Complete hydatidiform mole coexistent with a twin live fetus: clinical course of four cases with complete cytogenetic analysis

Based on zinc uptake in chick tibia, Zn bioavailability in cooked ground beef was equal to that of Zn in an inorganic standard (ZnSO4), whether Zn supplements were added to a soy-concentrate diet containing phytate or to a phytate-free egg-white diet. With both diet types, total tibia Zn was a linear (P < .01) function of supplemental Zn intake from ZnSO4, but the slope of the linear regression line was twice as great for the egg-white diet as for the soy-concentrate diet that contained phytate. At 10 mg/kg of supplemental Zn, freeze-dried ground beef produced the same tibia Zn concentration (and total Zn content) as that obtained with ZnSO4. The results suggest that the relative bioavailability of Zn in cooked ground beef is as great as that in ZnSO4, whether consumed in diets with or in those without phytate.     

Tubal hydatidiform mole

We report a tubal hydatidiform mole, most likely resulting from dispermic fertilization. Early hatching of the embryo, because of a defective zona pellucida, may have favored tubal implantation.     

不典型葡萄胎的超声诊断特点及分析

目的:总结不典型葡萄胎的声像特点,提高诊断正确率.方法:回顾我院近年来经超声检查后经手术病理证实的18例不典型葡萄胎的声像图特点并进行分析.结果:18例不典型葡萄胎中7例声像图类似不全流产、9例声像图类似过期流产、2例声像图类似宫腔积血,子宫均小于妊娠月份,多不合并黄素囊肿.CDFI:病灶区内无血流或仅少量血流信号显示.结论:由于不典型葡萄胎的超声特点无明显特异性,易被误诊为其他疾病,所以提高对本病的认识,密切结合临床,才能不断提高诊断符合率.     

p53, Bax and Bcl-2 expression, and apoptosis in gestational trophoblast of complete hydatidiform mole

This study investigates the extent of apoptosis in complete hydatidiform mole (CHM), using an in situ 3'-end DNA labelling (TUNEL) technique on formalin-fixed and paraffin-embedded sections. The sections were also immunostained with antibodies to p53, Bax and Bcl-2 proteins. In 10 normal placenta cases and 15 CHM cases, the apoptotic index was <1 and 2-4 per cent, respectively. The labelled trophoblastic cells possessed pyknotic nuclei and densely eosinophilic cytoplasm which corresponded well to the so-called apoptotic bodies by light and electron microscopy. The p53 positive reaction was restricted to the nuclei of cytotrophoblasts and intermediate trophoblasts, while the syncytiotrophoblasts showed only rare immunolocalization. Strong p53 expression was seen most often in cytotrophoblasts of CHM (>30 per cent of nuclei) which also showed a higher apoptosis index, while cytotrophoblasts in normal placentae were weakly and focally labelled (<10 per cent of nuclei). There were statistical differences between normal and CHM cases (P<0.05). Bcl-2 accumulation, on the other hand, was observed predominantly in syncytiotrophoblasts of normal placentae, and cytotrophoblasts and intermediate trophoblasts did not express Bcl-2 in all cases. Interestingly, syncytiotrophoblasts were found to be negative for Bax protein and positive in cytotrophoblast, which is consistent with the function of the protein in conveying increased apoptosis susceptibility to this cell population. The results show that the level of apoptosis correlates with the histological type of the gestational trophoblasts, and apoptosis index is higher in cytotrophoblasts in CHM. The fact that p53 quantitative expression and an increase in the Bax/Bcl-2 ratio were also observed in CHM suggested that they may contribute partly to the high level of apoptosis.     

Serum and tissue vascular endothelial growth factor levels in hydatidiform mole

Using a specific and sensitive enzyme immunoassay for vascular endothelial growth factor (VEGF), we measured the circulating levels of VEGF in patients with hydatidiform mole as well as in maternal serum during normal pregnancy. VEGF levels in maternal serum were elevated at 7 weeks and then fell to a plateau. Serum VEGF levels were increased in patients with hydatidiform mole above the normal pregnant levels, while no differences were seen related to the development of persistent trophoblastic disease. By semi-quantitative RT-PCR in molar tissue for VEGF and placenta growth factor, a member of VEGF family, neither of the mRNA levels have no relation to the development of persistent trophoblastic disease. These observations suggest serum VEGF levels will be of value as a new circulating marker of hydatidiform mole.     

