choriocarcinoma
Introduction
Introduction to choriocarcinoma Choriocarcinoma is a highly malignant tumor that is secondary to hydatidiform mole, abortion or full-term delivery. The incidence of the disease is about 0.0001% to 0.36%, a small number can occur after ectopic pregnancy, mostly women of childbearing age. Occasionally, the ovary of an unmarried woman is called primary choriocarcinoma. In the 1950s, the mortality rate was very high. In recent years, the application of chemical drugs has significantly improved the prognosis of choriocarcinoma. The choriocarcinoma mostly occurs in the uterus, but there are also no primary lesions found in the uterus and only metastases appear. The uterine choriocarcinoma can form single or multiple uterine wall tumors, which are dark red, purple or tan, with a diameter of 2 to 10 cm. Hemorrhagic necrotic tissue, tumor can protrude into the uterine cavity, invade the uterine wall or protrude into the serosal layer, brittle, easily bleed, tumor thrombus is often found in the parametrial vein, and the ovary can form polycystic flavin cyst. basic knowledge The proportion of illness: 0.0025% Susceptible people: mostly women of childbearing age Mode of infection: non-infectious Complications: choriocarcinoma
Cause
Choriocarcinoma
The vast majority of choriocarcinoma is related to pregnancy, which is secondary to hydatidiform mole, after abortion or normal delivery. It has also been reported that it can be directly caused by pregnant eggs, and even some of the nourishing leaf components from the eggs contained in the teratoma occur. Tubal pregnancy or abdominal pregnancy are rare.
The choriocarcinoma mostly occurs in the uterus, but there are also no primary lesions found in the uterus and only metastases appear. The uterine choriocarcinoma can form single or multiple uterine wall tumors, which are dark red, purple or tan, with a diameter of 2 to 10 cm. Hemorrhagic necrotic tissue, tumor can protrude into the uterine cavity, invade the uterine wall or protrude into the serosal layer, brittle, easily bleed, tumor thrombus is often found in the parametrial vein, and the ovary can form polycystic flavin cyst.
Histologically, choriocarcinoma is very different from general cancer. There is no common connective tissue stromal cells in choriocarcinoma. There are only necrotic cells composed of trophoblasts, blood clots and coagulative necrotic tissue, and there are no inherent blood vessels. Cancer cells directly contact the host blood to obtain nutrients. In the center of the cancerous foci, cancer cells are often not found. The closer to the margin, the more obvious the tumor cells are, but the fluff structure is not seen. Only the trophoblasts can be seen. .
Prevention
Choriocarcinoma prevention
1. Extensively carry out prenatal and postnatal care, popularize family planning knowledge, do a good job in contraception, reduce the chance of pregnancy, civilized life, prevent the spread of sexually transmitted diseases, and send pathology after abortion.
2. After the recent cure of choriocarcinoma, 1 to 3 courses of chemotherapy will be consolidate, and blood -HCG will be measured once a week. After 3 months, the normal chemotherapy will be consolidated once, and once every six months, the chemotherapy will not be relapsed after 2 years. .
3. After the choriocarcinoma is cured, the contraceptive women are strictly contraceptive for 2 years. In order to prevent the -HCG value from being affected by contraceptive factors, it is best to adopt a male condom and a female vaginal diaphragm twin contraceptive method.
4. The chance of malignant transformation of benign trophoblastic tumors is about 10% to 20% according to the current literature, so the follow-up work lasts for at least 2 years, and those who have conditions should be followed up for a long time.
Complication
Choriocarcinoma complications Complications choriocarcinoma
Prognosis is related to many factors, such as early diagnosis, timely treatment, and better prognosis. Childbirth, choriocarcinoma after abortion is less prognostic than benign hydatidiform choriocarcinoma; the longer the choriocarcinoma is found, the longer the so-called incubation period Long, the prognosis is poor, the concentration of chorionic gonadotropin is rapidly decreased after surgery, and the prognosis is good afterwards. If it is once decreased but not negative, and the persistence, the prognosis is poor.
