Benign hydatidiform mole
Benign hydatidiform mole (i.e. hydatidiform mole) the characteristic is the pathological change limits in the uterine cavity, also does not encroach upon the myometrium not to shift to other organs, is the benign clinical process completely, the corrosive hydatidiform mole (old name malignant hydatidiform mole) was the hydatidiform mole organization already invaded the myometrium or shifts to other organs. The myometrium hydatidiform mole organization continues to develop, may wear out the womb wall to cause the abdominal cavity internal hemorrhage, may also invade the extravagant ligament to form nearby the palace the goitre, perhaps enters the blood vessel through the womb wall blood sinus, shifts to the lung, the vagina or other organs. The choriocarcinoma (i.e. fabric cancer) is the nutrient cell which becomes malignant, its has lost the down either the hydatidiform mole organization’s structure disperses in the invasion myometrium or shifts to other organs, like the lung, the vagina, the brain, the liver, the spleen, the kidney and so on, the malignant degree is extremely high. The above these three kind of situations are very possible are a disease’s different development phase, namely becomes malignant by the benign hydatidiform mole for the corrosive hydatidiform mole further develops again for the fabric cancer.
??The first section benign hydatidiform mole
??Originates in embryo’s nutrient cell. Because down dropsy increases, forms the size different blister, becomes the string connected, resembles the grape, thus is called the hydatidiform mole.
??In the most hydatidiform moles, the placental villi organization basically completely turned the hydatidiform mole organization, but also has the minority hydatidiform mole only then the partial placental villi organization to become the hydatidiform mole. The former is called the complete hydatidiform mole, the latter is called the part hydatidiform mole.
??First, pathology
??Sees roughly: The water vesicle wall is humble, is translucent, the content serum, crevice between the blister and the blister fills the blood and congeals the blood clot. The incomplete hydatidiform mole has the part of normal placenta organization. The histology inspection, the complete hydatidiform mole has 3 characteristics:?The cell nutrient cell and the synthesis nutrient cell assumes the varying degree the proliferation, in the identical hydatidiform mole the different spot may be different;?Down mesenchymal dropsy assumes the blister type, intersititial cell vanishing, only sees the matrix;?The most blister shapes change in the down blood vessel vanishing, occasionally sees the early dropsy’s down obviously minority blood vessel, but could not see that has the nuclear red blood cell, indicated that the blood vessel does not have the function.
??The part hydatidiform mole except has a part of normal down, pathological change’s down dropsy same complete hydatidiform mole, but mesenchymal Chang Ke sees the blood capillary, in the blood vessel may see that has the nuclear red blood cell. The part hydatidiform mole nutrient cell proliferation’s degree reduces relatively.
??In these characteristics, is most important by the nutrient cell proliferation, although down dropsy and blood vessel’s change also lists as the characteristic, but whether or not will become malignant to later without the relations.
??Second, clinical manifestation
??(one) stops menstruating the morning which and time the pregnancy reaction hydatidiform mole’s pregnancy reaction eukyesia appears, and the symptom is more obvious.
??(two) the vagina bleeds starts after the menopause 6~8 weeks, at first leaves the volume of blood to be few, is the garnet, latter increases gradually or continues to bleed. Formation rate above 96%. Usually when the pregnancy 4 months, approaches discharges voluntarily may have the massive hemorrhage, and may see the grape type organization, if this time the stitch in time may cause the shock, even dies.
??(three) the abdominal pain sees not much, if has is also the recessive abdominal pain. But when the hydatidiform mole discharges, may have the paroxysmal abdominal pain, this time has the massive hemorrhages.
??(four) pregnants drafts the symptom partial patients high besides the vomiting during pregnancy, but may also present hypertension, dropsy, the albuminuria, even may present the eclampsia or the heart fades. But in the eukyesia are very few 20 weeks ago appears pregnants drafts the symptom high.
??(five) anemia and the infection long-term vagina bleed, may cause the varying degree anemia and the infection.
??(six) symptom.