The syndromes of hydatidiform mole. I. Cytogenetic and morphologic correlations

Cytogenetic and morphologic analysis of 23 hydatidiform moles allowed the division into at least two syndromes: (1) the syndrome of complete (classical) mole is without an ascertainable embryo/fetus, gives a diploid karyotype, and manifests a progressive fluid engorgement of the villi as well as a gross, haphazardly distributed trophoblastic hyperplasia; (2) the syndrome of partial (incomplete) mole has an ascertainable fetus (alive or dead), gives a triploid karyotype, and exhibits a slowly progressing hydatidiform swelling in the presence of functioning villous capillaries that spares many villi; trophoblastic immaturity is constant and focal hyperplasia is inconspicuous but present. A single case of diploid mole with unusual morphologic features, complete with a fetus, may herald yet another syndrome. Human chorionic gonadotropin levels were initially high in practically all cases. There was no malignant trophoblastic disease in this small series, but a plea is made that partial moles be followed carefully in order to establish their relation to choriocarcinoma.     

Villous cytotrophoblast proliferating potential in complete and partial hydatidiform mole: diagnostic value of silver-stained nucleolar organizer region (AgNOR)-associated proteins

Aside from their typical morphologic features, complete (CHM) and partial hydatidiform mole (PHM) are characterized by variable trophoblastic proliferation and/or atypia. CHM and PHM usually present little diagnostic difficulty. However, some may be extremely difficult to distinguish by morphologic features alone. Therefore, we investigated the diagnostic value of silver-stained nucleolar organizer region (AgNOR)-associated proteins in cytotrophblasts as compared to cytogenetic features of nine CHM, nine PHM and six non-molar spontaneous embryonic abortions (controls), as well as of two suspected CHM and two histologically suspected PHM. Tissue sections were submitted to autoclave pretreatment and to silver colloid solution. The proliferating potential of cytotrophoblasts was determined by the analysis of mean number and mean area of AgNORs per nucleus using a PC-based image analysis system. Mean values of AgNOR parameters were significantly different from each other (p < 0.001). Each of the four cases of tentative diagnosis could be assigned to the corresponding group of examined trophoblastic lesions. The evaluation of AgNORs in cytotrophoblasts contributes to a reliable discrimination of CHM and PHM; this fairly simple and economical method could serve as an useful addition to conventional methods of diagnosis in gestational trophoblastic disease.     

Ampullary tubal hydatidiform mole treated with linear salpingotomy. A case report

The striking male predominance in patients with adenocarcinoma of the esophagus (male:female ratio = 6:1) is not explained by known risk factors. We hypothesized that sex hormones could be responsible for this sex imbalance. If the hypothesis is correct, treatment that increases the estrogen level and/or decreases the testosterone level in males might reduce the risk of developing esophageal adenocarcinoma. To test our hypothesis, we performed a population-based, retrospective cohort study among all patients given a diagnosis of prostate cancer in Sweden between 1958 and 1992. The vast majority had received prolonged antiandrogenic treatment, typically with estrogens. A total of 100,215 patients were followed up for an average of 4 years. The standardized incidence ratio, the ratio of the observed to the expected number of incident cancers, was used as a measure of relative risk, with the expected number derived from the entire Swedish population. We observed 14 adenocarcinomas of the esophagus during follow-up in the cohort, compared to the 16 expected, yielding a relative risk close to unity (standardized incidence ratio = 0.9; 95% confidence interval = 0.5-1.5). Analysis by latency intervals after prostate cancer diagnosis revealed no clear trend toward increasing or decreasing risk over time. In conclusion, our Swedish data did not provide any support for our hypothesis of a role of sex hormones in the etiology of esophageal adenocarcinoma.     

Complete hydatidiform mole and coexisting normal fetuses. A report of two cases with contrasting outcomes

BACKGROUND: Multiple pregnancies consisting of a complete hydatidiform mole and coexisting fetuses are relatively rare but may become more common due to the increasing use of ovulation-induction agents. CASES: We report on a twin and a triplet pregnancy, conceived using clomiphene citrate, with contrasting outcomes. The twin pregnancy resulted in a term delivery of a healthy singleton and the triplet pregnancy in a termination at 17 weeks followed by the development of choriocarcinoma. CONCLUSION: The few cases available suggest that a subgroup of complete moles follows a more benign course and can be managed conservatively, allowing the pregnancy to go to term with appropriate follow-up, whereas other cases follow a more aggressive course. Larger case series are needed to develop definitive protocols.     

The assessment of the umbilical blood flow of the surviving twin after the intrauterine death of the other twin

This paper summarizes our experience with Doppler velocimetry in survivors of intrauterine co-twin demise. In the first trimester, ten dichorionic deaths occurred; none of the survivors developed flow disorders. During the second trimester, there were three intrauterine demises, two of them were monochorionic and the survivors developed flow disorders: one presented transitory venous flow aberration, the other one an impaired development of diastolic flow. In the third trimester, two intrauterine deaths occurred. One case of twin to twin transfusion syndrome (TTTS) was complicated by the donor's death and the recipient showed a loss of diastolic flow. The second one happened during a dichorionic twin pregnancy. The survivor presented high systolic/diastolic daily ratio (S/D = 7.8).     

