1
|
Dash SS, Sakhadeo U, Karmarkar S, Mittal N, Menon S, Rekhi B, Deodhar KK. Epithelioid trophoblastic tumor: A case series. INDIAN J PATHOL MICR 2023; 66:148-151. [PMID: 36656227 DOI: 10.4103/ijpm.ijpm_212_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
An epithelioid trophoblastic tumor (ETT) is an extremely rare gestational trophoblastic tumor. Cases of ETT present with abnormal vaginal bleeding in women of reproductive age group with marginally elevated beta human chorionic gonadotrophin (B-hCG) levels. Here, we describe a series of four patients (all were females) including histomorphology, immunoprofiles, and diagnostic difficulty of this rare entity. All cases were in their reproductive age group. The mean pre-treatment hCG level was 665.24 (mIU/mL). Microscopically, all cases had a tumor showing an epithelioid appearance arranged in large nests and sheets. Individual tumor cells were round to polygonal with abundant eosinophilic cytoplasm, with central vesicular nuclei and prominent nucleoli. Areas of hemorrhage, necrosis, and intercellular hyaline-like material deposition were identified in all cases (100%). Immunohistochemically, tumor cells in all cases showed diffuse positivity for AE1/AE3 and p63 (100%). GATA3 was available in one case (25%), which was positive in the tumor cells. In one case (25%), hPL was focally positive, and in one case (25%), it was negative. SALL4 was performed in two cases (50%) and was negative in tumor cells. The mean Ki67 labeling index was 19.2 (range 10-30%). All four patients underwent surgical intervention and were treated with hysterectomy. The mean follow-up in this series was 39.4 months (range 6-70), and all patients are alive to date with a mean survival of 32.8 months (range, 4-67).
Collapse
Affiliation(s)
| | - Uma Sakhadeo
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Srushti Karmarkar
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | |
Collapse
|
2
|
Hasija A, Balyan K, Debnath E, V R, Kumar M. Prediction of hypertension in pregnancy in high risk women using maternal factors and serial placental profile in second and third trimester. Placenta 2021; 104:236-242. [PMID: 33450643 DOI: 10.1016/j.placenta.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To evaluate the role of placental profile markers in second and third trimester of pregnancy in predicting hypertensive disorders of pregnancy (HDP) in women at high risk of preeclampsia. METHOD Women who were at high risk of preeclampsia underwent βhCG, ultrasound assessment of placental length, thickness and its ratio, uterine artery Doppler at 20-24 weeks and 28-32 weeks of gestation, the outcome at delivery was noted. Those who developed HDP were cases and those with normal outcome were controls. The placental profile markers among cases and controls were compared. RESULTS Hypertensive disorders of pregnancy was seen in 72/160 (45%) high risk women The serum β hCG levels at 20-24 weeks (p = 0.001) and 28-32 weeks (p = 0.018) was significantly high in women who had preeclampsia. Placental thickness was found to be less in among all subgroups of HDP, for preeclampsia, it was significantly low at 20-24 weeks (AUC- 0.743; sensitivity- 75%, specificity- 66.3%) and 28 weeks (AUC -0.764, sensitivity - 75.0% specificity - 78.7%). Uterine artery S/D ratio was considerable high in women with chronic hypertension (AUC -0.765), gestational hypertension (AUC -0.771) and preeclampsia (AUC -0.726) at 20-24 weeks. In preeclampsia group, uterine artery PI was highest and the best marker at 20-24 weeks (AUC -0.935, sensitivity - 100.0%, specificity - 87.6%). DISCUSSION The placental profile markers may be used to provide closer follow up in high risk pregnancies with abnormal placental profile levels, while less intense follow up in those with normal levels, thus channelizing the resources.
Collapse
Affiliation(s)
- Aayushi Hasija
- Department of Obstetrics and Gynecology, LHMC, New Delhi, India
| | - Kirti Balyan
- Department of Obstetrics and Gynecology, LHMC, New Delhi, India
| | - Ekta Debnath
- Department of Biochemistry, LHMC, New Delhi, India
| | - Ravi V
- Department of Statistics, LSR, New Delhi, India
| | - Manisha Kumar
- Department of Obstetrics and Gynecology, LHMC, New Delhi, India.
