Trophoblastic disease - Causes, Symptoms and Treatment .MF .
trophoblastic disease includes related tumors developing from placental tissue.It includes: hydatidiform mole (partial or complete), destruirujushchego molar pregnancy, choriocarcinoma and trophoblastic tumor of placental site.
Hydatidiform mole is a modified chorionic villous layer (changes in the form of bubbles), which is fully (full skid) or partially (partial mole) replaces normal tissue of the placenta.Prevalence of hydatidiform mole - a full 0.5 in 1000, a partial - 1.4 per 1000 pregnancies.
complete molar pregnancy - occurs when the fertilized egg damaged without chromosomes.The result is a doubling of the only paternal chromosomes, the zygote is a viable embryo is not formed, there is only the growth of the villi.Karyotype with 46 XX, less often XY.The most common cause of incomplete and proven hydatidiform mole is the fertilization of an egg by two sperm.In this case, the cells contain extra chromosomes, with the result that the embryo does not develop.In this case there
clinical picture in molar pregnancy is characterized by:
• bleeding from the genital tract (in 97% of cases) in the first trimester of pregnancy as a result of detachment hydatidiform mole from the decidua;
• an increase in the uterus, not the corresponding gestational age - possible cause accumulation of blood and abnormal growth of CVS;
• preeclampsia - 27% of pregnant women with eclampsia is rare, characterized by the appearance of protein in the urine, high blood pressure, hyperreflexia;
• toxicosis, uncontrollable vomiting in pregnancy -, severe electrolyte disturbances;
• embolism pulmonary artery branches
• ovarian cysts
The main diagnostic methods include:
• US - the main method of diagnosis of cystic skidding
• A blood test for hCG - identifying β-subunit of hCG more than 100 000 IU / l and higher, in conjunction with other factors, can reliably indicate a molar pregnancy
• The uterus, a lot more predpalagaemogo period, coupled with bloody discharge in the first trimester - a characteristic symptom.
Treatment - immediately after the diagnosis is necessary to relief severe complications of cystic skidding.After stabilization, a skid condition is necessary to evacuate.The most gentle method in this case - vacuum aspiration of the uterus.For patients who do not plan to have children - hysterectomy.
After the evacuation of hydatidiform mole is necessary to measure the level of hCG β-subunit, which should progressively reduced and normalized to 9 weeks after the evacuation.Pregnancy permitted after observation.
Prognosis is generally favorable, but in about 15% of patients the outcome is trophoblastic tumor, including metastatic 4%.This is especially important for older patients (over 40 years old - 37%).According to recent reports the use of adjuvant (directional) chemotherapy reduces the risk of the outcome in trophoblastic tumor.
horionkartsinoma (synonym - horionepitelioma) - a form of malignant trophoblastic disease arising after hydatidiform mole, abortion (25%) or after birth (20%).Rarely.The most frequent location - the uterus, in the site of implantation of the ovum.
Rare horionkartsinoma during pregnancy.Horionkartsinoma pregnancy zarakterizuetsya high degree of malignancy, leading to metastatic lesions in remote organazh.Symptoms for a long time can not be.Prognosis is generally unfavorable.
The most common symptoms are:
• bleeding from the genital tract, which can not be terminated after curettage require repeated procedures - the need to re-curettage - a characteristic figure.
• purulent and serous discharge from the genital tract - associated with suppurating tumor nodules, that is not so rare.
• Pain - during germination is characterized by the body.
To diagnose horionkartsinoma main method ostaestya ultrasound.Furthermore it can also be used: biochemical blood tests (to determine possible placental lactogen, estriol, human chorionic thyrotropin, etc.), hysteroscopy, MRI, CT, etc., at the discretion of the expert.
Trophoblastic tumor placental site - a rare tumor.It is characterized by invasive growth (in the body of the wall), metastasis rare.Usually chemotherapy with little effective.
Stage trophoblastic tumors (simplified scheme):
Stage I - tumor limited to the uterus
Stage II - the defeat of the uterus, vagina, Options
Stage III - metastases in lungs (no matter lesions genitals)
Stage IV - distant metastasesexcept lung metastases
has metastasized to the lungs at the time of diagnosis in 80% of patients.Identification on chest radiography.Liver metastases are observed in 10% of cases of disseminated trophoblastic tumors.
trophoblastic tumor treatment depends mainly on the stage of the disease, the state of the patient and her desire to have children in the future.In general, the treatment is carried out under the following schemes:
Stage I - monochemotherapy;hysterectomy and adjuvant chemotherapy;the development of chemotherapy resistance
Stage II - III - monochemotherapy;chemotherapy;chemotherapy 2nd line
Stage IV - chemotherapy, radiation therapy at a total dose of 30 Gy, surgical treatment of complications;regional chemotherapy in metastases to the liver
Gynecologist Kupatadze DD