The trophoblastic disease is a disease, the development of which comes from the elements of the placenta. The main manifestation of the disease is the inconsistency of the size of the uterus of the estimated period of pregnancy.
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Concept of trophoblastic disease
Trofoblastic disease - a group of benign and malignant neoplasms originating from the elements of the placenta. Trophoblastic disease occurs relatively rarely. Manifestations of trophoblastic disease are:
- Bubble drift (full or partial)
- Invasive bubble drift
- Horiciarcinoma or chorionepithelomoma
- Choriocarcinoma in combination with teratoma or embryonic cancer
- Malignant teratoma trophoblastic
- Tropofoblastic Placental Platter Tumor
Among the main reasons for the occurrence of trophoblastic disease, viral, immunological, enzymatic theory and protein deficiency are considered.
The risk factors for the occurrence of trophoblastic disease are:
- age of pregnant women older than 40 years
- The presence of early spontaneous abortions
- The probability of the development of the disease is higher in repeatedly
- The disease is more common in the countries of the East
- Signs of trophoblastic disease
The main symptoms of trophoblastic disease
One of the signs of trophoblastic disease is the inconsistency of the sizes of the uterus of the estimated period of pregnancy. More often the sizes of the uterus more than should be with the estimated period of pregnancy. An important feature of the trophoblastic disease is the formation of the ovarian cysts that reach large sizes and fill the entire small pelvis. With bubble drift cysts can appear during the first two weeks. The presence of a cyst is an unfavorable prognostic sign. In the trophoblastic disease of the pain, felt by the patient at the bottom of the abdomen and the lower back, are explained by the presence of tumor masses in the uterine cavity, especially when germinating the walls of the uterus.
In some cases, pain occurs due to the location of the metastatic tumor masses and the comprehensive of the nervous trunks. The presence of sharp stomach stomach pains can be explained by the purple of the uterus or twist the cyst. Pains can also be due to the localization of metastases in various organs of the abdominal cavity, so for example, pain in the chest area are a consequence of metastases in the lungs, headaches - metastases in the brain and t.D. Perhaps the presence of symptoms associated with the process of metastasis. The manifestation of intestinal obstruction is intestinal bleeding, cough with blood wets, paresis, cachexia and t.D.
The course of trophoblastic disease is characterized by early and intensive metastasis, especially when chorioncarcinoma. In some cases, the disease is first diagnosed on the basis of detection of metastases. Places, most frequently affected by metastases of trophoblastic tumors, mainly chorioncarcinoma, are the lungs, vagina and brain. Less rapid liver, kidneys, spleen, small intestine.
Methods for the diagnosis of trophoblastic disease
In the diagnosis of the disease, an important importance is attached to ultrasound. With a thorough study, a cyst visualization is possible, usually bilateral, side from the uterus. Characteristic ultrasound criteria for trophoblastic disease are more often found after 12 weeks of pregnancy. In earlier deadlines, the ultrasound signs of the disease are not informative enough.
For more reliable diagnostics, it is advisable to use the color Doppler mapping, which allows you to identify tumor nodes even when the usual ultrasound fails to clearly visualize the contours of the pathological focus in the structure of the uterine myometry. Color Doppler mapping makes it possible to estimate the state of the vascular bed with trophoblastic tumors of the uterus, as well as the effectiveness of the therapy. Clear visualization of the tumor foculation in the thickness of the myometrium can significantly reduce the amount of unjustified repeated diagnostic scraping of the uterus.
To diagnose the disease from the instrumental research methods, are also used:
- X-ray study
- Hysteroscopy (Study of the uterus uterus using endoscopic equipment)
- Radiography of the chest (establishes the fact of the presence and nature of metastases in the lungs, which makes it possible to judge the degree of prevalence of the disease, although it does not specify the nature of the trophoblastic tumor)
With laboratory studies, the level of human chorionic gonadotropin is determined in the urine and serum, placental lactogen, estriol, chorionic thyrotropin, alpha fetoprotein.
Histological verification is one of the main diagnostic methods, which makes it possible to establish not only the fact of the presence of trophoblastic disease, but also clarify the nature of the tumor.
