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 ...

Selected topics in trophoblastic pathology which are arousing current interest are briefly reviewed. These include the concept of villitis as a non-specific immunological lesion, changing views on the distinction between partial and complete hydatidiform mole, a reconsideration of the role of inadequate placentation in pregnancy hypertension and in spontaneous abortion, ...

The goal of the current review is to present the figures essential for counseling, when hydatidiform mole and normal fetus occur together. Previous reviews of prognosis and risks when mole and fetus are observed together did not adjust for differences in genetic constitution and thus varying risks for gynecologic and ...

The pregnancies responsible for two cases of choriocarcinomas were determined by the restriction fragment length polymorphism of human leukocyte antigen-DQ genes in the tumors and leukocytes from the patients, their husbands, and their children. The first case was preceded by three normal pregnancies, and the second case was preceded by ...

There is some disagreement about the validity of the clinical term "pregnancy tumor." On the basis of its clinical presentation and histologic appearance, some authors believe that it simply represents a pyogenic granuloma (PG), whereas others believe that the lesion is unique because of the apparent influence of female sex ...

In a series of 14 anembryonic pregnancies, deoxyribonucleic acid from trophoblast was examined with locus-specific minisatellite probes. It was found in each case that trophoblast from anembryonic pregnancy has both a maternal and a paternal contribution to its genome. This means that although anembryonic pregnancy shares characteristics with complete hydatidiform ...

A case of partial hydatidiform mole revealed by genetic marker analysis one maternal and two paternal chromosome complements. Levels of serum human chorionic gonadotropin were persistently elevated during follow-up. Avillous curettage specimens prior to chemotherapy were morphologically suspicious for gestational choriocarcinoma. It is still uncertain whether the risk for gestational ...

Repetitive hydatidiform mole was observed in four pregnancies. The pregnancies presented with heavy bleeding and vomiting, but the post-evacuation courses were uncomplicated, with rapid regression of serum hCG levels. Cytogenetic investigations, analyses of restriction fragment length polymorphisms, and flow cytometry in three pregnancies were consistent with diploid, biparental conception as ...

To determine the genetic origin of the complete hydatidiform mole, 20 abnormal pregnancies were studied with restriction fragment length polymorphism with five genomic probes: EJ 6.6, beta-globin gene, 3'alpha-hypervariable region, J-Bir, and St14. In the 12 cases of molar pregnancy, pure paternal origin was proved in 11 cases, but both ...

The examination of spontaneous abortion specimens is as important as doing perinatal autopsies or surgicals in today's practice of medicine. The results of the pathologist's examination assist obstetricians in specific follow-up of future pregnancies and geneticists in predicting the chances of specific developmental defects or repeat pregnancy loss. Without the ...

The medical records and pathologic specimens were reviewed from 33 patients with complete molar pregnancy at Brigham and Women's Hospital between 1980 and 1989. Two pathologists (D.R.G. and R.W.R.) reviewed all slides from the original sharp curettage to identify pathologic features that may be associated with persistent gestational trophoblastic tumor ...

Many neurologic disorders, such as eclampsia, pseudotumor cerebri, stroke, obstetric nerve palsies, subarachnoid hemorrhage, pituitary tumors, and choriocarcinoma, can develop in the pregnant patient. Maternal mortality from eclampsia, which ranges from 0 to 14%, can be due to intracerebral hemorrhage, pulmonary edema, disseminated intravascular coagulation, abruptio placentae, or failure of ...

We report on a 22 year old mother, a carrier of a 6;14 balanced reciprocal translocation, who aborted a triploid conceptus carrying a similar translocation. We showed the maternal origin of this triploidy, after non-disjunction at meiosis I. The phenotypic expression as a non-molar pregnancy, the contribution of the maternal ...

The development and refinement of osseointegration have had primary impetus in treatment of the totally edentulous patient. The same principles, however, may be applied to the partially edentulous patient. Osseointegrated fixtures used in conjunction with mechanical or magnetic attachments may be used to construct partial or full overdentures. This allows ...

Gestational choriocarcinoma can follow a term birth, a nonmolar abortion, or a complete hydatidiform mole. Among hydatidiform moles, heterozygous ones resulting from fertilization of an egg devoid of a nucleus by a diploid sperm (XY) or by dispermy (XX or XY) have been suggested to carry an increased predisposition to ...

This paper reviews the progress which has been achieved with combination chemotherapy of experimental murine central nervous system trypanosomiasis. Successful treatments have been achieved with suramin followed by 5-nitroimidazoles; difluoromethylornithine in combination with bleomycin, 9-deazainosine, suramin, arsenicals, antimonials and diamidines; and also the arsenicals in combination with the 5-nitroimidazoles or ...

A case of the combination of a complete hydatidiform mole and a coexisting, living fetus arising from a twin pregnancy, subsequent to clomiphene citrate therapy for ovulation induction, is presented. The diagnostic problems of this combination as well as the incidence of molar pregnancy following the use of ovulation inducers ...

