Epithelioid trophoblastic tumor (ETT) is an unusual variant of gestational trophoblastic tumor that is closely related to choriocarcinoma and placental site trophoblastic tumor (PSTT) but shows different morphologic, immunohistochemical features. ETT grows in a nodular pattern compared with the infiltrative pattern of PSTT. Histologically the tumor is characterized by uniform population of mononucleate intermediate trophoblastic cells that resemble the trophoblastic cells in the chorionic laeve, so we called them "chorionic-type intermediate trophoblast". Immunohistochemically ETT was positive for cytokeratin, epithelial membrane antigen(EMA) and staining for human placental lactogen (hPL) and human chorionic gonadotrophin (hCG) was generally patchy, focal or negative whereas PSTT contained more hPL-positive cells than hCG-positive cells. ETT can behave in a malignant fashion such as distant metastasis. We experienced a case of ETT by clinical result, pathologic finding, so we report a case with brief literature review.
Choriocarcinoma ; Chorion ; Female ; Humans ; Keratins ; Membranes ; Neoplasm Metastasis ; Placental Lactogen ; Pregnancy ; Trophoblastic Neoplasms* ; Trophoblastic Tumor, Placental Site ; Trophoblasts*

Pregnancy is normally a state of erythroid hyperplasia. Increased erythropoiesis during pregnancy is controlled by erythropoietin, which is augmented by the action of placental lactogen and inhibited by high levels of estrogen. We described a case of a patient with pure red cell aplasia during pregnancy that resolved completely in the postpartum period.
Erythropoiesis ; Erythropoietin ; Estrogens ; Humans ; Hyperplasia ; Placental Lactogen ; Postpartum Period ; Pregnancy* ; Red-Cell Aplasia, Pure*

BACKGROUND: There are many factors that influence the differentiation and growth of trophoblasts. During differentiation of trophoblasts, two major hormones are secreted ; human chorionic gonadotropin (hCG) and human placental lactogen (hPL). These two hormones are secreted in a peculiar pattern during pregnancy and function of these hormones is not yet fully understood. Also, it is not known whether these hormones directly influence the differentiation and growth of trophoblasts. On the other hand, it is known that choriocarcinoma cells are undifferentiated, so they are unable to form syncytiotrophblasts. And many factors may be associated with this inhibitory potential. OBJECTIVE: The purpose of this study was to observe whether the hCG and hPL are associated with differentiation and growth of early placental trophoblasts and becoming malignant. METHOD: The hCG, hPL, IL-6 and insulin were added to cytotrophoblasts isolated from normal 8 to 10 gestational weeks' placental tissues by a degree of concentration, and observed the secreted hPL concentration and morphological change to syncytiotrophoblasts daily. And it was performed in Bewo cells in same manner. RESULT: The increased hPL secretion was noted in hCG, hPL, IL-6 and insulin were added normal trophoblasts and this may result from differentiation of cytotrophoblasts to syncytiotrophoblasts. Also, morphological changes to syncytiotrohoblasts was observed at the same time. But, Increased hPL secretion and syncytiotrophoblasts formation was not detected in Bewo cells. CONCLUSION: In this study, it seems that hCG, hPL, IL-6 and insulin had an influence on differentiation and growth of normal trophoblasts. On the other hand, no changes in hPL secretion and morphology at the choriocarcinoma cell line tells us that defects of differentiation in choriocarcinoma is due to abnormalities of the receptors on hCG and hPL or a differentiation associated gene, not a defect of these hormones themselves.
Cell Line ; Choriocarcinoma ; Chorionic Gonadotropin* ; Female ; Gonadotropins ; Hand ; Humans* ; Insulin ; Interleukin-6 ; Placental Lactogen* ; Pregnancy ; Trophoblasts*

BACKGROUND: Recent studies have suggested that implantation site intermediate trophoblasts (ISITs) and chorionic type intermediate trophoblasts (CTITs) show different immunohistochemical findings, and that each type has specific location in placentas. However, we observed that both subtypes are intimately admixed in many areas of the placentas and both types are proliferated around the infarcts. METHODS: In order to examine the site specificity in their distribution and the changes of intermediate trophoblasts (ITs), if any, in the pre-eclamptic placentas, quantitative analyses of ISITs and CTITs using p63, CD146, placental alkaline phosphatase, human placental lactogen, and alpha-inhibin were performed in normal and pre-eclamptic placentas containing infarcts. RESULTS: In the fetal membranes of both normal and pre-eclamptic placentas, CTITs and ISITs were equally identified, forming distinct layers. ISITs were predominant in the intervillous septum and basal plate, while CTITs were predominant in the subchorionic area. At the margin of infarcts in pre-eclamptic placentas, both subtypes were increased in number, forming distinct layers. CONCLUSIONS: The subtypes of ITs do not have site specificity in placentas. Increased number of ITs and zonal distribution around infarcts suggest that CTITs and ISITs have differentiation associated relationship, and the differentiation might be related to the microenvironment of placenta, such as intraplacental oxygen concentration.
Alkaline Phosphatase ; Chorion ; Extraembryonic Membranes ; Fluconazole ; Immunohistochemistry ; Inhibins ; Oxygen ; Placenta ; Placental Lactogen ; Pre-Eclampsia ; Sensitivity and Specificity ; Trophoblasts