| |
Collapse
|
3
|
Al Mamari N, Al Zawawi N, Khayat S, Badeghiesh A, Son WY, Dahan MH. Revisiting serum β-hCG cut-off levels and pregnancy outcomes using single embryo transfer. J Assist Reprod Genet 2019; 36:2307-2313. [PMID: 31605261 DOI: 10.1007/s10815-019-01583-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/06/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The objective of this study is to identify the pregnancy outcomes based on day-16 β-hCG level assessed with modern assays, in fresh single embryo transfers. METHODS A retrospective cohort study at a single academic center between 2013 and 2017. A total of 1076 pregnancies were included. RESULTS Pregnancies were divided into 10% groupings of 107-108 patients each. The 10 groups did not differ for baseline characteristics. There was no difference on outcomes based on cleavage or blastocyst transfer. At a serum β-hCG level of 103 ± 13 (range 74-135), 50% had a biochemical loss. Biochemical pregnancy losses remained 21% at serum β-hCG range (136-197). It was only once serum β-hCG level reached 199-252 that the probability of a biochemical pregnancy loss was 12%. Interestingly, if a clinical pregnancy is present even at low day-16 serum β-hCG levels, the likelihood of live birth is approximately 50%. This maximizes to 75% when the serum β-hCG level was at least 253 IU/L. The relationship between serum day-16 β-hCG levels and clinical pregnancy or live birth is quite strong with correlation coefficients above 0.8 which accounted for more than 75% of the variability in outcomes in both cases. Receiver operator curves determined that the cut-off for a clinical pregnancy was 190 and for live birth, it was 213 IU/L. CONCLUSION An increase in the serum β-hCG levels at which to expect a reassuring outcome is required based on modern assays, as compared with the old cut-off levels.
Collapse
Affiliation(s)
- Naama Al Mamari
- MUHC Reproductive center, McGill University, 888 boulevard de Maisonneuve East, # 200, Montreal, QC, H2L4S8, Canada.
| | - Nabighah Al Zawawi
- MUHC Reproductive center, McGill University, 888 boulevard de Maisonneuve East, # 200, Montreal, QC, H2L4S8, Canada
| | - Suhaib Khayat
- MUHC Reproductive center, McGill University, 888 boulevard de Maisonneuve East, # 200, Montreal, QC, H2L4S8, Canada
| | - Ahmed Badeghiesh
- MUHC Reproductive center, McGill University, 888 boulevard de Maisonneuve East, # 200, Montreal, QC, H2L4S8, Canada
| | - Weon-Young Son
- MUHC Reproductive center, McGill University, 888 boulevard de Maisonneuve East, # 200, Montreal, QC, H2L4S8, Canada
| | - Michael H Dahan
- MUHC Reproductive center, McGill University, 888 boulevard de Maisonneuve East, # 200, Montreal, QC, H2L4S8, Canada
| |
Collapse
|
4
|
Altay MM, Mert SA, Gemici A, Kaplan M, Gelisen O. Successful technique of manual vacuum aspiration for treatment of type 2 cesarean scar pregnancies: evaluation of 40 cases. J Matern Fetal Neonatal Med 2019; 34:2693-2700. [PMID: 31575309 DOI: 10.1080/14767058.2019.1670807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To demonstrate the effectiveness and safety of the defined manual vacuum aspiration (MVA) technique for treatment of type 2 cesarean scar pregnancies (CSPs). METHODS We treated 40 patients with CSP by MVA at the Early Pregnancy Clinic of our hospital between 1 January 2012 and 31 December 2014. The files of patients were reviewed and evaluated retrospectively. Eligibility criteria were hemodynamic stability and at least 2 mm myometrial thickness at the anterior part of the CSP. The key-point of successful MVA procedure is to keep away from entering the cesarean scar cavity directly; instead, CSP is displaced from the implantation site by applying vacuum, only while the cannula is passing near. RESULTS During the study period, the ratio of CSP to total pregnancies was 1/1000. The ratio of CSP to cesarean delivery (CD) was 1/372. In that time period, CSPs were constituted 4.41% of all ectopic pregnancies. Total of 40 patients were treated with dilatation and MVA. Complications such as excessive hemorrhage, persistence of CSP, and any need of extra intervention were not observed. The beta-hCG values of 21 patients (52.5%) decreased below 10 mIU/mL after the first 15 days, and the rest decreased below 10 mIU/mL after 3 weeks following MVA. CONCLUSIONS This MVA technique for treatment of CSP is easily applicable and effective method with high success and low complication rates. For appropriately selected patients, we think that this method can be considered as the first- line treatment.