Forty-nine women who had received chemotherapy for gestational trophoblastic disease subsequently became pregnant a total of 65 times. Of these 65 pregnancies, 42 (64.7%) terminated in term births, 4 (6.1%) in premature births, 1 (1.5%) in stillbirth, 8 (2.3%) in spontaneous abortion and 7 (10.8%) in elective abortion, while 3 ...

A patient with an intrauterine pregnancy of 27 weeks had a coexisting pulmonary metastatic choriocarcinoma. On the chest radiograph the lung metastases appeared as pulmonary infiltrates, simulating atypical pneumonia. Serum human chorionic gonadotrophin levels were normal for gestational age. Treatment with methotrexate was successful. This is the first reported case ...

Three cases of intracranial meningiomas occurring in young pregnant women are presented. The typical growth pattern of these tumors is slow, producing insidious and chronic visual disturbances. In contrast, during pregnancy meningiomas may follow a rapidly progressive course, producing dramatic and relatively acute visual loss. This accelerated growth pattern is ...

In this paper, we report on the effect of brain microtubule-associated proteins (MAPs) on the dynamic instability of microtubules as well as on the nucleation activity of purified centrosomes. Under our experimental conditions, tau and MAP2 have similar effects on microtubule nucleation and dynamic instability. Tau increases the apparent elongation ...

An unusual case of recurrent benign trophoblastic growth occurring for the fourth time in a gravida 4, para 0, 30-year-old woman is reported. Prophylactic chemotherapy was instituted to avert the disaster again, without success. The question of her future obstetric outcome poses a formidable dilemma and no radical measures could ...

Postnatal growth of the face is a composite function of genetic and environmental factors. A sudden traumatic insult due to the use of forceps at birth could have long-term effects which could detrimentally influence growth and development. This study examines the development of the skeletal and dental components of forceps ...

Fifteen patients with repetitive hydatidiform mole were followed at the New England Trophoblastic Disease Center between 1965-1988. The medical records were examined to determine the patients' age, gravidity, parity, clinical presentation, development of post-molar tumor, and subsequent pregnancy experience. Each molar tissue was reviewed pathologically. Seven patients had repetitive complete ...

Serum levels of hCG and its free subunits were measured in patients with partial and complete hydatidiform moles and in women with normal 10-week pregnancies. whereas complete moles had higher levels of percent-free beta-hCG than partial moles (2.4 versus 1.0; P less than or equal to .005), partial moles had ...

Because of the association of preeclampsia with hydatidiform mole, and since levels of 19-hydroxyandrostenedione (19-OH-A) and androstenedione (A) are raised in hypertensive diseases of pregnancy, we compared plasma 19-OH-A and A in hydatidiform mole patients with control early pregnant women. Both steroids were significantly elevated in 27 patients with partial ...

Forty-one molar pregnancies seen at the University Teaching Hospital Enugu, Nigeria during the 10-year period 1976-1985 are analyzed. The incidence of hydatidiform mole was 0.82 per 1000 pregnancies. The incidence of molar pregnancy was lowest among teenage women and increased markedly with advancing age over 35 years. Hyperemesis gravidarum, a ...

The authors present the case of a 32-year-old female with a hard, bony mass on her left forehead, present for several years, which rapidly increased in size after she became pregnant. Neuroradiologically, the tumor appeared to have originated in the interosseous space, and it invaded the subgaleal and intracranial spaces ...

A patient with vaginal bleeding in the first trimester of pregnancy had a serum human chorionic gonadotropin (hCG) titer of 495,132 mlU/ml and an abdominal ultrasound examination revealed an intrauterine gestational sac without a fetal pole. Two and a half weeks later the hCG titer was 385,000 mlU/ml and a ...

Seven cases of triploidy were encountered by the Prenatal Diagnosis Program at Dartmouth-Hitchcock Medical Center over an 8-year period through associated pregnancy complications. We describe the characteristic findings that facilitate prenatal diagnosis and management. Our experience includes fetuses with major central nervous system abnormalities (spina bifida aperta, holoprosencephaly) and anterior ...

The prevalence of dysplastic naevi was studied in a population-based survey of 380 30 to 39-year-old and 50 to 59-year-old non-Maoris in Milton, a small town in the south of New Zealand. Photographs of all pigmented naevi greater than or equal to 4 mm in diameter were taken during the ...

The development of germ cell carcinoma of the ovary during pregnancy is a rare occurrence. Recent advances in chemotherapy have improved significantly the prognosis for patients with early stage disease. Use of cytotoxic agents in pregnancy traditionally has been avoided because of possible teratogenic effects. We describe a pregnant patient ...

Molar pregnancy with a coexisting live fetus is a rare occurrence. We present morphologic and cytogenetic analysis of a recent case. Cytogenetic studies revealed a 46, XX karyotype for the fetus, the normal placenta, and the abnormal placenta. Chromosome banding studies confirmed the presence of maternal and paternal chromosomes in ...

