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Theca-lutein cysts. a Gray scale transvaginal images of the left ovary demonstrate multiple thin walled cysts in the enlarged ovary. This appearance was bilateral in a patient with elevated beta hCG levels. This case did not exhibit the typical but less common appearance of the “spoke wheel” where ovarian stroma is visible centrally. The appearance was similar for the right ovary. b Colour doppler transvaginal ultrasound images of the left ovary demonstrates flow in walls of the intervening thin septations between cyst locules
Source publication
Gestational trophoblastic diseases (GTD) encompass a spectrum of rare pre-malignant and malignant entities originating
from trophoblastic tissue. This updated review will highlight important radiological features, pathology and classifcation,
and provide insight into the clinical management of these uncommon disorders. There is a wide geographic va...
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Objectives: To evaluate the expression of emerging immune targets in the tumor-infiltrating immunocytes (TIIs) of human gestational trophoblastic neoplasia (GTN) specimens, and to analyze the correlation between the expression patterns and prognosis of GTN patients. Methods: Between January 2008 and December 2017, patients who were diagnosed histol...
Citations
... Sua raridade e complexidade são fatores que aumentam o desafio tanto para os profissionais de saúde quanto para as mulheres que são afetadas por ela. A DTG abrange várias entidades, como mola hidatiforme, coriocarcinoma e tumor trofoblástico, cada uma com suas próprias características e desafios clínicos (Chawla et al., 2023). ...
Objetivo: Discutir de forma abrangente a terapêutica da Doença Trofoblástica Gestacional (DTG). Metodologia: Revisão integrativa da literatura realizada nas bases de dados Biblioteca Virtual da Saúde (BVS), Google Acadêmico e PubMed, utilizando os descritores em Ciências da Saúde (DeCS): “Gravidez”, “Doença Trofoblástica Gestacional” e “Tratamento” combinados entre si pelo operador booleano AND. Resultados: A doença trofoblástica gestacional (DTG) é um grupo raro de condições afetando células trofoblásticas da placenta, incluindo mola hidatiforme e coriocarcinoma gestacional. Sua incidência varia globalmente, ocorrendo em cerca de 1 a 1,5 gestações por 1.000. Fatores como idade materna, história obstétrica e etnia influenciam sua prevalência, com maior risco em mulheres jovens ou mais velhas e com histórico de gestações anômalas. O reconhecimento precoce é crucial, considerando sintomas como sangramento vaginal, aumento anormal do útero, hipertensão e sinais respiratórios indicativos de metástases pulmonares. A abordagem terapêutica varia conforme o tipo de DTG. Na mola hidatiforme, a evacuação uterina é comum. No coriocarcinoma, a quimioterapia é central, enquanto a doença trofoblástica persistente pode necessitar de quimioterapia, cirurgia ou ambos. A abordagem deve incluir suporte emocional e psicológico, envolvendo uma equipe multidisciplinar para garantir o manejo adequado e centrado no paciente. O aumento da incidência em certas áreas pode ser devido a diagnósticos mais precisos e mudanças nos fatores de risco, como a idade materna e o uso de técnicas de reprodução assistida. Conclusão: O manejo eficaz da DTG demanda reconhecimento precoce, abordagem terapêutica individualizada e suporte emocional, destacando a importância da educação contínua e prevenção.
... It can develop during pregnancy or in non-pregnant individuals. Additionally, spontaneous abortion, induced abortion, normal term or premature delivery, and ectopic pregnancy can also lead to choriocarcinoma [2][3][4]. In China, one out of every 2,882 pregnant women is diagnosed with choriocarcinoma [5]. ...
Objectives
Choriocarcinoma is a highly malignant and aggressive trophoblastic tumor. In our previous study, we discovered that the speckle-type POZ protein (SPOP), which recognizes substrates of E3 ubiquitin ligase, plays a crucial role in trophoblast-derived choriocarcinoma cell lines. Therefore, we investigated the correlation between SPOP and the substrate kinesin-like protein KIF23, as well as the role of KIF23 in choriocarcinoma cells.
Methods
We constructed JAR cells overexpressing SPOP using lentiviral vectors and subsequently screened the related proteins through ubiquitination-modified quantitative proteomic analysis. The relationship between KIF23 and SPOP was determined using western blotting, and CCK-8, plate cloning, flow cytometry, and Transwell assays were used to investigate the effects of KIF23 and SPOP/KIF23.
