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Query: UMLS:C0027960 (mole)
 21,279 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After a mole has been evacuated there are two ways of treating the condition: routine chemotherapy from the beginning or chemotherapy reserved for selected cases. They offer the same chances of cure. Seeing that the risk of malignancy in our country is 5 per cent and that selective chemotherapy only exposes a small number of patients to the risk of such treatment, we have adopted the scheme of follow-up suggested by Bagshawe and recommended by OERTC. The follow-up is based on radio-immune assay for HCG carried out at regular intervals for two years. Only cases where the level of HCG is higher than 25,000 international units per litre, one month after curettage, or cases where the rise in HCG is associated with metastases, are treated with chemotherapy. In our experience, which is based on 20 cases, we acknowledge the value of radio-immune assaying. It is superior to immunological tests used for pregnancy diagnosis in sensitivity. It also appears to us that systematic treatment routinely administered and treatment based on raised levels of HCG two months after evacuation of a mole are useless. Only 3 cases were treated with chemotherapy out of the 20 cases that were followed up. We have had no malignancy after 2 and 3 years of checking back on the patients. Treatment given routinely from the start would have been unnecessary exposure to the risks of chemotherapy for 17 patients. Had we taken into account the abnormal rise in HCG after 8 weeks we would still have treated 7 patients instead of 3 with the same results as far as cure. We have worked out a graph for the drop in the levels of HCG after a mole has been evacuated. This may serve as a base for criteria for treatment in the future. Cases where the levels of HCG are above the 95 percentile are considered as at risk to evolve into malignant forms of disease. Consequently earlier treatment can be started (before the 6th month) without altering the number of patients who are going to be treated.
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PMID:[Prevention of the malignant form of trophoblastic disease after a hydatidiform mole: systematic or selective chemotherapy]. 18 22

Angiography has proved valuable as a method for visualizing the position and extent of trophoblastic tumors. Angiography together with the determination of gonadotropin makes a more exact diagnosis possible and, therefore, an individual therapy. The treatment must be intentionally carried out's the age of the patient plays an important role here. For many cases today, purely conservative therapy with cytostatic drugs is possible. This method was used in 11 female patients with suspected or histologically established trophoblastic tumors. In 4 women, the tumor was suspected a because of the reincrease in HCG excretion following a hydatidiform mole. A metastasizing mole was established histologically in 3 patients and a choriocarcinoma, in 4 patients. A good correspondence was found between angiographic and macroscopic findings in 6 women who underwent surgery. In evaluating control angiograms following chemotherapy, it should be noted that tumors do not recede completely in every case.
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PMID:[Efficacy of angiography for the diagnosis of trophoblastic tumors (author's transl)]. 18 16

1. Membrane potentials have been recorded from cells of seminiferous tubules of rats in vitro using micro-electrodes. The value in 808 impalements was -28-2 +/- 0-3 mV (mean +/- S.E.) at 33 degrees C. 2. Increasing the potassium concentration depolarized the cells, a tenfold increase in concentration causing a depolarization of 16 mV. Removal of sodium from the bathing solution caused a hyperpolarization of 3 mV at a potassium concentration of 5-9 m-equiv/l. Removal of chloride and replacement with impermeant anions had no effect on potential. Removal of calcium from the bathing solution caused a minor but significant depolarization. 3. Ouabain (10-3 M), dinitrophenol (2-5 times 10-4 M) or removal of glucose from the bathing fluid all caused depolarization. The membrane potentials of the cells were sensitive to temperature over the range 10-33 degrees C, the apparent activation energy for the reactions maintaining the potential being approximately 6 kcal/mole. 4. Membrane potentials in seminiferous tubules were independent of age of the animal, were insensitive to previous hypophysectomy and were insensitive to a number of hormones (FSH, LH, HCG, oxytocin). In high concentration prostaglandin E1 caused depolarization. 5. Acetazoleamide (4 times 10-5 M) caused a rapid, but reversible, depolarization of the tubular cells. This was also true in conditions when the HCO'3/CO2 buffer system was replaced with Tris-buffer. Another carbonic anhydrase inhibitor (p-sulphonamido-benzoic acid) had similar effects on cell potentials as acetazoleamide. These results are discussed in relation to the nature of the ionic secretion produced in the tubules. 6. Occasional cells showed phasic variations in membrane potential. A possible connexion between these variations and the contractile activity of the tubules is discussed.
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PMID:Intracellular potentials in cells of the seminiferous tubules of rats. 115 7

