Gestational trophoblastic disease: Difference between revisions
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==Partial (incomplete) hydatidiform mole== | ==Partial (incomplete) hydatidiform mole== | ||
'''Mola hydatidosa partialis''' (MHP) | '''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 [[Human chorion gonadotrophin|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== | ||
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==Links== | ==Links== | ||
=== | ===Related articles=== | ||
*[[Malignant tumors in gynecology]] | *[[Malignant tumors in gynecology]] | ||
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*[[Malignant tumors of the ovaries]] | *[[Malignant tumors of the ovaries]] | ||
=== | ===External links=== | ||
*[http://www.onkogyn.cz/ www.onkogyn.cz] | *[http://www.onkogyn.cz/ www.onkogyn.cz] | ||
Revision as of 17:06, 14 February 2023
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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.
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Partial (incomplete) hydatidiform mole
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.
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“[1]. Na ultrazvuku je patrný obraz „sněžení“[1]. Malignizuje ve 4–8 %[1]. Léčbou je vakuumexhausce a RCUI, dispenzarizace a monitoring hladin hCG.
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.
Choriocarcinoma
Iron
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
| 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 |
