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Ngu SF, Ngan HYS. GTN Diagnosis and Staging. Hematol Oncol Clin North Am 2024:S0889-8588(24)00079-0. [PMID: 39155174 DOI: 10.1016/j.hoc.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Majority of gestational trophoblastic neoplasia (GTN) follows molar pregnancies where diagnosis is mostly based on persistent or rising serum human chorionic gonadotrophin (hCG). Diagnosis of GTN could be based on clinical presentation, serum hCG measurement, imaging, histology, and genotyping. A high index of suspicion in women of reproductive age presenting with abnormal vaginal bleeding or unusual systematic presentation is important. An accurate staging and classification system for GTN is crucial to evaluate the risk and the prognosis of patients, and to optimize treatment. GTN is staged using the International Federation of Gynecology and Obstetrics 2000 staging and the modified World Health Organization prognostic scoring system.
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Affiliation(s)
- Siew-Fei Ngu
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR.
| | - Hextan Y S Ngan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR
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2
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Gao M, Bhosale P, Devine C, Palmquist S, Javadi S. US, MRI, CT Performance and Interpretation of Uterine Masses. Semin Ultrasound CT MR 2023; 44:541-559. [PMID: 37821051 DOI: 10.1053/j.sult.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Uterine masses are commonly encountered as incidental findings during cross-sectional imaging or when individuals present with symptoms such as pain and bleeding. The World Health Organization categorizes tumors of the uterine corpus into 5 distinct groups: endometrial epithelial tumors and their precursors, tumor-like growths, mesenchymal uterine tumors, tumors with a combination of epithelial and mesenchymal elements, and various other types of tumors. The primary imaging method for assessing uterine abnormalities is transvaginal ultrasound. However, magnetic resonance imaging (MRI) can be employed to enhance the visualization of soft tissues, enabling a more detailed characterization of uterine masses. This article aims to outline the imaging features of both benign and malignant uterine masses using ultrasound, MRI, and computed tomography.
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Affiliation(s)
- Mamie Gao
- University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Priya Bhosale
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Sanaz Javadi
- University of Texas MD Anderson Cancer Center, Houston, TX
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3
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Modi MKP, Jasani GA, Raithatha NS, Suthar PP. Choriocarcinoma-Driven Uterine Perforation in a Bicornuate Anatomy: An Elusive Encounter. Cureus 2023; 15:e48841. [PMID: 38106706 PMCID: PMC10723019 DOI: 10.7759/cureus.48841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Choriocarcinoma, an aggressive gestational trophoblastic disease, infrequently manifests with spontaneous uterine perforation. We report the case of a 22-year-old female with five months of amenorrhea presenting with acute abdominal pain. Ultrasound and MRI assessment highlighted a uterine perforation with choriocarcinoma. Subsequent total abdominal hysterectomy revealed choriocarcinoma in the bicornuate uterus with uterine perforation. Histopathological analysis confirmed the diagnosis of choriocarcinoma in the cornu of the uterus. Timely diagnosis is vital to reduce mortality. Notably, choriocarcinoma in a bicornuate uterus is exceptionally rare. Radiological evaluations are critical for diagnosis, staging, and follow-up.
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Affiliation(s)
| | | | - Nitin S Raithatha
- Obstetrics and Gynaecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Pokhraj P Suthar
- Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, USA
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4
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Bonito G, Masselli G, Gigli S, Ricci P. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part I: Obstetric (Non-Fetal) Complications. Diagnostics (Basel) 2023; 13:2890. [PMID: 37761257 PMCID: PMC10528445 DOI: 10.3390/diagnostics13182890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of acute abdominal pain during pregnancy and puerperium. MRI overcomes some drawbacks of US, avoiding the ionizing radiation exposure of a computed tomography (CT) scan. Although CT is not usually appropriate in pregnant patients, it is crucial in the emergency evaluation of postpartum complications. The aim of this article is to provide radiologists with a thorough familiarity with the common and uncommon pregnancy and puerperium abdominal emergencies by illustrating their imaging appearances. The present first section will review and discuss the imaging findings for acute abdominopelvic pain of obstetric (non-fetal) etiology.
