1、 gestational trophoblastic disease(GTD)妊娠滋养细胞疾病妊娠滋养细胞疾病2011.7.22妊娠滋养细胞疾病(2)1Introductionngestational trophoblastic disease(GTD)are a group of diseases from the placenta nourish cells of the disease,it includes hydatidiform mole,invasive hydatidiform mole,velvet carcinoma and rare placenta parts nour
2、ish cell tumors.妊娠滋养细胞疾病(gestational trophoblastic disease，GTD)是一组来源于胎盘滋养细胞的疾病，它包括葡萄胎、侵袭性葡萄胎、绒癌及罕见的胎盘部位滋养细胞肿瘤 n In addition to hydatidiform mole GTD outside the call of pregnancy nourish cell tumors(gestational trophoblastic neoplasia,GTN)除葡萄胎以外的GTD称之妊娠滋养细胞肿瘤妊娠滋养细胞疾病(2)2nyears to imaging diagnosis G
3、TD mainly depends on the type ultrasound and color doppler ultrasound.多年来影像学诊断GTD主要依赖B型超声及彩色多普勒超声 nMagnetic resonance imaging(magnetic resonance imaging,magnetic resonance imaging)reported less磁共振成像(magnetic resonance imaging，MRI)的相关报道较少 妊娠滋养细胞疾病(2)3Clinical manifestations nhydatidiform mole is beni
4、gn lesions,according to the organization for the fetus or pregnancy embryonic composition,will hydatidiform mole divided into the completeness and some sex hydatidiform mole.葡萄胎属良性病变，根据妊娠组织中有无胎儿或胚胎成分，将葡萄胎分为完全性与部分性葡萄胎 nDo not understand about the etiology,more than 40 years old or less than 20 years
5、old,incidence 病因不甚明了，大于40岁或小于20岁，发病率增高nThe main and yunkun defect,and empty the eggs are fertilized,double sperm to fertilise relevant 主要与孕卵缺损，空卵受精、双精子受精有关n Presented with postmenopausal bleeding as the main symptoms of pregnancy often early,heavy,reaction long临床上以停经后阴道出血为主要症状，妊娠反应往往早、重、长 妊娠滋养细胞疾病(2
6、)4Clinical manifestations nAbnormal uterine body check,individuals can increase a abdominal pain and pregnancy-induced hypertension merger.体查子宫异常增大，个别人可有腹痛及合并妊高症 nFlavin cyst in completeness hydatidiform mole incidence of 30-50%黄素囊肿在完全性葡萄胎发生率为3050%nThe ultrasonic inspection for the main method and i
7、n combination with B-HCG abnormal increases,the rush hour extended and symptoms,signs may diagnose disease超声为主要检查方法，结合B-HCG异常升高，高峰时间延长及症状、体征可诊断本病 妊娠滋养细胞疾病(2)5Clinical manifestations nAggressive hydatidiform mole clinical mainly for irregular vaginal bleeding.侵蚀性葡萄胎临床主要表现为不规则阴道出血nAbnormal uterine inc
8、reases,flavin cyst persist and lung,vaginal metastases performance.子宫异常增大，黄素囊肿持续存在以及肺、阴道转移灶表现。nChoriocarcinoma is a highly malignant tumor cells nourish绒毛膜癌是一种高度恶性的滋养细胞肿瘤n50%hydatidiform mole secondary to secondary to abortion,25%,22.5%,2.5%secondary to term pregnancy secondary to ectopic pregnancy5
9、0%继发于葡萄胎，25%继发于流产，22.5%继发于足月妊娠，2.5%继发于异位妊娠 nThe clinical manifestations of the vaginal bleeding,amenorrhoea,abdominal pain,uterine abnormal increase,soft and lung,vagina,brain metastasis symptoms.临床表现为阴道出血，闭经，腹痛，子宫异常增大、质软以及肺、阴道、脑转移症状。妊娠滋养细胞疾病(2)6GTD clinical diagnosis standard GTD临床诊断标准临床诊断标准 nHave
10、hydatidiform mole history,and in the second after the qing eight to 12 weeks,HCG without rain to normal,and have an irregular vaginal bleeding or radiological examination tip mass infringed womb jiceng,lungs or transfer the shadow can be diagnosed as aggressive PuTaoTai.有葡萄胎病史，并在第2次清宫后 8 12 周，HCG 未降
11、至正常，有不规则阴道流血或影像学检查提示肿块侵犯子宫肌层，或肺部有转移阴影者可诊断为侵袭性葡萄胎 n hydatidiform mole after the qing dynasty palace,H CG has been reduced to a normal period of time,and the symptoms appear HCG and rise or lungs,diagnosis for aggressive transfer PuTaoTai;And no histological examination,above 1 years who happened to c
