benign mole
Introduction
Introduction to benign moles The trophoblasts derived from the embryos, due to the increase of villus edema, form blisters of varying sizes, which are connected in a string and resemble grapes, so they are called hydatidiform moles. In most hydatidiform moles, the placental villus tissue has almost completely turned into hydatidiform mole tissue, but there are also a few hydatidiform moles that only part of the placental villi tissue becomes hydatidiform mole. The former is called a complete mole, and the latter is called a partial mole. The cause of hydatidiform mole is unknown. The study found that the occurrence of hydatidiform mole is related to nutritional status, socioeconomic and age. The pregnancy reaction in amenorrhea and pregnancy reaction is earlier than normal pregnancy, and the symptoms are more obvious. The vaginal bleeding begins 6 to 8 weeks after amenorrhea. The initial amount of bleeding is dark, dark red, and gradually increase or continue to bleed. The incidence rate is above 96%, usually around 4 months of pregnancy. basic knowledge The proportion of illness: 1% Susceptible people: women Mode of infection: non-infectious Complications: shock abortion pulmonary edema
Cause
Benign mole fetus
Age (45%):
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 demonstrated that each type of hydatidiform mole has genetic characteristics. The chromosomal genome of a complete hydatidiform mole is a paternal source, ie, the egg develops in the absence of oogonia nucleus or inactivation of the procollagen nucleus. The karyotype is diploid, 90% of which is 46, XX, fertilized by a vacant egg (no genetic material egg) and a haploid sperm (23, X), and restored to diploid by self-replication (46, XX), the regrowth develops, called empty egg fertilization. The minority karyotype is 46, XY, which is the sperm of two sex chromosomes (23, X and 23, Y) and simultaneously fertilized, called double sperm fertilization. Partial hydatidiform nucleus is often triploid, 80% is 69,XXY, and the rest is 69, XXX or 69,XYY, from a normal egg and double sperm fertilization, which brings a set of redundant father chromosome components, It can also be caused by a normal haploid egg (or sperm) combined with a diploid gamete that fails meiosis.
Nutritional status (20%):
The nutritional status of pregnant women is low and may also cause the disease.
Prevention
Benign hydatidiform mole prevention
All patients with hydatidiform moles should be followed up regularly. It is best to contact the hospital for a long time. More importantly, they should be reviewed regularly within 2 years. The purpose is to find malignant changes at an early stage, but sometimes there may be residual blisters, which should be advised. Patients should take effective contraceptive measures for at least 2 years. They should be reviewed once a month for the first half of the year. If irregular vaginal bleeding, hemoptysis, headache or other discomfort occurs, they should go to the hospital immediately.
In addition to asking whether menstruation is normal, you should also pay attention to whether there are any symptoms mentioned above. Check whether the uterus is well-recovered, whether there is purple or blue nodules in the vagina and vulva, and there is a shadow in the chest (preferably the chest film).
Pregnancy test is very important in the follow-up examination. After the hydatidiform mole is completely removed, about 60% of the patients will be negative in the pregnancy test within 30 days, and still positive in more than 40 days. The malignant or residual vesicular block should be highly suspected. The pregnancy test has been completed. If you turn to yin and return to Yang in the follow-up, if you are not pregnant, you should be highly suspicious of malignant transformation. If the original urine is positive, the dilution test has turned negative, and the dilution test in the follow-up is positive again. Especially those with increased dilution should also be highly suspected of malignant transformation. .
Complication
Benign hydatidiform complications Complications, shock abortion, pulmonary edema
First, major bleeding
If the hydatidiform mole is not diagnosed and treated in time, repeated bleeding may occur, and the blood in the uterine cavity may cause blood loss. It may also cause large bloodshed when it is naturally discharged. Hemorrhagic shock or even death may occur on the basis of anemia. Therefore, hydatidiform mole should be treated as an emergency, and short-term delays may cause more blood loss and harm the patient.
Second, the mole is not aborted
After spontaneous abortion or abortion, there may be residual blister-like blocks. The patients who have a spontaneous abortion before the hospitalization of the moles are admitted to the hospital. Those who can withstand the operation of the uterus should immediately clear the palace, discharge the elderly, have signs of infection, apply antibiotics. The mutual control was carried out several days later.
