《妇产科学》课程教学课件（PPT讲稿）14.Gestational Trophoblastic Diseases（GTDs）

Gestational Trophoblastic Diseases(GTDs) Dong xiaojing

Gestational Trophoblastic Diseases (GTDs) Dong xiaojing

Introduction Encompass a spectrum of neoplastic disorders that arise from placental trophoblastic tissue after abnormal fertilization The first and only disseminated solid tumors Highly curable by chemotherapy Unique and characteristic tumor marker:hCG Characters: lack of a fetus,trophoblastic cell hyperplasia,edema of villous stroma,loss of normal villous blood vessels

Introduction Encompass a spectrum of neoplastic disorders that arise from placental trophoblastic tissue after abnormal fertilization The first and only disseminated solid tumors Highly curable by chemotherapy Unique and characteristic tumor marker:hCG Characters: ²lack of a fetus, trophoblastic cell hyperplasia, edema of villous stroma, loss of normal villous blood vessels

Classification Benign- hydatidiform mole (HM) GTDs invasive mole (chorioadenoma Gestational destruens) Throphoblastic choriocarcinoma tumor (GTT) placental site trophoblastic tumor (PSTT)

Classification invasive mole (chorioadenoma destruens) choriocarcinoma placental site trophoblastic tumor (PSTT) GTDs Benign- hydatidiform mole (HM) Gestational Throphoblastic tumor (GTT)

Hydatidiform mole Molar pregnancy After pregnancy,syncytiotrophoblastic and cytotrophoblastic cells proliferate,edema of stroma,hydropic villi to form mole(bubble) Abnormal placenta accompanying specific abnormal genetics

Hydatidiform mole Molar pregnancy After pregnancy, syncytiotrophoblastic and cytotrophoblastic cells proliferate, edema of stroma, hydropic villi to form mole(bubble) Abnormal placenta accompanying specific abnormal genetics

Complete chorionic villi are converted into a mass of clear vesicles Size of vesicles are variable in diameter,hang in clusters from thin pedicles,like grape Incomplete Focal change,fetus or at least an amnionic sac Avascular villi swelling

Complete ²chorionic villi are converted into a mass of clear vesicles ²Size of vesicles are variable in diameter, hang in clusters from thin pedicles, like grape Incomplete ²Focal change, fetus or at least an amnionic sac ²Avascular villi swelling

1.Incidence and epidemiology Incidence varies dramatically in different regions of the world In USA or Europe,1 in 1500 pregnancies In Mexico,1 in 125 In Far East and Southeast Asian,5 to 15 fold than in USA Complete is more often than incomplete

1. Incidence and epidemiology Incidence varies dramatically in different regions of the world ²In USA or Europe, 1 in 1500 pregnancies ²In Mexico, 1 in 125 ²In Far East and Southeast Asian, 5 to 15 fold than in USA  Complete is more often than incomplete

High risk factors women≤20and>40 years Low economic status Nutrition:diets deficient in protein and folic acid,carotene deficiency Particular ABO blood groups Cell heredity:abnormal fertilization of ovum and sperm,enucleate egg,triploid, especially the abnormal of sperm

High risk factors ²women 40 years ²Low economic status ²Nutrition: diets deficient in protein and folic acid, carotene deficiency ²Particular ABO blood groups ²Cell heredity: abnormal fertilization of ovum and sperm, enucleate egg, triploid, especially the abnormal of sperm

2.Pathology Gross Various vesicles,thin wall,transparent, mucous fluid,blood and clots filled in vesicle space Histologic character Trophoblast proliferate Edema of villous stroma No embryogenetic blood vessels in stroma

2. Pathology Gross ²Various vesicles, thin wall, transparent, mucous fluid, blood and clots filled in vesicle space Histologic character ²Trophoblast proliferate ²Edema of villous stroma ²No embryogenetic blood vessels in stroma

Comparison between complete and incomplete type Feature Complete Incomplete Villous edema Diffuse Focal Trophoblastic cell Diffuse Focal hyperplasia Embryonic tissue Absent Present Slight B-hCG High (>50 000) elevation Diploid Triploid Karyotype 46XX(90%) 69XXY(90%) Genetic parentage Paternal Biparental

Comparison between complete and incomplete type Feature Complete Incomplete Villous edema Diffuse Focal Trophoblastic cell hyperplasia Diffuse Focal Embryonic tissue Absent Present β-hCG High (>50 000) Slight elevation Karyotype Diploid 46XX(90%) Triploid 69XXY(90%) Genetic parentage Paternal Biparental

Theca-lutein cysts Surface is smooth,yellowish and lined with luteal cells,diameter from 10cm to more, thin wall,multichamber in section Overstimulation of luteal elements by large amounts of chorionic gonadotropin secreted by proliferated trophoblast Often occurred in both side and in complete (30%-50%)

Theca-lutein cysts ²Surface is smooth, yellowish and lined with luteal cells, diameter from 10cm to more, thin wall, multichamber in section ²Overstimulation of luteal elements by large amounts of chorionic gonadotropin secreted by proliferated trophoblast ²Often occurred in both side and in complete (30%~50%)