Navegando por Palavras-chave "hydatidiform mole"
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- ItemSomente MetadadadosCentralized Coordination of Decentralized Assistance for Patients with Gestational Trophoblastic Disease in Brazil A Viable Strategy for Developing Countries(Sci Printers & Publ Inc, 2016) Braga, Antonio; Burla, Marcelo; Freitas, Fernanda; Uberti, Elza; Viggiano, Mauricio; Sun, Sue Yazaki [UNIFESP]; Maesta, Izildinha; Elias, Kevin M.; Berkowitz, Ross S.OBJECTIVE: To report on the Brazilian Association of Gestational Trophoblastic Disease's (GTD) formation of a network of regional care at specialized centers for women with GTD. STUDY DESIGN: We developed a questionnaire composed of 15 questions, which was sent by email to the 38 Brazilian GTD Reference Center (BGTDRC) Directors who are members of the Brazilian Association of GTD, in order to characterize the professionals involved in the care of patients with GTD and the type of assistance provided. RESULTS: The Directors of the BGTDRCs are usually specialists in Gynecology and Obstetrics (97%), with a median experience of a decade in treating women with GTD. The BGTDRCs are linked to university hospitals in 75% of centers and provide completely free medical care in 87%. However, 52% of centers do not perform chemotherapy in their reference center, and patients are referred elsewhere for chemotherapy. Despite some difficulties, the rate of patients lost to follow-up before human chorionic gonadotropin remission is 9%, and the GTD mortality rate is 0.9%. CONCLUSION: Due to large regional disparities, the BGTDRCs are not uniformly organized. However, under the coordination of the Brazilian Association of GTD there is now strong communication and collaboration among reference centers, which has significantly advanced both patient care and research into the management of these diseases.
- ItemSomente MetadadadosEpidemiological Report on the Treatment of Patients with Gestational Trophoblastic Disease in 10 Brazilian Referral Centers Results After 12 Years Since International FIGO 2000 Consensus(Sci Printers & Publ Inc, 2014-05-01) Braga, Antonio; Hartmann Uberti, Elza Maria; Fajardo, Maria do Carmo; Viggiano, Mauricio; Sun, Sue Yazaki; Grillo, Bruno Maurizio; Padilha, Sergio Lunardon; Andrade, Jurandyr Moreira de; Souza, Christiani Bisinoto de; Madi, Jose Mauro; Maesta, Izildinha; Silveira, Eduardo; Universidade Federal do Rio de Janeiro (UFRJ); Irmandade Santa Casa Misericordia Porto Alegre Ma; Universidade Federal de Goiás (UFG); Universidade Federal de São Paulo (UNIFESP); Parana Univ Hosp; Universidade de São Paulo (USP); Caxias do Sul Univ; Guilherme Alvaro Hosp SantosOBJECTIVE: To evaluate treatment of Brazilian patients with gestational trophoblastic disease (GTD).STUDY DESIGN: A retrospective cohort study with analysis of medical reports performed in 10 Brazilian referral centers from January 2000 to December 2011.RESULTS: Of 5,250 patients 3 died (0.06%) at the time of uterine evacuation. Spontaneous remission of GTD (group G1) was observed in 4,103 cases, and 1,144 (21.8%) progressed to gestational trophoblastic neoplasia (GTN) (G2). In G1 2,716 (66.2%) had complete hydatidiform mole (HM) and 1,210, partial HM (29.5%); 3,772 patients (92.7%) recovered as noted in December 2012. In G2, of 1,118 patients treated, initial histopathological results of previous gestation were complete HM (77.5% [n = 886]), partial HM (8.8% [n = 100]), and choriocarcinoma (8.0% [n = 92]); 930 (81.3%) were low-risk, 200 (17.5%) were high-risk GTN, and 14 had placental site trophoblastic tumor (PSTT) (1.2%); cure was achieved in 1,078 cases (96.4%), but 26 patients (2.3%) died (4 low-risk [0.4%], 19 high-risk [9.5%], and 3 PSTT [21.4%]).CONCLUSION: The highest death rates were due to high-risk GTN and PSTT. Patients with molar pregnancy should be referred to a referral center for an early diagnosis and prompt treatment of GTN in order to reduce the morbidity and mortality found in advanced stages.