From May 1979 through December 1988, 146 patients with gestational trophoblastic tumors (71 hydatidiform mole, 3 partial mole, 15 choriocarcinoma and 57 persistent trophoblastic tumors) were studied. A total of 1178 daily urine samples were collected before and/or after treatment, and in the course of follow-up. H93 RIA (an HCG specific assay), H80 RIA (an assay detecting hCG and hLH) and a hCG alpha assay measured levels in the urine specimens. Three hCG declining patterns (pattern D, P and R) based on the H93 RIA assay were noted. Patients showing pattern D had the most favorable outcome (no mortality at all). However, pattern P and R had a 10% and 14.3% mortality rate, respectively. The ratios of H80/H93, hCG alpha/H93, hCG alpha/H80 in the urine specimens were similar in both pattern D and R (excluding samples from a patient who expired later). However, the ratios of H80/H93, hCG alpha/H93, hCG alpha/H80 of samples from the patient (CK) who expired later were significantly different from those of the pattern D and R. This was suggestive of a marked unbalanced secretion of hCG and its subunit in the urine specimens of patient CK. The molecular forms in pattern D were similar to the standard hCG. However, the molecular form in pattern R of 3 fatal choriocarcinomas showed a great variation, from smaller to larger than the standard hCG. The isoelectric points of hCG in pattern D and R were all acidic. In clinical practice, we can measure the ratios of H80/H93, hCG alpha/H93 and hCG alpha/H80, molecular forms, and isoelectric points of hCG.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experience of human chorionic gonadotropin assays in gestational trophoblastic tumors. 168 Sep 61

The current study was undertaken in an effort to identify the clinical characteristics and natural history of partial moles. Three cases recently managed at Tripler Army Medical Center and 52 cases collected from the medical literature were reviewed. The mean age of the women at diagnosis was 25.6 years. The mean gestational age at diagnosis was 23.8 weeks. The most common presenting symptom was vaginal bleeding in 69 per cent of women. Although triploidy was the most frequent karyotype (68 per cent), normal 46,XY or XX karyotypes were present, and phenotypically normal infants were delivered of mothers with a coexisting molar pregnancy. Malignant trophoblastic disease occurred in 14.5 per cent of the women. All of them achieved remission with adjuvant therapy. Partial moles are considered a less virulent form of molar pregnancy. The clinical characteristics and natural history are not entirely dissimilar from the complete mole. Malignant sequelae can occur after the evacuation of a partial mole. These women should be followed with serial serum beta-HCG.
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PMID:Partial hydatidiform moles: a review. 244 83

A peculiar case of gestational trophoblastic disease is described. A 24 year old female with former history of three molar pregnancies, spontaneous abortion and anembryoic pregnancy was admitted because of a newly diagnosed hydatiform mole (ex novo). After uterine curettage followed by a low oral dose of methotrexate (0.5 mg/kg/day) for five days. The HCG levels determined in plasma by beta-HCG- radioinmmunoassay, became negative until four months of follow3 up. An intrauterine device was installed. She resumed HCG positivity a year later and a histerectomy was performed. A post-surgical diagnosis of invasive mole was made. Since the possibility of intercurrent pregnancy was lowered by the presence of a intrauterine device, we assumed that trophoblastic transformation into an invasive mole adopted a sort of dormant period before its resurge (resurrection) independently either from curettage of chemotherapy.
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PMID:[Molar pregnancy (primary or recurrent?)]. 256 6

A rare case of hydatidiform mole occurring 7 consecutive times in a Chinese woman is presented. She was first seen in 1979 at the age of 23 years, with a molar pregnancy and subsequently had 6 consecutive moles, the last being in July, 1986; at this visit the patient and her husband were very depressed, and convinced that a normal pregnancy was unlikely and requested a hysterectomy. They were warned earlier several times, of the possible long-term consequences of a recurrent mole and that their chance of having a normal baby was very remote. A total hysterectomy was performed at her last presentation as the patient requested one, instead of dilatation and curettage for a persistently high HCG and bulky uterus following suction evacuation. Histology revealed an invasive mole. The beta HCG level was less than 4IU/l by the end of September, 1986 and she is still being followed-up.
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PMID:Recurrent hydatidiform mole: a report of a patient with 7 consecutive moles. 323 84

