Preditores Clínicos e Histopatológicos de Tumor Trofoblástico Gestacional pós-Mola Hidatiforme Completa
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Data
2000-04-01
Autores
Maestá, Izildinha [UNESP]
Rudge, Marilza Vieira Cunha [UNESP]
Abreu, Eliane Souto de [UNESP]
Dalben, Ivete [UNESP]
Peraçoli, José Carlos [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
Resumo
Objetivo: definir os preditores clínicos e histopatológicos mais eficientes da evolução da mola hidatiforme completa (MHC) para tumor trofoblástico gestacional (TTG). Métodos: estudo prospectivo clínico e histopatológico de todas as portadoras de MHC, atendidas entre 1990 e 1998 no Hospital das Clínicas de Botucatu -- UNESP. A avaliação clínica pré-esvaziamento molar classificou a gravidez molar em: MHC de alto risco e MHC de baixo risco. Foram analisados os preditores clínicos para TTG, estabelecidos por Goldstein et al.¹ e por outros autores2--10. A avaliação histopatológica incluiu a determinação do diagnóstico de MHC, segundo os critérios de Szulman e Surti11, e o reconhecimento dos fatores de risco para TTG, de Ayhan et al.8. Os preditores clínicos e histopatológicos foram correlacionados com o desenvolvimento de TTG pós-molar. Resultados: em 65 portadoras de MHC, cistos do ovário maiores que 6 cm e tamanho uterino maior que 16 cm foram os preditores clínicos mais eficientes de TTG. A proliferação trofoblástica, a atipia nuclear, a necrose/hemorragia, a maturação trofoblástica e a relação cito/sinciciotrofoblasto não foram preditores significativos para TTG. A correlação entre preditor clínico e histopatológico para o desenvolvimento de TTG não foi possível porque nenhum parâmetro histopatológico foi significativo. Conclusões: mais estudos são necessários para avaliar possíveis preditores de persistência (TTG) e sua aplicação no contexto clínico das MHC. Enquanto isso, a determinação seriada de hCG sérico permanece o único indicador prognóstico seguro para TTG pós-MHC.
Purpose: to determine the most efficient clinical and histopathological predictors of complete hydatidiform mole (CHM) after gestational trophoblastic tumors (GTT). Methods: a prospective clinical and histopathological study was performed on all patients with CHM treated at the University Hospital of Botucatu between 1990 and 1998. Preevacuation clinical evaluation allowed the classification of molar pregnancy into high risk and low risk CHM. The author analyzed the clinical predictors of GTT established by Goldstein et al.¹ and by other authors2--10. The histopathological evaluation included the confirmation of CHM diagnosis based on the criteria by Szulman and Surti11 and the understanding of risk factors for GTT by Ayhan et al.8. The clinical and histopathological predictors were correlated with the postmolar GTT. Results: ovarian cysts larger than 6 cm and uterus size larger than 16 cm were the most efficient clinical predictors of GTT in 65 patients with CHM. Trophoblastic proliferation, nuclear atypia, necrosis/hemorrhage, trophoblastic maturation, and the ratio cytotrophoblast to syncytiotrophoblast were not significant predictors of GTT. The correlation between the clinical and histopathological predictors for the development of GTT was not possible, as no histopathological parameter was significant. Conclusion: additional investigations could evaluate other predictors for persistent disease, and its usefulness in a clinical context. The sequential determination of plasmatic beta-hCG remains the only safe predictor for persistent disease.
Purpose: to determine the most efficient clinical and histopathological predictors of complete hydatidiform mole (CHM) after gestational trophoblastic tumors (GTT). Methods: a prospective clinical and histopathological study was performed on all patients with CHM treated at the University Hospital of Botucatu between 1990 and 1998. Preevacuation clinical evaluation allowed the classification of molar pregnancy into high risk and low risk CHM. The author analyzed the clinical predictors of GTT established by Goldstein et al.¹ and by other authors2--10. The histopathological evaluation included the confirmation of CHM diagnosis based on the criteria by Szulman and Surti11 and the understanding of risk factors for GTT by Ayhan et al.8. The clinical and histopathological predictors were correlated with the postmolar GTT. Results: ovarian cysts larger than 6 cm and uterus size larger than 16 cm were the most efficient clinical predictors of GTT in 65 patients with CHM. Trophoblastic proliferation, nuclear atypia, necrosis/hemorrhage, trophoblastic maturation, and the ratio cytotrophoblast to syncytiotrophoblast were not significant predictors of GTT. The correlation between the clinical and histopathological predictors for the development of GTT was not possible, as no histopathological parameter was significant. Conclusion: additional investigations could evaluate other predictors for persistent disease, and its usefulness in a clinical context. The sequential determination of plasmatic beta-hCG remains the only safe predictor for persistent disease.
Descrição
Palavras-chave
Doença trofoblástica gestacional, Gonadotrofinas coriônicas, Cisto de ovário, Complete hydatidiform mole, Gestational trophoblastic disease, Chorionic gonadotrophins, Ovarian cysts
Como citar
Revista Brasileira de Ginecologia e Obstetrícia. Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, v. 22, n. 3, p. 167-173, 2000.