Mole
Introduction
Introduction to the mole For the villus matrix microvessels disappear, and thus the villus matrix effusion, forming unequal size bubbles, shaped like grapes, it is called hydatidiformmole. There are partial sexual characteristics, most of which are complete hydatidiform moles. The clinical diagnosis of hydatidiform moles refers to complete hydatidiform moles. For some hydatidiform moles with placental tissue or fetus, partial hydatidiform moles are used. In tissues with spontaneous abortion, 40% of patients have a certain vesicular degeneration, but are not diagnosed as hydatidiform moles. Hydatidiform moles are more common in rice-rice countries, so it is thought to be related to nutrition. Studies have found that gestational trophoblastic tumor (GTT) patients have low levels of folic acid activity in their serum, and folate deficiency during embryonic angiogenesis affects thymine synthesis, leading to embryos. The lack of blood vessels in the dead and placental villi; the low consumption of carotene in the diet, the increased risk of hydatidiform mole; the increase in the incidence of hydatidiform mole in the vitamin A deficiency area; the decrease in the content of trace elements Zn and Se in the hydatidiform mole tissue. basic knowledge The proportion of sickness: 0.0023% Susceptible population: pregnant women Mode of infection: non-infectious Complications: pulmonary edema heart failure
Cause
Cause of hydatidiform mole
Nutritional factors (10%):
Hydatidiform moles are more common in rice-rice countries, so it is thought to be related to nutrition. Studies have found that gestational trophoblastic tumor (GTT) patients have low levels of folic acid activity in their serum, and folate deficiency during embryonic angiogenesis affects thymine synthesis, leading to embryos. The lack of blood vessels in the dead and placental villi; the low consumption of carotene in the diet, the increased risk of hydatidiform mole; the increase in the incidence of hydatidiform mole in the vitamin A deficiency area; the decrease in the content of trace elements Zn and Se in the hydatidiform mole tissue.
Endocrine disorders (25%):
It is believed that the occurrence of hydatidiform mole is related to the impaired or degraded ovarian function, so it is more common in women under the age of 20 and over 40 years old. Animal experiments have shown that the removal of the ovaries early in pregnancy can cause vesicular changes in the placenta, so it is believed that estrogen deficiency may be the cause of hydatidiform mole.
Infection factor (20%):
Many authors believe that hydatidiform moles are associated with viral infections, but no real evidence has been found so far.
Pregnant egg defect (10%):
May be related to abnormal development of the egg itself.
Racial factors (10%):
Differences in the incidence of inter-ethnic hydatidiform moles have attracted attention. It has been reported that the incidence of hydatidiform moles in African American women is only half that of other women. In Singapore, the incidence of Eurasian hybrid moles is twice as high as that of Chinese, Indians and Malaysians.
Overexpression of proto-oncogenes and inactivation of tumor suppressor gene variants (10%):
Protooncogenes and tumor suppressor genes are genes that control cell growth and differentiation. The activation and overexpression of proto-oncogenes and the inactivation of tumor suppressor genes are related to tumorigenesis.
Prevention
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.
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. It should be highly suspected of malignant transformation or residual vesicular block.
The pregnancy test has turned negative, and in the case of re-diagnosis, if it is not pregnant, it should be highly suspected of malignant transformation. If the original urine is positive, the dilution test has turned negative, and the dilution test in the follow-up examination is positive again, especially if the dilution is increased. Highly suspected of malignant transformation.
Complication
Hydatidiform complications Complications pulmonary edema heart failure
1, 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.
2, hydatidiform mole abortion
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.
3, 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, and it is better to implement chemotherapy after the discovery.
4, malignant change
It becomes an aggressive hydatidiform mole or choriocarcinoma with a malignant rate of about 10% to 20%.
5, 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
Hydatidiform mole symptoms Common symptoms Uterine abnormalities during pregnancy Increase vaginal bleeding Excessive abdominal pain Pain during pregnancy with abdominal pain... Hyperthyroidism during pregnancy
Clinical manifestation
1, amenorrhea because the grape line occurs in the trophoblast of the pregnant egg, so there are more than 2 to 3 months or more amenorrhea.
2, vaginal bleeding is a serious symptom, is the performance of spontaneous abortion of hydatidiform mole. Generally starting from 2 to 3 months of amenorrhea, mostly intermittent small amount of bleeding, but there may be repeated large bleeding in the meantime, such as careful examination, sometimes in the bleeding can be found in the blister. Vaginal bleeding apparently comes from the uterus. In addition to the vaginal discharge, part of it accumulates in the uterus; it may also accumulate in the uterus for a while, so that the amenorrhea time is prolonged.
