gestationaltrophoblasticdiseases(gtds)教材.ppt

Gestational Trophoblastic Disease (GTD);;Hydatidiform Mole (molar pregnancy);Definition and Etiology ;In a ‘complete mole’ the mass of tissue is completely made up of abnormal cells There is no fetus and nothing can be found at the time of the first scan. ;In a ‘partial mole’, the mass may contain both these abnormal cells and often a fetus that has severe defects. In this case the fetus will be consumed ( destroyed) by the growing abnormal mass very quickly. (shrink) ;Incidence ;Repeat hydatidiform moles occure in 0.5-2.6% of patients, and these patiens have a subsequent greater risk of developing invasive mole or choriocarcinoma There is an increased risk of molar pregnancy for women over the age 40 ;Approximately 10-17% of hydatidiform moles will result in invasive mole Approximately 2-3% of hydatidiform moles progress to choriocarcinoma ( most of them are curable) ;Complete hydatidiform mole demonstrating enlarged villi of various size;Hydatidiform mole: specimen from suction curettage;A large amount of villi in the uterus.;The microscopic appearance of hydatidiform mole: Hyperplasia of trophobasitc cells Hydropic swelling of all villi Vessles are usually absent;A sonographic findings of a molar pregnancy. The characteristic “snowstorm” pattern is evident.;Transvaginal sonogram demonstrating the “ snow storm” appearance. ;Color Dopplor facilitates visualization of the enlarged spiral arteriesclose proximity to the “ snow storm” appearance;Color Doppler image of a hydatidiform mole and surrounding vessels. The uterine artery is easily identified from its anatomical location.;;Dopplor waveform analysis demonstrates low vascular resistance(RI=0.29) in the spiral arteries, much lower than that obtained in normal early pregnancy;;Partial hydartidiform mole;Microscopic image of partial molar pregnancy.; Here is a partial mole in a case of triploidy. Note the scattered grape-like masses with intervening normal-appearing placental tissue. ; Large bilate