The Role of Surgery in the Management of Gestational Trophoblastic Neoplasia The Hungarian Experience.

Objective: To review the role of surgery in the management of gestational trophoblastic neoplasia (GTN) over the past 38 years in our national trophoblastic disease center.

Study Design: Between January 1, 1977, and December 31, 2014, 371 patients with low-risk GTN and 190 patients with high-risk GTN were treated with chemotherapy, surgical interventions, or both. The indications for hysterectomy included excision of large uterine tumor masses, uterine hemorrhage or sepsis, or a drug-resistant uterine focus.

Changes in the management of high-risk gestational trophoblastic neoplasia in the National Trophoblastic Disease Center of Hungary.

Objective: To compare the clinical management of patients with high-risk gestational trophoblastic neoplasia (GTN) among the periods of 1977-1990, 1991-2000, and 2001-2012 at the National Trophoblastic Disease Center of Hungary and to assess the efficacy of the FIGO 2000 staging and risk factor scoring system in comparison to the original WHO prognostic scoring system (1983).

Study Design: We reviewed the medical records of 185 patients with high-risk GTN. From 1977-2000, patients were classified according to the original WHO prognostic scoring system (1983).

Clinical epidemiology and management of gestational trophoblastic neoplasia in Hungary in the past 34 years.

Objective: To review our clinical experience in the treatment of patients with gestational trophoblastic neoplasia (GTN) over the past 34 years in our national trophoblastic disease center.

Study Design: Between January 1, 1977, and December 31, 2010, 331 patients with low-risk GTN and 174 patients with high-risk GTN (altogether 505) were treated. The patients were directed to the national trophoblastic disease center from all parts of Hungary.

30 years' experience in the treatment of low-risk gestational trophoblastic neoplasia in Hungary.

Objective: To review the clinical experience in the treatment of patients with low-risk gestational trophoblastic neoplasia (GTN) over the past 30 years in a national trophoblastic disease center.

Study Design: Between January 1, 1977, and December 31, 2007, 302 patients with low-risk GTN were treated. The patients were directed to our institution from all parts of Hungary.

Primary pulmonary choriocarcinoma: a case report.

Background: Primary pulmonary choriocarcinoma (PPC) is an extremely rare clinical entity. In contrast with gestational trophoblastic tumors that show an extreme sensitivity for chemotherapy, extragonadal choriocarcinomas are mostly unresponsive to surgical and chemotherapeutic treatment and are associated with poor prognosis. The reason non-gestational choriocarcinomas behave so differently from gestational tumors is unknown.

25 years' experience in the treatment of gestational trophoblastic neoplasia in Hungary.

Objective: To review our clinical experience in the treatment of gestational trophoblastic neoplasia (GTN) over the past 25 years in our national trophoblastic disease center.

Study Design: Between January 1, 1977, and December 31, 2001, we treated 355 patients with GTN. The patients were between 14 and 53 years of age, with an average of 28.

Alloimmune and autoimmune background in recurrent pregnancy loss - successful immunotherapy by intravenous immunoglobulin.

Problem: Immunotherapies [leukocyte immunization, intravenous immunoglobulin (IVIG)] introduced to treat women with recurrent spontaneous abortions (RSA) have still controversial results in most clinical trials. A selection of these patients would be advantageous for higher efficacy.

Method Of Study: A complex immunological panel assay was offered to patients with reproductive failure without any other known cause.

How long should patients be followed after molar pregnancy? Analysis of serum hCG follow-up data.

Objective: We analyzed human chorionic gonadotropin (hCG) follow-up data of patients with molar pregnancy. Women often do not complete recommended post-disease screening. Our purpose was to determine if continuing follow up of uncomplicated molar cases beyond attaining undetectable hCG levels is necessary for detecting relapse of gestational trophoblastic disease.

High anti-paternal cytotoxic T-lymphocyte precursor frequencies in women with unexplained recurrent spontaneous abortions.

A number of cases of unexplained (idiopathic) recurrent spontaneous abortions may be attributable to immunological mechanisms. Several lines of evidence indicate that some immunocompetent effector cell populations play an important role in the pathogenesis of unexplained miscarriages. However a suitable method is lacking for defining an existing immunological background of recurrent spontaneous abortions.

Placental site trophoblastic tumor. Clinical and pathological report of two cases.

Placental site trophoblastic tumor (PSTT) is the rarest disease of the gestational trophoblast. Our two cases will be interesting not only because of the rarity of the disease, but because both were recognized before operation. Since the tumor cells are lined up tightly side by side, this disease must be distinguished primarily from tumors of epithelial origin.

Sonographic diagnosis of a retroperitoneal dermoid cyst in a young girl.

We describe the detection and management of a retroperitoneal dermoid cyst in a young girl. Transabdominal ultrasound revealed in the pelvis a complex mass with anechogenic and echogenic components characteristic of a dermoid cyst. Initially, it was presumed to be of ovarian origin, because extragonadal dermoid cysts are very rare in adolescence; however, the findings on physical examination were normal.

Ovarian cysts in children and adolescents: their occurrence, behavior, and management.

Study Objective: To evaluate the characteristics and symptoms of ovarian cysts, their connection with the methods of treatment, and the effectiveness of the therapy.

