1.
Analysis of cell‐free DNA in maternal blood in screening for aneuploidies: updated meta‐analysis
Gil, M. M.; Accurti, V.; Santacruz, B. ...
Ultrasound in obstetrics & gynecology,
September 2017, Letnik:
50, Številka:
3
Journal Article
ABSTRACT
Objectives
To review clinical validation or implementation studies of maternal blood cell‐free (cf) DNA analysis and define the performance of screening for fetal trisomies 21, 18 and 13 and ...
sex chromosome aneuploidies (SCA).
Methods
Searches of PubMed, EMBASE and The Cochrane Library were performed to identify all peer‐reviewed articles on cfDNA testing in screening for aneuploidies between January 2011, when the first such study was published, and 31 December 2016. The inclusion criteria were peer‐reviewed study reporting on clinical validation or implementation of maternal cfDNA testing in screening for aneuploidies, in which data on pregnancy outcome were provided for more than 85% of the study population. We excluded case–control studies, proof‐of‐principle articles and studies in which the laboratory scientists carrying out the tests were aware of fetal karyotype or pregnancy outcome. Pooled detection rates (DRs) and false‐positive rates (FPRs) were calculated using bivariate random‐effects regression models.
Results
In total, 35 relevant studies were identified and these were used for the meta‐analysis on the performance of cfDNA testing in screening for aneuploidies. These studies reported cfDNA results in relation to fetal karyotype from invasive testing or clinical outcome. In the combined total of 1963 cases of trisomy 21 and 223 932 non‐trisomy 21 singleton pregnancies, the weighted pooled DR and FPR were 99.7% (95% CI, 99.1–99.9%) and 0.04% (95% CI, 0.02–0.07%), respectively. In a total of 563 cases of trisomy 18 and 222 013 non‐trisomy 18 singleton pregnancies, the weighted pooled DR and FPR were 97.9% (95% CI, 94.9–99.1%) and 0.04% (95% CI, 0.03–0.07%), respectively. In a total of 119 cases of trisomy 13 and 212 883 non‐trisomy 13 singleton pregnancies, the weighted pooled DR and FPR were 99.0% (95% CI, 65.8–100%) and 0.04% (95% CI, 0.02–0.07%), respectively. In a total of 36 cases of monosomy X and 7676 unaffected singleton pregnancies, the weighted pooled DR and FPR were 95.8% (95% CI, 70.3–99.5%) and 0.14% (95% CI, 0.05–0.38%), respectively. In a combined total of 17 cases of SCA other than monosomy X and 5400 unaffected singleton pregnancies, the weighted pooled DR and FPR were 100% (95% CI, 83.6–100%) and 0.004% (95% CI, 0.0–0.08%), respectively. For twin pregnancies, in a total of 24 cases of trisomy 21 and 1111 non‐trisomy 21 cases, the DR was 100% (95% CI, 95.2–100%) and FPR was 0.0% (95% CI, 0.0–0.003%), respectively.
Conclusions
Screening by analysis of cfDNA in maternal blood in singleton pregnancies could detect > 99% of fetuses with trisomy 21, 98% of trisomy 18 and 99% of trisomy 13 at a combined FPR of 0.13%. The number of reported cases of SCA is too small for accurate assessment of performance of screening. In twin pregnancies, performance of screening for trisomy 21 is encouraging but the number of cases reported is small. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Resumen
Análisis del ADN fetal en sangre materna para la detección de aneuploidías: un metaanálisis actualizado
Objetivos
Revisar estudios clínicos de validación o de implementación de análisis de ADN fetal (cfDNA, por sus siglas en inglés) en la sangre materna y definir el desempeño de la detección de las trisomías fetales 21, 18 y 13 y las aneuploidías de los cromosomas sexuales (SCA, por sus siglas en inglés).
Métodos
Se realizaron búsquedas en PubMed, EMBASE y The Cochrane Library para identificar todos los artículos revisados por pares sobre pruebas de cfDNA para la detección de aneuploidías entre enero de 2011, cuando se publicó el primer estudio, y el 31 de diciembre de 2016. Los criterios de inclusión fueron estudios revisados por pares sobre la validación o la implementación clínica de pruebas de cfDNA materno en la detección de aneuploidías, en los que se proporcionaban datos sobre los resultados del embarazo para más del 85% de la población estudiada. Se excluyeron los estudios de casos y controles, los artículos sobre estudios de viabilidad y los estudios donde los científicos de laboratorio que realizaron las pruebas, conocían el cariotipo fetal o el resultado del embarazo. Las tasas combinadas de detección (TD) y de falsos positivos (TFP) se calcularon utilizando modelos de regresión bivariantes de efectos aleatorios.
