扬州大学：《妇产科学》课程教学课件（PPT讲稿）38 妊娠滋养细胞疾病 Gestational Trophoblastic Disease 1/2

Gestational Trophoblastic Disease

1 Gestational Trophoblastic Disease

introductionDefinationgestational trophoblastic disease (GTD) isfromof diseaseoriginatedagroupcells,villoseplacentaltrophoblasticincludingmole,invasivehydatidiformmole, choriocarcinoma and a kind of lesscellintrophoblastictumorcommonplacenta

2 introduction ❖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

introductionRelations among the diseases: Benign mole is considered to be abnormalformation of placenta accompanied by the specialabnormalhereditary;Invasive mole results from benign mole;Choriocarcinoma and the trophoblastic cell tumorin placenta may result from benign mole, termpregnancy, abortion and ectopic pregnancy

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

Those that invade locally or metastasize arecollectively known as gestationaltrophoblastic neoplasia (GTN).Hydatidiform mole is themost commonform of GTN. While invasive mole andchoriocarcinoma are malignant,ahydatidiform mole can behave in amalignant or benign fashion

4 ❖Those that invade locally or metastasize are collectively known as gestational trophoblastic neoplasia (GTN). Hydatidiform mole is the most common form of GTN. While invasive mole and choriocarcinoma are malignant, a hydatidiform mole can behave in a malignant or benign fashion

Hydatidiform Mole

5 Hydatidiform Mole

IntroductionDefination: hydatidiform mole means thatafterpregnancy the placentaltrophoblasticcells proliferate abnormally,thereis stromaledema, and forms vesicula which is like grapeon itsapparence.Classification : hydatidiform mole is dividedinto complete and incomplete type

6 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

No methods exist to accurately predict the clinicalbehavior of a hydatidiform mole by histopathologyThe clinical course is defined by the patient'sserum human chorionic gonadotropin (hCG) curveafter evacuationofthemole.In80%of patientswith a benign hydatidiform mole, serumhCG levels steadily drop to normal within 8-12weeks after evacuation of the molar pregnancy. Inthe other 20%of patients with a malignanthydatidiform mole, serum hCG levels either riseorplateau

7 ❖No methods exist to accurately predict the clinical behavior of a hydatidiform mole by histopathology. The clinical course is defined by the patient's serum human chorionic gonadotropin (hCG) curve after evacuation of the mole. In 80% of patients with a benign hydatidiform mole, serum hCG levels steadily drop to normal within 8-12 weeks after evacuation of the molar pregnancy. In the other 20% of patients with a malignant hydatidiform mole, serum hCG levels either rise or plateau

Etiology+the etiology is not clear:A diet deficient in animal fat and carotene may be a riskfactorEtiology of complete hydatidiform moleEpidemiology: the morbidity of hydatidiform mole is differentin different area.High risk factors:1.nourishing status,social economy2.age:over 35and 40years old;below20yearsold3.hydatidiform mole history:if a patient has the history of 1 or 2timeshydatidiform molethen the morbidity ofthe hydatidiformmole when pregnant again is 1% and 15~20% respectivelyX

8 Etiology ❖the etiology is not clear： ❖A diet deficient in animal fat and carotene may be a risk factor ❖Etiology of complete hydatidiform mole Epidemiology: the morbidity of hydatidiform mole is different in different area. 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

GeneticfactorsA complete mole contains no fetal tissue. Ninetypercent are 46,XX, and 10% are 46,XY.1.2Complete moles can be divided into 2 types:AndrogeneticcompletemoleHomozygousTheseaccountfor80%ofcompletemolesTwoidenticalpaternalchromosomecomplements,derivedfrom duplicationofthepaternal haploidchromosomesAlwaysfemale:46,YYhasneverbeenobserved

9 Genetic factors: A complete mole contains no fetal tissue. Ninety percent are 46,XX, and 10% are 46,XY.1,2 Complete moles can be divided into 2 types: Androgenetic complete mole Homozygous These account for 80% of complete moles. Two identical paternal chromosome complements, derived from duplication of the paternal haploid chromosomes. Always female; 46,YY has never been observed

HeterozygousTheseaccountfor20%ofcompletemolesMaybemale orfemaleAll chromosomes areofparental originmost likely due to dispermy.10

10 ❖Heterozygous ❖These account for 20% of complete moles. ❖May be male or female. ❖All chromosomes are of parental origin, most likely due to dispermy