Trophoblastic disease - Causes, symptoms and treatment. MF.

Trophoblastic disease includes related tumors developing from placental tissue. It includes: a bladder skid( partial or complete), destructive bladder skidding, choriocarcinoma and trophoblastic tumor of the placental site.

Bumble skid

Bubble skid is a modified villous layer of the chorion( changes in the form of bubbles), which completely( full drift) or partially( partial drift) displaces normal placental tissue. The prevalence of bladder skidding is a full 0.5 to 1000, partial - 1.4 to 1000 pregnancies.

Full bladder skidding - occurs when a defective ovum is fertilized, without chromosomes. As a result, only the paternal chromosomes are duplicated, the zygote is not viable, the embryo does not form, only the growth of villi occurs. Karyotype at the same time 46 XX, less often XY.The most frequent and proven cause of incomplete bladder skidding is the fertilization of the egg with two spermatozoa. In this case, the cells contain additional chromosomes, which leads to the fact that the embryo does not develop. In this case triploidy is observed - the cells carry 69 chromosomes. The fetus has signs of triploidy: numerous malformations. However, it should be noted that with incomplete bladder skidding, it is still possible to develop a viable fetus.

The clinical picture with a bubble drift is characterized by:

• bloody discharge from the genital tract( in 97% of cases) in the first trimester of pregnancy as a result of the detachment of the bubble drift from the decidua;
• an increase in the uterus that does not correspond to the duration of pregnancy - a possible cause of blood accumulation and pathological growth of the chorion;
• preeclampsia - in 27% of pregnant women, with eclampsia developing rarely, characterized by the appearance of protein in the urine, increased blood pressure, hyperreflexia;
• toxicosis, indomitable vomiting of pregnant women - severe electrolyte disturbances are possible;
• thyrotoxicosis
• embolism of the branches of the pulmonary artery
• ovarian cysts

The main diagnostic methods are:
• Ultrasound is the main method for diagnosing blistering
• Analysis of the blood for HCG - detection of the β subunit of HCG more than 100,000 IU /in combination with other factors, can reliably testify to the bubble drift of
• The uterus, much longer than the presumptive period, in a compartment with bloody discharge in the first trimester is a characteristic symptom.

Treatment - Immediately after the diagnosis is made, it is necessary to stop the severe complications of bladder skidding. After stabilization of the state, the skid must be evacuated. The most gentle method is vacuum-aspiration of the uterus. For patients who do not plan to have children - extirpation of the uterus.

After evacuation of the pancreatic drift, it is necessary to measure the level of the β-subunit of CG, which should progressively decrease and normalize to 9 weeks after evacuation. Pregnancy is allowed after the observation is completed.

The prognosis is usually favorable, but in about 15% of patients the outcome is trophoblastic tumors, of which 4% are metastatic. This is especially important for patients of the older age group( over 40 years old - 37%).According to recent data, the use of adjuvant( directed) chemotherapy reduces the risk of an outcome in a trophoblastic tumor.

Trophoblastic tumors

Chorion carcinoma( synonymous with chorionepithelioma) is a malignant form of trophoblastic disease that occurs after bladder skipping, abortion( 25%), or after childbirth( 20%).It is rare. The most common location - the uterine cavity, in the place of implantation of the fetal egg.

Rare chorionic carcinoma occurs during pregnancy. Chorionic carcinoma in pregnancy is characterized by a high degree of malignancy, leading to metastatic lesions in distant organases. Symptoms for a long time may not be. The forecast is generally unfavorable.

The most common symptoms are:

• Bleeding from the genital tract, which may not stop after scraping, require a repeat procedure - the need for repeated scraping is a characteristic indicator.
• Purulent and serous discharge from the genital tract - are associated with suppuration of tumor nodes, which is not so rare.
• Pain - characteristic of organ germination.

For the diagnosis of chorion carcinoma by the main method of ultrasound. In addition, a biochemical blood test can also be used( placental lactogen, estriol, chorionic thyrotropin, etc.), hysteroscopy, MRI, CT, etc., at the discretion of a specialist.

The trophoblastic tumor of the placental site is a rare tumor. It is characterized by invasive growth( in the organ wall), metastasis is rare. As a rule, chemotherapy is not very effective.

Stages of trophoblastic tumors( simplified scheme):

Stage I - tumor is confined to the uterus
Stage II - affection of the appendages of the uterus, vagina,
parameter. Stage III - Metastases to the lungs( regardless of lesions)
Stage IV - Remote metastases,in the lungs

At the time of diagnosis, 80% of patients have metastases to the lungs. Detection on chest radiography. Metastases in the liver are observed in 10% of cases of disseminated trophoblastic tumors.

Treatment of trophoblastic tumors mainly depends on the stage of the disease, on the condition of the patient and her desire to have children in the future. In general, the treatment is carried out according to the following schemes:

Stage I - monochemotherapy;Extirpation of the uterus and adjuvant chemotherapy;polychemotherapy in the development of resistance
Stage II - III - monochemotherapy;polychemotherapy;polychemotherapy of the 2nd line
Stage IV - polychemotherapy, radiation therapy in a total dose of 30 Gy, surgical treatment of complications;Regional chemotherapy with liver metastases

Doctor gynecologist Kupatadze D.D.