Results
We identified the KIF23 protein and observed that SPOP promoted its degradation. The abundance of KIF23 increased after the addition of the protease inhibitor MG132. KIF23 was highly expressed in choriocarcinoma cells. Compared with JAR cells transfected with NC–small-interfering RNA (siRNA), the proliferation, invasion, migration, and percentage of G0/G1 cells in the KIF23-siRNA group were significantly lower, and the activation of the Akt/GSK3β signaling pathway was markedly attenuated. Additionally, the sh-SPOP+KIF23-siRNA group exhibited significantly inhibited JAR cell proliferation, invasion, and migration, along with clearly attenuated activation of the Akt/GSK3β signaling pathway.
Conclusions
SPOP attenuates the proliferation, invasion, and migration of choriocarcinoma JAR cells by promoting KIF23 degradation.
BACKGROUND
During postmolar evacuation surveillance, beta-human chorionic gonadotropin (β-hCG) regression levels can predict invasive disease while Doppler ultrasound can assess in vivo tumor neovascularization and quantify uterine blood supply. As an ancillary tool to β-hCG monitoring, ultrasound can detect the early presence of viable trophoblastic tissues and identify patients at risk of developing postmolar gestational trophoblastic Neoplasia (PMGTN).
OBJECTIVE
The objective of this study was to correlate uterine artery Doppler ultrasound with β-hCG levels during pre- and postmolar evacuation surveillance among patients with complete mole.
MATERIALS AND METHODS
A cohort of patients with sonographic diagnosis of complete hydatidiform mole and managed with suction curettage in the same institution were prospectively followed up after evacuation. The pre- and postmolar evacuation surveillance period was at days 1, 7, 14, 21, 28, and 35. Monitoring of serum β-hCG levels was based on the standard regression curve. For Doppler ultrasound parameters, monitoring of the systolic/diastolic (S/D) ratio, pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) was based on its relationship with its serum β-hCG levels. The ultrasound images generated were archived and reviewed by the authors. Descriptive and inferential statistics were utilized to analyze median differences. For the correlation of uterine artery Doppler flow parameters, analysis for the test of difference used Pearson correlation and multiple linear regression analysis for the odds ratio.
RESULTS
Sixteen of the 23 enrolled patients completed the protocol (16 of 23, 69.50%). A majority had spontaneous remission (13; 81%) while 3 cases (19%) presented increasing and plateauing β-hCG levels. The pre- and post evacuation median β-hCG levels showed a significant decrease ( P = 0.001). As post evacuation β-hCG levels decreased, PSV also decreased ( r = 0.478, P = 0.061) while Doppler parameters, RI, PI, and S/D ratio increased. However, when post evacuation β-hCG levels rose or plateaued, Doppler parameters decreased. These changes had statistical correlation (all P < 0.05). Moreover, the magnitude of the relationship for β-hCG and Doppler parameters was moderate and ranged from 0.524 to 0.581. Among the Doppler parameters, the S/D ratio and RI of the right uterine artery strongly predicted a rise in β-hCG levels. The odds ratio of predicting increased β-hCG levels and risk of gestational trophoblastic neoplasia by the right S/D ratio were − 2683.67 (confidence interval [CI] = −271.692–5095.655; P = 0.034) and by the right RI − 66,193.34 (CI = −161,818.107–29,431.433; P = 0.046). Notably, Doppler parameter changes appeared early at day 14 up to day 35 and before the appearance of abnormal β-hCG regression patterns.
CONCLUSION
There is a strong correlation between uterine artery Doppler flow changes and β-hCG levels during postmolar evacuation surveillance. The inverse relationship of the S/D ratio, PI and RI, and β-hCG regression patterns confirms spontaneous remission of the disease. For patients with abnormal β-hCG patterns, this relationship is altered. The Doppler changes become erratic, unpredictable, and significantly decreased. These changes were detected as early as 2 weeks post evacuation. Thus, the use of ultrasound as an adjunct to β-hCG post evacuation surveillance can predict abnormal β-hCG regression patterns and identify patients at risk of developing postmolar gestational trophoblastic neoplasia (PMGTN).