Resultados
En total, se identificaron 35 estudios relevantes que se usaron para el metaanálisis sobre el desempeño de la prueba de cfDNA en la detección de aneuploidías. Estos estudios informaron sobre los resultados del cfDNA en relación con el cariotipo fetal a partir de pruebas invasivas o resultados clínicos. En el total combinado de 1963 casos de trisomía 21 y 223 932 embarazos con feto único sin trisomía 21, las TD y TFP ponderadas combinadas fueron del 99,7% (IC 95%, 99,1–99,9%) y del 0,04% (IC 95%, 0,02–0,07 %), respectivamente. En un total de 563 casos de trisomía 18 y 222 013 embarazos con feto único sin trisomía 18, las TD y TFP ponderadas combinadas fueron del 97,9% (IC 95%, 94,9–99,1%) y del 0,04% (IC 95%, 0,03–0,07%), respectivamente. En un total de 119 casos de trisomía 13 y 212 883 embarazos con feto único sin trisomía 13, las TD y TFP ponderadas combinadas fueron del 99,0% (IC 95%, 65,8‐100%) y del 0,04% (IC 95%, 0,02–0,07%), respectivamente. En un total de 36 casos de monosomía X y 7676 embarazos con feto único no afectados, las TD y TFP ponderadas combinadas fueron del 95,8% (IC 95%, 70,3–99,5%) y del 0,14% (IC 95%, 0,05–0,38%), respectivamente. En un total combinado de 17 casos de SCA distintos de los de monosomía X y los 5400 embarazos con feto único no afectados, las TD y TFP ponderadas combinadas fueron del 100% (IC 95%, 83,6–100%) y 0,004% (IC 95%, 0,0–0,08% ), respectivamente. Para los embarazos de gemelos, en un total de 24 casos de trisomía 21 y 1111 casos sin trisomía 21, la TD fue del 100% (IC 95%, 95,2–100%) y la TFP fue del 0,0% (IC 95%, 0,0–0,003%), respectivamente.
Conclusiones
El cribado mediante el análisis del cfDNA en la sangre materna en embarazos con feto único podría detectar >99% de fetos con trisomía 21, un 98% con trisomía 18 y un 99% con trisomía 13, con una TFP combinado del 0,13%. El número de casos notificados de SCA es insuficiente para una evaluación precisa del desempeño del cribado. En los embarazos de gemelos, el rendimiento del cribado de la trisomía 21 es alentador, pero el número de casos notificados es pequeño.
摘要
通过分析母体血液游离DNA筛查非整倍体:最新的meta分析结果
目的
回顾对母体血液游离(cell‐free,cf)DNA进行分析的临床验证或应用研究,确定其对胎儿21、18、13三体和性染色体非整倍体(sex chromosome aneuploidies,SCA)的筛查能力。
方法
检索PubMed、EMBASE和The Cochrane Library,查找2011年1月(此类研究首次发表时间)至2016年12月31日间发表的通过检测cfDNA筛查非整倍体的所有同行评议文献。纳入标准为经同行评议的通过检测母体cfDNA筛查非整倍体的临床验证或应用研究,其中给出了85%以上的研究人群的妊娠结局。排除病例对照研究、原理验证文献以及进行检测的实验室人员知晓胎儿核型或妊娠结局的研究。采用双变量随机效应回归模型计算合并检出率(detection rates,DRs)和假阳性率(false‐positive rates,FPRs)。
结果
共检索到35项相关研究,将其纳入cfDNA检测对非整倍体筛查能力的meta分析中。研究报道了通过侵入性检查或临床结局获得的与胎儿核型有关的cfDNA结果。总共1963例 21三体和223 932例非21三体单胎妊娠,加权合并DR和FPR分别为99.7%(95% CI,99.1%~99.9%)和0.04%(95% CI,0.02%~0.07%)。共563例18三体和222 013例非18三体单胎妊娠,加权合并DR和FPR分别为97.9%(95% CI,94.9%~99.1%)和0.04%(95% CI,0.03%~0.07%)。共119例13三体和212 883例非13三体单胎妊娠,加权合并DR和FPR分别为99.0%(95% CI,65.8%~100%)和0.04%(95% CI,0.02%~0.07%)。共36例X 单体和7676例非X 单体的单胎妊娠,加权合并DR和FPR分别为95.8%(95% CI,70.3%~99.5%)和0.14%(95% CI,0.05%~0.38%)。总共17例SCA(除外X单体)和5400例非SCA单胎妊娠,加权合并DR和FPR分别为100%(95% CI,83.6%~100%)和0.004%(95% CI,0.0%~0.08%)。双胎妊娠中,共24例21三体和1111例非21三体,DR为100%(95% CI,95.2%~100%),FPR为0.0%(95% CI,0.0%~0.003%)。
结论
单胎妊娠中,通过分析母体血液cfDNA进行筛查,21三体胎儿检出率>99%,18三体检出率为98%,13三体检出率为99%,合并FPR为0.13%。由于报道的SCA例数过少,不能准确评估筛查能力。双胎妊娠中, 21三体的筛查能力值得关注,但报道的病例数较少。
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
2.
