Y. Zalel

Unsuspected uterine leiomyosarcoma discovered during treatment with a gonadotropin-releasing hormone analogue: A case report and literature review

We report a case of a 37-year-old woman who had received five courses of gonadotropin-releasing hormone (GnRH) agonist (Decapeptyl) for presumed uterine leiomyomata associated with episodes of uterine bleeding. Submucous myoma (histologically proven) was partially removed on the first visit. After a period of significant reduction in the tumor size and cessation of uterine bleeding, the symptoms recurred along with rapid re-growth of the uterus. Total abdominal hysterectomy was performed and the pathologic evaluation revealed leiomyosarcoma with a high mitotic rate. This case and the literature review emphasize the problems encountered with the early diagnosis of uterine leiomyosarcoma during GnRH agonist therapy.

Gestational trophoblastic disease following the evacuation of partial hydatidiform mole: a review of 66 cases

OBJECTIVE The current study was undertaken in order to identify the clinical characteristics and natural history, as well as methods of investigation and available therapy, of persistent gestational trophoblastic disease (GTD) following the evacuation of partial hydatidiform mole (PM). METHODS Case reports of persistent GTD following the evacuation of partial mole, were searched using the Medline computerized retrieval system. There were 66 such cases (including 4 cases treated at our department), representing 2.9% of GTD following PM. RESULTS The mean age of the women at diagnosis was 28.4 years and mean gravidity was 2.99. The mean gestational age at diagnosis was 15.5 weeks and the mean uterine size was 13.6 weeks. The most common presenting symptom was vaginal bleeding. In the majority of the patients, the pre-evacuation diagnosis was incomplete or missed abortion. CONCLUSIONS Although the malignant potential of PM is low, persistent GTD may develop after PM and may even metastasize, it is usually responsive to single agent chemotherapy but may require combination chemotherapy. Therefore, after evacuation of PM, these women should be followed with serial serum b-hCG. Further research is needed to enable earlier identification of PM that eventually will develop persistent GTD.

A partial hydatidiform mole following in vitro fertilization and embryo transfer

1. Bello GV, Schonholtz D, Moshirpur J, Jeng D and Berkowitz RL: Combined pregnancy: The Mount Sinai experience. Obstet Gynecol Surv 1986;41(10):603-613 2. Bearman DM, Vieta PA, Snipes RD, Gobien RP, Garcia JE, Rosenwaks Z: Heterotopic pregnancy after in vitro fertilization and embryo transfer. Fertil Steril 1986;45(5):719-721 3. Dor J, Seidman DS, Levran D, Ben-rafael Z, Ben-Shlomo I, Mashiach S: The incidence of combined intrauterine and extrauterine pregnancy after in vitro fertilization and embryo transfer. Fertil Steril 1991;55(4):833-834 4. Goldman GA, Fisch B, Ovadia J, Tadir Y: Heterotopic pregnancy after assisted reproductive technologies. Obstet Gynecol Surv 1992;47(4):217-221 5. Barash A, Shoham Z, Blickstein I, Yamini M, Borenstein R: Simultaneous tubal and intra-uterine pregnancy following in vitro fertilization and embryo transfer. Acta Obstet Gynecol Scand 1989;68:643-644 6. Guireis RR: Simultaneous intrauterine and ectopic pregnancies following in-vitro fertilization and gamete intra-fallopian transfer: A review of nine cases. Hum Reprod 1990;5:484--48

Successful resolution of persistent trophoblastic disease after partial mole with the EMA-CO regimen

A 29-year-old nullipara with partial hydatidiform mole at 8 weeks had pre-evacuation hCG levels of 275,000 mIU/ml. Free beta-hCG levels were measured as 3% (normal value below 4%). The patient developed persistent gestational trophoblastic disease, failed to respond to methotrexate and actinomycin D, but has responded to combination chemotherapy with EMA-CO. Such a response to EMA-CO was not reported previously.