18GestationalTrophoblasticDiseases（GTDs）幻灯片.pptVIP

Gestational Trophoblastic Disease (GTD) Types of GTD Benign Hydatidiform mole/molar pregnancy (complete or incomplete) malignant Invasive mole Choriocarcinoma (chorioepithelioma) Placental site trophoblastic tumor Types of GTD The term Gestational Trophoblastic Tumors has been applied the latter three conditions Arise from the trophoblastic elements Retain the invasive tendencies of the normal placenta or metastasis Keep secretion of the human chorionic gonadotropin (hCG) Hydatidiform Mole (molar pregnancy) Definition and Etiology Hydatidiform mole is a pregnancy characterized by vesicular swelling of placental villi and usually the absence of an intact fetus. The etiology of hydatidiform mole remains unclear, but it appears to be due to abnormal gametogenesis and fertilization Definition and Etiology In a ‘complete mole’ the mass of tissue is completely made up of abnormal cells There is no fetus and nothing can be found at the time of the first scan. Definition and Etiology In a ‘partial mole’, the mass may contain both these abnormal cells and often a fetus that has severe defects. In this case the fetus will be consumed ( destroyed) by the growing abnormal mass very quickly. (shrink) Incidence 1 out of 1500-2000 pregnancies in the U.S. and Europe 1 out of 500-600 (another report 1%) pregnancies in some Asian countries. Complete incomplete Incidence Repeat hydatidiform moles occure in 0.5-2.6% of patients, and these patiens have a subsequent greater risk of developing invasive mole or choriocarcinoma There is an increased risk of molar pregnancy for women over the age 40 Incidence Approximately 10-17% of hydatidiform moles will result in invasive mole Approximately 2-3% of hydatidiform moles progress to choriocarcinoma ( most of them are curable) Clinical risk factors for molar pregnancy Cytogenetics Complete molar pregnancy Chromosomes are paternal , diploid 46,XX in 90% cases 46,XY in a small part Partial molar pregnancy Chr