Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 18 , ISSUE 3 ( July-September, 2024 ) > List of Articles

REVIEW ARTICLE

Trophoblastic Diseases

Kazuo Maeda, Asim Kurjak

Keywords : Chemotherapy, Color/power Doppler flow mapping, Real-time B-mode, Three-dimensional image, Three-dimensional power Doppler

Citation Information : Maeda K, Kurjak A. Trophoblastic Diseases. Donald School J Ultrasound Obstet Gynecol 2024; 18 (3):282-297.

DOI: 10.5005/jp-journals-10009-2042

License: CC BY-NC 4.0

Published Online: 30-09-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Although trophoblastic diseases were frequent in East Asia in the past, choriocarcinoma is rare at present after the introduction of effective chemotherapy and postmolar management in Japan. Molar pregnancy has also decreased, possibly due to ultrasound diagnosis and termination in early pregnancy. The outcome of the disease has greatly improved by ultrasound diagnosis, including real-time B-mode, color/power Doppler flow images, and pulsed Doppler tumor blood flow studies.


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  1. Japan Society of Obstetrics and Gynecology, Japanese Pathological Society. The general rules for clinical and pathological management of trophoblastic diseases. 2nd ed. Tokyo: Kanehara Shuppan; 1995.
  2. Weaver DT, Fisher RA, Newlands ES, et al. Amniotic tissue in complete hydatidiform moles can be androgenetic. J Pathol 2000;191(1):67–70. DOI: 10.1002/(SICI)1096-9896(200005)191:1<67::AID-PATH576>3.0.CO;2-X
  3. Kajii T, Ohama K. Androgenetic origin of hydatidiform mole. Nature 1977;268(5621):633–634. DOI: 10.1038/268633a0
  4. Ohama K, Kajii T, Okamoto E, et al. Dispermic origin of XY hydatidiform moles. Nature 1981;292(5823):551–552. DOI: 10.1038/292551a0
  5. Lorigan PC, Sharma S, Bright N, et al. Characteristics of women with recurrent molar pregnancies. Gynecol Oncol 2000;78(3 pt. 1):288–292. DOI: 10.1006/gyno.2000.5871
  6. Bae SN, Kim SJ. Telomerase activity in complete hydatidiform mole. Am J Obstet Gynecol 1999;180(2 Pt 1):328–333. DOI: 10.1016/s0002-9378(99)70208-5
  7. Lazarus E, Hulka C, Siewert B, et al. Sonographic appearance of early complete molar pregnancy. J Ultrasound Med 1999;18:589–594. DOI: 10.7863/jum.1999.18.9.589
  8. Szulman AE, Philippe E, Boue JG, et al. Human triploidy association with partial hydatidiform moles and nonmolar conceptuses. Hum Pathol 1981;12(11):1016–1021. DOI: 10.1016/s0046-8177(81)80259-6
  9. Hirose M, Kimura T, Mitsuno N, et al. DNA flow cytometric quantification and DNA polymorphism analysis in the case of, a complete mole with a coexisting fetus. J Ass Reprod Genet 1999;16(5):263–267. DOI: 10.1023/a:1020319629999
  10. Suita S, Sono K, Tajiri T, et al. Malignant germ cell tumors: clinical characteristics, treatment and outcome. A report from the study group for pediatric solid malignant Tumors in the Kyushu area, Japan. J Pediatr Surg 2002;37:1703–1706. DOI: 10.1053/jpsu.2002.36700
  11. Weiss S, Amit A, Schwarz MR, et al. Primary choriocarcinoma of the vulva. Int J Gynecol Cancer 2001;11(3):251–254. DOI: 10.1046/j.1525-1438.2001.01005.x
  12. Yahata T, Kodama S, Kase H, et al. Primary choriocarcinoma of the uterine cervix: clinical, MRI, and color Doppler ultrasonographic study. Gynecol Oncol 1997;64(2):274–278. DOI: 10.1006/gyno.1996.4541
  13. Coskun M, Agildere AM, Boyvart F, et al. Primary choriocarcinoma of the stomach and pancreas: CT findings. Eur Radiol 1988;8(8):1425–1428. DOI: 10.1007/s003300050567
  14. Liu Z, Mira JL, Cruz-Caudilo JC. Primary gastric choriocarcinoma:a case report and review of the literature. Arch Pathol Lab Med 2001;125(12):1601–1604. DOI: 10.5858/2001-125-1601-PGC