Third, the grape fetal embolism
The blister-like blocks can be transferred with blood or to other parts of the body. The most common ones are the lungs and vagina, and hemorrhagic lesions can be formed locally. A small amount of emboli may not be examined closely and may resolve by itself. Liang et al reported that 1 case of extensive lung metastases due to induction of labor with oxytocin, pulmonary arteriospasm syndrome, death from pulmonary edema, heart failure, hydatidiform mole embolism can be different from malignant tumor metastasis, can be itself Immunosuppression disappeared, Lin Qiaozhi, Su Yingkuan reported, and it is better to implement chemotherapy after the discovery.
Fourth, malignant changes
It becomes an aggressive hydatidiform mole or choriocarcinoma with a malignant rate of about 10% to 20%.
Five, ovarian luteinized cyst pedicle torsion
Most cases occur after the hydatidiform mole is discharged, and when the pedicle is twisted, the torsional uterine attachment should be surgically removed immediately.
Symptom
Benign hydatidiform mole symptoms Common symptoms Pregnancy reaction Pregnancy-induced hypertension Amenorrhea Paroxysmal abdominal pain Abdominal pain Proteinuria Hypertension Edema Epilepsy shock
The pregnancy reaction in amenorrhea and pregnancy reaction is earlier than normal pregnancy, and the symptoms are more obvious. The vaginal bleeding begins 6 to 8 weeks after amenorrhea. The initial amount of bleeding is dark, dark red, and gradually increase or continue to bleed. The incidence rate is above 96%, usually around 4 months of pregnancy, when there is a large amount of bleeding near the self-discharge, and grape-like tissue can be seen. At this time, a lot of bleeding can cause shock or even death if not treated in time. Abdominal pain is rare, if it is also a recessive abdominal pain, but when the hydatidiform mole is discharged, there may be paroxysmal abdominal pain. At this time, there is a lot of bleeding. Some patients may have hypertension, edema, and protein in addition to pregnancy and vomiting. Urine, even eclampsia or heart failure, and symptoms of pregnancy-induced hypertension in the normal pregnancy rarely occur 20 weeks ago, anemia and infection of long-term vaginal bleeding, can lead to varying degrees of anemia and infection.
Examine
Inspection of benign moles
According to the history, symptoms, signs, hydatidiform diagnosis is no difficulty.
hCG determination
The trophoblasts of the hydatidiform mole are hyperproliferative, producing a large amount of hCG, which is higher than the normal pregnancy of the corresponding month.
B-ultrasound
There is no fetal, placenta, and amniotic fluid images in the uterine cavity during B-ultrasound examination. Only the "falling snow-like" echo is seen. If there is bleeding, the irregular liquid dark area can be seen. The falling snow echo is the specific imaging feature of the hydatidiform mole.
Fetal heart rate measurement
Symptoms Atypical fetal heart rate normal pregnancy After 2 months, Doppler can hear the fetal heart, but only some uterine blood flow murmurs can be heard during the mole.
X-ray examination
Although the uterus has been more than 5 months old, the fetal bones are not seen on the abdominal X-ray.
Diagnosis
Diagnosis and identification of benign hydatidiform mole
Differential diagnosis
First, abortion
Although hydatidiform mole patients often exhibit abortion, their uterus is often larger than the same period of pregnancy; and the pregnancy test is positive, the titer is higher, so it is not difficult to identify, but the uterus of hydatidiform mole patients also have no special increase or when In the early stage, it is often confused with threatened abortion. However, the titer of the positive pregnancy test is higher than the threatened abortion at the end of the hydatidiform mole, and the B-ultrasound can be distinguished.
Second, polyhydramnios
Occurred in the late season of pregnancy, acute polyhydramnios may occur in the mid-pregnancy period, may have difficulty breathing, no vaginal bleeding, while hydatidiform moles have difficulty breathing, but repeated vaginal bleeding, B-ultrasound can be It is not difficult to identify your own characteristics.
Third, uterine fibroids and pregnancy
Uterine fibroids are detected before pregnancy, it is not difficult to identify, fibroids combined with pregnancy generally no vaginal bleeding, double-diagnosis may be found in the fibroids exist in a part of the palace, B-ultrasound can be identified.
Fourth, twin pregnancy
It is most difficult to identify single-oval twins with amniotic fluid and threatened abortion. The clinical manifestations are very similar. The titer of pregnancy test is also higher than normal, which often leads to misdiagnosis. The twin pregnancy usually has no vaginal bleeding. Hydatidiform moles are common and can be diagnosed by ultrasonography.
