Browsing by Author "Rakić, Aleksandar (57217053634)"

Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Detectable serum levels of beta subunit of human chorionic gonadotropin (βhCG) in nonpregnant, perimenopausal women bring confusion in both clinician and patient and could lead to unnecessary diagnostic and therapeutic procedures. A 45-year-old woman with the continuous elevation of βhCG underwent hysteroscopy, two laparoscopic surgeries, two explorative uterine cavity curettages and three cycles of cytostatic therapy. No ultrasonographic, macroscopic or histological signs of pregnancy, both uterine and ectopic or gestational trophoblastic disease were found. Both radiographic and computed tomography reports ruled out the presence of a nongynecological neoplasm. All recommended steps were taken for confirmation or ruling out the possibility of heterophile antibodies interference, but the results were not absolute. Finally, the referent laboratory confirmed the presence of the antibodies, but their exact type remains unknown. This case underlines the importance of the universally accepted protocol in the cases of persistent βhCG elevation in nonpregnant, perimenopausal women. © 2020 Japan Society of Obstetrics and Gynecology

Purpose: Polycystic ovary syndrome (PCOS) is an endocrine, metabolic, and reproductive disorder which, according to the Rotterdam criteria, affects up to 24% of women of childbearing age. Although the prevalence of infertility in this subpopulation of women is high, the optimal treatment has not been fully established yet. Insulin resistance is considered to be an important mechanism involved in the development of PCOS; hence, the aim of this narrative review is to present an overview of the current pharmacological insulin-sensitizing treatment modalities for infertile women with PCOS. Methods: A MEDLINE and PubMed search for the years 1990–2023 was performed using a combination of keywords. Clinical trials with insulin sensitizers used for infertility treatment as well as analyses of systematic reviews and meta-analyses were evaluated. When deemed necessary, additional articles referenced in the retrieved papers were included in this narrative review. Results: Several insulin-sensitizing compounds and various therapeutical protocols are available for infertility treatment of women with PCOS. Metformin is the most common adjuvant medication to induce ovulation in infertile women with PCOS and is more frequently administered in combination with clomiphene citrate than on its own. Recently, inositol and glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as possible options for infertility treatment in PCOS. Conclusion: The future of medical treatment of PCOS women with infertility lies in a personalized pharmacological approach, which involves various compounds with different mechanisms of action that could modify ovarian function and endometrial receptivity, ultimately leading to better overall reproductive outcomes in these women. © The Author(s), under exclusive licence to Hellenic Endocrine Society 2023.

Introduction. Invasive mole, a form of gestational trophoblastic neoplasia (GTN), is defined as penetration of molar tissue into the myometrium and/or presence of extrauterine metastases. An invasive mole arising from a complete hydatidiform mole is more common than an invasive mole arising from the partial hydatidiform mole. Dilatation and uterine evacuation and/or curettage (D&E/C) is the first step in managing molar pregnancy. Uterine perforation is the most serious complication of this procedure. A less common one is the false passage. Case report. The first case report describes a 47-year-old woman who was referred to our Clinic under the suspicion of GTN, with elevated serum beta human chorionic gonadotropin (beta hCG) levels. Intraoperatively, devitalized ovular tissue arising from the uterine perforation was observed. Histopathological exam (HPE) of tissue obtained from hysterectomy confirmed an invasive mole as a result of uterine perforation made during D&E/C. The second patient, a 32-year-old woman with vaginal bleeding, nausea, and high levels of serum beta hCG levels was admitted to our Clinic. After four D&E/C, and persistently high levels of serum beta hCG levels, explorative laparotomy has been performed. A false passage created during D&E/C with necrotic and molar tissue was observed. The partial hydatidiform mole was confirmed by the HPE. Conclusion. This is the second reported case in the literature of postmolar GTN as a result of iatrogenic perforation of the uterus, and also the first described case of postmolar GTN arising from a false passage, created as an iatrogenic complication of D&E/C. A national survey of iatrogenic events during the treatment of gestational trophoblastic disaeses is needed since these events could completely change the therapeutic strategies in managing these diseases. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.