Cases reported "Trophoblastic Neoplasms"

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1/7. Erythrocytosis associated with a placental-site trophoblastic tumor.

    We present a case of placental-site trophoblastic tumor associated with erythrocytosis. This 42-year-old woman had persistent amenorrhea and low elevations of her hCG titer after term delivery of a healthy female infant. The woman was noted to have polycythemia of uncertain etiology and was treated with serial phlebotomy. Placental-site trophoblastic tumor was diagnosed and hysterectomy was performed, with subsequent resolution of the polycythemia. Although erythrocytosis has been reported with other gynecologic tumors, this is the first reported association with a placental-site trophoblastic tumor. A role has been suggested for placental lactogen in erythropoiesis during pregnancy based on previous animal studies. Diffuse positive staining for hPL is characteristic of placental-site trophoblastic tumors. We postulate that hPL may have played an ancillary role to erythropoietin in the erythrocytosis demonstrated in this case. Spider angiomata and splenomegaly are interesting clinical features previously described in association with placental-site trophoblastic tumors, and were demonstrated in this patient.
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ranking = 1
keywords = gynecologic
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2/7. ifosfamide alone and in combination in the treatment of refractory malignant gestational trophoblastic disease.

    OBJECTIVE: We attempted to evaluate the use of ifosfamide either alone or in combination in patients with refractory malignant gestational trophoblastic disease. STUDY DESIGN: Our study comprised, in part, a phase II multiinstitutional trial of ifosfamide in refractory gynecologic malignancies and, in part, a review of institutional experience with ifosfamide in combination chemotherapy. RESULTS: Single-agent ifosfamide produced a significant response in titer in one of two patients with refractory choriocarcinoma. ifosfamide with etoposide and cisplatin (also known as VIP) resulted in significant response in human chorionic gonadotropin titers in three patients with highly refractory metastatic gestational trophoblastic disease and one cure in this group of patients. CONCLUSION: ifosfamide has activity in refractory choriocarcinoma and, when combined with etoposide and cisplatin (VIP), may be curative.
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ranking = 1
keywords = gynecologic
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3/7. pneumothorax following induction chemotherapy in patients with lung metastases: a case report and literature review.

    A 29-year-old patient presented with bilateral pulmonary lesions following surgery for recurrent placental site trophoblastic tumor (PSTT). On day seven after institution of the 'EMA' regimen (etoposide, medium dose methotrexate with folinic acid rescue and actinomycin-D), complete pneumothorax occurred. Closed-system air drainage brought only transient lung expansion and subsequent talc pleurodesis was needed. During follow-up, complete regression of lung metastases was observed. A literature survey of post-chemotherapy pneumothorax in patients with lung metastases disclosed fourteen hitherto reported cases. Including the present PSTT case, non-epithelial gynecologic malignancy (3 patients) ranks second to osteogenic sarcoma (6 cases) with regard to the primary tumor involved.
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ranking = 1
keywords = gynecologic
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4/7. Placental site trophoblastic tumor associated with immature ovarian teratoma.

    This paper describes a woman who developed three malignancies within a very short time. Two of these, immature teratoma and placental site trophoblastic tumor, were rare gynecological neoplasms. The third was a breast carcinoma. This is the first report of an association of placental site trophoblastic tumor with a primary germ cell tumor of the ovary.
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ranking = 1
keywords = gynecologic
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5/7. Fluorescent in situ hybridization assessment of chromosome copy number in gestational trophoblastic disease.

    The concurrence of congenital trisomy 8 mosaicism and gestational trophoblastic disease in a forty-two-year-old Gravida IV, Para IV female has been described. In contrast to other cases in the literature, this patient had no additional confounding chromosomal abnormalities other than trisomy 8. To the best of our knowledge, this was the only reported case of constitutional trisomy 8 mosaicism associated with gestational trophoblastic disease, a rare gynecological disease entity in and by itself. The present report describes fluorescent in situ hybridization (FISH) studies for assessing chromosome 8 copy number on various patient tissues. The results of the FISH studies are compared with each other and with the original cytogenetic studies. It is concluded that the overall frequency of trisomy 8 cells is lower in the FISH studies using archival material than in the original conventional cytogenetic studies. This is true for the uterus and lung tissues with a metastatic tumor. The possible reasons for the somewhat different frequencies found between conventional cytogenetics via GTG-banding and interphase cytogenetics via FISH are discussed.
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ranking = 1
keywords = gynecologic
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6/7. Constitutional trisomy 8 mosaicism and gestational trophoblastic disease.

    Concurrence of congenital trisomy 8 mosaicism and gestational trophoblastic disease in a 42-year-old gravida IV, para IV female is described in the present report. In contrast to other cases described in the literature, our patient had no known additional confounding chromosomal abnormalities other than trisomy 8. The finding of trisomy 8 mosaicism in yet another type of cancer provides further support for the hypothesis of an increased predisposition to cancer in tissues with constitutional genomic imbalance, which can manifest itself as numerical chromosomal abnormalities (e.g., trisomies) or structural chromosomal abnormalities (e.g., translocations). To the best of our knowledge, this is the only report in the English literature of constitutional trisomy 8 mosaicism associated with gestational trophoblastic disease, a rare gynecologic disease entity in itself.
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ranking = 1
keywords = gynecologic
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7/7. Endometrial adenocarcinoma with trophoblastic differentiation.

    OBJECTIVE: To report a case of stage IIIc poorly differentiated endometrial adenocarcinoma with trophoblastic differentiation and to review previously reported cases. methods: The clinical course and histopathology of the case were reviewed, and a literature search for other reported cases was performed. RESULTS: The tumor contained syncytiotrophoblast-like giant cells that stained positively for the beta subunit of human chorionic gonadotropin (beta-hCG), and the patient's serum beta-hCG level was elevated (95 mIU/ml), but became undetectable after treatment. Beta-hCG was used as a tumor marker during further therapy. At 16 months' survival, she remains without evidence of disease and with a beta-hCG (level < 5 mIU/ml). Nine other cases of trophoblastic differentiation in gynecologic nontrophoblastic tumors have been reported, five in endometrial carcinomas which we review. CONCLUSIONS: Trophoblastic differentiation in gynecologic nontrophoblastic tumors is rare. Beta-hCG may be useful as a tumor marker in these cases. The clinical behavior of these tumors has been aggressive, with advanced stages at diagnosis, early widespread metastases or recurrences and poor patient outcomes. The patient presented in this report, however, remains without evidence of disease 16 months following diagnosis and may be the longest survivor with this tumor reported to date.
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ranking = 2
keywords = gynecologic
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