The practice of advising a women with hydatidiform mole to use contraception for 1-2 years before planning pregnancy is re-examined in the light of new information on etiology and cytogenetics of mole, risk of developing choriocarcinoma, as well as new technologies for following early pregnancy. The risk of choriocarcinoma after molar pregnancy has been reported at 1-15%, while the risk after all other types of pregnancy varies widely in the literature. Incidence of trophoblastic tumors varies much less in population-based estimates. It is unknown whether the risk of choriocarcinoma is the same for all 3 cytogenetic types of moles, homozygous complete XX, heterozygous complete XY or partial mole. It is likely that a defective ovum is the pathologic basis for mole and choriocarcinoma. The risk of subsequent malignancy is unrelated to the histologic appearance of the mole. The risk of habitual mole ranges from 1:50 to 1:150. As habitual moles recur, the risk of chorionic malignancy falls to extinction. Contraception does not affect the risk of choriocarcinoma: the reason why contraception was advised is that HCG levels due to normal pregnancy could not be distinguished from those due to mole before the advent of quantitative radioimmunoassay and ultrasound. Now normal pregnancy can be documented as early as 1 week after conception by radio receptor assay for HCG, combined with serial ultrasound.
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PMID:Postmolar contraception. 328 45

Sixty two patients with gestational trophoblastic disease were investigated and treated between January 1977-December 1983. The value of pelvic arteriography was examined. The cases included: 45 moles with a simple outcome. 14 cases of invasive trophoblastic neoplasia after evacuation of the mole. 3 choriocarcinomas after full term pregnancy. Pelvic arteriography was performed in 14 patients. 9 of the 14 patients presented with persistent HCG secretion 6 to 8 weeks after evacuation of the mole. Before chemotherapy was begun, we looked for unfavourable prognostic features such as extra-pelvic metastases, multiple pulmonary metastases, high HCG secretion, delay between the initial event and starting chemotherapy of more than six months. The Ishizuka score was calculated. Six arteriography type I readings suggested choriocarcinoma with an Ishizuka score above five. Double chemotherapy (oncovin-methotrexate) was started successfully (with a one year follow up). Only two patients had unfavourable factors. Two arteriography type III suggested persistent moles, with an Ishizuka score below five. Chemotherapy (only methotrexate) was successful). It was not possible to classify the last arteriography, so the patient was treated successfully with double chemotherapy. Three patients failed to recover with chemotherapy. Arteriography was indicated to determine the site of HCG secretion. Three hysterectomies were performed. Tissue choriocarcinoma was found. Two diagnoses of choriocarcinoma were confirmed by arteriography: In one case an unexplained pleurisy appeared six months after full term. HCG was then positive. In the other case, extrauterine pregnancy was first suspected, but the woman had not had intercourse for six months. Arteriography demonstrated tubal choriocarcinoma. So pelvic arteriography is useful for managing complicated gestational trophoblastic disease.
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PMID:[Importance of arteriography in complicated trophoblastic disease]. 609 10

Comparing the cytogenetic and morphological data on cases of hyperplasia and neoplasia of the trophoblast allows some conditions to be better defined and separated. The term partial mole or embryonic mole should be replaced by the term triploid syndrome because of the especially strong correlation between the triploid caryotype and the special aspect of the placenta. Triploidy is usually the result of fecundation of a haploid ovule by two spermatozoids, probably due to the similarity of the haploids of the two parents, as is suggested by the study of HLA antigens. Classical hydatidiform mole, or perivillous trophoblastic hyperplasia, is usually discovered earlier, during an ultrasound examination or abortion and its histological diagnosis is easy. The caryotype of complete hydatidiform mole is diploid, nearly always XX, with the two sex chromosomes coming from the father (the maternal sex chromosome being eliminated). The caryotype of vesicular dystrophia without trophoblastic hyperplasia is, on the other hand, normal. Trophoblastic microcarcinomas have a better known presentation. And trophoblastic carcinomas are distinct from non-trophoblastic neoplasms which secrete HCG and from benign trophoblastic pseudo-tumors which are often non-secretory.
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PMID:[Trophoblastic gestational diseases. Triploid syndrome, perivillous trophoblastic hyperplasia, trophoblastic pseudotumor, trophoblastic microcarcinoma and carcinoma]. 625 52


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