Absence of upper limbs (amelia) in surviving intrauterine twin after salpingectomy for ectopic pregnancy

A patient is described who had simultaneous tubal and intrauterine pregnancies. The tubal pregnancy was treated by salpingectomy at 51 days after the onset of the last menstrual period. The surviving twin was born after 42 weeks gestation and had no upper limbs (amelia).     

Twin pregnancy with one fetus in a rudimentary horn: a case report of a surviving twin

We report herein the case of a 30-year-old man who developed a primary leiomyosarcoma (LMS) 11 years after undergoing a median sternotomy for mediastinal seminoma followed by 50 Gy radiotherapy. He was given two courses of chemotherapy, resulting in 90% tumor regression, after which resection of the tumor with adjacent chest wall structures was carried out. Reconstruction was performed using a methylmethacrylate prosthesis prepared preoperatively. Postoperatively, he received two additional courses of chemotherapy and has had no sign of recurrence for 45 months.     

Coexistent thyroid cancer and pregnancy

OBJECTIVE: A study was performed to determine the appropriate time for the initiation of therapy for thyroid carcinoma first diagnosed during pregnancy. DATA SOURCES: Material on thyroid cancer cases was obtained from the New Mexico Tumor Registry, Albuquerque, a computerized population-based registry for the state of New Mexico, and the Indian reservation facilities in New Mexico and Arizona (a Surveillance, Epidemiology, and End Results Registry funded by the National Cancer Institute, Bethesda, Md) for the period 1970 to 1991. STUDY SELECTION: All cases of thyroid cancer, except medullary and anaplastic, in patients aged 18 to 46 years were evaluated. Subgroups were established for (1) all women who were noted to be pregnant at the time of their initial diagnosis and (2) all women with thyroid cancer in the 18- to 46-year-old age group. DATA EXTRACTION: The information was extracted by a certified tumor registrar for age, sex, thyroid cancer, specific type of thyroid cancer, period, race, year of diagnosis, accession date, last date seen, tumor status, treatment, and patient status. DATA SYNTHESIS: There have been no deaths in the pregnant group with a follow-up ranging from 0.5 to 20 years. There was no statistically significant difference in observed survival rates between the pregnant group and 465 women, aged 18 to 46 years, with comparable thyroid cancers or in the death rates of women aged 18 to 67 years in the general population. CONCLUSIONS: Surgical treatment for patients with well-differentiated thyroid cancer diagnosed during pregnancy can be delayed until after parturition.     

Coexistent minocycline-induced systemic lupus erythematosus and autoimmune hepatitis

BACKGROUND AND OBJECTIVES: The K-ras gene is one of the most extensively investigated oncogenes in a wide variety of human tumors, but has rarely been studied in distal bile duct carcinoma (DBDC). We sought to investigate the diagnostic and prognostic value of K-ras codon 12 mutations in this type of tumor. METHODS: Forty-seven patients who had undergone resection for DBDC were analyzed to reveal the incidence of K-ras codon 12 mutations, the locus most frequently involved. A rapid and simple two-step, semi-nested polymerase chain reaction (PCR) technique was used to detect mutations in paraffin-embedded tumor samples. RESULTS: The PCR mismatch amplification technique demonstrated that 35 (75%) of the 47 tumors harbored a point mutation in codon 12 of the K-ras oncogene. Patients with mutated tumors had no statistically different survival time compared to those patients without a mutation in the tumor. In contrast, negative microscopic margins proved to be a significant prognosticator. CONCLUSIONS: K-ras codon 12 mutations are common in DBDC and may be useful in the diagnosis and early detection of these tumors. However, no prognostic value of these mutations could be identified in this analysis. The results of this study also suggest that negative surgical margins remain the mainstay of prognostication in resectable DBDC. However, due to the small number of patients included in this study, the results obtained should be interpreted with care.     

Coexistent Hirschsprung's disease and esophageal achalasia in male siblings

Achalasia of the esophagus developed in two male siblings soon after birth, and they were successfully treated by surgery. Persistent signs resulted in the later diagnosis of Hirschsprung's disease. One required subtotal colectomy and ileoanal anastomosis, and the other is managing well on conservative treatment. Genetic analysis of the genes encoding the RET protooncogene, endothelin-3, and the endothelin-3 receptor did not show any defect. Familial achalasia of the esophagus in combination with Hirschsprung's disease has never been reported.