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Affiliation(s)
- Giacomo Bonito
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
| | - Gabriele Masselli
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy;
| | - Paolo Ricci
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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5
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Algeri P, Spazzini MD, Seca M, Garbo S, Villa A. About uterine enhanced myometrial vascularity: Doppler ultrasound could reduce misdiagnosed life-threatening vaginal bleeding after pregnancy and guide the management. J Ultrasound 2023; 26:695-701. [PMID: 36284049 PMCID: PMC10468474 DOI: 10.1007/s40477-022-00734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/18/2022] [Indexed: 11/29/2022] Open
Abstract
Enhanced myometrial vascularity is a rare entity in which an abnormal communication between vessels of the myometrial wall, potentially derived from all pregnancies, increases bleeding risk. Spontaneous regression is possible, but often, it is not foreseeable in which cases it's better to adopt a waiting behaviour and in which others a treatment is required. We reported three cases of enhanced myometrial vascularity: two occurring after vaginal delivery, and the third one after a scar pregnancy. The first case was successfully treated by embolization, the second one was subjected to curettage complicated by uterine perforation; the third one underwent embolization as well, but subsequently required hysterctomy for persistent methrorragia. As we treated these similar cases in three different ways, we decided to perform a mini review of the literature in the aftermath. Considering literature data, we strongly believe that the detection of peak systolic speed by colour-Doppler ultrasound together with a careful evaluation of clinical symptoms, could be a good guide to the best treatment of each patient.
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Affiliation(s)
- Paola Algeri
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy.
| | - Maria Donata Spazzini
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Marta Seca
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza e Brianza, Italy
| | - Stefano Garbo
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Antonella Villa
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
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6
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Libretti A, Longo D, Faiola S, De Pedrini A, Troìa L, Remorgida V. A twin pregnancy with partial hydatidiform mole and a coexisting normal fetus delivered at term: A case report and literature review. Case Rep Womens Health 2023; 39:e00544. [PMID: 37753223 PMCID: PMC10518573 DOI: 10.1016/j.crwh.2023.e00544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
Hydatiform mole occurs in 1/1000 singleton and 1/20000-100,000 twin pregnancies. Although the pregnancy often ends in a miscarriage or presents with many obstetric complications such as preeclampsia, vaginal bleeding, hyperthyroidism, prematurity, or fetal malformations, in some cases of twin pregnancy, one of the fetuses can develop normally. Coexistence of a viable fetus in a twin molar pregnancy is more commonly described for cases of complete hydatiform moles than partial hydatiform moles. A partial hydatiform mole coexisting with a normal fetus was suspected in a 40-year-old woman, G2P1, at twelve weeks of gestation of a twin dichorionic diamniotic pregnancy. Serial antenatal ultrasound scans and serial evaluations of human chorionic gonadotropin were performed, and a healthy baby was delivered at term without any obstetric or neonatal complications. A twin pregnancy with partial hydatidiform mole and a coexisting normal fetus is a rare obstetric condition that can result, under proper management, in the delivery of a healthy baby without any sequelae for the mother or child.
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Affiliation(s)
- Alessandro Libretti
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, 20090 Novara, Italy
| | - Daniela Longo
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
| | - Stefano Faiola
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20134 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20134 Milan, Italy
| | - Alberto De Pedrini
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
| | - Libera Troìa
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, 20090 Novara, Italy
| | - Valentino Remorgida
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, 20090 Novara, Italy
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7
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Advances in diagnostics and management of gestational trophoblastic disease. Radiol Oncol 2022; 56:430-439. [PMID: 36286620 PMCID: PMC9784364 DOI: 10.2478/raon-2022-0038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) is a heterogeneous group of rare tumours characterised by abnormal proliferation of trophoblastic tissue. It consists of benign or premalignant conditions, such as complete and partial molar pregnancy and variants of malignant diseases. The malignant tumours specifically are commonly referred to as gestational trophoblastic neoplasia (GTN). They consist of invasive mole, choriocarcinoma, placental-site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). CONCLUSIONS Patients with GTD are often asymptomatic, although vaginal bleeding is a common presenting symptom. With the advances in ultrasound imaging in early pregnancy, the diagnosis of molar pregnancy is most commonly made in the first trimester of pregnancy. Sometimes, additional imaging such as chest X-ray, CT or MRI can help detect metastatic disease. Most women can be cured, and their reproductive function can be preserved. In this review, we focus on the advances in management strategies for gestational trophoblastic disease as well as possible future research directions.