Symptom
Chorionic cancer symptoms common symptoms abortion vaginal bleeding excessive vaginal blood secretions
1. Clinical features: Where hydatidiform mole, irregular vaginal bleeding after delivery or abortion, the uterus can not be rehabilitated as expected, larger and softer, should consider the possibility of choriocarcinoma.
2. Blood or urine HCG measurement: elevated titer or blood, urine positive after HCG negative.
3. X-ray lung slices: There are spherical shadows in the lungs, which are distributed in the lung fields on both sides, sometimes only a single metastatic lesion, or several nodules merge into cotton balls and mass lesions.
4. Pathological diagnosis: large necrotic tissue and clots can be seen in the myometrium or other resected organs. A large number of long-lived trophoblasts can be seen around them, and there is no fluff structure.
Examine
Examination of choriocarcinoma
(1) Those with histological examinations are subject to histological diagnosis. In the histological examination, choriocarcinoma only sees a large number of nourishing cells and hemorrhagic necrosis. If fluff is seen, the diagnosis of choriocarcinoma can be ruled out.
(2) Those who have no histological examination, who have miscarriage, childbirth, symptoms or metastases after ectopic pregnancy, and have elevated hCG, can be diagnosed as choriocarcinoma, and the hydatidiform mole is diagnosed as choriocarcinoma after more than one year after hysterectomy. .
(3) When there is suspected brain metastasis, CT and B-ultrasound can be used to show metastases, but the lesions are small, and may not be clearly diagnosed. It can be used for cerebrospinal fluid and plasma hCG determination, cerebrospinal fluid hCG level: plasma hCG level >1 : 60, it shows that hCG directly into the cerebrospinal fluid, can be diagnosed as brain metastasis.
Diagnosis
Diagnosis and diagnosis of choriocarcinoma
First, malignant moles generally believe that evil grapes only occur after hydatidiform moles and choriocarcinoma can occur in full-term postpartum, after abortion (including ectopic pregnancy, spontaneous abortion or induced abortion), followed by malignant transformation of puerperal cancer, choriocarcinoma and venomous It is possible, but there are differences in the time of occurrence. According to the experience of Peking Union Medical College Hospital, the most common (96.5%) of the malignant changes in the six months after the release of hydatidiform moles are malignant moles, and most of them are more than one year (92.85). %) for choriocarcinoma, which occurs in between 6 months and 1 year, and it is generally said that the longer the interval, the greater the possibility of choriocarcinoma.
Second, syncytial endometritis (syncytial endometritis) After full-term postpartum, especially after abortion or hydatidiform mole discharge, curettage or resection of the uterus can be found in the superficial muscle layer, especially the placenta attachment site, there are scattered trophoblasts ( In the case of syncytiotrophoblasts and inflammatory cells, it looks like a tumor image, but the deep muscle layer is sub-invasive, and the blood or urine hCG measurement is mostly negative, so it is not in the scope of trophoblastic disease. After curettage, it gradually returns to normal. Park (1981) believes that the term "endometrial inflammation" is inappropriate, because cells involved in benign erosion are mononuclear, non-syncytial and multi-nuclear. There is no obvious inflammatory process.
Third, trophoblastic pseudotumor has various names. In addition to trophoblastic pseudotumor (Kurman, 1976), there are also syncytoma ("Syncytioma", Qwing, 1960), atypical choriocarcinoma (atypical) Choriocarcinoma, Merdrand, 1959), refers to the "an unusually persitent form of benign chorionic invasion" that is not typical of choriocarcinoma and does not metastasize ("an unusually persitent form of benign chorionic invasion"). The trophoblastic reactive hyperplasia forms a tumor. In histology, the syncytiotrophoblasts also show pleomorphism, and there are also large grotesque nuclei. There is no villus structure. It is difficult to identify with choriocarcinoma, but according to none. The mitotic image, lack of cytotrophoblastic cells, does not invade the deep muscle layer of the uterus and causes damage, and can be differentiated from choriocarcinoma.