Methods: A retrospective analysis of data on girls with ovarian cysts was performed at a university clinic. Participants included 119 girls in whom 144 ovarian cysts were found by ultrasound examination performed either routinely or for a specific purpose.

c-myc, c-erbB-2, c-fms and bcl-2 oncoproteins. Expression in normal placenta, partial and complete mole, and choriocarcinoma.

Objective: To determine the expression of bcl-2, c-myc, c-fms and c-erbB-2 oncoproteins in normal placentas, partial and complete hydatidiform moles, and choriocarcinomas and to examine the possible presence of mutations in the K-ras gene in complete moles and choriocarcinomas.

Study Design: The expression of the above oncoproteins was determined immunohistochemically by specific antibodies for these proteins on formalin-fixed paraffin sections of 18 normal placentas, 17 partial moles, 25 complete moles and 11 choriocarcinomas. This was followed by polymerase chain reaction analysis (exons 12 and 13) of K-ras gene for possible mutations in complete moles and choriocarcinomas.

The polymorphic human TLX-B/CD46/MCP system and its implications in transplantation and reproduction.

TLX antigens have been found on most peripheral blood cells, trophoblasts, seminal vesicle cells and sperms. These antigens seem to be associated with the membrane cofactor protein (MCP) and the CD46 antigen. Alloantibodies to TLX antigens with Fc tau RII-blocking features were obtained by transfusion of leucocytes or platelets.

[Detection of gamma-interferon mRNA in JEG-3 choriocarcinoma cell line by means of polymerase chain reaction].

To investigate the pathogenesis of choriocarcinoma the authors employed a newly developed gene amplification method by reverse polymerase chain reaction for the detection of gamma-interferon messenger RNA in JEG-3 choriocarcinoma cell line. Polymerase chain reaction products were analysed by agarose gel electrophoresis. Using 1 Kb DNA ladder as a marker, 84 base-pair fragment was selectively amplified correlating with published gamma-interferon gene fragment length.

Tetraploidy in human placenta. A dilemma in molar and non-molar pregnancies.

17 cases of partial molar pregnancy were analysed cytogenetically by the direct-preparation method. Eight partial moles were triploid, 7 diploid/tetraploid mosaic, and 2 tetraploid. In the course of prenatal cytogenetic screening, out of 1,263 chorionic villus samplings, 2 tetraploid and 1 diploid/tetraploid cases were found.

Effect of choriocarcinoma supernatant on natural killer and lymphokine-activated killer cell activity.

The effect of JEG-3 choriocarcinoma supernatant on human natural killer cell and lymphokine-activated killer cell activity was investigated. Choriocarcinoma supernatants from JEG-3 cell lines were obtained at the time of their optimal growth. K562 erythroblastoid cells were used as target cells for natural killer and lymphokine-activated killer cell mediated lysis in a 51Cr release assay.

Updated screening protocol for abortion services.

We performed 2976 first-trimester abortions at our outpatient center in 1986. In 16 cases (0.54%), products of conception could not be confirmed histologically, although history, bimanual pelvic examination, and urine pregnancy test were suggestive of pregnancy.

The frequency and management of uterine perforations during first-trimester abortions.

The frequency and management of uterine perforation during first-trimester abortions remain a matter of continuing debate among gynecologists. The rate of uterine perforations was 1.3/1000 procedures (eight cases) in 6408 women undergoing first-trimester abortions at our clinic.

Association of previous abdominal surgery and significant adhesions in laparoscopic sterilization patients.

Many surgeons believe that women who have undergone laparotomy are not good candidates for laparoscopic sterilization. Many of those women are admitted for minilaparotomy. However, women without previous surgery can also have adhesions.

Laparoscopic sterilization combined with dilation and evacuation up to 18 weeks' gestation.

First-trimester suction curettage abortion performed at the time of laparoscopic sterilization does not increase the morbidity or failure rate of either procedure. No studies have been done to determine the safety of laparoscopic sterilization in association with midtrimester pregnancy termination by dilation and evacuation. Between Jan 1, 1987, and Feb 1, 1988, we performed 21 laparoscopic sterilizations at the time of second-trimester terminations of pregnancy.

Availability of donated oocytes from an ambulatory sterilization program.

An oocyte donor program was established at the Women's Medical Pavilion, Dobbs Ferry, New York, in 1987 for women lacking normal ovarian function. The oocytes were donated voluntarily in stimulated cycles by women undergoing laparoscopic sterilization. If the donors agreed to use ovulation-induction agents and be monitored, they were compensated for their time and inconvenience.

[Partial mole with lung metastases and multiple abnormalities of the fetus].

The authors report on a patient with partial mole, multiple malformations and lung metastases requiring chemotherapy. This case shows that the partial hydatidiform mole must therefore be carefully monitored by serial beta-hCG titres following evacuation to ensure the achievement of complete sustained remission.

Direct chromosomal preparation for studying hydatidiform moles.

This report describes a simple direct method to obtain chromosomes from hydatidiform moles. Of 24 moles, 20 have been successfully karyotyped by this method. Of the 20 cases, 14 were complete and six were partial.