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TROPHOBLASTIC DISEASE

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TROPHOBLASTIC DISEASE is a disease of the trophoblast (part of the ovum) that forms the placenta. The development of trophoblastic disease is possible not only during pregnancy, but also after childbirth and abortion. A simple cystic skid (non-invasive form), a cystic skid - an invasive form, or a destructive cystic skid , and chorionepithelioma, or choriocarcinoma, are distinguished. These forms of trophoblastic disease are believed to be stages of a single disease.

Cystic skid (non-invasive form): the chorionic villi are swollen, have the appearance of bubbles, the trophoblast is hypertrophied. With a full bubble skid, all the villi are reborn, with a partial - part of the villi. The fruit usually dies, but with a partial drift may remain viable. When invasive vesicle is introduced, the chorionic villi penetrate deeply and the underlying myometrium, but the tissue does not destroy it and does not metastasize. In the case of the malignant form, the chorionepithelioma, they show rapid invasive growth with destruction of the myometrium, hemorrhages, necrosis, and rapid metastasis to the lungs, brain, and liver.

Clinically, the cystic skid is characterized by a rapid increase in the size of the uterus that does not correspond to the gestational age, often with bloody discharge with an admixture of vesicles, pains in the lower abdomen. With an invasive form and chorionepithelioma, these symptoms are more pronounced, accompanied by lower abdominal pain, bleeding, weakness.

The diagnosis is made on the basis of the inconsistency between the size of the uterus and the gestational period, the results of an ultrasound examination, in which there is a characteristic picture of a blizzard in the absence of a fetus and a bilateral enlargement of the ovaries with the formation of cysts of the corpus luteum - the so-called tekalyuteinovyh cysts. Pathognomonic sign is also a sharp increase in the level of human chorionic gonadotropin (CG) in the urine and blood. With simple blistering, CG level is lower than with invasive and chorionepithelioma. In the presence of choriocarcinoma (or if it is suspected), radiography of the lungs and computed tomography of the brain are necessary in order to exclude metastases.

Treatment . Patients need hospitalization, careful curettage of the uterus or vacuum aspiration. After a thorough histological examination of the material obtained, the question of the further tactics of the patient is decided. In the case of a simple form of a caries skidding, a patient is carefully monitored, in which determination of the level of CG in the blood or urine is crucial. A high level of the hormone within 4–5 weeks after the removal of the whelping or an increase in the level of the hormone in a threefold study for 1 month after removal is an indication for chemotherapy. When chorionepithelioma is detected, extirpation of the uterus is indicated, followed by chemotherapy under the control of CG levels in urine and blood for 2 years.

The prognosis for the timely treatment of blistering is favorable; with chorionepithelioma without metastases and short duration of the disease (less than 4 months after pregnancy) and effective chemotherapy - satisfactory; with chorionepithelioma with metastases and duration of the disease for more than 4 months - unfavorable.

Repeated pregnancy after a blistering is not recommended earlier than 2 years. During this time, in the 1st year a monthly determination of CG is carried out, in the 2nd year - every 3 months.