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TROPHOBLASTIC DISEASE

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TROPHOBLASTIC DISEASE - a disease of trophoblast (part of the fetal egg) from which the placenta is formed. The development of trophoblastic disease is possible not only during pregnancy, but also after childbirth and abortion. There are simple cystic skid (non-invasive form), cystic skid - invasive form, or destroying cystic skid , and chorionepithelioma, or choriocarcinoma. It is believed that these forms of trophoblastic disease are stages of one disease.

Bubble drift (non-invasive form): chorionic villi are swollen, look like vesicles, trophoblast is hypertrophied. With a complete cystic drift, all the villi are regenerated, with a partial - part of the villi. The fetus usually dies, but with partial skidding it can remain viable. With invasive bladder skidding, the chorionic villi deeply penetrate the underlying myometrium, but the tissue does not destroy it and does not metastasize. With a malignant form - chorionepithelioma - a rapid invasive growth is noted with the destruction of the myometrium, hemorrhages, necrosis and rapid metastasis to the lungs, brain and liver.

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

The diagnosis is made on the basis of the discrepancy between the size of the uterus and the gestational age, the results of an ultrasound scan, in which there is a characteristic pattern of “snow storm” in the absence of the fetus and bilateral ovarian enlargement with the formation of yellow body cysts - the so-called tecalutein cysts. A pathognomonic sign is also a sharp increase in the level of chorionic gonadotropin (CH) in the urine and blood. With simple bladder drift, the level of chronic hepatitis C is lower than with invasive and with chorionepithelioma. In the presence of choriocarcinoma (or if it is suspected), an X-ray of the lungs and computed tomography of the brain are necessary to exclude metastases.

Treatment . Patients need hospitalization, careful curettage of the uterine cavity or vacuum aspiration. After a thorough histological examination of the material obtained, the question of further tactics of managing the patient is resolved. In the case of a simple form of cystic skidding, the patient is carefully monitored, in which the determination of the level of chronic hepatitis C in the blood or urine is crucial. A high level of the hormone for 4 to 5 weeks after removal of the cystic drift or an increase in the level of the hormone with a triple study within 1 month after removal is an indication for chemotherapy. If chorionepithelioma is detected, hysterectomy is indicated followed by chemotherapy under the control of the level of chronic hepatitis C in the urine and blood for 2 years.

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

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