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8
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Bezzi C, Monaco L, Ghezzo S, Mathoux G, Bergamini A, Zambella E, Fallanca F, Samanes Gajate AM, Presotto L, Sabetta G, Mangili G, Cioffi R, Bettinardi V, Gianolli L, Mapelli P, Picchio M. 18F-FDG PET/CT May Predict Tumor Type and Risk Score in Gestational Trophoblastic Disease. Clin Nucl Med 2022; 47:525-531. [PMID: 35353763 DOI: 10.1097/rlu.0000000000004135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to investigate the role of 18F-FDG PET/CT in predicting pathological prognostic factors, including tumor type and International Federation of Gynecology and Obstetrics (FIGO) score, in gestational trophoblastic disease (GTD). METHODS Retrospective monocentric study including 24 consecutive patients who underwent to 18F-FDG PET/CT from May 2005 to March 2021 for GTD staging purpose. The following semiquantitative PET parameters were measured from the primary tumor and used for the analysis: maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolisis (TLG). Statistical analysis included Spearman correlation coefficient to evaluate the correlations between imaging parameters and tumor type (nonmolar trophoblastic vs postmolar trophoblastic tumors) and risk groups (high vs low, defined according to the FIGO score), whereas area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to assess the predictive value of the PET parameters. Mann-Whitney U test was used to further describe the parameter's potential in differentiating the populations. RESULTS SUVmax and SUVmean resulted fair (AUC, 0.783; 95% confidence interval [CI], 0.56-0.95) and good (AUC, 0.811; 95% CI, 0.59-0.97) predictors of tumor type, respectively, showing a low (ρ = 0.489, adjusted P = 0.030) and moderate (ρ = 0.538, adjusted P = 0.027) correlation. According to FIGO score, TLG was instead a fair predictor (AUC, 0.770; 95% CI, 0.50-0.99) for patient risk stratification. CONCLUSIONS 18F-FDG PET parameters have a role in predicting GTD pathological prognostic factors, with SUVmax and SUVmean being predictive for tumor type and TLG for risk stratification.
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Affiliation(s)
| | | | | | | | | | | | - Federico Fallanca
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute
| | | | - Luca Presotto
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute
| | - Giulia Sabetta
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Mangili
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Cioffi
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Luigi Gianolli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute
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9
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Ultrasound Imaging of Acquired Myometrial Pseudoaneurysm: The Role of Manipulators as an Unusual Cause during Laparoscopic Surgery. Diagnostics (Basel) 2022; 12:diagnostics12010164. [PMID: 35054332 PMCID: PMC8774433 DOI: 10.3390/diagnostics12010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
An acquired uterine artery myometrial pseudoaneurysm can occur due to inflammation, trauma, or iatrogenic causes, such as surgical procedures, and can lead to profuse bleeding. The efficacy of uterine manipulators in gynecological surgery, particularly as a cause of a pseudoaneurysm, has been poorly discussed in the literature. In this paper, we discuss a case of a 39-year-old woman with profuse uterine bleeding that occurred seven days after operative laparoscopic surgery for endometriosis. The color Doppler ultrasound better evoked the arterial-like turbulent blood flow inside this cavity. These sonographic features were highly suggestive of uterine artery pseudoaneurysm, presumably related to a secondary trauma caused by the manipulator. The diagnosis was subsequently re-confirmed by angiography, and the patient was treated conservatively with uterine artery embolization. Ultrasound has been shown to be a valuable and safe tool for imaging pseudoaneurysm and guiding subsequent interventional procedures. Accordingly, we briefly review the most suitable manipulators used in benign gynecological surgeries to verify if the different types in use can guide the surgeon towards the correct choice according to surgical needs and thus prevent potentially dangerous trauma.