  15. Wang JC, Angeles S, Chak P, et al. Choriocarcinoma of the gallbladder: treated with cisplatine-based chemotherapy. Med Oncol 2001;18:165–169. DOI: 10.1385/MO:18:2:165
  16. Sievert K, Weber EA, Herwig R, et al. Pure primary choriocarcinoma of the urinary bladder with long-term survival. Urology 2000;56(5):856. DOI: 10.1016/s0090-4295(00)00772-x
  17. Koga K, Izuchi S, Maed K, et al. Treatment of chorionepithelioma of uterine cervix with hypogastric arterial infusion of amethopterin. J Jpn Obstet Gynecol Soc 1966;13:245–249. PMID: 6010650.
  18. Chama CM, Nggada HA, Nuhu A. Cutaneous metastasis of gestational choriocarcinoma. Int J Gynecol Obstet 2002;77(3):249–250. DOI: 10.1016/S0020-7292(01)00589-6
  19. Bohlmann MK, Eckstein FS, Allemann Y, et al. Intracardiac, resection of a metastatic choriocarcinoma. Gynecol Oncol 2002;84:157–180. DOI: 10.1006/gyno.2001.6475
  20. Gersak B, Lakic N, Gorjup V, et al. Right ventricular metastatic, choriocarcinoma obstructing inflow and outflow tract. Ann Thorac Surg 2002;73(5):1631–1633. DOI: 10.1016/s0003-4975(01)03516-0
  21. Kondo S. Personal communication. In: Maeda K, editor. Gestational trophoblastic disease, Lecture in the Ian Donald Inter-University School of Medical Ultrasound, Dubrovnik; 1995.
  22. Steigrad SM, Cheung AP, Oshborn RA. Choriocarcinoma coexistent with and intact, pregnancy: case report and review of the literature. J Obstet Gynecol Res 1999;25:197–203. DOI: 10.1111/j.1447-0756.1999.tb01147.x
  23. Jacque SM, Quershi F, Doss BJ, et al. Intraplacental choriocarcinoma associated with viable pregnancy: pathologic features and implications for the mother and infant. Pediatr Dev Pathol 1998;1(5):380–387. DOI: 10.1007/s100249900052
  24. Feltmate CM, Genset DR, Goldstein DP, et al. Advances in the understanding of placental site trophoblastic tumor. J Reprod Med 2002;47:337–341. PMID: 12063871.
  25. Santoso JT, Coleman RI, editors. Handbook of Gyn Oncology. New York: McGraw Hill; 2001.
  26. Mangili G, Garavaglia E, De Marzi P, et al. Metastatic placental site trophoblastic tumor. Report of a case with complete response to chemotherapy. J Reprod Med 2001;46(3):259–262. PMID: 11304870.
  27. Remadi S, Lifschita-Mercer B, Ben-Hur H, et al. Metastasizing placental site trophoblastic tumor: immunohistochemical and DNA analysis. 2 case reports and a review of the literature. Arch Gynecol Obstet 1997;259(2):97–103. DOI: 10.1007/BF02505316
  28. Feltmate CM, Genest DR, Wise L, et al. Placental site trophoblastic tumor: A 17-year experience at the New England Trophoblastic Disease Center. Gynecol Oncol 2001;82(3):415–419. DOI: 10.1006/gyno.2001.6265
  29. Monclair T, Abeler VM, Kren J, et al. Placental site trophoblastic tumor (PSTT) in mother and child: first report of PSTT in infancy. Med Pediatr Oncol 2002;38(3):187–191. DOI: 10.1002/mpo.1308
  30. Piura B. Placental site trophoblastic tumor: a challenging rare entity. Eur J Gynaecol Oncol 2006;27(6):545–551. PMID: 17290581.
  31. Baergen RN, Rutgers JL, Young RH, et al. Placental site trophoblastic tumor: a study of 55 cases and review of the literature emphasizing factors of prognostic significance. Gynecol Oncol 2006;100(3):511–520. DOI: 10.1016/j.ygyno.2005.08.058
  32. Allison KH, Love JE, Garcia RL. Epithelioid trophoblastic tumor: review of a rare neoplasm of the chorionic-type intermediate trophoblast. Arch Pathol Lab Med 2006;130(12):1875–1877. DOI: 10.5858/2006-130-1875-ETTROA
  33. Shih IM, Kurman RJ. Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma. Am J Surg Pathol 1998;22(11):1393–1403. DOI: 10.1097/00000478-199811000-00010
