妊娠滋养细胞疾病2011722

gestational trophoblastic disease ( GTD) 妊娠滋养细胞疾病2011.7.22Introductionn gestational trophoblastic disease ( GTD) are a group of diseases from the placenta nourish cells of the disease, it includes hydatidiform mole , invasive hydatidiform mole , velvet carcinoma and rare placenta parts nourish cell tumors.妊娠滋养细胞疾病 ( gestational trophoblastic disease，GTD)是一组来源于胎盘滋养细胞的疾病，它包括葡萄胎、侵袭性葡萄胎、绒癌及罕见的胎盘部位滋养细胞肿瘤 n In addition to hydatidiform mole GTD outside the call of pregnancy nourish cell tumors (gestational trophoblastic neoplasia, GTN) 除葡萄胎以外的 GTD称之妊娠滋养细胞肿瘤n years to imaging diagnosis GTD mainly depends on the type ultrasound and color doppler ultrasound .多年来影像学诊断 GTD主要依赖 B型超声及彩色多普勒超声 n Magnetic resonance imaging (magnetic resonance imaging, magnetic resonance imaging) reported less磁共振成像 ( magnetic resonance imaging， MRI) 的相关报道较少 Clinical manifestations n hydatidiform mole is benign lesions, according to the organization for the fetus or pregnancy embryonic composition, will hydatidiform mole divided into the completeness and some sex hydatidiform mole .葡萄胎 属良性病变，根据妊娠组织中有无胎儿或胚胎成分，将葡萄胎分为完全性与部分性葡萄胎 n Do not understand about the etiology, more than 40 years old or less than 20 years old, incidence 病因不甚明了，大于 40岁或小于 20岁，发病率增高n The main and yunkun defect, and empty the eggs are fertilized, double sperm to fertilise relevant 主要与孕卵缺损，空卵受精、双精子受精有关n Presented with postmenopausal bleeding as the main symptoms of pregnancy often early, heavy, reaction long临床上以停经后阴道出血为主要症状，妊娠反应往往早、重、长 Clinical manifestations n Abnormal uterine body check, individuals can increase a abdominal pain and pregnancy-induced hypertension merger .体查子宫异常增大，个别人可有腹痛及合并妊高症 n Flavin cyst in completeness hydatidiform mole incidence of 30-50% 黄素囊肿在完全性葡萄胎发生率为 3050% n The ultrasonic inspection for the main method and in combination with B-HCG abnormal increases, the rush hour extended and symptoms, signs may diagnose disease超声为主要检查方法，结合 B-HCG异常升高，高峰时间延长及症状、体征可诊断本病 Clinical manifestations n Aggressive hydatidiform mole clinical mainly for irregular vaginal bleeding .侵蚀性葡萄胎 临床主要表现为不规则阴道出血n Abnormal uterine increases, flavin cyst persist and lung, vaginal metastases performance.子宫异常增大，黄素囊肿持续存在以及肺、阴道转移灶表现。 n Choriocarcinoma is a highly malignant tumor cells nourish绒毛膜癌 是一种高度恶性的滋养细胞肿瘤n 50% hydatidiform mole secondary to secondary to abortion, 25%, 22.5%, 2.5% secondary to term pregnancy secondary to ectopic pregnancy50%继发于葡萄胎， 25%继发于流产， 22.5%继发于足月妊娠， 2.5%继发于异位妊娠 n The clinical manifestations of the vaginal bleeding, amenorrhoea, abdominal pain, uterine abnormal increase, soft and lung, vagina, brain metastasis symptoms. 临床表现为阴道出血，闭经，腹痛，子宫异常增大、质软以及肺、阴道、脑转移症状。GTD clinical diagnosis standard GTD临床诊断标准 n Have hydatidiform mole history, and in the second after the qing eight to 12 weeks, HCG without rain to normal, and have an irregular vaginal bleeding or radiological examination tip mass infringed womb jiceng, lungs or transfer the shadow can be diagnosed as aggressive PuTaoTai .