12、horiocarcinoma.葡萄胎清宫后，H CG已降至正常水平一段时间，又出现症状及HCG 升高或肺部有转移，诊断为侵袭性葡萄胎；而无组织学检查，1年以上发生者为绒毛膜癌。nAll that abortion,ectopic pregnancy,postpartum term anomalies H CG rising malignant GTN,general diagnosis of flocking carcinoma.But if GuaGong pathological examination after see ShuiPaoZhuang organization or bio
13、psy see fluff,still the diagnosis of aggressive PuTaoTai凡流产、宫外孕、足月产后出现异常H CG升高的恶性GTN，一般诊断为绒癌。但若刮宫后病理检查见水泡状组织或组织切片见到绒毛者，仍诊断为侵袭性葡萄胎瘤妊娠滋养细胞疾病(2)7MR Imaging（葡萄胎）（葡萄胎）nThe volume,and uterine cavity expansion,expand its note the amount of relatively uniform space capsule and a long T1,T2 signal,and long c
14、hange nourish cell hyperplasia,with edema,formed the blister size differ about子宫体积扩大，子宫腔扩大，其内可见大量较均匀的分隔和小囊呈长T1、长T2信号改变，与滋养细胞增生，绒毛间质水肿，所形成大小不等的水泡有关 nThe soft tissue mass of uterine cavity,a typical honeycomb,or grapes.form,and by the formation of the water-blister structure arrangement about state宫腔内
15、的软组织肿块影，呈典型“蜂窝”状或“葡萄”状，与所形成的水泡状结构排列状态有关 妊娠滋养细胞疾病(2)8MR Imaging（葡萄胎）（葡萄胎）nMass coated complete,endometrial signal continuous,muscular pressure is thinning,and pathology change lesions not involving womb jiceng are in agreement.肿块包膜完整，子宫内膜信号连续，肌层呈受压变薄改变，与病理上病变未侵犯子宫肌层相一致。n Uterine cavity and muscle lay
16、er has not seen the obvious increase of the blood vessels,thick,author and interstitial inner tire source sex disappear blood vessels relevant.structure arrangement about state子宫腔及肌层未见明显增粗、迂曲的血管，与间质内胎源性血管消失有关。妊娠滋养细胞疾病(2)9MR Imaging（葡萄胎）（葡萄胎）nDWI high b value in that honeycomb mass,or grapes.shape st
17、ructure spread not limited with pathological changes,low degree of malignant cells are arranged,not too crowded,water molecules spread a smooth relevant DWI高b值时显示肿块内“蜂窝”状或“葡萄”状结构扩散不受限，与病变恶性程度低，细胞排列不太密集，水分子扩散较顺畅有关妊娠滋养细胞疾病(2)10MR Imaging（葡萄胎）（葡萄胎）nEnhance scanning performance for multiple relatively u
18、niform space strengthening,solid component not strengthened,and the water-blister structure and expansion of the blood supply.增强扫描表现为多发较均匀的分隔强化，实性成分不强化，与扩张的水泡状结构缺乏血供有关。妊娠滋养细胞疾病(2)11n hydatidiform mole benign view of size differ in the blisters,microscopically nourish cells different degree,the hyper
19、plasia edema,the increase in size,outline rules,interstitial inner tire source sex disappear blood vessels,but not involving uterine muscle layer.良性葡萄胎大体观为大小不等的水泡，镜下见滋养细胞不同程度增生，绒毛间质水肿，体积增大，轮廓规则，间质内胎源性血管消失，但未侵犯子宫肌层Pathological characteristics（葡萄胎）（葡萄胎）妊娠滋养细胞疾病(2)12MR Imaging（恶性（恶性 GTD）nCapsule incomp
20、lete soft tissue mass,can show,a“crumb also cellular”,or“grapes.”shape,it shows high signal with pathological changes,flake necrosis related 包膜不完整的软组织肿块，可呈团块状，亦可呈“蜂窝”状或“葡萄”状，其内可见片状高信号，与病变坏死相关 nEndometrial signal discontinuous mass,infringe upon womb jiceng,and uterine muscle layer boundary is not cl
21、ear,is one of the most important features in GTD malignant子宫内膜信号不连续，肿块侵犯子宫肌层，与子宫肌层界限不清，是恶性GTD的重要特征之一 妊娠滋养细胞疾病(2)13MR Imaging（恶性（恶性 GTD）nUterine cavity mass and around and muscular layer appeared a lot of thick,the author increase blood flow in T1W empty signal,on display the clear,this tumor itself
22、the biological characteristics of the cancer itself is concerned,no inherent blood vessels,but rather on damage blood vessels with nutrients,and nearby abnormal high HCG hormone level stimulation,the blood vessels of the original make uterine level disorders and even appear typical blood lake shape
