Gestational trophoblastic disease: Difference between revisions
Feedback

From WikiLectures

VisualWikitext
No edit summary
(checked by the editor)
 
(8 intermediate revisions by one other user not shown)
Line 17: Line 17:
| range = 390
| range = 390
| pages = 211–213
| pages = 211–213
}}</ref> is a '''fetal invasion''' '''of tissues''' that defies normal control mechanisms. Normally, trophoblast invasion should resolve within '''30 days''' of termination of pregnancy (delivery, miscarriage, ectopic pregnancy)<ref name="Rob-Martan" />. We distinguish ''mola hydatidosa partialis'', ''mola hydatidosa completa'', ''mola hydatidosa proliferans'' a ''choriokarcinom''.
}}</ref> is a '''fetal invasion''' '''of tissues''' that defies normal control mechanisms. Normally, trophoblast invasion should resolve within '''30 days''' of termination of pregnancy (delivery, miscarriage, ectopic pregnancy)<ref name="Rob-Martan" />. We distinguish ''mola hydatidosa partialis'', ''mola hydatidosa completa'', ''mola hydatidosa proliferans'' a ''choriokarcinom''.  
[[Image:Complete Hydatidiform Mole (6032015405).jpg |thumb| 200px| Complete mole]]
[[Image:Complete Hydatidiform Mole (6032015405).jpg |thumb| 200px| Complete mole]]


==Partial (incomplete) hydatidiform mole==
==Partial (incomplete) hydatidiform mole==
'''Mola hydatidosa partialis''' (MHP) vzniká oplozením vajíčka dvěma spermiemi najednou (69,XXX; 69,XXY). Takto vzniklá '''triploidní zygota''' má dvě sady otcovských a jednu sadu mateřských haploidních chromosomů. Malignizuje raritně. Klinicky se vyskytuje nepravidelné krvácení v prvním trimestru (kvůli vývojovým vadám se plod jen výjimečně dožívá porodu, pokud se dožije, vždy po něm umírá). Léčbou je vakuumexhausce a [[RCUI]], dispenzarizace a monitoring hladin [[hCG]].
'''Mola hydatidosa partialis''' (MHP) it is created by the fertilization of an egg by two sperm at the same time (69,XXX; 69,XXY).The resulting triploid zygote has two sets of paternal and one set of maternal haploid chromosomes. It rarely becomes malignant. Clinically, there is irregular bleeding in the first trimester (due to developmental defects, the fetus rarely survives delivery, if it survives, it always dies after it). The treatment is vacuum exhaust and [[RCUI]], dispensary and monitoring of [[Chorionic gonadotropin|hCG]] levels.
[[image:Invasive hydatidiform mole - intermed mag.jpg|thumb| 200px| Proliferating mole]]
[[image:Invasive hydatidiform mole - intermed mag.jpg|thumb| 200px| Proliferating mole]]
==Complete hydatidiform mole==
==Complete hydatidiform mole==
'''Mola hydatidosa completa''' (MHC) vzniká '''oplozením prázdného vajíčka''' (0 chromozomů) dvěma spermiemi najednou (46,XX; 46,XY), nebo jednou spermií, která se endoreduplikuje (46,XX). Obě sady chromozomů jsou tak paternálního původu. Embryo se nemůže vyvíjet, klky jsou bezcévnaté, edematózní, se vzhledem „hrozníčků vína“<ref name="Rob-Martan" />. Na ultrazvuku je patrný obraz „sněžení“<ref name="Rob-Martan" />. Malignizuje ve 4–8 %<ref name="Rob-Martan" />. Léčbou je vakuumexhausce a RCUI, dispenzarizace a monitoring hladin hCG.
'''Mola hydatidosa completa''' (MHC) it is created by fertilization of '''an empty egg''' (0 chromosomes) by two sperm at the same time (46,XX; 46,XY),or by a single sperm that endoreduplicates (46,XX). Both sets of chromosomes are thus of paternal origin. The embryo cannot develop, the villi are avascular, edematous, with the appearance of "wine grapes“<ref name="Rob-Martan" />. The image of "snowfall" is visible on the ultrasound<ref name="Rob-Martan" />. Malignant in 4-8 %<ref name="Rob-Martan" />. The treatment is vacuum exhaust and RCUI, dispensary and monitoring of hCG levels.
==Proliferating mole==
==Proliferating mole==
'''Mola invasiva''' (''mola proliferans'', ''mola destruens'', MP) is the most aggressive. Biologically, it is of an uncertain nature. Treatment is vacuum exhaust and RCUI, 20% require chemotherapy.
'''Mola invasiva''' (''mola proliferans'', ''mola destruens'', MP) is the most aggressive. Biologically, it is of an uncertain nature. Treatment is vacuum exhaust and RCUI, 20% require chemotherapy.