The wet weight of the rat uterus increased 8-fold during pregnancy and fell by 70% within 5 days postpartum. Uterine collagen increased about 5-fold during pregnancy and also fell by 70% within 5 days. The crosslink pyridinoline remained constant at 0.28 mole/mole collagen at every time point, with the possible ...

Lateral cephalometric radiographs were evaluated to determine the posttreatment stability of 66 patients treated with LeFort I osteotomies to reposition their maxillae superiorly. The sample was divided into three groups based on the degree of pretreatment overbite: openbite subsample--no incisal overlap; overlap subsample--incisal overlap and no incisal contact; contact subsample--incisal ...

The role of cultural and socioeconomic diversities (that is, marriage, conceptions at the extremes of reproductive life, consanguinity, economic affluence and such) were analyzed for significance in the epidemiologic study of gestational trophoblastic disease (GTD) in Saudi Arabia. For the study period, the incidence of hydatidiform mole remained unchanged at ...

Two examples of intraplacental choriocarcinoma are described. Both were small and had arisen in otherwise normal third trimester placentas. The covering mantle of many of the villi adjacent to the choriocarcinomas was formed, either focally or wholly, of neoplastic trophoblastic tissue: it is only at this stage of the development ...

There seems to be no higher incidence of primary brain tumor in pregnancy. There are no extracranial tumors that are likely to metastasize that are uniquely related to the specific pregnancy. Choriocarcinoma during the index pregnancy is rare. Although pregnancy-related choriocarcinoma has a high propensity for brain metastasis, it is ...

Placental molar change with a coexistent live fetus is an unusual entity, particularly when diagnosed in the second trimester of pregnancy. In this case report, the sonographic findings of an abnormally enlarged, diffuse molar placenta with a normal living fetus in the second trimester prompted karyotype analysis. Although triploidy was ...

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 ...

From July 1, 1969 to June 30, 1985, 381 patients received primary management for hydatidiform mole at Los Angeles County-University of Southern California Medical Center Women's Hospital. Three hundred fifty-eight of these women had complete records available for analysis. Of these, 277 women (77.4%) underwent suction curettage to remove the ...

Recent studies on the etiology and the cytogenetics of trophoblastic tumors suggest that hydatidiform mole and choriocarcinoma may be conditions with no causal relationship. With the advent of newer diagnostic methods which aid in the early diagnosis of pregnancy and help to differentiate it from abnormal pregnancy together with the ...

An 18-year-old woman presented during the 2nd month of her pregnancy with noncommunicating hydrocephalus due to a cerebellar hemangioblastoma. The tumor rapidly enlarged over a 12-day period after ventriculoperitoneal shunting, probably because of expansion of the vascular compartment. Serial computed tomography and magnetic resonance imaging observations support previous speculations in ...

Subterranean mole rats of the Spalax ehrenbergi superspecies in Israel have a distinctly developed vocal repertoire, presumably compensating together with olfaction for their complete blindness, thus providing an efficient communication system underground. Here we describe the unique organization of the cochlea of Spalax among mammals. The cochlea is subdivided into ...

Immunohistochemical techniques have been used to investigate the expression of fetal trophoblast antigens and the maternal leucocytic response in molar pregnancy and choriocarcinoma. The antigenic phenotype of morphologically defined trophoblast populations in complete, partial and invasive moles was analogous to that in normal pregnancy. All trophoblast phenotypes described in normal ...

In order to preserve the fertility of young patients with choriocarcinoma and invasive mole, chemotherapy alone was given without hysterectomy in 265 cases from 1959 through 1980. By the end of 1985, 205 patients had become pregnant after recovery, with a total of 355 pregnancies. Among these, 23 were terminated ...

Glycated albumin levels showed a progressive increase during normal pregnancy. The mean values (mole hexose/mole protein) were 1.68 +/- 0.27 (n = 15) in nonpregnant women, 1.83 +/- 0.21 (n = 11) in first trimester, 2.00 +/- 0.41 (n = 13) in second trimester, and 2.42 +/- 0.49 (n = ...

Traditional cephalometric analyses facilitate only cursory craniofacial evaluation. When a more rigorous geometric technique, in the form of finite element analysis, was applied to a retrospective series of lateral cephalographs taken before and after the completion of the orthodontic therapy, however, complex craniofacial size and shape changes were apparent. Such ...

Only partial studies evaluating the endocrine profile in molar pregnancy have been performed. In order to characterize the neuro-endocrine pattern during and after molar pregnancy, we studied the basal hormonal levels of hCG, human placental lactogen (hPL), FSH, GH, TSH, free thyroxine index (FTI), oestradiol-17 beta (E2), and progesterone (PG), ...

The sonographic appearance of gestational trophoblastic neoplasia is nonspecific and also seen in complete or partial hydatidiform mole, hydropic degeneration, degenerating fibroids, or ovarian dysgerminomas. Correlation with the serum human chorionic gonadotropin (hCG) level may be helpful since levels exceeding 100,000 IU/L are strongly suggestive of gestational trophoblastic neoplasia. However, ...