Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A brief summary is given of the developments leading to the current status of treatment of gestational trophoblastic neoplasms, both nonmetastatic and metastatic. Hydatidiform mole has been identified as the precursor type of pregnancy in approximately 50% of those women developing metastatic disease. The other half developed this as consequences of either a full-term delivery or some type of abortion. Sensitive assays for human chorionic gonadotropin (HCG) are needed in the diagnosis, management, and follow-up of these patients. Current therapy is outlined: nonmetastatic disease receives single agent chemotherapy with methotrexate or actinomycin D, with approximately 100% cure and 90% retention of reproductive function; metastatic disease, "low risk", receives single agent chemotherapy with the same drugs, with an expected cure rate of 95-100%; metastatic disease, "high risk", receives initial therapy with multiple agent chemotherapy, with a cure rate of approximately 75%. Current unresolved questions are discussed briefly.
 ...
PMID:Current status of treatment of gestational trophoblastic disease. 17 95

Three hundred and seventeen patients with gestational trophoblastic tumors were investigated and treated between 1957-1973. The risk of trophoblastic tumor was influenced by the outcome of the antecedent pregnancy (hydatidiform mole, non-mole abortion, term delivery) and the ABO blood groups of the mating couple; it was also influenced by the patient's age. The response to treatment with chemotherapy and , where appropriate, with surgery and radiotherapy, was influenced prfoundly by several factors. These included 1) the outcome of the antecedent pregnancy, 2) the total body burden of tumor at the time treatment stated as reflected by the urinary output of human chorionic gonadotrophin (CG), 3) the interval between the antecedent pregnancy and the start of chemotherapy, 4) the ABO groups of the mating couple, 5) the extent of mononuclear cell infiltration in the tumor, 6) the immunological status of the patient at the start of treatment, 7) the size of tumor masses, 8) the site of metastases and particularly the presence of intracranial metastases, and possibly by 9) the age and 10) the parity of the patient. A detailed study of the HLA antigens of the patient, her husband, and antecedent child has shown no positive effect on risk or prognosis. These data provide a basis for a scoring system that allows the prognosis to be defined at the time of diagnosis and facilitates tisk of drug resistance. Applied retrospectively to the cases from which the scoring system was generated, prognostic groups with survival rates ranging from 0-100% can be defined. Unfavorable prognostic factors combine so as to increase the probability of drug resistance.
 ...
PMID:Risk and prognostic factors in trophoblastic neoplasia. 18 54

Serum human chorionic gonadotropin (hCG) was measured by a radioreceptorassay (RRA) and radioimmunoassay (RIA) and serum hCG-beta and hCG-alpha by RIA in 10 patients with intact mole, 3 patients with choriocarcinoma, and 4 patients with hydatidiform mole during treatment. hCG levels by RRA were higher in 5 of 10 molar pregnancies and ranged from 20,900 to 100,000 ng/ml and from 30,000 to 100,000 ng/ml by RIA. hCG levels by RRA and RIA paralleled one another closely during treatment of hydatidiform mole. hCG-alpha was higher than hCG by RRA and RIA and hCG-beta in molar pregnancies, in the uterine venous blood draining a uterine choriocarcinoma, and during chemotherapy of choriocarcinoma. In 2 of 3 choriocarcinoma patients who eventually developed cerebral metastases, hCG-alpha increased while hCG and hCG-beta were declining or negative. hCG-beta was usually lower than hCG or hCG-alpha in all the cases studied. These results demonstrate the production of free alpha and beta subunits in trophoblastic disease. Further, due to the biospecificity, simplicity, and rapidity, the RRA of hCG is a sueful diagnostic aid during treatment of trophoblastic neoplasia until the levels fall to within the sensitivity range of the assay. Finally, the RIA of hCG, hCG-beta, and hCG-alpha, which requires several days, should be performed until they become negative or fall within normal range.
 ...
PMID:Human chorionic gonadotropin and its subunits in hydatidiform mole and choriocarcinoma. 19 42

The experience of the Southern Regional Trophoblastic Disease Center includes 222 patients who were referred from January 1972 to October 1977. The initial tissue diagnosis was hydatidiform mole in 212 patients and choriocarcinoma in ten. There was spontaneous remission of 142 (69%) of the moles and one of the choriocarcinomas, and 77 patients developed persistent trophoblastic disease. Of these, 58 had no evidence of metastasis, and all achieved remission with single-drug therapy. Nineteen patients developed metastases; 13 were in the "good prognosis" category, and all achieved remission with single-drug therapy. Five (83%) of the six patients with metastases in the "poor prognosis" group achieved remission with triple chemotherapy; one died of her disease.
 ...
PMID:Southern Regional Trophoblastic Disease Center, 1972--1977. 21 50

The incidence of malignant trophoblastic diseases in the population of Paraguay was low in the 1960-1969 and 1970-1974 periods, as shown by the analysis of unselected hospital admissions as compared to the total population. The Institute of Pathologic Anatomy and the National Tumor Registry in Asuncion, Paraguay, receive material from the entire republic. Cases are reported from all the affiliated centers. During the 10 years from 1960-1970, 227 cases of hydatidiform mole, 21 of choriocarcinoma, and 13 of chorioadenoma destruens were registered. In the 1970-1974 period, 121 hydatiform moles, 10 choriocarcinomas, and 3 chorioadenomas destruens were registered. To determine the incidence of choriocarcinoma and chorioadenoma destruens for Paraguay, the number of cases was divided by the number of total pregnancies, calculated from an analysis of 1965 estimates and related to the fertility rate in each age group. Using the estimated number of total pregnancies per year in Paraguay, there is 1 choriocarcinoma per 43,489 pregnancies and 1 chorioadenoma destruens per 70,252 pregnancies if all the probable pregnancies in the period of fertility are considered. Thus, the incidence of choriocarcinoma and chorioadenoma destruens is 0.229 and 0.142/1000 pregnancies, respectively. This means that 25.22 hydatidiform moles occur for 1 carcinoma or 17.46 hydatidiform moles for 1 chorioadenoma destruens. There were no differences in the calculations for the 1970-1974 period. Vaginal metastases were found in 28.57% of the patients with choriocarcinoma.
 ...
PMID:Malignant trophoblastic disease in paraguay. 22 99

