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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper starts with a short description of the history of the discovery of the hydatidiform mole ( Tulp in 1641) and of the treatment (before 1956, hysterectomy in most cases). After 1961 chemotherapy started to be used even in patients who had cerebral metastases. 72 patients who had attended Professor Hubinont 's department in the University Hospital of Saint-Pierre in Brussels between January 1971 and December 1981 were followed up. Questionnaires were sent to the patients and to their doctors who were treating them in order to try and find out what had happened in subsequent pregnancies and what the maternal and fetal consequences and complications were. The social class and the marital status of the patients was also considered as well as their wish to become pregnant again. Of the 72 cases that were followed up after evacuation 63 (87.5%) recovered while 9(12.5%) had clinical, biological or radiological signs of persistent non-metastatic (3) and metastatic (6 cases) active disease. The department asked patients not to become pregnant in the year following evacuation of the mole. 10% were sterilised, 4 by hysterectomy and 4 by tubal ligation. 42% used the oral contraceptive pill and 34% (24 cases) condoms. Control follow-up of patients who became pregnant was compared with a group of 2 529 pregnancies in Saint-Pierre Hospital during the year 1981. 44 out of the 72 patients who were followed up after hydatidiform mole became pregnant with a total of 52 pregnancies. Ten became pregnant in the first 6 months after attempting it, 11 between 6 and 12 months and 23 after a delay of 12 months. Out of the 52 pregnancies, 34 5%) had a live baby at term. 6 were premature and 31 out of 34 babies delivered at term were delivered vaginally and 3 by Caesarean. There were 9 spontaneous abortions (17%) and 2 terminations of pregnancy (4%). Three patients had repeated non-intentional abortions and one had a still-birth for which the cause could not be found. Only one other had a second mole. When these results are compared with the histories of these patients before they had the hydatidiform mole there did not seem to be any increase in the number of spontaneous abortions or premature labours, nor was there when this group was compared with a control group. Only one of the 38 live-born children showed a major congenital abnormality which was varus equinus. There was no possibility of picking out statistically anything of value as far as congenital malformations was concerned.
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PMID:[The reproductive function following a hydatidiform mole]. 632 1

A surgical case of multiple cerebral metastases from choriocarcinoma was reported, who was a 26 year-old female. She had received treatment of hydatid mole on April 1979, and admitted to our hospital for the consciousness disturbance and right hemiparesis. CT scan showed two high density tumors with marked brain edema. Emergency craniotomy was performed and five tumors were completely removed. Following the operation, symptoms of increased intracranial pressure and disturbance of consciousness were markedly improved in about a week. She received radiation therapy. After radiochemotherapy, a metastatic lung tumor was removed. Now her chorionic gonadotropin titers remain normal and she is able to perform all her household responsibilities despite a mild right hemiparesis. Recently, surgical treatment has been getting done for cerebral metastasis of choriocarcinoma. Because most of the metastatic cerebral lesions occur in relatively easy position for the operation. If symptoms of cerebral metastasis appear, we should performed surgical treatment as soon as possible.
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PMID:[Choriocarcinoma: cerebral metastasis from choriocarcinoma--a successfully surgical treated case]. 668 65

The fibrinolytic activity of 156 malignant and 36 benign solid tumors from autopsy and biopsy specimens was studied by the fibrin slide technique. The inhibitory activity against fibrinolysis was graded according to the lysis time of vascular tissues within the tumor. The results show that all malignant solid tumors, with the exception of prostate carcinoma, demonstrated varying degrees of inhibition of fibrinolysis. Persistently high inhibitory activity was found in squamous cell carcinoma of the esophagus, the respiratory tract, cervix uteri, and skin; carcinoma of uterus; colorectal carcinoma; small cell anaplastic carcinoma of lung; neuroblastoma, carcinoma of bile duct, while malignant tumors of the kidney show a lesser degree of inhibition. In contrast, with the exception of the hydatidiform mole, benign solid tumors show little or no inhibition. A similar absence of fibrinolytic activity is seen in metastatic disease. Further studies of the role of the fibrinolytic system in tumors seems warranted.
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PMID:Fibrinolytic activity in human tumor tissues. 668 89

Fifty-one patients with choriocarcinoma associated with term pregnancy were treated at the John I. Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1981. An overall remission rate of 61% was achieved: 65% for 43 patients who received all of their treatment at the center and 38% for eight patients who received treatment elsewhere before referral to the center. This remission rate was significantly less (P less than 0.005) than the 87% remission rate obtained in patients with choriocarcinoma after hydatidiform mole, abortion, or ectopic pregnancy combined. Three factors were determined which significantly influenced response to treatment in these patients: (1) time from delivery to treatment greater than 4 months (41% versus 80%, P less than 0.0005); (2) presenting symptomatology other than abnormal uterine bleeding (40% versus 87%; P less than 0.001); and (3) metastases to sites other than the lung and/or vagina (22% versus 72%, P less than 0.01). There appeared to be no advantage to treating all patients with choriocarcinoma after term pregnancy with initial multiple-agent chemotherapy unless other high-risk characteristics were present.
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PMID:Choriocarcinoma associated with term gestation. 670 38

The beta-human chorionic gonadotropin (HCG) radioimmunoassay was used to determine the presence of HCG immunoreactivity in serum of patients (n = 71) with diagnosis of cancer. Of patients with active neoplasia, 60.5% showed HCG immunoactivity above controls (greater than 5 mIU/ml). An apparent degree of correlation was observed with tumor activity in that a case with widespread metastases due to a colonic carcinoma exhibited the highest HCG levels while, in one patient, the level of HCG decreased progressively according to therapeutic response. A high frequency of immunoactive HCG was found in patients with carcinomas of the cervix, breast, gonad, and digestive system and in patients with melanoma. Trophoblastic cells were not evident in the tumors biopsied. Immunologic similarity of HCG secreted by tumors and that contained in serum of pregnant women, of patients with hydatidiform mole, and of males injected with exogenous HCG was shown by parallel inhibition curves in the radioimmunoassay. The positivity of HCG was predominant in cases of cervix carcinoma.
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PMID:Human chorionic gonadotropin immunoreactivity in serum of patients with malignant neoplasms. 686 51

