malignant mole
Introduction
Introduction to malignant moles The blister-like tissue of the hydatidiform mole has exceeded the scope of the uterine cavity, and it has been invaded into the deep part of the myometrium or metastasized in other parts, called malignant mole. The chance of occurrence is 5% to 20% of vitiparous malignant moles or choriocarcinoma, most of which occur within 6 months after the hydatidiform mole is removed, but there are also malignant changes before the hydatidiform moles are discharged. Although malignant hydatidiform mole has the characteristics of malignant tumor, the therapeutic effect and prognosis are better than that of choriocarcinoma. The main symptom of malignant mole is that within a few months after the discharge of the hydatidiform mole, irregular vaginal bleeding occurs, the amount is uncertain, the uterus is slightly larger and softer, such as uterine perforation, abdominal pain, internal bleeding, or even shock, the hydatidiform mole is transferred to The lungs may have hemoptysis; if they are transferred to the brain, they may show symptoms of hemorrhage or even die immediately; transfer to the intestine may cause gastrointestinal bleeding; transfer to the vulva, vagina and cervix, local blue nodules, nodules Can cause major bleeding. basic knowledge Sickness ratio: 0.0001% Susceptible people: more common in women Mode of infection: non-infectious Complications: shock
Cause
Cause of malignant mole
The exact cause of malignant moles is unclear. The following are possible factors:
Age factor (25%):
The exact cause of malignant moles is unknown. Case-control studies have found that the occurrence of malignant moles is related to nutritional status, socioeconomic and age. The age of etiological factors is a significant factor. The incidence of hydatidiform moles is 10 times higher than that of young women. The age less than plus age is also a high risk factor for complete hydatidiform mole. These two age groups are prone to fertilization defects. . Partial moles are not related to the age of the pregnant woman.
Genetic factors (30%):
Cytogenetic and pathological studies have shown that both types of malignant moles have genetic characteristics. The chromosomal genome of malignant hydatidiform moles is the source of the paternal line, that is, the egg develops in the absence of chromosomal nucleus or inactivation of the procollagen nucleus.
Prevention
Malignant mole prevention
Because hydatidiform mole is a disease caused by pregnancy, as long as you have a good family planning, implement contraceptive measures, reduce the number of pregnancies, you can avoid the hydatidiform mole, especially women over the age of 40 are no longer pregnant, because the elderly pregnancy is not only the mole The incidence is high and it is prone to malignant changes.
After the occurrence of hydatidiform mole, it is necessary to guard against postoperative malignant transformation. The observation of HCG changes after hydatidiform mole curettage is the most important measure to prevent malignant transformation. After 12 weeks of curettage, HCG continues to be higher than normal level, or once dropped to normal level. After the rapid increase, after the exclusion of residual hydatidiform mole and re-pregnancy, suggesting that the patient is already in the early stage of malignant hydatidiform mole, chemotherapy should be given in time.
Complication
Malignant hydatidiform complications Complications
If uterine perforation occurs, abdominal pain, internal bleeding, or even shock, hydatidiform mole may be transferred to the lungs to have hemoptysis; metastasis to the brain will appear and hemorrhage symptoms, or even die immediately; transfer to the intestine can cause gastrointestinal bleeding; transfer to the vulva , the vagina and the cervix, local blue nodules, nodules can cause massive bleeding.
Symptom
Malignant mole syndrome common symptoms shock internal bleeding abdominal pain uterine perforation
The main symptom of malignant mole is that within a few months after the discharge of the hydatidiform mole, irregular vaginal bleeding occurs, the amount is uncertain, the uterus is slightly larger and softer, such as uterine perforation, abdominal pain, internal bleeding, or even shock, the hydatidiform mole is transferred to The lungs may have hemoptysis; if they are transferred to the brain, they may show symptoms of hemorrhage or even die immediately; transfer to the intestine may cause gastrointestinal bleeding; transfer to the vulva, vagina and cervix, local blue nodules, nodules Can cause major bleeding.
Examine
Examination of malignant moles
1. Urine pregnancy test: After more than 2 months after the emptying of the hydatidiform mole, it was confirmed by the curettage that there was no residual vesicular block, and the urine pregnancy test continued to be positive, or negative and then positive, and there was malignant possibility.
2. X-ray chest X-ray: Malignant hydatidiform moles can often occur in the lungs. Therefore, for cough and hemoptysis, lung examination must be performed. It can be seen that cotton-like shadows are scattered throughout the lungs, especially in the right lung. Lower leaves, but no lung lesions, can not rule out erosion of moles.
3. Diagnostic curettage: If only vaginal bleeding, other symptoms and signs are not typical, can be used for diagnostic curettage, if a small amount of decidua or necrotic tissue is scraped, the aggressive mole can not be ruled out.
Diagnosis
Diagnosis and diagnosis of malignant mole
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Abortion: The history of hydatidiform mole is similar to threatened abortion, which is easy to be confused. Threatened abortion has menopause, vaginal bleeding and abdominal pain. The pregnancy test is positive, but most uterus at the time of hydatidiform mole is greater than the normal pregnancy of the corresponding gestational age, and the HCG level continues to be high. B-type ultrasound images do not show fetal sac and fetal heartbeat, but show the characteristics of hydatidiform mole.
2 twin pregnancy: the uterus is greater than the normal singleton pregnancy of the corresponding gestational age, HCG level is also slightly higher than normal, can be confused with hydatidiform mole, but there is no vaginal bleeding in twin pregnancy, B-mode ultrasound can confirm the diagnosis.
3. Too much amniotic fluid: generally occurs in pregnancy, if it occurs in the second trimester, the factor palace rapidly increases, it needs to be differentiated from the hydatidiform mole, there is no vaginal bleeding when the amniotic fluid is too much, the HCG level is in the normal range, B-mode ultrasound can confirm the diagnosis. .
