扬州大学：《妇产科学》课程教学课件（PPT讲稿）42 不孕症 infertility 2/3

Invasive Mole

GTD 1 Invasive Mole

IntroductionDefinition:Invasive molemeans the hydatidiformmole invade the uterine myometrium ormetastasizeto extrauterinetissueBiologicbehavior:Invasivemolevillusmayinvademyometrium or blood vessels or both, atitbeginningspreadlocally,invadethemyometrium,sometimespenetrateuterine wall and spread to the broad ligamentorabdominal cavityGTD2

GTD 2 Introduction • Definition: Invasive mole means the hydatidiform mole invade the uterine myometrium or metastasize to extrauterine tissue. • Biologic behavior: Invasive mole villus may invade myometrium or blood vessels or both, at beginning it spread locally,invade myometrium, sometimes penetrate the uterine wall and spread to the broad ligament or abdominal cavity

PathologyMacro examination:Different size of visculainmyometrium,there may be or may not beprimary focus in uterine cavity.when theinvasion is near serosal layer....Microexamination:Villose structure and trophoblastic cellsproliferation and differentiationdeficiency.villose and trophoblastic cells canbe found in most patients,and cause vascularwall necrosis and bleeding.GTD3

GTD 3 Pathology • Macro examination: Different size of viscula in myometrium,there may be or may not be primary focus in uterine cavity.when the invasion is near serosal layer. • Microexamination: Villose structure and trophoblastic cells proliferation and differentiation deficiency.villose and trophoblastic cells can be found in most patients,and cause vascular wall necrosis and bleeding

Clinical Manifestation.irregular vaginal bleedinguterine subinvolutionthecaluteindoescyst（notdisappear after emptying uterusabdominal painmetastatic focus manifestationGTD

GTD 4 Clinical Manifestation • irregular vaginal bleeding • uterine subinvolution • theca lutein cyst does not disappear after emptying uterus • abdominal pain • metastatic focus manifestation

Diagnosishistory and clinical manifestationsuccessive measurement of HcGultrasound examination.X-rayandCThistologicdiagnosisGTD

GTD 5 Diagnosis • history and clinical manifestation • successive measurement of HCG • ultrasound examination • X-ray and CT • histologic diagnosis

Choriocarcinoma

GTD 6 Choriocarcinoma

Introduction Choriocarcinoma is a highly malignanttumor,it can metastasize to the whole bodythroughblood circulation,damage tissuesand organs,cause bleedingand necrosis.The most common metastaticsite is lung,then vagina,brainand liver50% gestationalchoriocarcinoma resultfromhydatidiformmole (generally occurs over1year after emptying the mole),the rate ofoccurrenceafterabortion ortermdelivery is25%and25%respectively,seldomoccursafterectopicpregnancy.GTD

GTD 7 Introduction • Choriocarcinoma is a highly malignant tumor,it can metastasize to the whole body through blood circulation , damage tissues and organs,cause bleeding and necrosis. • The most common metastatic site is lung, then vagina,brain and liver • 50% gestational choriocarcinoma result from hydatidiform mole (generally occurs over 1 year after emptying the mole), the rate of occurrence after abortion or term delivery is 25% and 25% respectively, seldom occurs after ectopic pregnancy

PathologyMacroexamination:Most choriocarcinoma occurs in uterus,the tumor diameter 2-10cm, its color, section,cancer embolus is often found in parauterineveins,ovarian luteinizing cyst may be formed.Histologicexamination:Under microscopethehyperplasticcytotro-phoblastic cells and syntrophoblasticcells invadethe myometrium and bloodvessels accompanied by the bleeding andnecrosis, so the cancer cells can not be foundin the center.GTD8

GTD 8 Pathology • Macroexamination: Most choriocarcinoma occurs in uterus, the tumor diameter 2-10cm, its color, section, cancer embolus is often found in parauterine veins,ovarian luteinizing cyst may be formed. • Histologic examination: Under microscope the hyperplastic cytotro-phoblastic cells and syntrophoblastic cells invade the myometrium and blood vessels accompanied by the bleeding and necrosis, so the cancer cells can not be found in the center

PathologyS3U3CMGTD

GTD 9 Pathology

Clinical ManifestationVaginal bleedingPainUterineenlargementMassGTD10

GTD 10 Clinical Manifestation • Vaginal bleeding • Pain • Uterine enlargement • Mass