扬州大学：《妇产科学》课程教学课件（PPT讲稿）42 不孕症 infertility 1/3

Gestational Trophoblastic Disease

Gestational Trophoblastic Disease

ItroductionDefination:-gestationaltrophoblastic disease(GTD)is a group of disease originated fromplacental villose trophoblastic cells,including hydatidiform mole, invasivemole, choriocarcinoma and a kind ofless common trophoblastic cell tumorinplacenta

GTD 2 Itroduction Defination: – 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

IntroductionRelationsamongthe diseases:Benign mole is considered to be abnormal formation ofplacenta accompanied by the special abnormalhereditary ;-Invasive mole resultsfrom benignmole;- Choriocarcinoma and the trophoblastic cell tumor inplacenta may result from benign mole,term pregnancy,abortionand ectopicpregnancyNormal placentaHydatidiform molechoriocarcinoma

GTD 3 Introduction Relations 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. Normal placenta choriocarcinoma Hydatidiform mole

皖234567Hydatidiform Mole

GTD 4 Hydatidiform Mole

Introduction.Defination:Hydatidiformmole means that afterpregnancytheplacental trophoblastic cellsproliferate abnormally,there is stromal edema,and forms vesicula which is like grape on itsapparence.Classification:Hydatidiformmole is divided intocompleteand incompletetypeGTD5

GTD 5 Introduction • Defination: 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

Etiology.theetiologyis not clearEtiologyofcompletehydatidiformmoleEpidemiology:the morbidity of hydatidiformmole is different in different area.GTD

GTD 6 • the etiology is not clear • Etiology of complete hydatidiform mole Epidemiology: the morbidity of hydatidiform mole is different in different area. Etiology

EtiologyHigh riskfactors: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 thehistory of 1 or 2 times hydatidiform mole,then themorbidity of the hydatidiform mole when pregnantagainis 1%and 15~20%respectively.Geneticfactors:enucleate egg fertilization:chromosome karyotypeof complete moleisdiploid90%is 46xx,10% is46XY.GTD

GTD 7 • 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: enucleate egg fertilization: chromosome karyotype of complete mole is diploid ,90% is 46XX,10% is 46XY. Etiology

EtiologyEndoreduplicationEmpty+23X23X46XXovumHomozygous23XEmpty+46XXovum23XHeterozygous23XEmpty+46XYovum23Y46YYNon-viable gamete

GTD 8 Etiology

EtiologyEtiology of incomplete hydatidiformmole:the morbidity of incomplete mole is muchlower than that of the complete type, andit is not associated with age.Genetic factors: chromosome karyotypeof 90% incomplete mole is triploid.Themost common chromosome karyotype is69XXY,andthenis69XXXor69XYY.GTD

GTD 9 Etiology 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. – Genetic factors: chromosome karyotype of 90% incomplete mole is triploid. The most common chromosome karyotype is 69XXY, and then is 69XXX or 69XYY

23XEtiology23X+69XXX23X23Y23X+69XYY23Y23X23X69XXY+23Y69YYYNon-viablegamete10GID

GTD 10 Etiology