Explore the vast range of titles available.

Gestational Trophoblastic Neoplasia (GTN) are malignant trophoblastic proliferations requiring accurate monitoring to guide treatment and assess disease progression. Serum β-hCG is the standard biomarker for GTN monitoring, but it requires blood collection, which can be invasive and resource-intensive. Urinary β-hCG testing offers a non-invasive alternative, but its clinical reliability in GTN patients remains unclear. This study evaluates the correlation between urinary and serum β-hCG levels in GTN patients, aiming to determine the feasibility of urine β-hCG as a reliable non-invasive monitoring tool. A cross-sectional study was conducted at Dr. Hasan Sadikin General Hospital, Bandung, from June 2024 to February 2025, involving 31 patients diagnosed with GTN. A total of 86 paired serum and urine β-hCG samples were analyzed using enzyme-linked immunosorbent assay (ELISA). Data normality was assessed using the Kolmogorov-Smirnov test. Pearson's correlation and simple linear regression were used to evaluate the relationship between serum and urine β-hCG levels. Serum β-hCG levels were significantly higher than urine levels (P < 0.001), but a strong positive correlation was observed between the two (r = 0.985, P < 0.001), with a coefficient of determination = 96.9%). Urinary β-hCG exhibits a strong correlation with serum β-hCG in GTN patients, supporting its potential as a non-invasive monitoring tool. However, hydration status, renal function, and possible assay interferences should be considered. Combining serum and urine β-hCG measurements remains the optimal approach for accurate disease monitoring.

Human chorionic gonadotropin (hCG) is produced primarily by differentiated syncytiotrophoblasts, and represents a key embryonic signal that is essential for the maintenance of pregnancy. hCG can activate various signaling cascades including mothers against decapentaplegic homolog 2 (Smad2), protein kinase C (PKC), and/or protein kinase A (PKA) in several cells types by binding to luteinizing hormone/chorionic gonadotropin receptor (LHCGR) or potentially by direct/indirect interaction with transforming growth factor beta receptor (TGFβR). The molecule displays specialized roles in promoting angiogenesis in the uterine endothelium, maintaining myometrial quiescence, as well as fostering immunomodulation at the maternal-fetal interface. It is a member of the glycoprotein hormone family that includes luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and follicle-stimulating hormone (FSH). The α-subunit of hCG displays homologies with TSH, LH, and FSH, whereas the β subunit is 80–85% homologous to LH. The hCG molecule is produced by a variety of organs, exists in various forms, exerts vital biological functions, and has various clinical roles ranging from diagnosis and monitoring of pregnancy and pregnancy-related disorders to cancer surveillance. This review presents a detailed examination of hCG and its various clinical applications.

Purpose Measuring serum and cerebrospinal fluid human chorionic gonadotropin (hCG) is essential for the diagnosis of intracranial germ cell tumors. There are three types of hCG-related markers in clinical use: hCGβ, intact hCG, and total hCG. The best marker for the diagnosis of intracranial germ cell tumors, especially germinoma, is currently unknown. This study aimed to evaluate the usefulness of these hCG-related markers. Methods We investigated 19 serum samples obtained from 6 patients with histologically diagnosed germinoma treated in our institute. Serum hCGβ, intact hCG, and total hCG values were measured before, during, and after treatment. Samples with hCG values above the lower limits were considered positive. Results The positivity rates of serum hCGβ, intact hCG, and total hCG were 6% (1/17), 47% (7/15), and 42% (8/19), respectively, with the latter two having significantly higher positivity rates than hCGβ ( p  = 0.041). Both intact and total hCGs showed similar values. The median values of hCGβ, intact hCG, and total hCG before treatment were 0.1 ng/mL, 4.6 mIU/mL, and 4.5 mIU/mL, respectively. Conclusion Serum intact and total hCGs have higher detection rates than hCGβ in patients with germinoma using available commercial measurement tools.

It is now well established that maternal serum markers are often abnormal in fetal trisomy 21. Their determination is recommended for prenatal screening and pregnancy follow-up. However, mechanisms leading to abnormal maternal serum levels of such markers are still debated. Our objective was to help clinicians and scientists unravel the pathophysiology of these markers via a review of the main studies published in this field, both in vivo and in vitro, focusing on the six most widely used markers (hCG, its free subunit hCGβ, PAPP-A, AFP, uE3, and inhibin A) as well as cell-free feto–placental DNA. Analysis of the literature shows that mechanisms underlying each marker’s regulation are multiple and not necessarily directly linked with the supernumerary chromosome 21. The crucial involvement of the placenta is also highlighted, which could be defective in one or several of its functions (turnover and apoptosis, endocrine production, and feto–maternal exchanges and transfer). These defects were neither constant nor specific for trisomy 21, and might be more or less pronounced, reflecting a high variability in placental immaturity and alteration. This explains why maternal serum markers can lack both specificity and sensitivity, and are thus restricted to screening.

Accurately interpreting persistent, low human chorionic gonadotropin (hCG) levels is essential for managing gestational trophoblastic disease. Erroneous interpretation can lead to inappropriate interventions, including unnecessary chemotherapy or hysterectomy, or unjustified changes in chemotherapeutic regimens due to misidentification of a false-positive hCG as a true positive. The predominant etiology of phantom hCG is the presence of heterophilic antibodies. Consequently, screening for urine hCG is indispensable for its diagnosis because immunoglobulin is not generally present in urine. Here, we report about phantom hCG after a complete hydatidiform mole. Initial urine hCG evaluations were negative, although the serum hCG levels remained positive, leading to the diagnosis of phantom hCG. After subsequent delivery, urine hCG levels persisted at diminished levels. However, a different assay yielded negative hCG results for both serum and urine samples. The patient subsequently gave birth. The absence of hCG was consistently confirmed over five years.