Observation of 24 gestational trophoblastic tumors, i.e. 20 hydatidiform moles, 1 invasive hydatidiform mole, 1 non-metastatic and 2 metastatic choriocarcinomas, is reported. The diagnoses were based on case record data, clinical findings, echography and radioimmunoassay of human gonadotropin (HCG). The therapy was oriented towards maintaining fertility in reproductive women. For treatment with cytostatic drugs the patients were allocated to a low risk and a high risk group according to history, diagnosis and former therapy, and an appropriate mono- or combined therapy was started. 17 of 24 patients were cured by surgery in an initial therapy phase. 7 tumors were progressive, 6 of which responded to secondary surgical or cytostatic treatment. One patient died from metastases of choriocarcinoma. The total cure rate of 96% was rendered possible by regular follow-up including bimanual palpation, echography, HCG-assay and chest X-rays.
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PMID:[Current diagnosis and therapy of gestational trophoblastic tumors: experience with 24 patients]. 719 49

Four new cases of primary choriocarcinoma arising in the placenta during a seemingly normal gestation were studied at the Trophoblastic Disease Center of Northwestern University. In each case the patient presented with disseminated metastases while carrying an intrauterine gestation with a normally developing fetus. All four placental primaries were small; three of the tumors were microscopic and found only after extensive sectioning. Histologically, these tumors all appeared to arise from the cytotrophoblastic cells covering the stromal portion of villi, and in some areas the involved villi retained a portion of normal investing trophoblast. This study shows that gestational choriocarcinoma unassociated with hydatidiform mole can have an early stage in which chorionic villi are present. The consistently small size of the lesions studied suggests that primary placental choriocarcinoma may frequently be overlooked or missed, and that choriocarcinoma possibly has its origin in the placenta more often than in retained or persistent trophoblast following pregnancy.
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PMID:Gestational choriocarcinoma. Its origin in the placenta during seemingly normal pregnancy. 723 20

Single-agent chemotherapy for nonmetastatic gestational trophoblastic disease is most successful for patients who have had an antecedent molar pregnancy with a plateau or persistent beta-human chorionic gonadotropin elevation after molar evacuation. Traditionally, single-agent, five-day, intramuscular methotrexate has been associated with high cure rates, as has methotrexate with citrovorum factor rescue, which reduces toxicity. Standard definitions of low-risk gestational trophoblastic disease and response assessment are critical to a comparison of prognostic features related to single-agent therapy success. Methotrexate with folinic acid rescue administered as primary therapy does achieve an excellent therapeutic outcome with limited chemotherapy exposure but at increased cost. The weekly intramuscular methotrexate Gynecologic Oncology Group (GOG) regimen is inexpensive and allows close monitoring of disease status. Single-dose or pulsed actinomycin-D provides a high level of complete response, although gastrointestinal toxicity, mainly nausea and vomiting, is quite common. Management of first-line chemotherapy failures is unclear, although in the GOG methotrexate trial it was evident that another agent, such as actinomycin-D, should be used to provide the highest success rate. The use of a single agent in low-risk metastatic trophoblastic disease (lung and/or vaginal metastases) depends upon restricting it to patients who have not failed prior chemotherapy, have a low World Health Organization score and have no evidence of the presence of choriocarcinoma, but a much higher first-line failure rate should be anticipated than in nonmetastatic disease. Other single-agent regimens have been proposed that are worthy of investigation to create a safer, more efficacious and more convenient regimen for low-risk gestational trophoblastic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Development of single-agent chemotherapy regimens for gestational trophoblastic disease. 751 17

Gestational trophoblastic disease has been recognized as a form of abnormal pregnancy as early as 1600 AD, and choriocarcinoma was the first cancer to be cured with chemotherapy even in the presence of distant and widespread metastases. Important advances in the past include the standardization of terminology, the concept of assignment of risk and the use of staging systems, the centralization of care and the establishment of regional registries, and of course the development of the radioimmunoassay for the beta subunit of human chorionic gonadotropin. The current views on the management of this disease recognizes the need for a multidisciplinary approach, with chemotherapy remaining at the forefront but also utilizing newer diagnostic techniques when necessary, and keeping in mind the crucial role that surgery can play especially in resistant cases. At the same time, the importance of basics such as careful follow up after evacuation of a hydatidiform mole cannot be overemphasized. There will be a continual refinement of the chemotherapy regimes used, and the aim is to achieve a similar level of response with decreased toxicity to the patient.
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PMID:Current views on the management of trophoblastic tumors. 758 44

Choriocarcinoma of the bladder was diagnosed in a 54-year-old woman presenting with macroscopic hematuria 17 years following evacuation of a molar pregnancy. The patient was treated by cystoscopic transurethral tumor resection followed by three courses of triple-agent chemotherapy and total abdominal hysterectomy with bilateral salpingo-oophorectomy. Six months later a gradual rise in beta-human chorionic gonadotropin levels led to the diagnosis of recurrent bladder tumor at the site of the previous tumor. The patient underwent a conservative partial cystectomy, and 12 months postoperatively there was no evidence of disease. It is unclear whether the patient developed a primary urinary bladder choriocarcinoma or late metastatic disease from the previous molar pregnancy.
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PMID:Choriocarcinoma of the bladder. Report of a case of primary tumor or late metastasis of a molar pregnancy. 765 Jun 66


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