有葡萄胎病史，并在第 2次清宫后 8 12 周，HCG 未降至正常，有不规则阴道流血或影像学检查提示肿块侵犯子宫肌层，或肺部有转移阴影者可诊断为侵袭性葡萄胎 n hydatidiform mole after the qing dynasty palace, H CG has been reduced to a normal period of time, and the symptoms appear HCG and rise or lungs, diagnosis for aggressive transfer PuTaoTai; And no histological examination, above 1 years who happened to choriocarcinoma .葡萄胎清宫后， H CG已降至正常水平一段时间，又出现症状及 HCG 升高或肺部有转移，诊断为侵袭性葡萄胎；而无组织学检查， 1年以上发生者为绒毛膜癌 。 n All that abortion, ectopic pregnancy, postpartum term anomalies H CG rising malignant GTN, general diagnosis of flocking carcinoma. But if GuaGong pathological examination after see ShuiPaoZhuang organization or biopsy see fluff, still the diagnosis of aggressive PuTaoTai凡流产、宫外孕、足月产后出现异常 H CG升高的恶性 GTN，一般诊断为绒癌。但若刮宫后病理检查见水泡状组织或组织切片见到绒毛者，仍诊断为侵袭性葡萄胎瘤MR Imaging （葡萄胎）n The volume, and uterine cavity expansion, expand its note the amount of relatively uniform space capsule and a long T1, T2 signal, and long change nourish cell hyperplasia, with edema, formed the blister size differ about子宫体积扩大，子宫腔扩大，其内可见大量较均匀的分隔和小囊呈长 T1、长 T2信号改变，与滋养细胞增生，绒毛间质水肿，所形成大小不等的水泡有关 n The soft tissue mass of uterine cavity, a typical “honeycomb“, or “grapes.“ form, and by the formation of the water- blister structure arrangement about state宫腔内的软组织肿块影，呈典型 “蜂窝 ”状或 “葡萄 ”状，与所形成的水泡状结构排列状态有关 MR Imaging （葡萄胎） n Mass coated complete, endometrial signal continuous, muscular pressure is thinning, and pathology change lesions not involving womb jiceng are in agreement.肿块包膜完整，子宫内膜信号连续，肌层呈受压变薄改变，与病理上病变未侵犯子宫肌层相一致。n Uterine cavity and muscle layer has not seen the obvious increase of the blood vessels, thick, author and interstitial inner tire source sex disappear blood vessels relevant. structure arrangement about state子宫腔及肌层未见明显增粗、迂曲的血管，与间质内胎源性血管消失有关。 MR Imaging （葡萄胎） n DWI high b value in that “honeycomb“ mass, or “grapes.“ shape structure spread not limited with pathological changes, low degree of malignant cells are arranged, not too crowded, water molecules spread a smooth relevant DWI高 b值时显示肿块内 “蜂窝 ”状或 “葡萄 ”状结构扩散不受限，与病变恶性程度低，细胞排列不太密集，水分子扩散较顺畅有关MR Imaging （葡萄胎）n Enhance scanning performance for multiple relatively uniform space strengthening, solid component not strengthened, and the water- blister structure and expansion of the blood supply.增强扫描表现为多发较均匀的分隔强化，实性成分不强化，与扩张的水泡状结构缺乏血供有关。n hydatidiform mole benign view of size differ in the blisters, microscopically nourish cells different degree, the hyperplasia edema, the increase in size, outline rules, interstitial inner tire source sex disappear blood vessels, but not involving uterine muscle layer .