  34. Sebire NJ, Lindsay I. Current issues in the histopathology of gestational trophoblastic tumors. Fetal Pediatr Pathol 2010;29(1):30–44. DOI: 10.3109/15513810903266120
  35. Kurjak A, Zalud I, Predanic M, et al. Transvaginal color and pulsed Doppler study of uterine blood flow in the first and early second trimesters of pregnancy: normal versus abnormal. J Ultrasound Med 1994;13(1):43–47. DOI: 10.7863/jum.1994.13.1.43
  36. Kurjak A, Zalud L, Salihagic A, et al. Transvaginal color Doppler in the assessment of abnormal early pregnancy. J Perinat Med 1991;19(3):155–165. DOI: 10.1515/jpme.1991.19.3.155
  37. Koga K, Maeda K. Prophylactic chemotherapy with amethopterin for the prevention if choriocarcinoma following removal of hydatidiform mole. Am J Obstet Gyncol 1968;100:270–275. DOI: 10.1016/S0002-9378(15)33732-7
  38. Gungor T, Ekin M, Dumanli H, et al. Color Doppler ultrasonography in the earlier differentiation of benign molehydatidiform from malignant gestational trophoblastic disease. Acta Obstet Gynecol Scand 1998;77(8):860–862. PMID: 9776602.
  39. Vegh GL, Fulop V, Liu Y, et al. Differential gene expression pattern between normal human trophoblast and choriocarcinoma cell lines: downregulation of heat shock protein-27 in choriocarcinoma in vitro and in vivo. Gynecol Oncol 1999;75(3):391–396. DOI: 10.1006/gyno.1999.5599
  40. Shigematsu T, Kamura T, Wake N, et al. DNA polymorphism analysis of a pure polymorphism non-gestational choriocarcinoma of the ovary: case report. Eur J Gynecol Oncol 2000;21:153–154. PMID: 10843474.
  41. Bettencourt E, Pinto E, Abreul E, et al. Placental site trophoblastic tumor: the value of transvaginal colour and pulsed Doppler sonography (TV-CGS) in its diagnosis: case report. Eur J Gynecol Oncol 1997;18:461–464. PMID: 9443010.
  42. Savelli L, Pollastri P, Mabrouk M, et al. Placental site trophoblastic tumor diagnosed on transvaginal sonography. Ultrasound Obstet Gynecol 2009;34(2):235–236. DOI: 10.1002/uog.6449
  43. Okumura M, Fushida K, Rezende WW, et al. Sonographic appearance of gestational trophoblastic disease evolving into epithelioid trophoblastic tumor. Ultrasound Obstet Gynecol 2010;36(2):249–251. DOI: 10.1002/uog.7560
  44. PMK TK, Kim SN, Lee SK. Analysis of risk factors for postmolar trophoblastic disease: categorization of risk factors and effect of prophylactic chemotherapy. Yonsei Med J 1996;37:412–419. DOI: 10.3349/ymj.1996.37.6.412
  45. Soto-Wright V, Goldstein DP, Bernstein MR, et al. The management of gestational trophoblastic tumors with etoposide, methotrexate, and actinomycin D. Gynecol Oncol 1997;64(1):156–159. DOI: 10.1006/gyno.1996.4534
  46. Newlands ES, Oaradubas FJ, Fisher RA. Recent, advances in gestational trophoblast disease. Hematol Oncol Clin North Am 1999;13(1):225–244. DOI: 10.1016/s0889-8588(05)70162-3
  47. Nozue A, Ichikawa Y, Minami R, et al. Postpartum choriocarcinoma complicated by brain and lung metastases treated successfully with EMA/CO regimen. BJOG 2000;107(9):1171–1172. DOI: 10.1111/j.1471-0528.2000.tb11120.x
  48. Okamoto T, Goto S. Resistance to multiple agent chemotherapy including cisplatin after chronic low-dosage oral etoposide. Administration in gestational choriocarcinoma. Gynecol Obstet Invest 2001;52(2):139–141. DOI: 10.1159/000052959
  49. Kang SB, Lee CM, Kim JW, et al. Chemoresistant choriocarcinoma cured by pulmonary lobectomy and craniotomy. Int J Gynecol Cancer 2000;10(2):165–169. DOI: 10.1046/j.1525-1438.2000.00021.x