OBJECTIVEGenistein, a major soy isoflavone metabolite (SIF), inactivates oxidation activity of bovine lactoperoxidase (LPO). Modification of the heme moiety of LPO by nitrogen-containing compounds has been shown to inactivate LPO. In contrast, SIF mediated inactivation of LPO does not involve a heme modification and the mechanism of SIF inhibition is poorly understood.

METHODSAfter inactivation of LPO by genistein in the presence of H(2)O(2), trypsin-digested LPO peptide fragments were collected and analyzed by MALDI-TOF-MS to characterize the chemical binding of genistein(s) to LPO.

RESULTSThe heme moiety of LPO was not modified by genistein. A covalent binding study showed that (3)H-genistein bound to LPO with a ratio of ∼12 to 1. After HPLC analysis and peak collection, trypsin-digested peptide fragments were analyzed by MALDI-TOF-MS. The 3H-genistein co-eluted peptide fragments (RT=24 min) were putatively identified as 199IVGYLDEEGVLDQNR214 with two bound genistein molecules or a genistein dimer (2 259 Da), 486TPDNIDIWIGGNAEPMVER504 with two bound genistein molecules or a genistein dimer (2 663 Da), and 161ARWLPAEYEDGLALPFGWTQR182 with three bound genistein molecules or a genistein trimer (3 060 Da). The fragment with a mass of 1 792 Da (RT=36 min) was identified as 132CDENSPYR139 with three genistein molecules or a genistein trimer.

CONCLUSIONSThe results suggest that LPO was inactivated by irreversible covalent binding of genistein or genistein polymers to particular peptide fragments constituting regions of the outward domain. No genistein interaction with the prosthetic heme moiety of LPO was observed.

Animals ; Cattle ; Enzyme Activation ; drug effects ; Genistein ; metabolism ; Hydrogen Peroxide ; pharmacology ; Isoflavones ; pharmacology ; Lactoperoxidase ; metabolism ; Placental Lactogen ; Protein Binding

A case of primary gastric choriocarcinoma with multiple liver metastases is described. A 54-year-old man underwent gastrectomy for an advanced cancer. An ulcerofungating tumor with extensive hemorrhagic necrosis was found in the anterior wall of the prepyloric antrum. The histologic examination revealed a biphasic pattern composed of uninucleated cyto or intermediate trophoblasts and syncytiotrophoblasts. A small area of the adenocarcinoma forming glandular structures and poorly differentiated solid sheets was also noted on the superficial portion of the tumor. Immunohistochemical staining for the beta human chorionic gonadotropin (-hCG) and the human placental lactogen (hPL) showed strong immunoreactivity, particularly in the cytoplasms of the syncytiotrophoblasts and intermediate trophoblasts, respectively. A diagnosis of the choriocarcinoma was made. Multiple hepatic nodules consistent with metastases were noted on the abdominal sonogram. The serum -hCG level of the patient was significantly increased.
Adenocarcinoma ; Choriocarcinoma* ; Chorionic Gonadotropin ; Cytoplasm ; Diagnosis ; Female ; Gastrectomy ; Humans ; Liver ; Middle Aged ; Necrosis ; Neoplasm Metastasis ; Placental Lactogen ; Pregnancy ; Stomach Neoplasms ; Stomach* ; Trophoblasts

Pregnancy is a complex metabolic state involving dramatic alterations in the hormonal or cytokine environments (increases in estrogen, progesterone, prolactin, cortisol, human chorionic gonadotropin, placental growth hormone and human placental lactogen, TNF-alpha, resistin, leptin, and a decrease in adiponectin) as well as an increasing burden of fuel utilization by the conceptus. Metabolically, the first trimester is characterized by increased insulin sensitivity and lipogenesis. The second and third trimesters, in contrast, are characterized by insulin resistance and increased lipolysis.
Chorionic Gonadotropin ; Cytokines ; Estrogens ; Female ; Growth Hormone ; Humans ; Hydrocortisone ; Insulin ; Insulin Resistance ; Leptin ; Lipogenesis ; Lipolysis ; Placental Hormones ; Placental Lactogen ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Third ; Progesterone ; Prolactin ; Resistin ; Tumor Necrosis Factor-alpha