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10
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A 10-Year Retrospective Review of Prenatal Applications, Current Challenges and Future Prospects of Three-Dimensional Sonoangiography. Diagnostics (Basel) 2021; 11:diagnostics11081511. [PMID: 34441444 PMCID: PMC8394388 DOI: 10.3390/diagnostics11081511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022] Open
Abstract
Realistic reconstruction of angioarchitecture within the morphological landmark with three-dimensional sonoangiography (three-dimensional power Doppler; 3D PD) may augment standard prenatal ultrasound and Doppler assessments. This study aimed to (a) present a technical overview, (b) determine additional advantages, (c) identify current challenges, and (d) predict trajectories of 3D PD for prenatal assessments. PubMed and Scopus databases for the last decade were searched. Although 307 publications addressed our objectives, their heterogeneity was too broad for statistical analyses. Important findings are therefore presented in descriptive format and supplemented with the authors’ 3D PD images. Acquisition, analysis, and display techniques need to be personalized to improve the quality of flow-volume data. While 3D PD indices of the first-trimester placenta may improve the prediction of preeclampsia, research is needed to standardize the measurement protocol. In highly experienced hands, the unique 3D PD findings improve the diagnostic accuracy of placenta accreta spectrum. A lack of quality assurance is the central challenge to incorporating 3D PD in prenatal care. Machine learning may broaden clinical translations of prenatal 3D PD. Due to its operator dependency, 3D PD has low reproducibility. Until standardization and quality assurance protocols are established, its use as a stand-alone clinical or research tool cannot be recommended.
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11
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Wang S, Han X. Morphological Study of Color Doppler Ultrasound Imaging to Observe the Effect of Ocular Fundus Surgery. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
High myopia continues to progress and the eye axis continues to grow, resulting in mechanical dilatation of the eyeball wall, and with the increase of age, resulting in a variety of myopic fundus pathological changes. Considering that in the late stage of fundus disease, patients can
obviously feel the impact of the disease on vision, and ophthalmologists are needed for direct diagnosis, intervention and treatment. The impact of early lesions on vision is relatively weak, and patients can not detect the emergence of these lesions in time, which can only be found by fundus
survey. Therefore, the automatic detection of early lesions of fundus disease (especially microaneurysms) is not only of great significance for early diagnosis and early treatment of fundus disease, but also a good reference for the detection of other fundus diseases. In this paper, color
ultrasound can effectively analyze the origin of fundus diseases. The results showed that with the changes of age, eye axis and posterior sclera shape in high myopia, the area and range of myopic arc and choroidal atrophy arc expanded, the thickness of nerve fiber and choroid became thinner,
and the fovea of macula mainly shifted vertically. In addition, it was also found that myopic arc, choroidal atrophic arc area, retinal thickness, nerve fiber thickness, choroidal thickness, vertical distance from macular fovea to optic disc center were correlated with age and eye axis.
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Affiliation(s)
- Shilong Wang
- Linyi Central Hospital, Linyi Shandong, 276400, China
| | - Xue Han
- Linyi Central Hospital, Linyi Shandong, 276400, China
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12
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Ismail S, Mikhael K, Salloum N, Alshehabi Z. An invasive mole with pulmonary metastases in a 55-year-old postmenopausal Syrian woman: a case report and review of the literature. J Med Case Rep 2021; 15:13. [PMID: 33455574 PMCID: PMC7812724 DOI: 10.1186/s13256-020-02630-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background Invasive mole is a subtype of gestational trophoblastic neoplasms (GTNs) that usually develops from the malignant transformation of trophoblastic tissue after molar evacuation. Invasive moles mostly occur in women of reproductive age, while they are extremely rare in postmenopausal women. Case presentation We present the case of a 55-year-old postmenopausal Syrian woman who was admitted to the emergency department at our hospital due to massive vaginal bleeding for 10 days accompanied by constant abdominal pain with diarrhea and vomiting. Following clinical, laboratory and radiological examination, total hysterectomy with bilateral salpingo-oophorectomy was performed. Histologic examination of the resected specimens revealed the diagnosis of an invasive mole with pulmonary metastases that were diagnosed by chest computed tomography (CT). Following surgical resection, the patient was scheduled for combination chemotherapy. However, 2 weeks later the patient was readmitted to the emergency department due to severe hemoptysis and dyspnea, and later that day the patient died in spite of resuscitation efforts. Conclusion Although invasive moles in postmenopausal women have been reported previously, we believe our case is the first reported from Syria. Our case highlights the difficulties in diagnosing invasive moles in the absence of significant history of gestational trophoblastic diseases. The present study further reviews the diagnostic methods, histological characteristics and treatment recommendations.
