblastic disease(GTD), a study was done retrospectively on 114 patients with GTD(60 in Hydatidiform mole, 10 in invasive mole, 44 in choriocarcinoma) treated from Jan. 1, 1985 to Dec. 31, 1994 at the Department of Obstetrics and Gynecology, Kosin Medical College, Pusan, Korea. We obtained the following results ; The incidence of GTD was 1 per 73 deliveries in H. mole, 1 per 437 deliveries in invasive mole, and 1 per 99 deliveries in choriocarcinoma. The most prevalent age was 21-40 groups. Abnormal vaginal bleeding was a main symptom and sign. 30.6% of H. mole was managed by dilatation and curettage. 90.0% of invasive mole and 51.4% of choriocarcinoma were managed by surgical treatment and chemotherapy. The overall remissinon rate of choriocarcinoma was 71.4%(100.0% in stage I, 66.7% in stage II, 54.5% in stage III, 50.0% in stage IV).
Busan ; Choriocarcinoma ; Dilatation and Curettage ; Drug Therapy ; Female ; Gestational Trophoblastic Disease* ; Gynecology ; Humans ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Incidence ; Korea ; Obstetrics ; Pregnancy ; Retrospective Studies ; Trophoblasts ; Uterine Hemorrhage

In order to explore a potential indicator of predicting the occurrence and development of gestational trophoblastic tumor, the expression of c-erbB2 oncogene in human normal placenta, hydatidiform mole and choriocarcinoma was investigated. The expression of c-erbB2 was detected immunohistochemically by monoclonal antibody against the gene on the formalin-fixed paraffin sections of 21 hydatidiform moles, 21 invasive moles, 20 choriocarcinomas and 30 normal placentas. Results showed that the expression level of c-erbB2 was significantly higher in gestational trophoblastic tumor than in hydatidiform mole and normal placenta of midterm and term pregnancy (P < 0.05), while there was no significant difference between patients with gestational trophoblastic tumor of stage III, IV and those of stage I, II. It was demonstrated that overexpression of c-erbB2 may closely associated with malignant transformation of hydatidiform mole, not only providing important insight into pathogenesis of gestational trophoblastic tumor, but also having an important significance for the early diagnosis and early treatment of gestational trophoblastic tumor.
Biomarkers, Tumor ; Choriocarcinoma ; metabolism ; Female ; Genes, erbB-2 ; Humans ; Hydatidiform Mole ; metabolism ; Hydatidiform Mole, Invasive ; metabolism ; Placenta ; metabolism ; Pregnancy ; Receptor, ErbB-2 ; biosynthesis ; genetics ; Uterine Neoplasms ; metabolism

Gestational trophoblastic disease is derived from the intermediate trophoblast cells which are arisied from the fetal chorion. The incidence of invasive mole in Korea was about 1.8 per 1000 delivereies. The rate of ectopic pregnancy is about 1.9% of all pregnancies. An ectopic pregnancy located in the cornual portion of uterus occurs in only 2-4% of all ectopic pregnancies. It is rare that the invasive mole is associated with cornual pregnancy. A case of metastatic invasive mole in the lung arising from a cornual pregnancy is reported, which was cured by operation and combination chemotherapy.
Chorion ; Drug Therapy, Combination ; Female ; Gestational Trophoblastic Disease ; Hydatidiform Mole, Invasive* ; Incidence ; Korea ; Lung* ; Pregnancy ; Pregnancy* ; Pregnancy, Ectopic ; Trophoblasts ; Uterus

Gestational trophoblastic tumors (GTTs) are malignant lesions that often cause abnormal genital bleeding and may present with hemoptysis, intraperitoneal bleeding or acute neurologic deficits. GTTs are generally highly chemosensitive with more favorable outcomes than other comparable malignancies. Here we report a rare case of invasive mole (FIGO stage IV, WHO score16) presenting with renal subcapsular hematoma due to bleeding renal metastasis. The patient had a pretreatment β-human chorionic gonadotrophin (β-HCG) level of 462 047 mIU/ml and received combined chemotherapy with etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine with also adjuvant surgeries including hysterectomy and nephrectomy. The patient recovered well and the tumor has remained in complete remission for one year and a half.
Antineoplastic Combined Chemotherapy Protocols ; Female ; Hemorrhage ; etiology ; Humans ; Hydatidiform Mole, Invasive ; complications ; Kidney ; pathology ; Pregnancy ; Uterine Neoplasms ; complications

PURPOSE: To investigate the role of gadolinium enhanced MR imaging in the evaluation of gestational trophoblastic tumors (invasive mole and choriocarcinoma). MATERIALS AND METHODS: Pre-enhanced T1-and T2-weighted images and gadolinium enhanced T1-weighted images of 34 gestational trophoblastic tumors (15 choriocarcinomas, 19 invasive moles) were evaluated retrospectively. Enhanced patterns of gestational trophoblastic tumors were analyzed. Morphologic differences and structural characterstics were analyzed by the evaluation of tumor margin, patterns of hemorrhagic necroses, development of intratumoral vascularity, and molar villi. Graded scores of MR findings between pre- and gadolinium enhanced images were given in the following criteria ; 1) visualization of tumor margin 2) distinction between tumor necrosis and zone of trophoblastic proliferation, and 3) molar villi. Statistical differences between graded scores of pre-and post-enhanced images were analyzed. RESULTS: Choriocarcinoma was a well-defined mass with peripheral rim enhancement and central hemorrhagic necrosis. Invasive mole was a ill-defined mass with partial necrosis, tiny cystic areas and increased intratumoral vascularity with dense reticular enhancement. Interface between tumor necrosis and zone of trophoblastic proliferation was better visualized on the gadolinium enhanced images than on the pre-enhanced images. Tumor margin and intratumoral molar villi were clearly discrimated on the gadolinium enhanced images only in invasive mole. There was no statistical difference in the visualization of tumor margin of choriocarcinoma between the pre-and post-enhanced images. CONCLUSION: Gadolinium enhanced MR image was helpful in the visualization of tumor characterstics in gestational trophoblastic tumors, and in the differential diagnosis between invasive mole and choriocarcinoma.
Choriocarcinoma ; Diagnosis, Differential ; Female ; Gadolinium* ; Hydatidiform Mole, Invasive ; Magnetic Resonance Imaging* ; Molar ; Necrosis ; Pregnancy ; Retrospective Studies ; Trophoblastic Neoplasms* ; Trophoblasts*