??1. the womb exceptionally increases: As a result of the down blister type denaturation and the palace cavity hematocele, more than half patient womb is bigger than the menopause month inspection to be often wider than the eukyesia womb lower segment and to be soft, although the womb has surpassed the pregnancy 5 month sizes still not to have the embryo heart fetal movement, does not hold the carcass of tire, because the minority patient hydatidiform mole necrosis degenerates either for the part hydatidiform mole, the womb size is possible and the gestation period match case or is small. Therefore, if the womb exceptionally increases, is helpful to the diagnosis. Otherwise, also cannot be an exception the hydatidiform mole.
??2. the pelvic cavity inspection may hold and the two-sided ovary flavine cyst: Flavine cyst big may surpass the head, many for two-sided, many. After the hydatidiform mole discharges, the cyst many reduces gradually, several Zhou Huoshu month later nature vanishing. Sometimes the flavine cyst may have the peduncle reverse and the breakage, has the abdominal pain.
??Third, diagnosis
??According to the medical history, the symptom, the symptom, the hydatidiform mole examines the diagnosis to be trouble-free. If the hydatidiform mole early time or the symptom are atypical, the diagnosis has when the difficulty available following auxiliary inspection:
??(one) the hCG determination hydatidiform mole’s nutrient cell excessive proliferation, produces massive hCG, compared with corresponding month eukyesia for high. Using this kind of difference, may take the auxiliary diagnosis basis. Ought to do the hCG maximum value determination, the method for details sees the pregnancy diagnosis chapter.
??(two) when supersonic inspection ultrasound inspection in the palace cavity does not have the embryo, the placenta, the amniotic fluid phantom, only sees “is snowing the type” the echo, if has the hemorrhage obviously anomalous fluidity dark space. Is snowing the type echo for the hydatidiform mole specificity phantom characteristic.
??(three) the embryo heart measured listens to the eukyesia 2 months later, Doppler may hear the embryo heart, but in hydatidiform mole time can only hear some womb blood stream static.
??although (four) X inspection womb has surpassed 5 month pregnancy size, but abdomen X absorbs the piece not to be able to see the embryo skeleton.
??Fourth, processing
??(one) clear palace: As soon as the hydatidiform mole passes through the diagnosis, namely should be clear immediately the palace. Generally uses attracts electrically operated blows the technique, one week later may the rescud one time, before the technique, be supposed to finish the blood transfusion preparation, when the technique cautious against womb perforation. For the prevention infection, around the surgery must use the antibiotic.
??After the surgery starts, may vein intravenous drip 5% glucose 500ml+ pitocin 5~10u, reduce in the technique to bleed, but not suitable before the surgery starts to use, in order to avoid the palace mouth has not opened, the uterus contraction pushes in the hydatidiform mole organization the palace wall blood sinus, proliferates to the lung in causes the pulmonary embolism.
??(two) ovary flavine cyst processing: The flavine cyst after the hydatidiform mole discharges can nature vanishing, not need the special handling generally, but like has the peduncle to reverse, adopts the different decubitus not to be able to alleviate must cut open the belly the investigation early.
??(three) becomes malignant prevention:
??1. the preventive womb excision method present many does not use. But is big to the age, non-gives birth the demander also to be possible to consider. 2. the preventive chemotherapy preventive chemotherapy prevents the effective measure which the hydatidiform mole becomes malignant. Its chemotherapy approves drafts:?The age is bigger than 40 years old;?The nutrient cell proliferation or has between changes highly;?Blows the grape organization by the small grape primarily;?after hCG continues does not drop or the drop, the ascensionist;?Non-revisit condition.
??(after four) makes a follow-up visit the hydatidiform mole to discharge, each week looks up one time hCG, after the negative, every 1~ in February to look up one time, second year each in June one time at least two years.
??While inspects hCG to make the sternum regularly. If the hydatidiform mole discharged the latter 2 months to urinate originally hCG still the masculine gender, after either once negative, masculine gender, either in the lung presented the shift shadow, should consider to become malignant, immediately chemotherapy.
??In order to avoid two times having the hydatidiform mole or becoming malignant should enjoin the patient to insist the contraceptive 1~2 years.
