Gestational trophoblastic disease - Diagnosis

Laboratory studies:-HCG serum is used to assess response to therapy and disease status-CBC is useful to detect secondary anemia hemorrhage-Liver enzymes may increase in the presence of liver metastases.
Imaging Studies:Pelvic ultrasound may reveal molar tissue in the uterus.Chest radiography is recommended because the lung is the most common location of metastasis.Chest computed tomography scan reveals micrometastaze about 45% of women with gestational trophoblastic neoplasia with normal radiography. CT scan of the abdomen and pelvis and MRI of the head are recommended in patients with lung metastases and hidatiforma Mola, Mola hidatiforma choriocarcinom or persistent. Lungs, lower genital tract, brain, liver, kidneys and gastrointestinal tract are common locations of metastases.
Procedures performed:Fine-suction and curettage may be performed in patients with persistent vaginal bleeding mole and hidatiforma-Uterine dilation performed at a woman with abnormal vaginal bleeding and positive pregnancy test can show a choriocarcinom.
Histological examination: Mola Full hidatiforma Vili has oedematous placental trophoblastic hyperplasia and the absence of fetal blood vessels or scarring. In hidatiforma partial mole, trophoblastic inclusions Vili in the shell and present. Fetal blood vessels are present. Hydropic degeneration of normal pregnancy and Vili edema is present, but no trophoblastic hyperplasia. Vili ghost can be observed. Mola Mola invasive has the same layout as hidatiforma but myometrium is invaded by this hemorrhage and tissue necrosis. Although chorionic choriocarcinomul has Vili, shows layers of trophoblast, hemorrhage and necrosis. Found in placental trophoblast trophoblastic tumor intermediaries between myometrial fibers without tissue necrosis.
Staging trophoblastic neoplasia:Stage I-delimited to the uterusStage II limited to genital structuresStage III lung metastasesOther metastases Stage IV.
Negative prognostic factors in staging include:-Over 40 years old-Pregnancy terminated by abortion in historyTasks in time-historySub-interval of seven months between previous pregnancy and initiating multiple-dose chemotherapyBeta-HCG serum level over 10. 000mUI/mlOver 5-cm tumor-Distant metastasis.
The differential diagnosis is made with urmataorele diseases: biliary obstruction, vesicular cancer, brain tumors, cerebrovascular accidents, tumors secreting HCG, hemorrhagic cystitis, nephrolithiasis, choriocarcinomul ovary.