- ItemSomente MetadadadosMaternal Near Miss According to World Health Organization Classification Among Women with a Hydatidiform Mole Experience at the New England Trophoblastic Disease Center, 1994-2013(Sci Printers & Publ Inc, 2016) Sun, Sue Yazaki [UNIFESP]; Goldstein, Donald P.; Bernstein, Marilyn R.; Horowitz, Neil S.; Mattar, Rosiane [UNIFESP]; Maesta, Izildinha; Braga, Antonio; Berkowitz, Ross S.OBJECTIVE: To investigate the frequency of potentially life-threatening conditions (PLTCs) and maternal near misses (MNMs) at the New England Trophoblastic Disease Center (NETDC) in recent years, when there has been earlier diagnosis of molar pregnancy. STUDY DESIGN: This study included patients with molar pregnancy at the NETDC between 1994 and 2013. Clinical and pathologic reports were reviewed. PLTC and MNM criteria and maternal deaths were searched in medical records using the World Health Organization criteria and classification. RESULTS: We identified 375 patients with molar pregnancy and no patient developed a MNM or maternal death. Only 6 (1.6%) had PLTCs (hemorrhage with hemodynamic instability, severe preeclampsia, respiratory distress, blood transfusion, and ICU admission). CONCLUSION: We observed a low rate of PLTC and no cases of MNMs or maternal deaths related to molar pregnancy, likely due to earlier diagnosis at the NETDC in recent years.
- ItemSomente MetadadadosMola hidatiforme - achados anatomopatológicos, imuno-histoquimicos e moleculares(Universidade Federal de São Paulo (UNIFESP), 2016-12-14) Martinez, Rosana Mercante [UNIFESP]; Alves, Maria Teresa de Seixas Alves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Hydatidiform mole (HM) is a benign tumor of placental trophoblastic cells, secondary to a fertility disorder causing abnormal development of the placenta. It can be classified as complete hydatidiform mole (CM) and partial hydatidiform mole (PM). The MC is diploid and the karyotype is 46, XX or 46, XY. In both cases we have the formation of a diploid zygote with duplication of paternal genetic load (diandria). On the other hand, the MP is triploid and 70% of the cases present the karyotype is 69, XXY. The distinction between the two types of HM and HM and not molar specimens (MN) is very important in view of differential risk for the development of persistent gestational trophoblastic disease. Aim: To correlate the pathological findings, immunohistochemical and molecular and miscarriage 27 samples sent to the Department of Pathology - UNIFESP, assessing the importance of complementary methods (STR and Immunohistochemistry) in the diagnosis of molar abortion. Methods: Twenty-seven samples were selected from the Department of Pathology file. Immunohistochemical analysis was reviewed by the pathologist and some samples that had no prior immunohistochemistry were required to perform the technique. To assess ploidy DNA was extracted from the samples and used genotyping of microsatellite technique (STR). Results: Correlating the initial pathology findings, immunohistochemical and molecular, we observed that 77,8% of cases were concordant, 14,8% discordant and 7,4% inconclusive. All discordant diagnosis were MC and triploid. Some cases of PM X MN the ploidy studies didn´t aid in the differential diagnostic, so the DNA ploidy in two cases was triploid. Conclusion: IHC evaluation of p57 protein is a practical and suitable for distinguishing between CM and PM. The analysis of p57 can be used with the ploidy studies to refine the diagnosis of early molar pregnancies
- ItemSomente MetadadadosA twin pregnancy with a hydatidiform mole and a coexisting live fetus: prenatal diagnosis, treatment, and follow-up(Medical Communications, 2017) Braga, Antonio; Obeica, Bruna; Werner, Heron; Sun, Sue Yazaki [UNIFESP]; Amim Junior, Joffre; Rezende Filho, Jorge; Araujo Junior, Edward [UNIFESP]Twin molar pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers. Magnetic resonance imaging is important for the diagnostic differentiation of placental mesenchymal dysplasia and exclusion of myometrial invasion. Here we present a case of twin molar pregnancy with a hydatidiform mole and a coexisting live fetus diagnosed at gestational week 14 using two-dimensional (2D) and three-dimensional (3D) ultrasound and magnetic resonance imaging. We also describe the obstetric management and postmolar follow-up.
- ItemSomente MetadadadosVEGF 936C/T Polymorphism and Gestational Trophoblastic Neoplasia(Sci Printers & Publ Inc, 2016) Sun, Sue Yazaki [UNIFESP]; Daher, Silvia [UNIFESP]; Signorini Filho, Roney Cesar [UNIFESP]; Rocha, Claudia Lima [UNIFESP]; Souza, Renato Teixeira [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]OBJECTIVE: To evaluate the relationship between the 936C/T polymorphism of VEGF and the occurrence of gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A retrospective study that included 8 patients with complete hydatidiform mole (CHM) that evolved into spontaneous remission (SR), 12 patients with CHM that progressed to GTN, and 20 control (C) patients without obstetric complications. Polymorphisms were detected by polymerase chain reaction amplified technique of patients' DNA, and genotype frequencies were compared between the groups. RESULTS: The genotype frequencies of the VEGF 936C/T polymorphism were as follows: SR group, 100% CC genotype