Although chemotherapy remains to be the mainstay of treatment of trophoblastic disease, hysterectomy has been performed as the primary management of nonmetastatic trophoblastic disease who desire sterilization and for uterine disease resistant to chemotherapy. Clinically, the documentation of disease regression is provided by serial quantitative serum beta-hCG assays and the persistent disease may be indicated when the serum beta-hCG values rise for 2 weeks or plateau for 3 weeks or more. Because of similarity in molecular structure, the confounding effect of an elevated LH on beta-hCG assessment in castrated women after treatment for trophoblastic disease has been documented. This LH cross-reactivity may be suspected in women with bilateral oophorectomy demonstrating persistent low levels of beta-hCG. It is particularly true when the assay is perfo-rmed by conventional polyclonal radioimmunoassay. We have experienced two cases of nonmetastatic trophoblastic disease whose serum beta-hCG assay plateaued at a low level after total abdominal hysterectomy with bilateral salpingo-oophorectomy and chemotherapy. Clinical and radiologic work-ups were done for metastatic lesion in dose patients, but the results were negative. The quantitative LH assays (Serono LH MAIAclone kit, Roma, Italy) were performed with the sera obtained from the patients; the results were 37 and 31 mIU/ml (1st IRP) with beta-hCG of 14 and 13 mIU/ml (1st IRP), respec-tively. With the initiation of oral estrogen replacement thrapy to those patients, the quantitative beta-hCG values fell below 5 mIU/ml (1st IRP) and they remained in complete chemical remission without any additional chemotherapy for one year. The persistant low titers of beta-hCG in those patients were considered to be result of LH cross-reactivity on beta-hCG assessment. It is concluded that whenever the assay of beta-hCG shows persistent low titers in the oophorectomized patient for treatment of trophoblastic disease, LH cross-reactivity should be suspected.
Drug Therapy ; Estrogen Replacement Therapy ; Female ; Gestational Trophoblastic Disease* ; Humans ; Hysterectomy ; Molecular Structure ; Ovariectomy ; Radioimmunoassay ; Sterilization ; Trophoblasts ; Uterine Diseases

Although chemotherapy remains to be the mainstay of treatment of trophoblastic disease, hysterectomy has been performed as the primary management of nonmetastatic trophoblastic disease who desire sterilization and for uterine disease resistant to chemotherapy. Clinically, the documentation of disease regression is provided by serial quantitative serum beta-hCG assays and the persistent disease may be indicated when the serum beta-hCG values rise for 2 weeks or plateau for 3 weeks or more. Because of similarity in molecular structure, the confounding effect of an elevated LH on beta-hCG assessment in castrated women after treatment for trophoblastic disease has been documented. This LH cross-reactivity may be suspected in women with bilateral oophorectomy demonstrating persistent low levels of beta-hCG. It is particularly true when the assay is perfo-rmed by conventional polyclonal radioimmunoassay. We have experienced two cases of nonmetastatic trophoblastic disease whose serum beta-hCG assay plateaued at a low level after total abdominal hysterectomy with bilateral salpingo-oophorectomy and chemotherapy. Clinical and radiologic work-ups were done for metastatic lesion in dose patients, but the results were negative. The quantitative LH assays (Serono LH MAIAclone kit, Roma, Italy) were performed with the sera obtained from the patients; the results were 37 and 31 mIU/ml (1st IRP) with beta-hCG of 14 and 13 mIU/ml (1st IRP), respec-tively. With the initiation of oral estrogen replacement thrapy to those patients, the quantitative beta-hCG values fell below 5 mIU/ml (1st IRP) and they remained in complete chemical remission without any additional chemotherapy for one year. The persistant low titers of beta-hCG in those patients were considered to be result of LH cross-reactivity on beta-hCG assessment. It is concluded that whenever the assay of beta-hCG shows persistent low titers in the oophorectomized patient for treatment of trophoblastic disease, LH cross-reactivity should be suspected.
Drug Therapy ; Estrogen Replacement Therapy ; Female ; Gestational Trophoblastic Disease* ; Humans ; Hysterectomy ; Molecular Structure ; Ovariectomy ; Radioimmunoassay ; Sterilization ; Trophoblasts ; Uterine Diseases

The purpose of this study was for clinical evaluating those women with low grade squamous intraepithelial lesions (LSIL) who have been detected on Pap smears. We analyzed 279,270 Pap smears, from January 1994 to August 1997, of which 703 cases were identified as LSIL, and their medical records were reviewed retrospectively. Among them, 616 cases were able to follow-up by altered methods (repeated Pap smear only vs. histologic examination) and their efficacy for detecting more significant lesion (high grade squamous intraepithelial lesion: HSIL or invasive cancer) were also compared. The results were as follows; 1. The frequency of LSIL on Pap smears was approximately 0.25%. 2. The mean age was 39 years (range 18 ~70 years). 3. Most of the gross finding of the cervix were normal or mild erosion. 4. Most of symptom was asymptomatic, or nonspecific. 5. Eighty-seven women with LSIL on initial Pap smears, have performed repeated Pap smears. 74 (85.1%) was normal, 7 (8.0%) was ASCUS, 6 (6.9%) was LSIL. Remained 529 women had subsequently histologic examination such as colposcopic directed biopsy or cone knife biopsy. These histologic results showed 192 (36.3%) with normal, 258 (48.8%) with LSIL, 77 (14.6%) with HSIL, 2 (0.4%) with microinvasive carcinoma. Based on the results in this study, we emphasize the importance of regular screening procedures for early detection of cervical lesions because there was no specific clinical characteristics in women with cytologic diagnosis of LSIL. In addition, we recommened colpo-scopic directed biopsy or cone knife biopsy as follow-up evaluation method in women with LSIL on initial Pap smear for detecting more significant cervical lesion.
Biopsy ; Cervix Uteri ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Mass Screening ; Medical Records ; Retrospective Studies

The purpose of this study was for clinical evaluating those women with low grade squamous intraepithelial lesions (LSIL) who have been detected on Pap smears. We analyzed 279,270 Pap smears, from January 1994 to August 1997, of which 703 cases were identified as LSIL, and their medical records were reviewed retrospectively. Among them, 616 cases were able to follow-up by altered methods (repeated Pap smear only vs. histologic examination) and their efficacy for detecting more significant lesion (high grade squamous intraepithelial lesion: HSIL or invasive cancer) were also compared. The results were as follows; 1. The frequency of LSIL on Pap smears was approximately 0.25%. 2. The mean age was 39 years (range 18 ~70 years). 3. Most of the gross finding of the cervix were normal or mild erosion. 4. Most of symptom was asymptomatic, or nonspecific. 5. Eighty-seven women with LSIL on initial Pap smears, have performed repeated Pap smears. 74 (85.1%) was normal, 7 (8.0%) was ASCUS, 6 (6.9%) was LSIL. Remained 529 women had subsequently histologic examination such as colposcopic directed biopsy or cone knife biopsy. These histologic results showed 192 (36.3%) with normal, 258 (48.8%) with LSIL, 77 (14.6%) with HSIL, 2 (0.4%) with microinvasive carcinoma. Based on the results in this study, we emphasize the importance of regular screening procedures for early detection of cervical lesions because there was no specific clinical characteristics in women with cytologic diagnosis of LSIL. In addition, we recommened colpo-scopic directed biopsy or cone knife biopsy as follow-up evaluation method in women with LSIL on initial Pap smear for detecting more significant cervical lesion.
Biopsy ; Cervix Uteri ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Mass Screening ; Medical Records ; Retrospective Studies