==Choriocarcinoma==
==Choriocarcinoma==
{{Podrobnosti|Nádory germinální|Neepitelové nádory ovária}}
{{Details|Germline tumors|Non-epithelial tumors of the ovary}}
Choriokarcinoma is an epithelial tumor of trophoblast cells. It metastasizes early hematogenously to the vagina, lungs, liver and brain<ref name="Rob-Martan" />.
Choriokarcinoma is an epithelial tumor of trophoblast cells. It metastasizes early hematogenously to the vagina, lungs, liver and brain<ref name="Rob-Martan" />.


It is the most treatable malignant tumor, it is treated with methotrexate or actinomycin D in mono- or polychemotherapy with curative intent in all stages with a good prognosis. The treatment is carried out in a specialized center.
It is the most treatable malignant tumor, it is treated with methotrexate or actinomycin D in mono- or polychemotherapy with curative intent in all stages with a good prognosis. The treatment is carried out in a specialized center.


==Tabulka==
==Table==
{| class="wikitable"
{| class="wikitable"
|-
|-
!Kritérium!!Kompletní mola!!Parciální mola
!Criterion!!Complete mole!!Partial mole
|-------------------------------------------------------------------------------------------------------------------------------------------
|-------------------------------------------------------------------------------------------------------------------------------------------
|'''Karyotyp'''||Diploidní (46;XX/XY)||Triploidní (69;XXX/Y)
|'''karyotype'''||Diploid (46;XX/XY)||Triploid (69;XXX/Y)
|-------------------------------------------------------------------------------------------------------------------------------------------
|-------------------------------------------------------------------------------------------------------------------------------------------
|'''Vznik'''||Androgenní  <br /> 2x spermie + vajíčko bez X  <br /> 1x spermie + vajíčko bez X => duplikace||Smíšený <br /> 2x spermie + normální vajíčko <br /> 1x 46 XX/Y spermie + normální vajíčko
|'''Origination'''||Androgenic  <br /> 2x sperm + egg without X  <br /> 1x sperm + egg without X => duplication||Mixed <br /> 2x sperm + normal egg <br /> 1x 46 XX/Y sperm + egg
|-----------------------------------------------------------------------------------------------------------------------------------------
|-----------------------------------------------------------------------------------------------------------------------------------------
|'''Embryo'''||Nikdy!||Umíra do 10. týdne
|'''Embryo'''||Never!||Dies by 10. week
|-------------------------------------------------------------------------------------------------------------------------------------------
|-------------------------------------------------------------------------------------------------------------------------------------------
|'''Klky'''||Avaskulární||Vaskularizované
|'''Villi'''||Avascular||Vascular
|-------------------------------------------------------------------------------------------------------------------------------------------
|-------------------------------------------------------------------------------------------------------------------------------------------
|'''Trofoblast'''||Difúzní proliferace||Fokální proliferace
|'''Trophoblast'''||Diffuse proliferation||Focal proliferation
|-------------------------------------------------------------------------------------------------------------------------------------------
|-------------------------------------------------------------------------------------------------------------------------------------------
|'''Atypie''' (buněčné)||Ano||Ne
|'''Atypia''' (cellular)||Yes||No
|-------------------------------------------------------------------------------------------------------------------------------------------
|-------------------------------------------------------------------------------------------------------------------------------------------
|'''hCG'''||Hodně zvýšené||Normální
|'''hCG'''||Much increased||Normal
|-------------------------------------------------------------------------------------------------------------------------------------------
|-------------------------------------------------------------------------------------------------------------------------------------------
|'''Choriokarcinom'''||2%||Vzácný
|'''Choriocarcinoma'''||2%||Rare
|-----------------------------------------------------------------------------------------------------------------------------------------
|-----------------------------------------------------------------------------------------------------------------------------------------
|}
|}
Line 59: Line 59:


==Links==
==Links==
===Související články===
===Related articles===


*[[Malignant tumors in gynecology]]  
*[[Malignant tumors in gynecology]]  
Line 65: Line 65:
*[[Malignant tumors of the ovaries]]
*[[Malignant tumors of the ovaries]]


===Externí odkazy===
===External links===


*[http://www.onkogyn.cz/ www.onkogyn.cz]
*[http://www.onkogyn.cz/ www.onkogyn.cz]

Latest revision as of 22:16, 14 February 2023

Partial mole

Gestational trophoblastic disease[1] is a fetal invasion of tissues that defies normal control mechanisms. Normally, trophoblast invasion should resolve within 30 days of termination of pregnancy (delivery, miscarriage, ectopic pregnancy)[1]. We distinguish mola hydatidosa partialis, mola hydatidosa completa, mola hydatidosa proliferans a choriokarcinom.

Complete mole

Partial (incomplete) hydatidiform mole[edit | edit source]

Mola hydatidosa partialis (MHP) it is created by the fertilization of an egg by two sperm at the same time (69,XXX; 69,XXY).The resulting triploid zygote has two sets of paternal and one set of maternal haploid chromosomes. It rarely becomes malignant. Clinically, there is irregular bleeding in the first trimester (due to developmental defects, the fetus rarely survives delivery, if it survives, it always dies after it). The treatment is vacuum exhaust and RCUI, dispensary and monitoring of hCG levels.

Proliferating mole

Complete hydatidiform mole[edit | edit source]

Mola hydatidosa completa (MHC) it is created by fertilization of an empty egg (0 chromosomes) by two sperm at the same time (46,XX; 46,XY),or by a single sperm that endoreduplicates (46,XX). Both sets of chromosomes are thus of paternal origin. The embryo cannot develop, the villi are avascular, edematous, with the appearance of "wine grapes“[1]. The image of "snowfall" is visible on the ultrasound[1]. Malignant in 4-8 %[1]. The treatment is vacuum exhaust and RCUI, dispensary and monitoring of hCG levels.

Proliferating mole[edit | edit source]

Mola invasiva (mola proliferans, mola destruens, MP) is the most aggressive. Biologically, it is of an uncertain nature. Treatment is vacuum exhaust and RCUI, 20% require chemotherapy.

Choriocarcinoma[edit | edit source]

Choriokarcinoma is an epithelial tumor of trophoblast cells. It metastasizes early hematogenously to the vagina, lungs, liver and brain[1].

It is the most treatable malignant tumor, it is treated with methotrexate or actinomycin D in mono- or polychemotherapy with curative intent in all stages with a good prognosis. The treatment is carried out in a specialized center.

Table[edit | edit source]

Criterion Complete mole Partial mole
karyotype Diploid (46;XX/XY) Triploid (69;XXX/Y)
Origination Androgenic
2x sperm + egg without X
1x sperm + egg without X => duplication		 Mixed
2x sperm + normal egg
1x 46 XX/Y sperm + egg
Embryo Never! Dies by 10. week
Villi Avascular Vascular
Trophoblast Diffuse proliferation Focal proliferation
Atypia (cellular) Yes No
hCG Much increased Normal
Choriocarcinoma 2% Rare


Links[edit | edit source]

Related articles[edit | edit source]

External links[edit | edit source]

Reference[edit | edit source]

  1. ↑ Jump up to: a b c d e f ROB, Lukáš – MARTAN, Alois – CITTERBART, Karel. Gynekologie. 2. edition. Praha : Galén, 2008. 390 pp. pp. 211–213. ISBN 978-80-7262-501-7.
Retrieved from "https://www.wikilectures.eu/index.php?title=Gestational_trophoblastic_disease&oldid=74724"