Gestational trophoblastic disease

Gestational trophoblastic disease

    * Introduction
    * Diagnosis
    * Treatment
Gestational trophoblastic disease includes several pathological entity that originates from the placenta. They include partial and complete mole, placental tumors, choriocarcinomul and invasive mole. Pathological processes listed can be malignant or premalignant and occur after abnormal fertilization.
Mole is an abnormal form of pregnancy in a non-viable fertilized egg is implanted in the uterus and make the normal processes of pregnancy in some pathological. Mole hidatiforme are divided into complete and partial complete the embryonic or fetal tissue shows no and appear empty when an egg without fertilization by a sperm nucleus is normal, complete mole exchange normally occurs when an egg is fertilized by two sperm. Mole choriocarcinom hidatiforme can turn into a cancer-cord.
Hidatiform derived from the Greek word "water drop" (hydatis) and the mole from the Latin "false conception." The term comes from the similarities and hydatid cyst.
Mole hidatifrome are frequent complications of pregnancy and occur with frequency 1 in 1,000 pregnancies. The etiology of the disease process is not well understood. Risk factors may include defects in egg, uterine abnormalities or nutritional deficiencies. Women under 20 years old or over 40 years is at risk.
Mola hidatiforma be treated by evacuating the uterus by uterine suction and curettage surgery as soon as possible after diagnosis to avoid risks choriocarcinomului. Patients are monitored until serum HCG decreased to undetectable levels. Invasive or metastatic mole may require chemotherapy and respond well to methotrexate. Response to treatment is about 100%. Patients are advised not to conceive for at least a year after a molar pregnancy. The chances of having another molar pregnancy is 1%. Molecular therapy is much more complicated when there is a viable fetus at the same time.
Over 80% of hidatiforme moles are benign. The prognosis after treatment is usually excellent. Close supervision is essential. In 10-15% of cases hidatiforme mole can develop into invasive moles. They penetrate deeply into the uterine wall so encouraging result of bleeding and other complications develop. In 3% of cases can turn into choriocarcinom, which is a fast-moving cancer, metastatic. Despite these adverse prognostic factors indicating a cure rate after treatment with chemotherapy is high. Over 90% of women with invasive mole, nonmetastazica will survive and retain the ability to conceive and carry pregnancies. When the disease stays in remission metastzica 85% although the ability to conceive is lost.
Gestational trophoblastic disease may be benign or malignant. Histologically it is classified hidatiforma mole, invasive mole, placental trophoblastic tumor and choriocarcinomul. Forms that invade locally or metastasize are known as gastationala trophoblastic neoplasia. Hidatiforma Mola is the most frequently encountered form of the disease. While choriocarcinomul are invasive and malignant mole, mole hidatiforma can manifest benign or malignant.
There are no methods to accurately predict the clinical behavior of molecules hidatiforme by histopathology. Defined clinical evolution of human chorionic gonadotrophin curve after mole evacuation. At 80% of patients with benign hidatiforma mole, serum hCG levels decrease to normal in 8-12 weeks after evacuation of molar pregnancy. The other 20% of patients with malignant mole hidatiforma serum HCG increase or maintain the set.
Pathogenesis Mola hidatiforma is considered malignant when serum HCG level was on set or increase during the monitoring period and a pregnancy is excluded. This condition occurs in 20% of the mole.
Mola hidatiforma the fetus or fetal tissue and triploid kariotip is known as partial or incomplete mole. Cases of incomplete hidatiforma mole have been reported with lung metastases, and at least one case of vaginal metastasis choriocarcinom the biopsy was reported in a patient with partial mole hidatiforma.
Mole invasive mole has the same characteristic histopathology hidatiforme, but invasion of myometrium with necrosis and hemorrhage or pulmonary metastases are common.
Vili Choriocarcinomul not present but has layers of trophoblast and hemorrhage. Choriocarcinomul is aneuploidy and may be heterogeneous depending on the type of task in which it is derived. If a mole hidatiforma preceded choriocarcinomul, are of paternal chromosomes. Maternal and paternal chromosomes are present whether a term task before choriocarcinomul. Of choriocarcinoame, 50% are preceded by hidatiforma mole, 25% abortions, 3% 22% ectopic pregnancy and other pregnancy to term. Choriocarcinomul was associated with ectopic pregnancy.
Placental trophoblastic tumor is a rare form of gestational trophoblastic neoplasia, a little over 200 cases reported in the literature. These patients are found trophoblast infiltrated myometrium without causing tissue destruction. Contain human placental lactogen Trofoblastele intermediate. These patients have persistent high levels of HCG. The treatment is hysterectomy with ovarian preservation. If the tumor recurs or metastases are present at initial diagnosis, chemotherapy is used with variable results. Radiation therapy can control the disease locally. Pulmonary metastasis is the most common, lower genital, brain, liver, kidney and gastrointestinal tract.
Signs and symptoms Choriocarcinomului incidence increases with age and is 5-15 times higher in women 40 years compared to younger ones. Most cases of gestational trophoblastic neoplasia are diagnosed when serum HCG is maintained in plateau or increase in patients seen after mole hidatiforma diagnosis. If metastases are present, signs and symptoms associated with metastatic disease include haemoptysis, abdominal pain, hematuria, and neurological symptoms.
Physical Exam: The lower genital tract metastases shows by blue papules or nodules. These are vascular and can bleed if they are deeply biopsied. Sensitivity may be present if abdominal or gastrointestinal liver metastases appeared. Defense abdomen and rebound tenderness may be present if a haemoperitoneum arose from bleeding through the abdominal metastases. Bleeding by metastases lead to signs and symptoms of hemorrhagic shock. Neurological deficits, from lethargy to coma can be detected brain metastases have occurred. Jaundice may be present if liver metastases cause biliary obstruction.
Disease progression: Patients with malignant hidatiforma mole, invasive or metastatic choriocarcinom need for systematic evaluation. Those with metastases are classified as high risk or low in fucntie certain criteria. Criteria for high-risk metastatic disease include liver or brain metastases, serum levels of HCG 40. 000 mu / L before initiation of chemotherapy, disease duration over 4 months, failed previous chemotherapy and malignant trophoblastic neoplasia after a pregnancy to term. Patients with malignant disease nonmetastazica or moderate risk metastatic trophoblastic neoplasia were 100% probability of cure with chemotherapy. The probability of cure after chemotherapy for metastatic gestational trophoblastic neoplasia patients with increased risk is about 75%. Probability of late recurrence after remission at one year is less than 1%.