Gestational trophoblastic disease(gtD)
Gestational trophoblastic disease (GTD)
introduction
introduction
Definition: gestational trophoblastic disease(GTD)is a group of disease originated from placental villose trophoblastic cells, including hydatidiform mole invasive mole, choriocarci- noma and a kind of less common trophoblastic cell tumor in placenta Relations among the diseases: certain relations exist among the diseases, benign mole is considered to be abnormal formation of placenta accompanied by the special abnormal hereditary invasive mole results from benign mole, chorio- carcinoma and the trophoblastic cell tumor in placenta may result from benign mole, term pregnancy, abortion and ectopic pregnancy. invasive mole, choriocarcinoma and trophoblastic cell tumor in placenta are also called gestational trophoblastic tumor (GTT
Definition:gestational trophoblastic disease(GTD)is a group of disease originated from placental villose trophoblastic cells,including hydatidiform mole,invasive mole, choriocarcinoma and a kind of less common trophoblastic cell tumor in placenta Relations among the diseases:certain relations exist among the diseases,benign mole is considered to be abnormal formation of placenta accompanied by the special abnormal hereditary ; invasive mole results from benign mole; choriocarcinoma and the trophoblastic cell tumor in placenta may result from benign mole,term pregnancy, abortion and ectopic pregnancy.invasive mole,choriocarcinoma and trophoblastic cell tumor in placenta are also called gestational trophoblastic tumor (GTT)
Hydatidiform Mole
Hydatidiform Mole
Definition hydatidiform mole means that after pregnancy the placental trophoblastic cells proliferate abnormally, there is stromal edema, and forms vesicula which is like grape on Its apparence Classification hydatidiform mole is divided into , complete and incomplete type among which the majority is complete type, and its malignant change rate is relatively high less mole is incomplete type and rarely has malignant change. the cause and the clinical course of the two types mole are different
[Definition]:hydatidiform mole means that after pregnancy the placental trophoblastic cells proliferate abnormally,there is stromal edema ,and forms vesicula which is like grape on its apparence. [Classification]:hydatidiform mole is divided into complete and incomplete type among which the majority is complete type, and its malignant change rate is relitively high;less mole is incomplete type and rarely has malignant change. the cause and the clinical course of the two types mole are different
[Etiology: the etiology is not clear . Etiology of complete hydatidiform mole Epidemiology: the morbidity of hydatidiform mole is different in different area High risk factors 1. nourishing status, social economy 2. age: over 35 and 40 years old; below 20 years old 3. hydatidiform mole history: if a patient has the history of l or 2 times hydatidiform mole, then the morbidity of the hydatidiform mole when pregnant again is 1% and 15-20% respectively Genetic factors. 1. enucleate egg fertilization: chromosome karyotype of complete mole is diploid 90% is 46XX, 10% is 46XY
[Etiology]:the etiology is not clear I.Etiology of complete hydatidiform mole Epidemiology: the morbidity of hydatidiform mole is different in different area. High risk factors: 1.nourishing status,social economy 2.age:over 35 and 40 years old;below 20 years old. 3.hydatidiform mole history:if a patient has the history of 1 or 2 times hydatidiform mole,then the morbidity of the hydatidiform mole when pregnant again is 1% and 15~20% respectively. Genetic factors: 1.enucleate egg fertilization:chromosome karyotype of complete mole is diploid ,90% is 46XX,10% is 46XY
II. Etiology of incomplete hydatidiform mole the morbidity of incomplete mole is much lower than that of the complete type, and it is not associated with age 1. Genetic factors: chromosome karyotype of 90% incomplete mole is triploid, which is formed by the fertilization of a monoploid egg and two monoploid sperm, or by the fertilization of a monoploid gg(sperm) and a meiotic deficiency spermlegg) The most common chromosome karyotype is 69XXY, and then is 69XXX or 69XYY
II. Etiology of incomplete hydatidiform mole the morbidity of incomplete mole is much lower than that of the complete type,and it is not associated with age. 1.Genetic factors: chromosome karyotype of 90% incomplete mole is triploid,which is formed by the fertilization of a monoploid egg and two monoploid sperm,or by the fertilization of a monoploid egg(sperm) and a meiotic deficiency sperm(egg). The most common chromosome karyotype is 69XXY,and then is 69XXX or 69XYY
Pathology The comparison of morphology and karyotype of complete and incomplete mole Complete mole Incomplete mole Embryotic or fetal tissue Villus stromal edema diffused localized Trophoblastic hyperplasia diffused localized Villus outline regular irregular Villus stromal blood vessel ryotype diploid triploid or tetraploid
[Pathology] The comparison of morphology and karyotype of complete and incomplete mole Completemole incomplete mole Embryotic or fetal tissue - + Villus stromal edema diffuseed localized Trophoblastic hyperplasia diffuseed localized Villus outline regular irregular Villus stromal blood vessel - + Karyotype diploid triploid or tetraploid
图12-10完全性葡萄胎。可见水肿的绒毛大小不等,有中央池。绒毛中有 许多可见周边滋养细胞增生
Clinical manifestation I complete mole: usually complete mole has the following typical symptoms 1. vaginal bleeding after amenorrhea the most common symptom, often occurs after 8-12 week of gestation (i). clinical manifestation(8-12 week after amenorrhea ii). cause of bleeding (iii). complication ii. uterus is abnormally enlarged and become soft (i) cause: over 1/2 patients; 1/3 patients; a few patients
[Clinical manifestation]: I.complete mole:usually complete mole has the following typical symptoms i.vaginal bleeding after amenorrhea:the most common symptom,often occurs after 8~12 week of gestation (i).clinical manifestation（ 8~12 week after amenorrhea） (ii).cause of bleeding (iii).complication ii.uterus is abnormally enlarged and become soft (i).cause:over 1/2 patients;1/3 patients;a few patients