erosive mole
Introduction
Introduction to aggressive moles Invasive hydatidiform mole refers to a malignant trophoblastic tumor that invades the myometrium or metastasizes outside the uterus. The erosive moles are all from benign moles, most of which occur within six months of the removal of the moles. Most of the aggressive moles occur within 6 months of the hydatidiform mole removal. Patients may present with irregular vaginal bleeding and may also have extrauterine metastatic lesions. The principle of erosive hydatidiform mole treatment is mainly chemotherapy, supplemented by surgery. Can be monotherapy or combination chemotherapy. Chemotherapy should continue until symptoms and signs disappear. HCG is measured once a week for 3 consecutive times in the normal range, and then 2-3 courses are consolidated. The lesions in the uterus, chemotherapy ineffective can be removed from the uterus extensive hysterectomy and high ovarian arteriovenous ligation. basic knowledge The proportion of the disease: the disease generally occurs in women during pregnancy, the incidence rate is 0.02% - 0.05%. Susceptible people: women Mode of infection: non-infectious complication:
Cause
Causes of aggressive moles
The villi of the invasive hydatidiform mole can locally spread into the myometrium or blood vessels, and the blister-like tissue invades the deep part of the myometrium, sometimes completely penetrating the uterine wall and expanding into the broad ligament or abdominal cavity.
Prevention
Erosive mole prevention
Erosive hydatidiform moles should be followed for at least 2 years, strict contraception for 1-2 years, preferably with a condom, should not use intrauterine devices and oral contraceptives. Invasive hydatidiform moles should be followed closely after clinical recovery, and no recurrence is cured in 5 years.
Complication
Erosive hydatidiform complications Complication
May be complicated by choriocarcinoma.
Symptom
Erosive mole syndrome common symptoms vaginal irregular bleeding
Most of the aggressive moles occur within 6 months of the hydatidiform mole removal. Patients may present with irregular vaginal bleeding and may also have extrauterine metastatic lesions. After the hydatidiform mole was lifted for 2 weeks or the plateau state was more than 3 weeks; 6 weeks after the calf emptying, the blood HCG continued to be high for more than 6 weeks.
Examine
Examination of aggressive moles
1. History and clinical manifestations According to the typical clinical manifestations or metastases symptoms within half a year after hydatidiform mole clearance, combined with the auxiliary diagnostic method, clinical diagnosis can be established.
2. HCG continuously measured -HCG continued to high level for more than 8 weeks after hydatidiformectomy, or HCG once dropped to normal level and rapidly increased. Clinically, hydatidiform moles, luteinized cysts or re-pregnancy were excluded, which can be diagnosed as erosion. Sexual moles.
3. Ultrasound examination B-mode ultrasound is a non-invasive examination, which can early detect the degree of invasion of hydatidiform tissue into the myometrium and assist in the diagnosis of intrauterine trophoblastic tumor lesions. The wall of the uterus shows a focal or diffuse glare or a honeycomb-like lesion between the light and dark areas, which should be considered as aggressive hydatidiform mole or choriocarcinoma.
4. Histological diagnosis alone can not be used as a diagnostic basis for invasive hydatidiform moles, but in the sections that invade the myometrium or metastasis, the signs of villus structure or villus degeneration can be seen, and the erosive grapes can be diagnosed. tire. If the diagnosis of the primary and metastatic lesions is inconsistent, as long as there is a villus structure in any specimen, it should be diagnosed as an aggressive mole.
Auxiliary inspection
1, the parauterine, vaginal and lung metastases were selected "electrocardiogram, histopathology, gynecological ultrasound, chorionic gonadotropin, etc.".
2. Patients with brain and systemic metastases were selected for "laparoscopic and craniocerebral CT examination".
Diagnosis
Diagnostic identification of invasive hydatidiform mole
diagnosis
Typical clinical manifestations or metastases appear within half a year after hydatidiform mole clearance. Combined with adjuvant examination, clinical diagnosis can be established.
Differential diagnosis
Hydatidiform mole: It can be diagnosed according to typical clinical manifestations. It needs to be differentiated from abortion, twin pregnancy, polyhydramnios, and uterine fibroids. Qing specimens must be sent for pathological examination.
Choriocarcinoma: Any occurrence of symptoms or metastases after abortion, childbirth, ectopic pregnancy, and elevated HCG, can be diagnosed as choriocarcinoma. The disease can be diagnosed as choriocarcinoma after more than one year after hydatidiform mole; erosive hydatidiform mole and choriocarcinoma are likely to occur within half a year to one year, and need to be identified by histological examination.