Fetal loss after chorionic villus sampling in twin pregnancy
Elger, T.; Akolekar, R.; Syngelaki, A. ...
Ultrasound in obstetrics & gynecology,
July 2021, 2021-07-00, 20210701, Letnik:
58, Številka:
1
Journal Article
ABSTRACT
Objective
To estimate the chorionic villus sampling (CVS)‐related risk of fetal loss in twin pregnancy after adjustment for chorionicity, nuchal translucency thickness (NT), intertwin ...
discordance in crown–rump length (CRL), maternal demographic characteristics and serum pregnancy‐associated plasma protein‐A (PAPP‐A) and free β‐human chorionic gonadotropin (β‐hCG).
Methods
This was a multicenter study from eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. Data were obtained prospectively from women with twin pregnancy undergoing routine ultrasound examination at 11–13 weeks' gestation. Multivariable logistic regression analysis with backward stepwise elimination was used to examine whether CVS provided a significant independent contribution to the prediction of risk of fetal loss after adjusting for maternal and pregnancy characteristics, including maternal age, racial origin and weight, method of conception, smoking status, parity, chorionicity, intertwin discordance in CRL, fetal NT ≥ 95th percentile and free β‐hCG and PAPP‐A multiples of the median. Similarly, within the CVS group, multivariable logistic regression analysis was used to investigate the effect of the number of intrauterine needle insertions and size of the needle on the risk of fetal loss.
Results
The study population of 8581 twin pregnancies undergoing ultrasound examination at 11–13 weeks' gestation included 316 dichorionic and 129 monochorionic twins that had CVS. First, in twin pregnancies undergoing CVS, compared to those not undergoing CVS, there was a 2‐fold increased risk of fetal loss at < 24 weeks' gestation and of loss at any stage in pregnancy. Second, the factors providing a significant independent contribution to the prediction of miscarriage or fetal loss in twin pregnancy were increased maternal weight, black racial origin, monochorionicity, and more so monoamnionicity, large intertwin discordance in CRL and increased fetal NT, and, in the case of fetal loss at any stage, there was also a contribution from assisted conception and low serum PAPP‐A. Third, after adjustment for maternal and pregnancy characteristics, CVS did not provide a significant contribution to the risk of fetal loss. Fourth, in twin pregnancies that had CVS, there was no significant contribution to fetal loss from the number of intrauterine needle insertions or needle size.
Conclusion
The 2‐fold increased risk of fetal loss following CVS in twin pregnancy can, to a great extent, be explained by maternal and pregnancy characteristics rather than the invasive procedure itself. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
A video of this article is available online here.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
3.
Prediction of pre‐eclampsia in twin pregnancy by maternal factors and biomarkers at 11–13 weeks' gestation: data from EVENTS trial
Benkő, Z.; Wright, A.; Rehal, A. ...
Ultrasound in obstetrics & gynecology,
February 2021, 2021-Feb, 2021-02-00, 20210201, Letnik:
57, Številka:
2
Journal Article
ABSTRACT
Objectives
First, to validate a previously developed model for screening for pre‐eclampsia (PE) by maternal characteristics and medical history in twin pregnancies; second, to compare the ...
distributions of mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI), serum placental growth factor (PlGF) and serum pregnancy‐associated plasma protein‐A (PAPP‐A) in twin pregnancies that delivered with PE to those in singleton pregnancies and to develop new models based on these results; and, third, to examine the predictive performance of these models in screening for PE with delivery at < 32 and < 37 weeks' gestation.
