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WANG XIN-YONG
Departmente of Gynecology
PREFACE
Whate is the happiest things for
a lady in the whole life ?
………..
To be a bride?
To get pregnent?
To be a mother ?
SUITABLE SPERMITY
SUITABLE SPERMITY
1 good sperm + 1 nice ovum =
wonderful
Fertilizition…..1,2,3….babys
Defination:
Itroduction
• gestational trophoblastic
disease (GTD) is a group of
disease originated from
placental villose trophoblastic
cells, including hydatidiform
mole, invasive mole,
choriocarcinoma and a kind of
less common trophoblastic cell
tumor in placenta.(PSTT)
Introduction
Relations among the diseases:
• Benign mole is considered to be
abnormal formation of placenta
accompanied by the special abnormal
hereditary ;
• Invasive mole results from benign mole;
• Choriocarcinoma and the trophoblastic
cell tumor in placenta may result from
benign mole, term pregnancy, abortion
and ectopic pregnancy.
Partial mole
Complete mole
Pathology
Partial mole
Complete mole
Clinical manifestation
complete mole:
• vaginal bleeding after
amenorrhea:3/4
• uterus is abnormally enlarged
and become soft
• Lack of fetus signs
• theca lutein ovarian cyst
• gestational vomitting and PIH
• Hyperthyroidism
Theca Lutein Ovarian Cyst
Theca Lutein Ovarian Cyst
Clinical Manifestation
Partial mole:
• may have the major
symptoms of complete
mole but it is slightly
manifested. no luteinizing
cyst. The histologic
examination of curettage
sample may confirm the
diagnosis.
Prognosis
complete mole has the latent
risk of local invasion or
telemetastasis
The high-risk factors includes
• β-HCG>100000IU/L
• uterine size is obviously
larger than that with
the same gestational
time.
Prognosis
• the luteinizing cyst is >6cm
• If >40 years old,the risk of
invasion and metastasis may
be 37%, If >50 years old,the
risk of invasion and metastasis
may be 56%.
• repeated mole:the morbidity of
invasion and metastasis
increase 3~4 times
Diagnosis
HCG measurement : serum
urine
Ultrasound examination
Detecting the fetal heart beat by
ultrasound Doppler
Diagnosis
Differential Diagnosis
abortion
twin pregnancy
polyhydramnios
Management
Emptying uterine cavity
• once the diagnosis is confirmed
the uterine cavity should be
emptied as soon as possible
Hysterectomy
• over 40 years old with high-risk
factors
• uterine size is over 14
gestational weeks
Management of luteinizing cyst
Management
Preventive chemotherapy
• over 40 years old
• the β-HCG is over
100kIU/L before
emptying mole
• the HCG regresion
curve is not
progressively declined
Preventive chemotherapy
• uterus is obviously larger than
the size of the amenorrhea
• luteinizing cyst is >6cm
• there is still over hyperplasia of
trophoblastic cells in the
second curettage
• no follow up conditions
Follow up
HCG qw till normal
QW×3m
Q2W×3m
QM×6m
Q6M×2y
Invasive Mole
Introduction
Definition:
Invasive mole means the
hydatidiform mole invade the
uterine myometrium or
metastasize to extrauterine
tissue.
Biologic behavior:
Invasive mole villus may
invade myometrium or blood
vessels or both, at beginning it
spread locally,invade
myometrium, sometimes
penetrate the uterine wall and
Pathology
Macro examination:
Different size of
viscula in
myometrium,there may
be or may not be primary
focus in uterine
cavity.when the invasion
is near serosal layer……
Invasive Mole
Pathology
Microexamination:
Villose structure and
trophoblastic cells proliferation
and differentiation
deficiency.villose and
trophoblastic cells can be found
in most patients,and cause
vascular wall necrosis and
bleeding.
Clinical Manifestation
irregular vaginal bleeding
uterine subinvolution
metastatic focus
manifestation
Diagnosis
history and clinical
manifestation
successive measurement of
HCG
ultrasound examination
X-ray and CT
histologic diagnosis
Invasive Mole
TREATMENT
Same to choriocarcinoma.
Discuss together
Choriocarcinoma
Introduction
Choriocarcinoma is a
highly malignant tumor,it
can metastasize to the
whole body through
blood circulation ,
damage tissues and
organs,cause bleeding
and necrosis.
Introduction
The most common metastatic
site is lung, then vagina,brain
and liver
Introduction
50% gestational
choriocarcinoma result from
hydatidiform mole (generally
occurs over 1 year after
emptying the mole), the rate of
occurrence after abortion or term
delivery is 25% and 25%
respectively, seldom occurs after
ectopic pregnancy.
After hydatidiform mole one
Pathology
Macroexamination:
Most
choriocarcinoma occurs
in uterus, the tumor
diameter 2-10cm, its
color, section, cancer
embolus is often found in
parauterine veins,ovarian
luteinizing cyst may be
formed.
Pathology
Histologic examination:
Under microscope the
hyperplastic cytotro-phoblastic
cells and syntrophoblastic cells
invade the myometrium and
blood vessels accompanied by
the bleeding and necrosis, so the
cancer cells can not be found in
the center.
Pathology
Clinical Manifestation
Vaginal bleeding
Pain
Uterine enlargement
Mass
Diagnosis
Clinical Features
Ultrasonography
Human Chorionic Gonadotrophin
CT
X-ray
Pathology
Differential Diagnosis
Hydatidiform mole
Invasive mole
Placental site trophoblastic tumors
Rudimental placenta
Metastasis
Lung
Vagina
Brain
Liver
Metastasis ( Lung )
Anatomic Staging
Stage I disease confined to
Stage II uterus
gestational trophoblastic
tumor extending outside
uterus but limited to
genital structures
Stage (adnexa,
gestationalvagina, broad
trophoblastic
III ligament)
disease extending to
lungs with or without
known genital tract
Stage all other metastatic sites
IV involvement
Management
Chemothera
py
Surgery
Good-prognosis Patients
(1) metastases are confined to the
lungs or pelvis;
(2) serum β-hCG levels are below
40,000 Miu/mL at the onset of
treatment; and
(3) therapy is started within 4
months of apparent onset of disease.
Poor-Prognosis Patients
(1) serum β-hCG titers
greater than 40,000
(2)disease diagnosed more