Horionkartsinoma - causes, symptoms, diagnosis and treatment
Horionkartsinoma - Trophoblastic tumor that develops as a result of malignant transformation of the chorionic epithelium. horionkartsinoma Clinic is characterized by bloody, serous or purulent discharge from the genital tract, pain in the abdomen; when metastasis - symptoms of the relevant bodies. Diagnosis requires horionkartsinoma determine the level of hCG and trophoblastic globulin in the blood, histological analysis scraping, US. horionkartsinoma Treatment may include chemotherapy, surgery.
Horionkartsinoma
trophoblastic disease, which occurs 05-83 cases per 1000 births. Most often precedes the development of horionkartsinoma molar pregnancy (40% of cases), abortion (25%), labor (22.5%), ectopic pregnancy (2.5%). Less common teratogenic horionkartsinoma not related to pregnancy. In rare cases there may be a simultaneous combination of hydatidiform mole and horionkartsinoma.
Horionkartsinoma structures formed from the trophoblast, chorionic villi syncytial tissue, sometimes - from the embryonic gonad cells. On a macroscopic structure is horionkartsinoma dark hemorrhagic mass of soft consistency with areas of ulceration and decay. Microscopic study determined horionkartsinoma disorderly proliferation of trophoblastic tissue, absence of stromal vascular and chorionic villi; the presence of Langhans cells and syncytial elements.
Horionkartsinoma usually located in the body of the uterus (in the zone preceding embryo implantation), which can be submucosal (83%), intramural - (5 6%) or subserous (7%) localization. When an ectopic form of primary horionkartsinoma lesions can be detected in the ovaries and fallopian tubes (1-4%); brain, lung, vagina (17%).
gynecology allocates ortotopnuyu, heterotopic and teratogenic horionkartsinomu. When ortotopnoy horionkartsinoma tumor is localized at the site of the previous implantation of the ovum - the uterus, tubes, abdomen. As it progresses horionkartsinoma grows and spreads to the vagina, the parameters, the greater omentum, bladder, straight or sigmoid colon, lungs.
Horionkartsinoma with heterotopic localization is initially detected embryo implantation zone, often - in the walls of the vagina, lung, and brain. Teratogenic horionkartsinoma is not related to previous pregnancies and refers to mixed tumors of embryonic origin. Location teratogenic horionkartsinom ekstragonadnoe - in the pineal gland, lung, mediastinum, stomach, retroperitoneal, bladder.
The staging horionkartsinoma adhere to the WHO classification, highlighting stage IV:
spontaneous abortion, ectopic pregnancy; patients undergoing molar pregnancy. Horionkartsinoma often diagnosed in women living in the Asian region.
Bleeding usually begins soon after medaborta, childbirth, miscarriage; sometimes - after a long delay menstruation or intermenstrual period. Along with the blood secretions when horionkartsinoma possible allocation of serous or purulent cables associated with necrosis of the tumor or infection site.
Repeated bleeding lead to anemizatsii; intoxication is accompanied by fever and chills. Often detected breast engorgement with nipple discharge molozivopodobnogo secret. During germination of tumor masses uterine body noted the appearance of pain in the abdomen and lower back. The presence of metastases in the lungs show cough and hemoptysis; brain - neurological symptoms (blurred vision, headache, dizziness, movement disorders). When horionkartsinoma occurs frequently metastatic lung damage (45-50%), vagina (35%), appendages, cervical, brain. The ovaries are often detected when horionkartsinoma tekalyuteinovye cysts.
pelvic exam can detect the presence of cyanotic nodes, germinating in the vagina; horionkartsinoma in the development against the backdrop of pregnancy there is an increase in uterine size compared to gestational age.
Through ultrasound revealed an increase in the uterus, the presence of fine-cystic uterine tissue tekalyuteinovye bilateral cysts. Tumor horionkartsinoma node can have sizes from a few centimeters to the size of an adult head. With a view to qualifying applied hysterography - X-ray of the uterus research.
Conducting a diagnostic scraping the uterine cavity with histological study scraping is not always informative, because the slides often contain blood clots, necrotic tissue of the endometrium and the unit cells of the trophoblast. For horionkartsinomu indicates detection of atypical cells in the syncytiotrophoblast scraping. Perhaps a cytology smears from infected tissues of the vagina, vulva, cervix, and biopsies of these areas.
Horionkartsinomu can be difficult to differentiate from trophoblastic tumor of placental site and invasive hydatidiform mole, which also characterized by infiltrative growth. A typical diagnostic feature is the definition of horionkartsinoma high content of HCG, AFP and trophoblastic β-globulin serum, which is excessively produced by the tumor. With the help of X-rays, tomography of the lungs and brain CT scan to determine whether there horionkartsinoma metastases in distant organs.
uterine perforation, septic conditions, the ineffectiveness of chemotherapy, significant lesions of the uterus and ovaries. The recommended amount of intervention is hysterectomy (in the absence of metastases in young women) or pangisterektomiya (women older than 40 years). Removing horionkartsinoma further supplemented by chemotherapy treatment. The criteria for cure is the normalization of hCG levels in the three assays performed with an interval of 1 week.
contraception COCs.
Patients with cystic skid having a high risk of transformation into horionkartsinomu, shown conducting preventive chemotherapy. The presence of metastases reduces the possibility of treatment up to 70%. When horionkartsinoma ovaries, which responds poorly to chemotherapy, the prognosis is almost always unfavorable.