Methods
Two datasets of prospective non‐intervention multicenter screening studies for PE in twin pregnancies at 11 + 0 to 13 + 6 weeks' gestation were used. The first dataset was from the EVENTS (Early vaginal progesterone for the preVention of spontaneous prEterm birth iN TwinS) trial and the second was from a previously reported study that examined the distributions of biomarkers in twin pregnancies. Maternal demographic characteristics and medical history from the EVENTS‐trial dataset were used to assess the validity of risks from our previously developed model. The combined data from the first and second datasets were used to compare the distributional properties of log10 multiples of the median (MoM) values of UtA‐PI, MAP, PlGF and PAPP‐A in twin pregnancies that delivered with PE to those in singleton pregnancies and develop new models based on these results. The competing‐risks model was used to estimate the individual patient‐specific risks of delivery with PE at < 32 and < 37 weeks' gestation. Screening performance was measured by detection rates (DR) and areas under the receiver‐operating‐characteristics curve.
RESULTS
The EVENTS‐trial dataset comprised 1798 pregnancies, including 168 (9.3%) that developed PE. In the validation of the prior model based on maternal characteristics and medical history, calibration plots demonstrated very good agreement between the predicted risks and the observed incidence of PE (calibration slope and intercept for PE < 32 weeks were 0.827 and 0.009, respectively, and for PE < 37 weeks they were 0.942 and −0.207, respectively). In the combined data, there were 3938 pregnancies, including 339 (8.6%) that developed PE and 253 (6.4%) that delivered with PE at < 37 weeks' gestation. In twin pregnancies that delivered with PE, MAP, UtA‐PI and PlGF were, at earlier gestational ages, more discriminative than in singleton pregnancies and at later gestational ages they were less so. For PAPP‐A, there was little difference between PE and unaffected pregnancies. The best performance of screening for PE was achieved by a combination of maternal factors, MAP, UtA‐PI and PlGF. In screening by maternal factors alone, the DR, at a 10% false‐positive rate, was 30.6% for delivery with PE at < 32 weeks' gestation and this increased to 86.4% when screening by the combined test; the respective values for PE < 37 weeks were 24.9% and 41.1%.
Conclusions
In the assessment of risk for PE in twin pregnancy, we can use the same prior model based on maternal characteristics and medical history as reported previously, but in the calculation of posterior risks it is necessary to use the new distributions of log10 MoM values of UtA‐PI, MAP and PlGF according to gestational age at delivery with PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
4.
Risk of fetal loss after chorionic villus sampling in twin pregnancy derived from propensity score matching analysis
Gil, M. M.; Rodríguez‐Fernández, M.; Elger, T. ...
Ultrasound in obstetrics & gynecology,
February 2022, 2022-Feb, 2022-02-00, 20220201, Letnik:
59, Številka:
2
Journal Article
ABSTRACT
Objective
To estimate the risk of fetal loss associated with chorionic villus sampling (CVS) in twin pregnancy, using propensity score analysis.
Methods
This was a multicenter cohort study ...
of women with twin pregnancy undergoing ultrasound examination at 11–13 weeks' gestation, performed in eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. The risk of death of at least one fetus was compared between pregnancies that had and those that did not have CVS, after propensity score matching (1:1 ratio). This procedure created two comparable groups by balancing the maternal and pregnancy characteristics that lead to CVS being performed, similar to how randomization operates in a randomized clinical trial.
Results
The study population of 8581 twin pregnancies included 445 that had CVS. Death of one or two fetuses at any stage during pregnancy occurred in 11.5% (51/445) of pregnancies in the CVS group and in 6.3% (515/8136) in the non‐CVS group (P < 0.001). The propensity score algorithm matched 258 cases that had CVS with 258 non‐CVS cases; there was at least one fetal loss in 29 (11.2%) cases in the CVS group and in 35 (13.6%) cases in the matched non‐CVS group (odds ratio (OR), 0.81; 95% CI, 0.48–1.35; P = 0.415). However, there was a significant interaction between the risk of fetal loss after CVS and the background risk of fetal loss; when the background risk was higher, the risk of fetal loss after CVS decreased (OR, 0.46; 95% CI, 0.23–0.90), while, in pregnancies with a lower background risk of fetal loss, the risk of fetal loss after CVS increased (OR, 2.45; 95% CI, 0.95–7.13). The effects were statistically significantly different (P‐value of the interaction = 0.005). For a pregnancy in which the background risk of fetal loss was about 6% (the same as in our non‐CVS population), there was no change in the risk of fetal loss after CVS, but, when the background risk was more than 6%, the posterior risk was paradoxically reduced, and when the background risk was less than 6%, the posterior risk increased exponentially; for example, if the background risk of fetal loss was 2.0%, the relative risk was 2.8 and the posterior risk was 5.6%.