A clinical study of trophoblastic neoplasia in a Nigerian population in Lagos over a four-year period is reported. A high incidence of one in 379 deliveries for benign trophoblastic tumor and one in 846 deliveries for malignant tumor was found. Seventeen percent of benign trophoblastic tumors in this series progressed to the malignant type, but malignant trophoblastic tumor was preceded by the benign type (hydatidiform mole) in 46 percent of cases. The anterior vaginal wall is a common site for metastases of malignant trophoblastic neoplasia and, in one patient, the lesion progressed further to form a vesicovaginal fistula. While the management of benign disease was conservative, all cases of malignant trophoblastic neoplasia received chemotherapy.
 ...
PMID:Trophoblastic neoplasia in an African urban population. 23 87

Polysaccharide complexes obtained by Westphal's method (modified by L. A. Zilbert et al) from the tissue of a primary tumour node and remote metastases (the lungs) of chorionoepithelioma of the uterus were used for differential diagnosis of chorionepithelioma of the uterus and hydatid mole. Investigations carried out showed that the reaction to the intradermal injection of polysaccharide complexes obtained from the remote metastases (the lungs) of chorionepithelioma of the uterus was highly specific and sensitive: positive reaction occurred only in the patients with chorionepithelioma of the uterus, and it was negative in the patients with hydatid mole. With a marked diminution (in the course of chemotherapy) of metastases in the lungs, when the immunological reaction to chorionic gonadotropin fell to 300--100 IU per litre of the urine, reaction to the intradermal injection of polysaccharide complexes from the metastases of chorionepithelioma of the uterus still remained positive.
 ...
PMID:[Use of an immunologic test for differential diagnosis of uterine chorionepithelioma and hydatid mole]. 80 84

Fifty-two cases of choriocarcinoma were recorded in the Jamaica Cancer Registry for the parishes of Kingston and St. Andrew, giving an incidence of 1:7,384 live births. This is intermediate between figures reported for Western metropolitan populations and for Far Eastern countries. Clinicopathological studies on 26 cases treated at the University Hospital in Jamaica revealed that 65% followed either normal pregnancy or abortion. Choriocarcinoma following a normal pregnancy or occurring without a previous history of pregnancy carried a poorer prognosis than those with a preceding hydatidiform mole. Many patients had primary neurological manifestations. The overall prognosis was poor due to late presentation with disseminated metastases. Of the 26 patients, 15 died of the disease within two years and only six appeared for a six-year follow-up.
 ...
PMID:Choriocarcinoma in Jamaica. 84 72

The immunobiology of heterotransplanted human tumors was investigated following transplantation into nude mice of human bronchogenic, colon, rectal, ovarian, gastric, endometrial, vaginal, bladder, renal, esophageal, embryonic cell, pancreatic, and breast carcinoma, as well as fibrosarcoma, rhabdomyosarcoma, malignant melanoma, astrocytoma, Wilm's tumor, endometrial hyperplasia, and hydatidiform mole. Several of these tumors were passaged up to 15 generations. During these passages no changes in latency period for tumor development or in histology were noted. There were significant differences between several tumors in the minimum number of cells required for successful transplantation; such differences were independent of the basic biologic aggressiveness of the individual tumors. Nude mice that received transplants of fibrosarcoma and endometrial carcinoma had increased serum IgM and numbers of spleen cells and complement receptor lymphocytes. No such changes were noted for mice that received transplants of malignant melanoma, In contrast, there were no apparent differences in the responses of nude mice, who were given transplants of human tumors, to be T-cell mitogens concanavalin A or phytohemagglutinin or in the number of theta-bearing spleen cells. The success rate for transplantation was significantly improved when explants, rather than single-cell suspensions, were performed. Tumors transplanted to nude mice derived from strictly homozygous matings behaved like tumors transplanted to mice born of heterozygous mothers. Finally, despite the dramatic size of subcutaneous tumor nodules, there were no examples of invasion or distant metastases.
 ...
PMID:Immunobiology of heterotransplanted human tumors in nude mice. 85 33

Uterine choriocarcinoma develops fairly frequently after passage of a hydatidiform mole and very rarely after normal pregnancy or abortion. The disease is highly curable by chemotherapy, especially if detected early. Histologic examination of uterine curettings is unreliable and the principal indicator of active primary or metastatic disease is the HCG titer. The ability to visualize the tumor is helpful for a variety of reasons. In the past, this has been achieved primarily through arteriography. Our experience with 6 patients suggests that sonography is as sensitive a detector as arteriography and perhaps somewhat more specific. These facts, plus its convenience and repeatability, make ultrasound the method of choice for visualization of intrauterine malignant trophoblastic disease. Arteriography will continue to play an important role where the sonographic findings are equivocal and where local invasion or distant metastases are suspected.
 ...
PMID:Complementary role of sonography and arteriography in management of uterine choriocarcinoma. 123 96


1 2 3 4 5 6 7 8 9 10 Next >>