Nongestational choriocarcinoma differentiation is extremely rare in breast neoplasms. It is characterized by tumor cells similar to chorionic trophoblastic cells, which react with human placental lactogen and human chorionic gonadotropin (hCG). A 56-year-old woman presented with a palpable right breast mass without past history of trophoblastic tumors. An F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan revealed one focus with low accumulation of FDG in the right breast (maximum standardized uptake value, 1.98). The patient underwent a right mastectomy and biopsy of sentinel nodes. Microscopically, the tumor was a typical invasive ductal carcinoma with multiple foci of choriocarcinoma features. Immunohistochemistry showed that the tumor cells resembling choriocarcinoma were positive for hCG antibody, but negative for HER2/neu, estrogen receptor, and progesterone receptor. A pathologic diagnosis of breast carcinoma with choriocarcinomatous features was made. To our knowledge, this is the first report of invasive carcinoma with choriocarcinomatous features and an unusual finding of low accumulation in an F-18 FDG PET/CT scan in Korea.
Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Choriocarcinoma ; Chorion ; Chorionic Gonadotropin ; Electrons ; Estrogens ; Female ; Humans ; Immunohistochemistry ; Korea ; Mastectomy ; Middle Aged ; Nitriles ; Placental Lactogen ; Pregnancy ; Pyrethrins ; Receptors, Progesterone ; Trophoblastic Neoplasms ; Trophoblasts

OBJECTIVES: The purpose of this experimental study was to investigate the toxic effects of toluene on the placental functions and reproductionin the rat. In this study, the expression of placental prolactin-growth hormone (PRL-GH) and Pit-1 genes, the frequency of placental trophoblast cells, and the reproductive data were analyzed. METHODS: The pregnancy of the Sprague-Dawley rats (250+/-25 g) was determined by verifying the presence of the copulatory plug or sperm in the vaginal smear and the day on which this was observed was defined as pregnancy day 0. The pregnant rats were divided into three groups. The control group was intraperitoneally (ip) injected with sesame oil, and the other two groups were given either 150 or 750 mg/kg BW/day of toluene resuspended in sesame oil during pregnancy days 7-11 and 16-20. The rats from the three experimental groups were sacrificed on pregnancy days 11 and 20, respectively. The mRNA levels of the PRL-GH, Pit-1a and b isotype genes were analyzed by Northern blot hybridization and Reverse transcription-polymerase chain reaction (RT-PCR), respectively. The hormonal concentration was analyzed by Radioimmunoassay. The frequency of the placental trophoblast cells was determined by means of a histochemical study. Reproductive data, such as the placenta and infnat weight, pregnancy period and litter size were surveyed at pregnancy day 20 and after birth. Statistical analysis was carried out by means of the SAS program (version 8.1). RESULTS: The mRNA levels of the PRL-GH family genes were reduced in a linear fashion by exposure to toluene. The mRNA levels of the Pit-1a and b isotype genes, which induce the expression of the PRL-GH family genes, were also reduced by exposure to toluene. The placental lactogen Iv and II concentrations in the rat placenta, fetus and maternal blood were also decreased by exposure to toluene. During the last stage of gestation, exposure to a high dose of toluene reduced the frequency of the spongiotrophoblast cells that secrete the PRL-GH hormones. Reproductive data such as the placenta and infant weight, and litter size were reduced, and the pregnancy period was extended in the toluene exposed group as compared with the control group. CONCLUSIONS: Toluene disrupts the PRL-GH hormone metabolism in the rat placenta and this leads to reproductive disorder.
Animals ; Blotting, Northern ; Fetus ; Humans ; Infant ; Litter Size ; Metabolism ; Parturition ; Placenta ; Placental Lactogen ; Pregnancy ; Radioimmunoassay ; Rats* ; Rats, Sprague-Dawley ; Reproduction* ; RNA, Messenger ; Sesame Oil ; Spermatozoa ; Toluene* ; Trophoblasts ; Vaginal Smears

Epithelioid trophoblastic tumor is an unusual type of trophoblastic tumor. Here we report on the clinicopathologic and immunohistochemical features of three cases of epithelioid trophoblastic tumor. All three patients were of reproductive age and presented with vaginal bleeding and mild elevation of human chorionic gonadotropin (hCG). All patients underwent a hysterectomy. The tumors consisted of epithelioid intermediate trophoblastic cells that were mononucleated and eosinophilic, or showed clear cytoplasm on microscopic examination. One case presented with a focal choriocarcinoma component. Immunohistochemically, the tumors displayed diffuse positivity for cytokeratin 18, E-cadherin, epidermal growth factor receptor, and p53 and focal positivity for p63 and hCG. However, expression of alpha-inhibin and placental alkaline phosphatase was almost negative. Tests for human placental lactogen and epithelial membrane antigen were also negative in all cases.
Alkaline Phosphatase ; Cadherins ; Choriocarcinoma ; Chorionic Gonadotropin ; Cytoplasm ; Eosinophils ; Female ; Gestational Trophoblastic Disease ; Humans ; Hysterectomy ; Inhibins ; Keratin-18 ; Mucin-1 ; Placental Lactogen ; Pregnancy ; Receptor, Epidermal Growth Factor ; Trophoblastic Neoplasms ; Trophoblasts ; Uterine Hemorrhage