  50. Knox S, Brooke SE, Wog-You Cheong J, et al. Choriocarcinoma and epithelial trophoblastic tumor: successful treatment of relapse with hysterectomy and high dose chemotherapy with peripheral stem cell support: a case report. Gynecol Oncol 2002;85(1):204–208. DOI: 10.1006/gyno.2002.6583
  51. Chou HH, Lai CH, Wang PN, et al. Combination of high-dose chemotherapy, autologous bone marrow/peripheral blood stem cell transplantation, and thoracoscopic surgery in refractory nongestational choriocarcinoma of a 45XO/46XY female: a case report. Gynecol Oncol 1997;64(3):521–525. DOI: 10.1006/gyno.1996.4598
  52. Cole LA, Butler S. Detection of hCG in trophoblastic disease. The USA hCG reference service experience. J Reprod Med 2002;47(6):433–444. PMID: 12092011.
  53. Committee on Gynecologic Practice, The American College of Obstetricians and Gynecologists. ACOG. Committee opinion: number 278, November 2002. Avoiding inappropriate clinical decisions based on false-positive human chorionic gonadotropin test results. Obstet Gynecol 2002;100(5 Pt 1):1057–1059. DOI: 10.1016/s0029-7844(02)02515-2
  54. Tanase K, Tawada M, Moriyama N, et al. Intra-arterial infusion chemotherapy for liver metastases of testicular tumors: report of two cases. Hinyokika Kiyo 2000;46(11):823–827. PMID: 11193306.
  55. Woolas RP, Bower M, Newlands ES, et al. Influence of chemotherapy for gestational trophoblastic disease on subsequent pregnancy outcome. Br J Obstet Gynaecol 1998;105(9):1032–1035. DOI: 10.1111/j.1471-0528.1998.tb10271.x
  56. Bower M, Rustin GJ, Newlands ES, et al. Chemotherapy for gestational trophoblastic tumours hastens menopause by 3 years. Eur J Cancer 1998;34(8):1204–1207. DOI: 10.1016/s0959-8049(98)00059-8
  57. Newlands ES, Bower M, Fisher RA, et al. Management of placental site trophoblastic tumors. J Reprod Med 1995;43(1):53–59. PMID: 9475150.
  58. Janni W, Hantschmann P, Rehbock J, et al. Successful treatment of malignant placental site trophoblastic tumor with combined cytostatic-surgical approach: case report and review of literature. Gynecol Oncol 1999;75(1):164–169. DOI: 10.1006/gyno.1999.5550
  59. Tsuji Y, Tsubamoto H, Hori M, et al. Case of PSTT treated with chemotherapy followed by open uterine tumor resection to preserve fertility. Gynecol Oncol 2002;87(3):303–307. DOI: 10.1006/gyno.2002.6827
  60. Twigs LB, Hartenbach E, Saltzman AK, et al. Metastatic placental site trophoblastic tumor. Int J Gynecol Obst 1998;60(Suppl l):S51–S55. DOI: 10.1016/S0020-7292(98)80005-2
  61. Swisher E, Drescher CW. Metastatic placental site trophoblastic tumor: long-term remission in a patient treated with EMA/CO chemotherapy. Gynecol Oncol 1998;68(1):62–65. DOI: 10.1006/gyno.1997.4888
  62. Chang YL, Chang TC, Hsuen KG, et al. Prognostic factors and treatment for placental site trophoblastic tumor report of 3 cases and analysis of 88 cases. Gynecol Oncol 1999;73(2):216–222. DOI: 10.1006/gyno.1999.5344
  63. Randall TC, Coukos G, Wheeler JE, et al. Prolonged remission of recurrent, metastatic placental site trophoblastic tumor after chemotherapy. Gynecol Oncol 2000;76(1):115–117. DOI: 10.1006/gyno.1999.5654
  64. Watanbe S, Shimokawa K, Sakasegawa K, et al. Choriocarcinoma in the pulmonary artery treated with emergency pulmonary embolectomy. Chest 2002;121(2):654–656. DOI: 10.1378/chest.121.2.654
  65. Kohyama S, Uematsu M, Ishihara S, et al. An experience of stereotactic radiation therapy for primary intracranial choriocarcinoma. Tumori 2001;87(3):162–165. DOI: 10.1177/030089160108700310
  66. Landanio G, Sartore-Bianchi A, Giannetta L, et al. Controversies in the management of brain metastases: the role of chemotherapy. Forum (Genova) 2001;11(1):59–74. PMID: 11734865.
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