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1、Gestational Trophoblastic Disease(GTD),妊娠滋养细胞疾病,Contents,Definition ClassificationEpidemiology and Risk FactorsGTDDiagnosisTreatment,Definition,Spectum of interrelated but histologically distinct tumors Originating from the placentaCharacterized by tumor marker,-HCGTendencies toward local invasion a
2、nd spread,Classification of GTD,Epidemiology and Risk Factors(1),Incidence1 to 2 per 1,000 deliverySome ethic groups and regions higherMaternal AgeUpper and lower extremes,higher riskHigher rates of abnormal fertilization,Obstetric HistoryPrior unsuccessful pregnanciesPersonal history of GTDOther Fa
3、ctorsCombination oral contraceptive(COC)pill useVitamin A and carotene deficiencyHigher educational levels,smoking,irregular menstrual cycles,Epidemiology and Risk Factors(2),Normal villi,Cytotrophoblast,CT,Syncytitrophoblst,ST,Intermediate tropboblast,IT,hCG+,The Karyotype of Molar Pregnancy,多余的父源基
4、因是造成滋养细胞增生的主要原因。,46,XX,69,XXY69,XYY,Hydatidiform Mole(Molar Pregnancy),Complete hydatidiform molePartial hydatidiform mole,Complete mole vs partial mole,Complete mole,Partial mole,Gross finding：Huge amount of grape-like structuresNo embryo componentsMicroscopic findings：Trophoblastic proliferationVi
5、llous edema,Complete hydatidiform mole,Gross finding：Focal molar,vary size Normal placenta tissueIdentifible fetal tissues Microscopic findings：Marked villous scallopingLess trophoblastic proliferationStromal tropboblastic inclusion,Partial hydatidiform mole,vaginal bleeding 停经后阴道出血(80%)excessive ut
6、erine 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,hCG升高,滋养细胞增生,Molar PregnancyClinical Features,Features of Complete and Partial Hydatidiform Moles,Diagnosis,Clinical features excessive uterine enl
7、argementtheca lutein cystelevated serum-hCG levels Sonography Complex,echogenic mass containing cystic spacesKaryotype analysis Pathology,宫内妊娠Intrauterine Pregnancy,葡萄胎Molar Pregnancy,Ultrasound Diagnosis,1.子宫明显大于相应孕周 2.宫腔内“落雪状“或“蜂窝状“回声 3.子宫肌层内无或稀疏血流 4.Partial mole：可见到胎儿部分,Complete mole,Partial mole
8、,Treatment of Hydatidiform Mole,Suction curettageProphylactic chemotherapyHysterectomyTheca-lutein ovarian cyst aspiration or oophorectomy when necessary,Follow up of Hydatidiform Mole,-HCG measurementPhysical and Gynecologic examinationSonography,X-ray,CTContraception 1 year,妊娠滋养细胞肿瘤Gestational Tro
9、phoblastic Neoplasia,GTDGestational Trophoblastic Tumor,GTT,侵蚀性葡萄胎 Invasive Hydatidiform Mole绒毛膜癌 Choriocarcinoma胎盘部位滋养细胞肿瘤 Placental Site Trophoblastic Tumor,PSTT上皮样滋养细胞肿瘤 Epithelioid Trophoblastic Tumor,Molar villi infiltrated into myometrium；Atypical trophoblastic proliferation；Apparent molar ves
10、icles,Invasive Mole Histology,Diffuse hemorrhage and necrosisWithout chorionic villiLack of vaculazationAtypia ST,CT and IT,ChoriocarcinomaHistology,Clinical Findings,Abnorminal virginal bleedingAbnorminal uterine sizeTheca-lutein cystAbdominal painPersistently elevated serum-hCG levelsMetastatic fo
11、ci:lung(80%),virginal(30%),pelvis(20%),hepatic(10%),brain(10%).,Criteria for the Diagnosis of GTN,FIGO Staging,Modified WHO Prognostic Scoring System as Adapted by FIGO,Treament of GTN,ChemotherapyLow risk GTT:MTX5FU/KSMHigh risk GTT:EMA/COEMA/EPTE/TPPVB/BEPSurgical management,Surgical management,Hy
12、sterectomyPSTTEpithelioid trophoblastic tumorEmergent indicationsSurgical resection of metastasesChemotherapy-resistantRepeat uterine curettageManagement of post-molar GTN in Europe,PSTT,Rare GTT;Pathologic characters；ITIHC:hCG()，hPL()Insensitive to chemotherapySurgical treatmentHigh risk factors：MI
13、5/HPInterval months from index pregnancy 2yrExtrauterine metastasis,Follow up,-HCG measurementPhysical and Gynecologic examinationSonography,X-ray,CTDuration 1st year:1/3months;2nd-3rd year:1/6months;Five years:1/every 1 year;Later:1/every 2 year.,Summary-1,葡萄胎是一种妊娠滋养细胞疾病；完全性葡萄胎多为二倍体，部分性葡萄胎多为三倍体；停经后阴道流血为常见症状；诊断依靠病理，辅助超声、血hCG等；处理以清宫为主；随访血hCG很重要。,Summary-2,Summary-3,妊娠滋养细胞肿瘤（GTN）包括侵蚀性葡萄胎和绒毛膜癌，胎盘部位滋养细胞肿瘤（PSTT）为一特殊类型GTT。除子宫病灶症状外，还需注意转移症状;血-hCG是重要的诊断根据和随访指标；GTN是化疗能达治愈的肿瘤;对非转移或低危型转移者，单药化疗即可显效.,OB/GYN Hospital of Fudan University,You are welcome,2009.6.6,