23、performance 肿块周围及子宫腔内及肌层出现大量增粗、迂曲的血管流空信号，于T1W I上显示最清楚，此与肿瘤本身的生物学特性有关，该肿瘤本身无固有的血管，而是依赖破坏邻近血管获取营养，加之异常高的HCG激素水平刺激，使子宫原来的血管层次紊乱，甚至出现典型的“血湖”状表现妊娠滋养细胞疾病(2)14MR Imaging（恶性（恶性 GTD）nDWI high b value shows limited spread disease malignant degree is high,dense cells are arranged,water molecules spread not smo
24、oth relevant.DWI高b值时显示扩散受限，与病变恶性程度高，细胞排列密集，水分子扩散不顺畅有关。妊娠滋养细胞疾病(2)15nIf the womb jiceng or outside the uterus tissue water-blister thing,see microscopic see for aggressive hydatidiform mole fluff 若子宫肌层或子宫外组织中见水泡状物，镜检见绒毛为侵袭性葡萄胎 nOnly piece nourish cells infiltration and hemorrhage,necrosis and absolut
25、ely none fluff the structure for flocking carcinoma仅为成片滋养细胞浸润及出血坏死，而完全不见绒毛结构者为绒癌 Pathological（恶性（恶性 GTD）妊娠滋养细胞疾病(2)16Differential diagnosisnMagnetic resonance imaging(MRI)for differentiating benign PuTaoTai and aggressive hydatidiform mole and cloth with soft nap is more beautiful,ultrasonic cancer
26、but for aggressive PuTaoTai and identification of flocking cancer also depends on the clinical and pathological diagnosis MRI对于鉴别良性葡萄胎与侵袭性葡萄胎及绒癌较超声更佳，但对于侵袭性葡萄胎与绒癌的鉴别还有赖于临床及病理诊断 nStill should identify with the following disease 还应与以下疾病鉴别 妊娠滋养细胞疾病(2)17Differential diagnosisEndometrial carcinoma子宫内膜癌:n
27、With endometrial uneven thickening showing the endometrial signal irregular,discontinuous and tumor deep abnormal signals of infringement to give priority 子宫内膜癌以子宫内膜不均匀增厚所表现出的子宫内膜信号不规则、不连续和肿瘤向深部侵犯的异常信号为主 nThe characteristic of malignant GTD blood flow“empty”signal and more help to identify kitchen b
28、leeding恶性GTD特征性的“血管流空”信号和多灶出血有助鉴别 nThe enhanced due to abnormal blood supply GTD malignant are very abundant,cause its abnormal strengthen than endometrial cancer.增强后由于恶性GTD异常血供非常丰富，造成其异常强化程度高于子宫内膜癌。妊娠滋养细胞疾病(2)18Differential diagnosisAdenomyosis子宫腺肌症:nThe increased to different extent,smooth contour
29、,sometimes visible uterine layered structure deformation子宫有不同程度的增大，轮廓光滑，有时可见子宫分层结构变形 nLesions performance for belt,limitations or thickening diffuse the muscular layer belt,T2WI focal sample signal can be mingled with focal high signal病灶表现为结合带弥漫性、局限性增厚或外肌层结合带样信号灶，T2WI 可混杂有局灶性高信号 nWhen a bleeding,T1
30、WI also can be mixed focal high signal oven.当有出血时，T1 WI 也可混杂局灶性高信号灶。nThe enhanced such lesions are sample strengthening belt增强后病灶呈结合带样强化 妊娠滋养细胞疾病(2)19Differential diagnosisEndometrial multiple polyps:子宫内膜多发息肉nAnd the benign hydatidiform mole MRI performance is very similar to the show for uterine ca
31、vity,honeycomb shape long T1,T2 signals such as long and T1,T2 and the space of the space,but the former is more even,generally no pregnancy symptoms such as history and vaginal bleeding,laboratory examination and without HCG abnormalities与良性葡萄胎的MRI表现非常相似，显示为子宫腔内“蜂窝”状长T1、长T2信号及等T1、等T2的分隔，但前者的分隔更加均匀，
32、一般无妊娠病史及阴道流血等症状，实验室检查亦无HCG 异常 妊娠滋养细胞疾病(2)20Treatment hydatidiform mole treatment:葡萄胎的治疗nremove uterine contents 清除宫腔内容物nhysterectomy子宫切除nFlavin cyst:many can be spontaneous regression黄素囊肿：多可自行消退nHigh-risk cases preventive chemotherapy 高危病例预防性化疗妊娠滋养细胞疾病(2)21Treatment The treatment of malignant GTD:恶性GTD的治疗nChemotherapy is given priority to,surgery,radiotherapy is secondary化疗为主，手术和放疗为辅nPay attention to follow-up 注意随访妊娠滋养细胞疾病(2)22Thanks!妊娠滋养细胞疾病(2)23