Conclusion
In twin pregnancy, after accounting for the risk factors that lead to both CVS and spontaneous fetal loss and confining the analysis to pregnancies at lower prior risk, CVS seems to increase the risk of fetal loss by about 3.5% above the patient's background risk. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Linked article: There is a comment on this article by Li and Li. Click here to view the Correspondence.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
5.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
6.
Perinatal outcome of monochorionic triamniotic triplet pregnancy: multicenter cohort study
Sileo, F. G.; Accurti, V.; Baschat, A. ...
Ultrasound in obstetrics & gynecology,
October 2023, 2023-10-00, 20231001, Letnik:
62, Številka:
4
Journal Article
ABSTRACT
Objective
Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and ...
late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies.
Methods
This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin‐to‐twin transfusion syndrome (TTTS), twin anemia–polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention.
Results
Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow‐up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity‐related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks' gestation was 49.2% (61/124).
Conclusion
Monochorionicity‐related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
7.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
8.
Sonoelastography as method for preliminary evaluation of uterine cervix to predict success of induction of labor
Muscatello, A; Di Nicola, M; Accurti, V ...
Fetal diagnosis and therapy,
02/2014, Letnik:
35, Številka:
1
Journal Article
Induction of labor is a useful practice to solve many obstetric situations but has a large impact on the health of women and their babies and therefore needs to be clearly justified clinically.
To ...
determine the sensitivity of sonoelastography in the evaluation of the cervix to predict the success of induction.
We enrolled 53 subjects preparing for induction of labor. Transvaginal evaluation of cervical length and a sonoelastogram were performed. We preliminarily classified the sonoelastograms into five elastography index (EI) categories and examined the different distribution of cesarean or spontaneous deliveries in various subgroups of EI by χ(2) test and multivariate analysis by logistic regression.
Statistical analysis revealed a significant difference of prevalence of spontaneous delivery (EI1-3 82.75%, EI4-5 45.8%) versus cesarean section (EI1-3 17.25%, EI4-5 54.16%) (p = 0.0072). The diagnostic validity of EI was evaluated using the receiver operating characteristic curve and cut-off of the predictive value was EI3.
The results of our study indicate that sonoelastography is an innovative technique that could allow a more objective preliminary evaluation of the cervix before inducing labor, however further studies with a larger number of subjects and a standardization of image acquisition are necessary.
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Naroči gradivo
9.
Uterine endometrioid carcinoma with focal area of choriocarcinomatous differentiation: case report
Carta, G; Accurti, V; Di Nicola, M ...
European journal of gynaecological oncology,
2014, Letnik:
35, Številka:
6
Journal Article
An endometrioid carcinoma coexisting with choriocarcinomatous differentiation is an uncommon event with an aggressive clinical course and a poor prognosis.
The authors describe an endometrioid ...
carcinoma of the endometrium provided with a focus of choriocarcinoma-like cells in a 50-year-old menstruated woman with a history of abnormal uterine bleeding. A total bilateral hystero-annessectomy was performed.
Histopathologic study showed endometrioid adenocarcinoma limited to the endometrium with a single microinvasive (< one mm) choriocarcinomatous focus. Immunohistochemistry established intense reactivity of tumor cells for CK 7 and AE1/AE3, for beta-human chorionic gonadotropin (beta-hCG), and for HER2 confirming the diagnosis. During the clinical course and follow-up, serum levels of beta-hCG were always negative. Up to date the patient is still alive with no evidence of disease.
Even if endometrioid carcinoma with choriocarcinomatous differentiation is considered highly malignant, occasionally it may have a good prognosis, especially when a non-invasive behaviour is detected together with negative serum beta-hCG levels.
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Dostopno za:
UL
10.
Naroči gradivo
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