1 / 21

NOVAK 34. Gestational Trophoblastic Disease

NOVAK 34. Gestational Trophoblastic Disease. 부산백병원 산부인과 R1 손영실. # Hydatidiform Mole (H-mole). INDEX. 1. Epidemiology 2. Complete Versus Partial Hydatidiform Mole 3. Clinical Features 4. Natural History 5. Diagnosis 6. Treatment 7. Follow-up. EPIDEMIOLOGY. ◎ Risk Factors

steven-goff
Download Presentation

NOVAK 34. Gestational Trophoblastic Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. NOVAK 34. Gestational Trophoblastic Disease 부산백병원 산부인과 R1 손영실

  2. # Hydatidiform Mole (H-mole)

  3. INDEX 1. Epidemiology 2. Complete Versus Partial Hydatidiform Mole 3. Clinical Features 4. Natural History 5. Diagnosis 6. Treatment 7. Follow-up

  4. EPIDEMIOLOGY ◎ Risk Factors - low nutritional and socioeconomic factors - low dietary intake of carotene - vitamin A deficiency - maternal age older than 35 years - use of oral contraceptive - history of irregular menstruation

  5. COMPLETE VERSUS PARTIAL HYDATIDIFORM MOLE (on the basis of gross morphology, histopathology, and karyotype)

  6. COMPLETE VERSUS PARTIAL HYDATIDIFORM MOLE 1. Complete H-mole ◎ Pathology - lack embryonic or fetal tissues - chorionic villi → generalized hydatidiform swelling & diffuse trophoblastic hyperplasia ◎ Chromosomes - usually have a 46,XX - molar chromosomes are entirely of paternal origin - ovum nucleus may be either absent or inactivated - 10% : 46,XY

  7. Empty ovum 23X 23X 46XX Endoreduplication Homozygous 23X Empty ovum 46XX 23X Heterozygous 23X Empty ovum 46XY 23Y 46YY Non-viable gamete COMPLETE VERSUS PARTIAL HYDATIDIFORM MOLE

  8. COMPLETE VERSUS PARTIAL HYDATIDIFORM MOLE 2. Partial H-mole ◎ Pathology ① Chorionic villi of varying size with focal hydatidiform swelling, cavitation, and trophoblastic hyperplasia ② Marked villous scalloping ③ Prominent stromal trophoblastic inclusions ④ Identifiable embryonic or fetal tissues ◎ Chromosome - generally have a triploid karyotype (69 chromosomes) - extra haploid set of vhromosome usually is derived from the father - 90 ~ 93% : triploid

  9. 23X 23X 69XXX 23X 23Y 23X 69XXX 23Y 23X 23X 69XXX 23Y 69YYY Non-viable gamete COMPLETE VERSUS PARTIAL HYDATIDIFORM MOLE

  10. CLINICAL FEATURES 1. Complete H-mole ① Vaginal bleeding - most common symptom - 97% → 84% - molar tissue separate from decidua & disrupt maternal vessels → large volumes of retained blood may distend endometrial cavity ② Excessive uterine size - relative to gestational age - one of classic signs of complete mole - expanded by both chorionic tissue & retained blood - generally associated with elevated levels of hCG

  11. CLINICAL FEATURES ③ Preeclampsia - observed in 27% of patients with complete mole - associated with HBP, proteinuria, and hyperreflexia - eclamptic convulsion rarely occur - preeclampsia develops almost in patients with excessive uterine size & markedly elevated hCG ④ Hyperemesis gravidarum - occurred in 25% of women with complete mole - particularly with excessive uterine size & markedly elevated hCG

  12. CLINICAL FEATURES ⑤ Hyperthyroidism - 7% of women in complete mole - Sx : tachycardia, warm skin, and tremor - Dx : serum free T4, T3 - If suspected before surgery, β-adrenergic blocking agent should be administered (to prevent many of the metabolic and cardiovascular complication of thyroid storm)

  13. CLINICAL FEATURES ⑥ Trophoblastic embolization - 2% of women in complete mole - Sx : chest pain, dyspnea, tachypnea, tachycardia & severe respiratory distress (during and after molar evacuation) ⑦ Theca lutein ovarian cysts - 50% of patients with complete mole - result from high hCG levels, cause ovarian hyperstimulation - after molar evacuation, cysts normally regress spontaneously within 2 to 4 months

  14. CLINICAL FEATURES 2. Partial H-mole • Do not have the dramatic clinical feature • In general, patients have the sign and symptoms of incomplete or missed abortion • partial mole can be diagnosed after histologic review of the tissue obtained by curettage

  15. NATURAL HISTORY 1. Complete H-mole - have a potential for local invasion(15%) and metastasis(4%) (after molar evacuation) - following signs ① hCG level > 100,000 mIU/ml ② excessive uterine enlargement ③ theca lutein cysts 6cm in diameter - patients with any one of these signs → high risk 2. Partial H-mole - 4% of patients : persistent tumor, usually nonmetastatic, chemotherapy is required to achieve remission

  16. DIAGNOSIS - Ultrasonography is a reliable and sensitive technique for diagnosis - Characteristic vesicular ultrasonographic pattern : snowstorm pattern (honey-comb appearance)

  17. TREATMENT 1. Hysterectomy - if the patient desires surgical sterilization, hysterectomy may be performed - the ovaries may be preserved, even though prominent theca lutein cysts are present - hysterectomy does not prevent metastasis, so, still required f/u hCG levels

  18. TREATMENT 2. Suction Curettage - preferred method of evacuation, for patients who desire to preserve fertility - the following steps ① oxytocin infusion : before induction of anesthesia ② cervical dilatation : retained blood in endometrial cavity may be expelled during dilatation ③ suction curettage : uterus may decrease dramatically in size ④ sharp curettage : performed to remove any residual molar tissue

  19. TREATMENT 3. Prophylactic Chemotherapy prevented metastasis reduced the incidence and morbidity of local uterine invasion - single course of actinomycin D at time of evacuation - useful in the management of high-risk complete mole

  20. FOLLOW - UP 1. Human Chorionic Gonadotropin (hCG) - monitored with weekly of hCG levels until these levels are normal for 3 consecutive weeks - followed by monthly until levels are normal for 6 consecutive months 2. Contraception - patients should be used effective contraception during the entire interval of hCG f/u - oral contraceptive may be used safely

  21. 감사합니다.

More Related