ABSTRACT: Chemotherapy is the reference treatment for gestational trophoblastic neoplasia. In case of chemoresistance, hysterectomy has to be considered even in women wishing to conceive. A 31-year-old nulliparous patient presented a recurrent invasive mole, despite two regimens of chemotherapy. She underwent a partial uterine resection of an intramyometrial choriocarcinoma followed by a third-line regimen. Two years later she gave birth by cesarean section at 32 weeks of amenorrhea to a healthy child after a spontaneous pregnancy. In order to preserve patient's fertility, conservative uterine surgery is an alternative to hysterectomy for selected chemoresistant gestational trophoblastic neoplasia.
Gynécologie Obstétrique & Fertilité 04/2012; 40(6):376-8. · 0.52 Impact Factor
ABSTRACT: Les môles hydatiformes complètes et partielles peuvent se compliquer à distance par une tumeur trophoblastique gestationnelle.
Le diagnostic de tumeur repose sur l’évolution anormale des hCG dans les suites d’une môle ou plus rarement sur l’histologie
de choriocarcinome. Le bilan d’extension des tumeurs permet de calculer le score FIGO qui définit les tumeurs à bas risque
à traiter par méthotrexate et les tumeurs à haut risque à traiter par polychimiothérapie. Le centre français de référence
des maladies trophoblastiques fonctionne en réseau entre Lyon, Tours, Paris et Marseille avec pour buts d’enregistrer les
patientes et d’optimiser leur prise en charge en France.
Partial and complete hydatidiform moles can secondarily turn to gestational trophoblastic neoplasia (GTN). Diagnosis of GTN
is made when hCG does not return to normal value after a molar pregnancy or when histology findings show a choriocarcinoma.
A check-up for metastasis allows calculating the FIGO score that differentiates low risk patients treated with methotrexate
from high risk patients treated with polychemotherapy. The French trophoblastic disease reference centre has been implemented
as an entity within a network organised between Lyon, Tours, Paris and Marseille; this network aims to register patients and
optimize the treatment of GTN patients in France.
Oncologie 09/2008; 10(10):604-611. · 0.17 Impact Factor
ABSTRACT: The aim of this study was both to analyse if gestational trophoblastic neoplasia (GTN) registered to the French Trophoblastic Disease Reference Center (TDRC) in Lyon (France) were managed according to the FIGO criteria for diagnosis of GTN and if chemotherapy was adapted to the 2000 FIGO prognostic scoring system.
Retrospective, descriptive analysis of 167 GTN registered to GTC of Lyon between 1999 and 2005.
On the one hand, 66% of women (104/158) had a diagnosis of GTN according to FIGO criteria. One third (n=54) of the patients therefore had a premature or erroneous diagnosis of a tumor, when the treatment started. No supporting element of this premature diagnosis has been found out for 26 patients. The identification of lung and vaginal metastasis and histological diagnosis of invasive mole appeared as the most mentioned inappropriate criteria for diagnosis. On the other hand, chemotherapy was adapted to 2000 FIGO scoring in 91, 5% of cases. Twelve low risk GTN were treated with polychemotherapy and two high risk GTN were treated with monochemotherapy. Moreover 29% of the patients received a non adequate treatment due to deviations from the recommended protocol.
Non respect of FIGO criteria for the diagnosis of GTN can lead to erroneous diagnosis of tumors. Identification of lung or vaginal metastasis or diagnosis of invasive mole should not automatically justify the diagnosis of gestational trophoblastic neoplasia if the decrease in HCG occurs properly. Respect of FIGO criteria for the diagnosis of GTN and adaptation of chemotherapy to 2000 FIGO scoring are necessary to avoid inadequate treatment of gestational trophoblastic neoplasia.
Gynécologie Obstétrique & Fertilité 04/2007; 35(3):205-15. · 0.52 Impact Factor