妊娠滋养细胞疾病-课件.pptVIP

Gestational Trophoblastic Disease(GTD) Contents Definition Classification Epidemiology and Risk Factors GTD Diagnosis Treatment Definition Spectum of interrelated but histologically distinct tumors Originating from the placenta Characterized by tumor marker,β-HCG Tendencies toward local invasion and spread Classification of GTD Epidemiology and Risk Factors (1) Incidence 1 to 2 per 1,000 delivery Some ethic groups and regions higher Maternal Age Upper and lower extremes, higher risk Higher rates of abnormal fertilization Epidemiology and Risk Factors (2) Obstetric History Prior unsuccessful pregnancies Personal history of GTD Other Factors Combination oral contraceptive(COC) pill use Vitamin A and carotene deficiency Higher educational levels, smoking, irregular menstrual cycles Normal villi The Karyotype of Molar Pregnancy Hydatidiform Mole(Molar Pregnancy) Complete hydatidiform mole Partial hydatidiform mole Complete mole vs partial mole Gross finding： Huge amount of grape-like structures No embryo components Microscopic findings： Trophoblastic proliferation Villous edema Gross finding： Focal molar, vary size Normal placenta tissue Identifible fetal tissues Microscopic findings： Marked villous scalloping Less trophoblastic proliferation Stromal tropboblastic inclusion Molar PregnancyClinical Features vaginal bleeding 停经后阴道出血 (80%) excessive uterine size 子宫异常增大变软 (~30%) theca lutein ovarian cysts 卵巢黄素化囊肿 hyperemesis gravidarum 妊娠剧吐 (8%) Preeclampsia 子痫前期征象 (1:74) abdominal pain 腹痛 Hyperthyroidism 甲亢征象 Features of Complete and Partial Hydatidiform Moles Diagnosis Clinical features excessive uterine enlargement theca lutein cyst elevated serum β-hCG levels Sonography Complex, echogenic mass containing cystic spaces Karyotype analysis Pathology Treatment of Hydatidiform Mole Suction curettage Prophylactic chemotherapy Hysterectomy Theca-lutein ovarian cyst aspiration or oophorectomy when necessary Follow up