Denis Afriansyah, Adhi Pribadi, Budi Handono, Siti Salima, Aisyah Shofiatun Nisa, Muhamad Rinaldi Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital-Padjadjaran University, Bandung, IndonesiaCorrespondence: Denis Afriansyah, Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital-Padjadjaran University, Jl. Pasteur No. 38, Kel. Pasteur, Kec. Sukajadi, Bandung, 40161, Indonesia, Tel +62 822 3984 4705, Email denis21003@mail.unpad.ac.idIntroduction: Gestational trophoblastic neoplasia (GTN) is a highly curable malignancy, but cases arising after abortion are uncommon and often diagnosed late. We report a recurrent high-risk GTN following abortion that relapsed multiple times despite etoposide–methotrexate–actinomycin D/cyclophosphamide–vincristine (EMA/CO).Case Report: A 26-year-old woman achieved initial remission with six cycles of EMA/CO but experienced several recurrences from 2021 to 2023. She presented again with rising β-hCG (16,925.8 mIU/mL) and an intrauterine mass. Paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE) was given for six cycles plus two consolidation cycles, resulting in complete remission. β-hCG normalized by January 2024 and remained undetectable for 12 months.Conclusion: This case highlights diagnostic challenges of post-abortion GTN and shows that TP/TE is an effective and well-tolerated salvage option for recurrent or EMA/CO-resistant GTN. Long-term β-hCG surveillance is essential to ensure durable remission and assess fertility outcomes.Keywords: gestational trophoblastic neoplasia, abortion, β-hCG, recurrence, salvage chemotherapy

This study was performed to assess the efficacy, safety, and prognostic factors of treatment protocols in patients with high‐risk gestational trophoblastic neoplasia (GTN). Data of 64 high‐risk GTN patients treated at our clinic between January 1993 and December 2020 were retrospectively analyzed. Patients were classified according to the FIGO staging and World Health Organization (WHO) scoring system, and demographic characteristics, treatment protocols (etoposide, methotrexate, actinomycin‐D, cyclophosphamide, vincristine [EMACO]; methotrexate, actinomycin‐D, cyclophosphamide [MAC]; etoposide, methotrexate, actinomycin‐D, etoposide, cisplatin [EMAEP]), complications, and survival outcomes were evaluated. The presence of metastatic disease, beta‐human chorionic gonadotropin (β‐hCG) levels, and treatment responses were analyzed in detail. The median age of the patients was 31.5 years (19–57), and 65.6% had metastatic disease. The most commonly used chemotherapy protocol was EMACO (75% of patients). Primary chemotherapy failure was seen in 42.1%, and the median number of cycles given until β‐hCG reset was 3 (1–9). Complete remission was achieved in 90.6% of the patients, whereas 9.4% died. The most common complications were neutropenia (24.3%), elevated liver function tests (17.6%), and anemia (17.6%). The presence of brain metastasis and a high WHO score (11–15) were significantly associated with mortality (p < 0.05). The EMACO protocol is a good option for the treatment of high‐risk GTN; however, the prognosis is worse, particularly in patients with brain metastases and a high WHO score. Improving the diagnosis and choosing the appropriate treatment protocol are crucial for the management of this disease. Summary It provides real‐world data on treatment outcomes from a substantial cohort of high‐risk GTN patients treated at a single institution. It offers detailed analysis of chemotherapy‐related complications across different regimens, information that is often underreported in the literature. It identifies specific patient subgroups who may benefit from alternative treatment approaches, potentially guiding more tailored management strategies. It contributes to the ongoing discussion about the limitations of current FIGO scoring and staging systems.

It has been shown that in controlled ovarian hyper stimulation cycles, defective luteal phase is common. There are many protocols for improving pregnancy outcomes in women undergoing fresh and frozen in vitro fertilization cycles. These approaches include progesterone supplements, human chorionic gonadotropin, estradiol, gonadotropin-releasing hormone agonist, and recombinant luteinizing hormone. The main challenge is luteal-phase support (LPS) in cycles with gonadotropin-releasing hormone agonist triggering. There is still controversy about the optimal component and time for starting LPS in assisted reproductive technology cycles. This review aims to summarize the various protocols suggested for LPS in in vitro fertilization cycles. Key words: Luteal-phase support, IVF, HCG, Progesterone, GnRH agonist, Recombinant LH.

PurposeTo summarize available evidence from randomized-controlled trials which have evaluated triggering of final oocyte maturation with concomitant GnRH agonists and hCG in patients undergoing IVF, and to analyze whether dual triggering is as efficacious as hCG triggering in terms of oocyte and pregnancy outcomes.MethodsA comprehensive literature search was performed to identify randomized-controlled trials comparing IVF outcomes between women receiving combined administration of hCG with GnRH agonists and those receiving hCG alone for triggering of final oocyte maturation.ResultsFour studies including 527 patients eligible for inclusion in meta-analysis were identified. No significant difference in the number of mature oocytes or fertilized oocytes retrieved was found between groups. Clinical pregnancy rate with dual triggering was significantly higher as compared with hCG-alone triggering (pooled OR = 0.48, 95% CI 0.31–0.77, P = 0.002), but there was no significant difference in the ongoing pregnancy rate between groups.ConclusionResults of meta-analysis indicate comparable or significantly improved outcomes with the use of GnRH agonists plus hCG as compared with hCG alone for triggering of final oocyte maturation.