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Affiliation(s)
- Sawsan Ismail
- Department of Pathology, Cancer Research Center, Faculty of Medicine, Tishreen University, Lattakia, Syria.
| | - Karen Mikhael
- Faculty of Medicine, Tishreen University, Lattakia, Syria
| | - Nehad Salloum
- Department of Obstetrics and Gynecology, Tishreen University Hospital, Lattakia, Syria
| | - Zuheir Alshehabi
- Department of Pathology, Cancer Research Centre, Faculty of Medicine, Tishreen University, Lattakia, Syria
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Su N, Zhao C, Zhang B, Qi Z, Gao B, Liu Z, Yang M, Jiang Y, Dai Q. The Role of Contrast-Enhanced Ultrasound in Evaluating Gestational Trophoblastic Neoplasia: A Preliminary Study. Cancer Manag Res 2020; 12:12163-12174. [PMID: 33281459 PMCID: PMC7711203 DOI: 10.2147/cmar.s277226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/24/2020] [Indexed: 11/24/2022] Open
Abstract
Objective We aimed to compare the imaging features of gestational trophoblastic neoplasias (GTNs) and benign pregnancy-related uterine diseases on contrast-enhanced ultrasound (CEUS) to explore the clinical value of CEUS in differentiating these two types of uterine lesions. Materials and Methods In this prospective study, patients with GTNs before and after chemotherapy and benign pregnancy-related uterine lesions received conventional US and CEUS. The imaging features and parameters of CEUS of the lesions were assessed. Results A total of 73 patients were enrolled in this study, including 48 with GTNs and 25 with benign lesions. The enhancement pattern of newly diagnosed GTNs was mainly diffuse enhancement (70.8%), with a non-enhanced area of less than 1/3 of the entire lesion. For the benign group, the enhancement pattern was mainly ring-shaped enhancement (72.0%), and the non-enhanced area was more than 1/2 (68.0%), significantly different from that of GTNs (P = 0.000 and 0.002, respectively). Forty-one lesions demonstrated unclear boundaries on greyscale US but clearly displayed on CEUS. In both the benign and malignant groups, the measurements of lesion size on CEUS were larger than those on greyscale US (P = 0.000). The measurement differences (ΔD: D2-D1) of the malignant cases were higher than those of the benign cases (P = 0.001). Conclusion GTNs and benign pregnancy-related uterine diseases have different imaging characteristics on CEUS. The boundary and involved range of the lesion can be clearly demonstrated on CEUS. CEUS possesses clinical value in diagnosing and evaluating GTNs and benign pregnancy-related diseases.
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Affiliation(s)
- Na Su
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenyang Zhao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Bo Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhenhong Qi
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Bin Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhenzhen Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Meng Yang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qing Dai
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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14
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Subbaiah M, Raj A, Durairaj J, Keepanasseril A. Role of hysteroscopy and ultrasound in early identification of post-molar gestational trophoblastic neoplasia. Eur J Obstet Gynecol Reprod Biol 2020; 254:33-37. [PMID: 32920420 DOI: 10.1016/j.ejogrb.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the role of hysteroscopy and ultrasound in early identification of gestational trophoblastic neoplasia (GTN) after molar evacuation. METHODS This was a prospective study involving 52 women with an ultrasound diagnosis of complete hydatidiform mole, attending a tertiary centre in south India between August 2016 and August 2019. Baseline characteristics such as age, serum beta-human chorionic gonadotropin(β-hCG) level, gestational age, and uterine size were noted. After the evacuation of molar pregnancy, weekly follow-up with β-hCG was performed, until three consecutive values were normal and then monthly for six months. Findings of transvaginal ultrasound and diagnostic hysteroscopy, performed on follow up at three weeks, were noted. Primary outcome was the development of GTN. Area under the curve(AUC) was calculated to assess the usefulness of these methods in early identification of GTN. RESULTS Thirteen women (25 %) developed GTN during follow up, within 6 months. Twenty six(50 %) cases had high-risk molar pregnancy. Positive findings on hysteroscopy and ultrasonography were noted in 44.2 % and 19.2 % respectively. AUC was 0.83(95 % CI, 0.70-0.97) for ultrasound and 0.82(95 % CI, 0.72-.92) for hysteroscopy. Sensitivity and specificity were 69.2 % and 97.4 % for ultrasound and it was 92.3 % and 71.8 % respectively for hysteroscopy in identifying those who developed GTN on follow-up. CONCLUSIONS Transvaginal ultrasound as well as hysteroscopy may help in early identification of women at risk of developing GTN following a molar evacuation. Being a non-invasive method with similar discriminative value, ultrasonographic evaluation may be used for early identification of women with GTN after validation in future studies.
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Affiliation(s)
- Murali Subbaiah
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India.
| | - Ashwini Raj
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | - Jayalakshmi Durairaj
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | - Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India
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