良性葡萄胎 大体观为大小不等的水泡，镜下见滋养细胞不同程度增生，绒毛间质水肿，体积增大，轮廓规则，间质内胎源性血管消失，但未侵犯子宫肌层Pathological characteristics （葡萄胎） MR Imaging （恶性 GTD）n Capsule incomplete soft tissue mass, can show, a “crumb also cellular”, or “grapes.” shape, it shows high signal with pathological changes, flake necrosis related 包膜不完整的软组织肿块，可呈团块状，亦可呈 “蜂窝 ”状或 “葡萄 ”状，其内可见片状高信号，与病变坏死相关 n Endometrial signal discontinuous mass, infringe upon womb jiceng, and uterine muscle layer boundary is not clear, is one of the most important features in GTD malignant子宫内膜信号不连续，肿块侵犯子宫肌层，与子宫肌层界限不清，是恶性 GTD的重要特征之一 MR Imaging （恶性 GTD）n Uterine cavity mass and around and muscular layer appeared a lot of thick, the author increase blood flow in T1W empty signal, on display the clear, this tumor itself the biological characteristics of the cancer itself is concerned, no inherent blood vessels, but rather on damage blood vessels with nutrients, and nearby abnormal high HCG hormone level stimulation, the blood vessels of the original make uterine level disorders and even appear typical “blood lake“ shape performance 肿块周围及子宫腔内及肌层出现大量增粗、迂曲的血管流空信号，于 T1W I上显示最清楚， 此与肿瘤本身的生物学特性有关， 该肿瘤本身无固有的血管，而是依赖破坏邻近血管获取营养， 加之异常高的 HCG激素水平刺激，使子宫原来的血管层次紊乱，甚至出现典型的 “血湖 ”状表现MR Imaging （恶性 GTD）n DWI high b value shows limited spread disease malignant degree is high, dense cells are arranged, water molecules spread not smooth relevant. DWI高 b值时显示扩散受限，与病变恶性程度高，细胞排列密集，水分子扩散不顺畅有关。 n If the womb jiceng or outside the uterus tissue water- blister thing, see microscopic see for aggressive hydatidiform mole fluff 若子宫肌层或子宫外组织中见水泡状物，镜检见绒毛为 侵袭性葡萄胎 n Only piece nourish cells infiltration and hemorrhage, necrosis and absolutely none fluff the structure for flocking carcinoma仅为成片滋养细胞浸润及出血坏死，而完全不见绒毛结构者为 绒癌 Pathological （恶性 GTD） Differential diagnosisn Magnetic resonance imaging (MRI) for differentiating benign PuTaoTai and aggressive hydatidiform mole and cloth with soft nap is more beautiful, ultrasonic cancer but for aggressive PuTaoTai and identification of flocking cancer also depends on the clinical and pathological diagnosis MRI对于鉴别良性葡萄胎与侵袭性葡萄胎及绒癌较超声更佳，但对于侵袭性葡萄胎与绒癌的鉴别还有赖于临床及病理诊断 n Still should identify with the following disease 还应与以下疾病鉴别 Differential diagnosisEndometrial carcinoma子宫内膜癌 :n With endometrial uneven thickening showing the endometrial signal irregular, discontinuous and tumor deep abnormal signals of infringement to give priority 子宫内膜癌以子宫内膜不均匀增厚所表现出的子宫内膜信号不规则、不连续和肿瘤向深部侵犯的异常信号为主 n The characteristic of malignant GTD blood flow “empty” signal and more help to identify kitchen bleeding恶性 GTD特征性的 “血管流空 ”信号和多灶出血有助鉴别 n The enhanced due to abnormal blood supply GTD malignant are very abundant, cause its abnormal strengthen than endometrial cancer.增强后由于恶性 GTD异常血供非常丰富，造成其异常强化程度高于子宫内膜癌。 Differential diagnosisAdenomyosis子宫腺肌症 :n The increased to different extent, smooth contour, sometimes visible uterine layered structure deformation子宫有不同程度的增大，轮廓光滑，有时可见子宫分层结构变形 n Lesions performance for belt, limitations or thickening diffuse the muscular layer belt, T2WI focal sample signal can be mingled with focal high signal病灶表现为结合带弥漫性、局限性增厚或外肌层结合带样信号灶， T2WI 可混杂有局灶性高信号 n When a bleeding, T1 WI also can be mixed focal high signal oven .当有出血时，