3, the uterus increases the uterus of most patients is greater than the corresponding uterus during the menopause month, many patients come to see the lower abdomen mass (flat uterus or flavin cyst), but there are a few uterus and menopause months meet or even less than Menopause months. There may be two cases: 1 is the atrophy of the villus vesicle degeneration, stop development, form a migratory mole; 2 part of the blister block has been discharged, so that the uterus shrinks, forming a miscarriage of the mole.
4, abdominal pain due to the rapid increase of the uterus and pain, or intrauterine hemorrhage, stimulate the contraction of the uterus and pain, can be light and heavy.
5. About half of the symptoms of pregnancy poisoning may cause severe vomiting after menopause, and later, hypertension, edema and proteinuria may occur.
6, no fetus and amenorrhea 8 weeks before and after, B-ultrasound monitoring, no fetal sac, fetal heart and fetus. During pregnancy, even 18 weeks, there is still no fetal movement, and the fetal heart can not be heard. B-scan scans show snow-like images without fetal images.
7, ovarian luteinized cyst often in some patients with ovarian luteinized cysts, can be found by double diagnosis or more easily by B-ultrasound.
8, some patients with hemoptysis may have hemoptysis or bloodshot, the doctor should take the initiative to ask if there is such a symptom.
9, anemia and infection repeated bleeding without timely treatment, will inevitably lead to anemia? Its related symptoms, individual can even die from bleeding. Repeated bleeding is easy to cause infection, such as vaginal operation is unclean or sexual intercourse during bleeding, it is more likely to cause infection. Infection can be limited to the uterus and attachments, which can lead to sepsis.
Examine
Hydatidiform examination
B-abdominal scan can be seen in the uterus may have dark areas of varying sizes, caused by blood in the uterine cavity, but also can be found in the fetus, that is, in addition to the snowflake, there may be fetal and / or placenta images, B The diagnosis of super-instrument without any trauma and high diagnosis rate is a powerful measure for the diagnosis of hydatidiform mole.
HCG determination: Accurate quantitative test of HCG is an important test for diagnosis and follow-up of hydatidiform mole. HCG is less at the beginning of normal pregnancy, and peaks at 8 to 10 weeks of pregnancy, then gradually decreases. After gestational age (100 days), HCG is obvious. Decreased, in double (multiple) fetal pregnancy, the amount of HCG is also higher than that of singleton. The amount of HCG in hydatidiform mole is much higher than normal, and continues to be high. In normal non-pregnant women, the serum HCG amount is <75mIU/ml. , -HCG<20mIU/ml, the median high serum value of normal pregnant women is below 100,000 mIU/ml, the highest value is 210,000 mIU/ml, and the serum HCG value of hydatidiform mole patients is much higher than 200,000 mIU/ml. Therefore, the clinical and B-ultrasound, single HCG high value, can determine the diagnosis of hydatidiform mole, such as quantitative follow-up examination HCG, HCG value is still high after 14 weeks of pregnancy, the diagnosis can be more clear.
The grapes were excluded for more than 8 weeks. After careful curettage, there was no residual hydatidiform mole in the uterine cavity. There was no luteinized cyst. The serum HCG remained above 1000mIU/ml or increased. After the color enhancement, malignant transformation was confirmed. The HCG value was below 1000mIU/ml. In the presence of luteinized cysts, it is necessary to carefully check for the presence or absence of metastatic lesions, or may be due to ovarian luteinized cysts, and should be followed closely. If the flavin cysts subsided, and the HCG decline, follow the benign moles. .
Diagnosis
Hydatididia diagnosis
diagnosis
The clinical manifestations of amenorrhea, most of the two or three months after amenorrhea or some later, vaginal bleeding, blood can be more or less, intermittent, in most cases, the uterus is greater than the menopause month, the uterus up to four or five When the size of the month is pregnant, not only the pregnant woman can not feel the fetal movement, can not touch the fetal block, can not hear the fetal heart, and carefully check the vaginal bleeding. If a blister-like block is found, the diagnosis can be confirmed.
1, B ultrasound abdominal scan.
2. HCG determination.
3. Currently, X-ray technology is rarely used to diagnose hydatidiform moles.
Differential diagnosis
1, 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.
2, 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.
3, 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.
4, 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.
