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

Thirty-one patients with nonmetastatic trophoblastic disease (NMTD) and 39 patients with metastatic trophoblastic disease (MTD) of gestational origin were treated primarily with actinomycin D. Complete and sustained remission was achieved with actinomycin D alone in 94% of patients with NMTD and 67% with MTD. In the nonmetastatic group, 93% of patients without choriocarcinoma (non-CCA) achieved remission with actinomycin D, as compared to 100% (only 3 patients) with CCA. in the metastatic group, 76% of patients without CCA achieved remission with actinomycin D, as compared to 56% where CCA was present. Fourteen of the 15 patients who failed to respond completely to actinomycin D alone subsequently responded to methotrexate (10 patients), triple therapy (3 patients), methotrexate plus triple therapy (1 patient), and methotrexate plus vinblastine (1 patient). One patient died with widespread metastases despite intensive chemotherapy with actinomycin D and triple therapy. No serious toxic side effects were encountered even in treated patients with pre-existing laboratory evidence of impaired hepatic function.
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PMID:Actinomycin D as the primary agent for gestational trophoblastic disease. 17 Oct 55

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.
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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.
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PMID:Southern Regional Trophoblastic Disease Center, 1972--1977. 21 50

Two hundred and sixty-five patients with malignant trophoblastic disease were admitted to the Southeastern Trophoblastic Disease Center at Duke University Medical Center between July 1966 and June 1976. Of these 165 patients, 20 had choriocarcinoma following a term gestation with a survival rate of 60% as compared to 95% survival rate for the remaining 245 patients. Previously described risk factors of initial human chorionic gonadotropin (hCG) titer of greater than 100,000 IU/24 hr urine, duration of symptoms for more than 4 months, significant prior unsuccessful chemotherapy or cerebral or hepatic metastases identified the "poor prognosis" group. Post-term gestation "poor prognosis" patients had a significantly lower cure rate (47%), than other patients with "poor prognosis" for gestational trophoblastic disease (75%; P less than 0.05). Post-term gestation choriocarcinoma has a propensity for more extensive metastatic spread and would appear to be less responsive to conventional chemotherapy, which may be due to an altered immune response in these patients. This suggests that an antecedent term pregnancy should be added to the previously described high-risk factors for patients with malignant trophoblastic disease.
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PMID:Choriocarcinoma following term pregnancy. 41 76

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.
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PMID:Complementary role of sonography and arteriography in management of uterine choriocarcinoma. 123 96

Fourteen patients with intractable bleeding of obstetric or gynecological origin underwent transcatheter angiographic arterial embolization. Three patients had postpartum hemorrhage associated with dilutional coagulopathy, anticoagulant therapy and placental leukemic metastases, or placenta percreta. One patient had locally advanced gestational trophoblastic tumor, one had uterine sarcoma and 8 had advanced cervical malignancy. Bleeding was completely controlled in all patients regardless of the initiating event. The embolizing material was gelatin sponge particles in 12 patients, and spring coil in 2. In experienced hands, angiographic arterial embolization is a safe, effective and less invasive alternative to surgical ligation in some clinical states of pelvic female genital tract hemorrhage.
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PMID:Angiographic embolization for control of pelvic genital tract hemorrhage. Report of 14 cases. 131 91

Seventy-six women diagnosed with gestational trophoblastic disease (GTD) from 1985 to 1989 completed questionnaires evaluating their status on mood disturbance, marital satisfaction, sexual functioning, psychosocial response to illness, and report of the most stressful event occurring within the past year. Multivariate analyses of variance (MANOVA) were conducted on dependent measures to examine differences between diagnostic groups (partial mole, complete mole, persistent disease), time from diagnosis (less than 1 year, 1-2 years, or 3-5 years from diagnosis), and follow-up status (active disease or remission). MANOVAs revealed no significant differences in the dependent measures based on time from diagnosis, type of medical treatment received, or type of molar disease. The metastatic disease group displayed significantly greater mood disturbance (F(1, 66) = 17.63, P less than 0.0001) and reported suffering clinically significant levels of distress and significantly greater levels of distress in response to the illness (F(33, 39) = 2.32, P less than 0.006). Women with active disease also reported significantly greater levels of distress in response to the illness (F(33, 39) = 2.76, P less than 0.001). Across disease types, GTD patients experience clinically significant levels of anxiety, anger, fatigue, confusion, and sexual problems and are significantly impacted by pregnancy concerns for protracted periods of time.
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PMID:The psychological, social, and sexual consequences of gestational trophoblastic disease. 132 84

Both CT and MR imaging have had a major impact on gynecologic oncologic imaging, and new technology and imaging techniques are still being introduced. CT maintains a role in gynecologic pelvic cancer imaging because of cost-effectiveness, high spatial resolution, fast examination time, and wide availability. CT is particularly advantageous for lymph node metastasis screening and guided-biopsy of metastases and recurrent tumor. CT currently is recommended for primary staging of ovarian cancer and advanced cancers of the cervix and endometrium, detection of persistent and metastatic gestational trophoblastic disease, and evaluation of recurrent gynecologic pelvic cancers.
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PMID:Computed tomography of gynecologic neoplasms. 163 Dec 87

A clinicopathological and immunohistochemical study of a fatal case of placental site trophoblastic tumor (PSTT) is presented. PSTT is a rare variant of trophoblastic disease. Histologically the tumor is characterized by a monomorphic cell population, derived from the extravillous intermediate trophoblast. The tumor cells contain human placental lactogen (HPL) as the predominant marker, while human chorionic gonadotropin (HCG) is present only locally. PSTT has a malignant potential. In the case presented the tumor finally developed the biphasic pattern of choriocarcinoma. The clinical and pathological features of the malignant PSTT are reviewed. Establishing the diagnosis and predicting the biologic behavior of PSTT may be difficult. If metastases occur the prognosis is poor regardless of therapeutic intervention.
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PMID:Malignant placental site trophoblastic tumor. A case report and a review of the literature. 165 95

Major advances have been achieved during the past 40 years in the epidemiology, etiology, pathology, endocrinology, immunology, diagnosis, and treatment of molar pregnancy (MP) and gestational trophoblastic neoplasia (GTN). MP is now recognized as composing two distinct entities--complete and partial, with distinct histopathology, genetics, and clinical presentations. Proper management is dependent on a thorough understanding of each type. Early diagnosis and effective treatment of patients with GTN has resulted in 100 percent cure rates in non-metastatic disease and in the majority of patients with metastases. In most instances, resistant disease leading to death results from delayed diagnosis and overwhelming tumor burden. Moreover, in most instances successful treatment can be accomplished with preservation of fertility and normal pregnancy outcome anticipated. A rare variant of choriocarcinoma called placental site trophoblastic tumor (PSTT) has been described, which, although curable by surgery when localized, is usually fatal when disseminated. It is anticipated that during the decade of the nineties the scientific work in progress will lead to earlier diagnosis and improved survival in resistant cases.
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PMID:Gestational trophoblastic neoplasia in the 1990s. 166 40


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