Elizabeth E. Torok

Natural history of hydatidiform mole after primary evacuation

From 1962 to 1978, 738 patients with hydatidiform mole were referred to the John I. Brewer Trophoblastic Disease Center of Northwestern University for follow-up and human chorionic gonadotropin (hCG) testing after evacuation. There was spontaneous regression of trophoblastic disease in 596 (80.8%) of the 738 patients. Of these 596 patients, regression occurred in 11 (1.8%) by day 10 after evacuation, in 124 (20.8%) between days 11 and 30, in 255 (42.8%) between days 31 and 60, and in 206 (34.6%) between days 61 and 170. Treatment with chemotherapeutic agents was required in 142 (19.2%) of the 738 patients; 125 (16.9%) of these had invasive mole (107 nonmetastatic and 18 metastatic) and 17 (2.3%) had choriocarcinoma (13 nonmetastatic and four metastatic). All 596 patients whose hCG titers declined spontaneously to normal levels have remained well and free of disease. All 142 treated patients experienced permanent remission. Thus, all 738 patients are well and free of disease 4 to 18 years after evacuation of the hydatidiform mole. The follow-up regimen described in this report furnishes information on natural history of molar pregnancies after evacuation and provides an excellent means by which all patients can be safely managed following termination of a hydatidiform mole.

Gestational trophoblastic disease: A comparative study of the results of therapy in patients with invasive mole and with choriocarcinoma

Abstract A study was made to compare the results of chemotherapy in patients with invasive mole and with choriocarcinoma as obtained in a Center for Trophoblastic Diseases with those obtained in 82 individual hospitals. In the Center 179 patients were treated. In the 82 hospitals 93 patients were treated, in most instances there being only one patient treated in an individual hospital. The data indicate that successful treatment is statistically better in the Center. In only one category of disease—choriocarcinoma, nonmetastatic—is the success of therapy equal in the Center and in the individual hospitals. In the 28 patients transferred to the Center, after failure of therapy in the 82 hospitals, treatment was successful in 17 (60.8 per cent). Possible reasons for the better results obtained in the Center are mentioned.

Fatal gestational trophoblastic disease: An analysis of treatment failures

Forty-eight of 399 patients referred to the John I. Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 to 1979 for treatment of gestational trophoblastic disease (invasive mole or choriocarcinoma) died. All patients who died had histologically documented metastatic choriocarcinoma. The time from pregnancy event to treatment was greater than 4 months and/or the pretreatment human chorionic gonadotropin titer was greater than 100,000 IU/L in 64% of these patients. Seventy-one percent of fatal cases developed in association with term pregnancies, abortions, or ectopic pregnancies rather than hydatidiform moles. Fifty percent of patients who died had metastases to the liver, brain, and/or peritoneal cavity when they first presented for treatment. The most common causes of death were hemorrhage from one or more metastatic sites (42%) and pulmonary insufficiency (31%). Factors primarily responsible for the treatment failures in these patients were: (1) presence of extensive disease at the time of initial treatment; (2) inadequate initial treatment; and (3) failure or presently used chemotherapy protocols in advanced disease. Secondary chemotherapy, radiation therapy to sites other than the brain, and adjuvant surgical procedures failed to improve survival in these high-risk patients.

Gestational trophoblastic disease: origin of choriocarcinoma, invasive mole and choriocarcinoma associated with hydatidiform mole, and some immunologic aspects.

Publisher Summary This chapter focuses on choriocarcinoma arising during pregnancy that is accompanied by a fetus. It is observed that gestational choriocarcinoma invariably originates as a sequel to hydatidiform mole, abortion, term gestation, or ectopic pregnancy, rather than having its origin within the conceptus during the course of the pregnancy. Most choriocarcinoma following normal pregnancy arise from bits of residual adherent trophoblast, focal placenta accreta, placental giant cells, or normal intravascularly growing trophoblast of the placental site. The events leading to the diagnosis of choriocarcinoma includes the delivery of the products of conception, abortion, term gestation, or molar pregnancy, followed by abnormal uterine bleeding or symptoms produced by metastatic disease. The determination of the presence of and the quantity of human chorionic gonadotropin (hCG) is significantly important in the detection, diagnosis, follow-up, and in the monitoring of therapy of patients with choriocarcinoma. The extensive and detailed pathologic examination of the placenta of term or near-term gestations in patients harboring the disease makes it possible to gain essential information and insight into the time of the development of choriocarcinoma and the manner in which it develops.

Hepatic Enzyme Activities in Rats Made Diabetic with Alloxan and with Guinea Pig Anti-insulin Serum

In diabetes abnormally high rates of gluconeogenesis have been demonstrated by various methods. Here it is confirmed that in rats which have been fasted or treated with alloxan, changes occur in hepatic enzyme activity which are compatible with an adaptation to increased rates of gluconeogenesis; there are increased glutamic-pyruvic and glutamic-oxalacetic transaminase and glucose-6-phosphatase activities and reduced lactic dehydrogenase activity. Comparable effects were demonstrated in the livers of rats killed in a diabetic state twenty-four to sixty hours after injection of guinea pig anti-insulin serum, with the exception that glutamic-pyruvic transaminase activity was not increased and glutamic-oxalacetic transaminase activity was increased when expressed per liver protein or per body weight, but there was no change in the activity of the total liver. This finding provides suggestive evidence that increased gluconeogenesis is also characteristic of this experimental diabetic syndrome produced by anti-insulin serum.

Gestational trophoblastic disease: The effect of duration of disease and hCG titer on response to therapy

The height of the pretreatment hCG titer and the time interval from termination of the antecedent pregnancy to institution of treatment were determined in 352 patients with gestational trophoblastic disease in order to judge their effect, both individually and together, on response to therapy. When all patients in need of treatment for gestational trophoblastic disease, both metastatic and nonmetastatic, were considered as one group, examination of time alone, of hCG titer alone and of time and titer together each permitted the identification of patients at high risk with equal reliability (p less than 0.0005 for each). When patients with only metastatic gestational trophoblastic disease were evaluated, time and titer taken separately and together each identified those patients at high risk, but not in an equal manner (time alone, p = 0.02; titer alone, p less than 0.05; time and titer together, p less than 0.0005). Time and hCG titer, alone or in combination, did not have a statistically significant effect on outcome when patients with metastatic choriocarcinoma were considered separately. Other factors, such as metastatic site and antecedent pregnancy, seem to be more important in determining prognosis than duration of disease and hCG titer in this group of patients.