By trophoblastic disease is understood the complex of neoplasms of placenta trophoblasts arising during pregnancy.
Proliferative neoplasia develops in benign and malignant forms. Trophoblastic disease is called bladder drift( complete and partial, invasive and simple), tumors of epithelial trophoblast and placental site, chorionepithelioma.
Diagnostics of different trophoblastic states includes both biochemical methods of investigation( analysis on human chorionic gonadotropin) and instrumental( ultrasound, computer and magnetic resonance imaging).
In establishing the diagnosis, a woman undergoes removal of the fetus through the abdominal wall and an incision in the uterus( hysterotomy or cesarean section), the effects of chemotherapeutic substances, since surgical procedures in the uterus often reveal a developing chorionic carcinoma. The evacuation of a bubble drift is mandatory.
Trophoblastic disease - infrequent in obstetric practice.0.1% of births detect the presence of a bubble drift. At 0.0001% of abortions, artificial or natural births, there is a case of development of chorion carcinoma.
A simple bladder skip is diagnosed in women under 24 years of age, an invasive form that is characteristic of women over 40 years of age. Chorion carcinoma develops in pregnant women 25-30 years old.
The International Classification of Diseases establishes the discreteness of trophoblastic disease on the basis of the quality of trophoblast degeneration.
Malignant tumors are characterized by low or high aggressiveness, with or without metastases.
Relying on the classification of trophoblastic disease according to clinical signs from FIGO, the following order of the disease is revealed:
- 1 stage - a new growth of trophoblasts not leaving the uterus;
- Stage 2 - trophoblastic neoplasia extends beyond the uterus and the local area includes uterine ligaments, vagina, ovaries, but remains only within the reproductive system;
- 3 stage - trophoblastic tumor penetrates into the lung structures;
- Stage 4 - metastases penetrate from the lungs into the brain, kidney, liver, digestive system, spleen.
Causes of development of
The etiology of pathogenetic processes in all manifestations of trophoblastic disease is unified.
Predisposition to the development of neoplasia are the following factors:
- the consequences of a viral influenza infection;
- high level of hyaluronidase;
- protein deficiency;
- intrachromosome rearrangements;
- immune responses;
- the initial state of the egg with a gene disorder.
Pregnancy in women under 35 years with similar pathologies occurs 5 times less often than in fruit-bearing women over 40 years.
Less significant causes, but taking place in the statistics of the occurrence of trophoblastic disease, are the facts of the past state of pregnancy:
- borne delivery;
- artificial abortion( abortion and artificial delivery);
- ectopic pregnancy;
- spontaneous abortions.
According to the geographical distribution in the statistics of cases of trophoblastic disease, fertile women of the eastern half of the globe are leading. In Western countries, neoplasia is much less likely to affect trophoblasts of the placenta.
The degeneration of placental trophoblasts occurs equally during pregnancy, and after normal birth, all forms of abortion.
Symptoms of trophoblastic tumor
Clinical signs of trophoblastic disease most often begin to appear 3 months after the termination of pregnancy( labor, spontaneous, natural or artificial interruption).
The duration of the latent period of onset of trophoblastic disease sometimes exceeds 0.5 years, 1 year, etc. There is a manifestation of symptoms of the disease after a 20-year latent period.
There are no specific symptoms for the manifestation of chorionic carcinoma. Manifestation of the disease is noted with the uterine location of the tumor and its communication with the uterine cavity. Bloody discharge from the vagina is the first symptom and practically the only one at the initial stages of trophoblastic disease development.
Bloody discharges differ in morphology:
- gaps are light, duration is moderate;
- gaps - light, character - plentiful;
- intensity - uniform, character - long;
- intensity - periodic, with time the intensity increases;
- sudden strong blood discharge.
The accepted gynecologic practice assumes after a blood allocation procedure of a curettage. When trophoblastic neoplasia is characterized by a repeated isolation of the sexual organs of blood secretions after the first scraping.
Multiple scraping is a typical symptom of trophoblastic disease.
The size of the uterine walls increases in size, exceeding the parameters for this gestation period. Pregnant women are accompanied by continuing vomiting, frequent jumps of blood pressure, distant signs of hyperthyroidism( rapid heartbeat, excessive sweating, redness of the skin).
With invasive bladder drift, infiltrate growth occurs, a high probability of tumor degeneration into a malignant form. More than 30% of cases of invasive form result in metastasis in the labia, vagina and lungs.
The examination of patients begins with the collection of anamnesis of data, the entry of which shows how long the symptoms are concerned and what pathologies are marked by the patient.
The gynecologist exposes the patient to further gynecological examination. During palpation, one can often feel the knot in the genitals and the uterine hyperplasia.
A tumor more than 4 mm is detected by the ultrasound technique. A biochemical blood test reveals a pathologically high level of chorionic gonadotropin.
The main diagnostic tool is biopsy biopsy( blood, clots), laparoscopy, puncture of metastases, opening of the hyperplastic vaginal area.
Detection of metastases occurs by computer and magnetic resonance imaging, pulmonary radiography, angiography of small pelvic vessels.
Treatment of trophoblastic disease
The treatment of trophoblastic disease depends on the stage of its development and the form of manifestation. The bladder pump does not involve the use of chemotherapeutic techniques, but vacuum extraction with subsequent scraping of the uterus.
When detecting the malignant nature of trophoblastic disease, chemotherapy with a matched drug regimen is used, for example, Etoposide + Cisplatin.
Contraception after all treatments is at least 1.5 years. Removal of the uterus, vaginal ligaments or uterine fragments is indicated in patients of post-productive age or in the absence of pregnancy planning in patients of childbearing age.
After chemotherapy, MRI of the brain is performed once every 2 years.
Follow-up control consists of periodic monitoring of the level of chorionic gonadotropin, the nature of monthly, echographic examinations.
Seven patients out of ten with a former malignant tumor survive after a competent and timely treatment. In the absence of malignancy of placental trophoblasts, survival after trophoblastic disease is 100%.
Relapses of the disease do not exceed the rate of 4-7%.
Women of childbearing age manage to maintain reproductive function.