1、Gestational Trophoblastic Disease(GTD)妊娠滋养细胞疾病妊娠滋养细胞疾病Contents DefinitionClassification of GTD Hydatidiform mole Complete Partial Invasive mole Choriocarcinoma Plascental site trophoblastic tumor ， PSTT Epithelioid trophoblastic tumor Epidemiology and Risk Factors (1)Epidemiology and Risk Factors (2
2、)Normal villiCytotrophoblast, CTSyncytitrophoblst, STIntermediate tropboblast, IThCG +多余的父源基因是造成滋养细胞增生的主要原因。多余的父源基因是造成滋养细胞增生的主要原因。46,XX69,XXY69,XYYHydatidiform Mole(Molar Pregnancy) nComplete hydatidiform molenPartial hydatidiform moleComplete molePartial molenvaginal bleeding 停经后阴道出血 (80%)nexcessiv
3、e uterine size 子宫异常增大变软 (30%)ntheca lutein ovarian cysts 卵巢黄素化囊肿 nhyperemesis gravidarum 妊娠剧吐 (8%) nPreeclampsia 子痫前期征象 (1:74)nabdominal pain 腹痛nHyperthyroidism 甲亢征象Features of Complete and Partial Hydatidiform MolesDiagnosisnexcessive uterine enlargementntheca lutein cystnelevated serum -hCG levels
4、 宫内妊娠Intrauterine Pregnancy葡萄胎Molar PregnancyUltrasound Diagnosis1.子宫明显大于相应孕周 2.宫腔内“落雪状“或“蜂窝状“回声 3.子宫肌层内无或稀疏血流 4.Partial mole：可见到胎儿部分Complete molePartial moleTreatment of Hydatidiform Mole Follow up of Hydatidiform Mole 2 4 6 8 10 12 14持续性持续性GTDPersistent trophoblastic diseasePersistent trophoblasti
5、c disease人工流产人工流产Therapeutic abortion足月产足月产Term pregnancyWeeks after evacuation10001001010.10.01葡萄胎自然转归葡萄胎自然转归Hydatidiform mole-spontaneous regression妊娠滋养细胞肿瘤妊娠滋养细胞肿瘤Gestational Trophoblastic Neoplasia, GTDGestational Trophoblastic Tumor, GTTn侵蚀性葡萄胎侵蚀性葡萄胎 Invasive Hydatidiform Molen绒毛膜癌绒毛膜癌 Chorioca
6、rcinoman胎盘部位滋养细胞肿瘤胎盘部位滋养细胞肿瘤 Placental Site Trophoblastic Tumor, PSTTn上皮样滋养细胞肿瘤上皮样滋养细胞肿瘤 Clinical FindingsCriteria for the Diagnosis of GTN1. Plateau of -hCG lasts for four measurements over a period of 3 weeks of longer (days 1, 7, 14, and 21)2. Rise of -hCG of 3 weekly consecutive measurements or
7、longer, over a period of 2 weeks or more (days 1, 7, and 14)3. -hCG remains elevated for 6 months or more4. Histologic diagnosis of choriocarcinomaFIGO StagingStage Disease confined to the uterusStage GTN extends outside of the uterus but is limited to the genital structures (adnexa, vagina, broad l
8、igament)Stage GTN extends to the lung, with or without known genital tract involvementStage All other metastatic sites (brain, liver)Modified WHO Prognostic Scoring System as Adapted by FIGOScores0124Age(yr)4040Antecedent pregnancyMoleAbortionTermInterval months from indexpregnancy44671213Pretreatme
9、nt serum -hCG(mIU/mL)103103104104105105Largest tumor size (including uterus)38Previous failed chemotherapy drugs12Low risk = WHO score of 0 to 6; High risk = WHO score of7Treament of GTNSurgical managementPSTTnRare GTT;nInterval months from index pregnancyFollow up先期妊娠先期妊娠葡萄胎葡萄胎 葡萄胎，流产，葡萄胎，流产， 足月产，异位妊娠足月产，异位妊娠距前次葡距前次葡萄胎时间萄胎时间半年以内，半年以内，不超过不超过1年年 半年以上半年以上恶性程度恶性程度不高，仅不高，仅4%远处转移远处转移 极高极高组织学组织学有绒毛有绒毛 无绒毛无绒毛OB/GYN Hospital of Fudan UniversityYou are welcome2009.6.6
