Authored by Kazuo Maeda
Case
PurposeThe author treated choriocarcinoma (Ch-C) with systemic primary Methotrexate (MTX) and achieved complete remission with the disappearance of primary and metastatic foci by repeated 200 to 300 mg intensive MTX courses, confirmed by the loss of human chorionic gnadotropine (hCG) in the serum and urine. Thus, the author intended to prevent choriocarcinoma (Ch-C) with MTX chemotherapy.
Methods
As the Ch-C was the most frequently developed after
hydatidiform mole, Ch-C prevention was tried in 1960s in Kyushu
University Department of Obstetrics and Gynecology [1], by the
administration of MTX generally for 70mg per-oral in post molar
cases within 3 weeks after the mole, which was 10 mg MTX per
day for a week after the mole, in cases of negative pregnancy
test that was no hCG output, who were 104 cases, where vaginal
examination was detailed, pregnancy test was repeated, some cases
received chest X-ray looking for early pulmonary metastasis, where
no early metastasis was detected, but three cases, who had positive
urinary pregnancy test., namely, they were post molar persisted
trophoblastic disease diagnosed by persistent hCG output, The hCG
might be originated from trophoblasts remained in patients body
after hydatid mole, because an endometrial specimen revealed
remained trophoblasts, namely, hCG was sensitive marker of
trophoblastic diseases.
Results and Conclusion
Urinary pregnancy test was negative after administration of
340mg MTX in total in a case, while other 2 cases received 200-
300mg MTX in total at negative pregnancy test, where negative
hCG test will mean no remained trophoblast cell, namely, malignant
trophoblastic disease was prevented by the MTX therapy, actually,
no choriocarcinoma developed after the MTX course in 107 cases
of MTX treatment in this study, while 81 cases of no MTX treatment
after the mole developed 6 cases of Ch-C (12%) within 2 years after
the mole, which was significantly more than 107 prophylactic MTX
therapy and no Ch-C (0%) [1]. Also it will be emphasized that 3
persisted trophoblastic diseases showed no significant difference
to 6 Ch-C (12%) in 81 cases, that meant the MTX treatment was
effective to prevent Ch-C due to the MTX treatment of persistent
trophoblastic disease, namely, postmolar Ch-C is caused by the
persisted trophoblastic disease, namely, the persistent trophoblastic
disease is the base of gestational choriocarcinoma.
Thus, the most important point to prevent gestational choriocarcinoma is MTX treatment of persistent trophoblastic disease after the hydatidiform mole. Thus, ultrasound B-mode should detect hydatidiform mole correctly in early pregnancy, as the typical molar cyst may be incorrectly diagnosed to missed abortion or blighted ovum to receive the termination of hydatidiform pregnancy without the molar diagnosis, which lost the chance of choriocarcinoma prevention without postmolar chemotherapy, which is the treatment of persisted trophoblastic disease after molar pregnancy. Molar pregnancy is correctly diagnosed 2 weeks after the doubtful ultrasound examination. Let us diagnose hydatidiform mole correctly with ultrasound to get the chance to prevent choriocarcinoma after the mole.
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