Collapse
Affiliation(s)
- Mehmet Metin Altay
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sule Atalay Mert
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Ali Gemici
- Obstetrics and Gynecology, Guven Hospital, Ankara, Turkey
| | - Metin Kaplan
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Orhan Gelisen
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
5
|
Godbole K, Kulkarni A, Kanade A, Kulkarni S, Godbole G, Wakankar A. Maternal Serum Aneuploidy Screen and Adverse Pregnancy Outcomes. J Obstet Gynaecol India 2016; 66:141-8. [PMID: 27651593 DOI: 10.1007/s13224-015-0826-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To find out whether maternal serum screening for fetal chromosomal aneuploidy predicts adverse pregnancy outcomes. METHODS A two-year retrospective case-control study was conducted at a tertiary hospital. Pregnant women with a high-risk serum screen but with chromosomally normal fetuses (n = 189) were compared to those with low-risk screen (controls, n = 157) for adverse pregnancy outcomes. RESULTS Women with high-risk double marker or combined screen were found to have higher prevalence of LBW [OR 2.56; 95 % CI (1.01-6.53), p < 0.05] and PT [OR 2.93; 95 % CI (1.11-7.65), p < 0.05], while women with high-risk triple screen had higher prevalence of PIH [OR 3.72; 95 % CI (1.23-11.18); p < 0.05], Oligo [OR 4.50; 95 % CI (1.30-15.64); p < 0.05], delivery by C-section [OR 2.51; 95 % CI (1.41-4.47); p < 0.005] as compared to low-risk women. PAPP-A was found to be a significant predictor of birth weight (R (2) = 12.2 %, β ± SE = 0.224 ± 0.069; p < 0.005) and gestational age (R (2) = 4.9 %, β ± SE = 0.613 ± 0.296; p < 0.05). Beta hCG in first and hCG in second trimester predicted oligohydramnios (R (2) = 9.2 %, β ± SE = -0.077 ± 0.025; p < 0.005). The areas under the ROC curves of PAPP-A for LBW and PT were 0.70(p < 0.01) and 0.684 (p < 0.05), respectively. CONCLUSION A "high-risk" maternal serum screen with abnormal PAPP-A and/or beta hCG/HCG is associated with adverse pregnancy outcomes and may help identifying women requiring additional fetal surveillance.
Collapse
Affiliation(s)
- Koumudi Godbole
- Department of Genetic Medicine, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, 411004 India
| | - Aparna Kulkarni
- Fetal Medicine Unit, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Asawari Kanade
- Department of Research, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Shilpa Kulkarni
- Department of Obstetrics and Gynecology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Girish Godbole
- Department of Obstetrics and Gynecology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Anuradha Wakankar
- Department of Obstetrics and Gynecology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| |
Collapse
|
6
|
Helmy S, Koch M, Kölbl H, Grohmann-Izay B, Solomayer E, Bader Y. Correlation of the volume of ectopic pregnancy and MTX therapy outcome: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2014; 184:108-11. [PMID: 25490001 DOI: 10.1016/j.ejogrb.2014.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate a possible correlation between the volume of the tubal ectopic pregnancy (EP) measured by vaginal-ultrasound (VUS) and methotrexate (MTX) therapy outcome. STUDY DESIGN Data of EP volume measured by one expert-sonographer, viability, clinical symptoms, previous IVF/insemination, follow-up of β-hCG and progesterone levels, and treatment of EP was collected of 100 patients with sonographically diagnosed EP, who attended the Department of Obstetrics and Gynecology of the Medical University Vienna between March 2008 and September 2011. RESULTS The mean volume of EP (mVol.) in the group with successful MTX therapy (n = 38) was 5.11 ml, 95%CI [2.4; 7.8] with a median 3.2 ml, IQR [5.0], in the group with unsuccessful MTX treatment (n = 11) it was 15.24 ml, 95%CI [-2.6; 33.1], with a median 4.4 ml, IQR [11.4]. We could observe a trend towards a lower mVol. in the successful MTX group (5.11 ml vs. 15.24 ml). We could not show a significant correlation (u-test p = 0.208). CONCLUSION A clear tendency was observed towards a lower mVol. in the successful MTX therapy group, but we could not verify a statistically significant correlation of volume of EP and MTX therapy outcome most likely due to the small sample size. This was the first study investigating the correlation of volume of EP and MTX therapy outcome as principal question.
Collapse
Affiliation(s)
- S Helmy
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
| | - M Koch
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
| | - H Kölbl
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
| | | | - E Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Clinics of Saarland, Homburg/Saar, Germany
| | - Y Bader
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Clinics of Saarland, Homburg/Saar, Germany.
| |
Collapse
|