What Is a Trophoblastic Tumor?

Trophoblastic tumor, alias: Trophoblastic disease; Trophoblastoma; Trophoblastoma; Trophoblastoma; Ulcerative islet cell tumor; Gastrinoma; Tumor cells secrete gastrin; Trophoblast tumor refers to the embryo The tumor formed by malignant trophoblasts. The earliest is divided into two kinds of benign hydatidiform mole, and another malignant type is called chorionic epithelial cancer. Later it was found that between these two, there is another morphology that resembles hydatidiform mole, but has a certain malignancy, which can invade the muscle layer or transfer to distant places.

Basic Information

nickname: Trophoblastic disease; Trophoblastoma
English name: rophoblastic tumor
Visiting department: Obstetrics and Gynecology

Common causes: Doctrine of malnutrition; doctrine of virus; doctrine of endocrine disorders; doctrine of pregnancy defect; racial factors; doctrine of cytogenetic abnormalities
Common symptoms: Amenorrhea, pregnancy reaction, irregular vaginal bleeding

Causes of trophoblastic tumors

Theory of malnutrition

The lack of folic acid in experimental animals can cause embryo death. It is speculated that maternal deficiency of folic acid may be related to the occurrence of trophoblastic tumors. Especially during the period of embryonic blood vessel formation (13 to 21 days after conception), such as the lack of folic acid and histidine in nutrients, it will affect the synthesis of thymine, resulting in lack of blood vessels in the placental villi and embryo necrosis. The basic pathological changes of hydatidiform mole also accord with this point.

2. Virology

Some people think that hydatidiform mole is related to viral infection. In the 1950s, a filtering virus was isolated from hydatidiform moles and choriocarcinoma tissues, known as "pro-villus virus", and this virus was considered to be the cause of trophoblastic tumors. But for more than 30 years, no one has confirmed the existence of this virus. In the 1960s, authors examined trophoblastic tumor specimens through electron microscopy. They saw inclusion bodies in some cytoplasms, similar to the virus particles seen in experimental leukemias. Therefore, they proposed that trophoblastic tumors are induced by filtered viruses. But there are also objections.

3. Endocrine disorders theory

According to the WHO comprehensive report, the incidence of hydatidiform moles in the 15 to 20-year-old group is higher than that in the 20-35-year-old group. The risk of disease over 40 years of age is increased. The risk of hydatidiform moles in pregnant women over 50 years of age will be 20-35 years old. 200 times, this period is characterized by ovarian function is not completely stable or has gradually declined, so it is thought whether trophoblast tumors are closely related to ovarian endocrine function, and whether ovarian dysfunction is related to imperfect egg production.

4. Pregnancy egg defect theory

The occurrence of hydatidiform mole is associated with abnormal egg production. As mentioned above, the incidence of hydatidiform mole is higher among women younger than 20 years old or older than 40 years old, and the rate of spontaneous abortion and neonatal deformity of women in this age group is also high, which may be related to the defects of the pregnant eggs themselves.

5. Race factors

Hydatidiform mole is more common in Asian countries, especially in Southeast Asia, so it may be related to race. But racial issues are related to factors such as environment, climate, eating habits, water sources, infectious diseases, animal vectors, and so on.

6. Cytogenetic abnormality theory

Studies on chromatin and chromosomes found that the majority of hydatidiform trophoblasts were positive for sex chromatin. Sexual chromatin appears in trophoblasts on the 11th day of human embryos, and can exist in human life. It shows one of two sex chromosomes in human female mesenchymal cells, which can be stained during division, so at low power Can be seen under the microscope.

Clinical manifestations of trophoblastic tumors

The symptoms of benign hydatidiform moles are often similar to those of pregnancy, with amenorrhea and pregnancy reactions. However, the pregnancy reaction is often earlier and more obvious than normal pregnancy. Irregular vaginal bleeding begins 6 to 8 weeks after amenorrhea. The initial bleeding is small, dark red, and it gradually increases and continues. Therefore, patients often appear to varying degrees. Of anemia. When hydatidiform moles are to be spontaneously discharged (usually around 4 months of pregnancy), major bleeding can occur, and timely treatment can lead to shock or even death of the patient. There is sometimes a clear grape-like substance in the discharged blood. If found, it is very helpful for diagnosis.

In approximately 10% of patients, in addition to hyperemesis gravidarum, proteinuria, edema, hypertension, and other pregnancy-induced hypertension may occur, and even eclampsia symptoms may occur, and convulsions and coma may occur. Heart failure has also occurred. Because normal pregnancy rarely occurs during pregnancy before 20 weeks of pregnancy, hydatidiform mole should be suspected if it occurs. Sometimes patients may also have flustered shortness of breath. In the past, it was thought to be complicated by heart disease. In recent years, it has been known that hyperthyroidism is caused by increased HCG. Abdominal pain is not common in hydatidiform mole, even if it is acute, it mainly occurs in those who have abnormally enlarged uterus in the first pregnant woman, but when hydatidiform mole will be discharged, it can be caused by contraction of the uterus and paroxysmal abdominal pain, which is often accompanied by bleeding Increase the phenomenon. If there is no acute abdominal pain when discharged, complications should be considered. There is no obvious metastasis in the lungs of hydatidiform mole patients, but there is hemoptysis. The hemoptysis disappears immediately after hydatidiform mole excretion.

Trophoblast tumor test

Cell tumor ideal tumor marker. The diagnosis and treatment of this type of tumor are of special significance. Due to the development of science and technology such as biochemistry, molecular biology, radioimmunoassay, radioreceptor assay, monoclonal antibody preparation, hormone immunofluorescence assay, and electron microscope technology, HCG secretion site, molecular structure, amino acid arrangement and biology And further understanding of immunological functions. Therefore, the determination of HCG content is helpful for the diagnosis and treatment of normal and abnormal pregnancy, especially in the diagnosis and treatment of trophoblastic tumors, and can be regarded as a specific tumor marker of trophoblastic tumors.

Trophoblastic tumor diagnosis

1. Inquire about the history of pregnancy. If the last pregnancy is hydatidiform mole, if the lesion occurs within 1 year after the benign hydatidiform mole is excreted, the malignant hydatidiform mole is more likely; if it is more than 1 year or the last pregnancy is term or abortion, and this time trophoblastic disease, Most are choriocarcinoma.

2. Nervous system symptoms such as vaginal bleeding, cough, hemoptysis, headache, and visual impairment are common in medical history.

3. Gynecological examinations include uterine enlargement, tenderness, tenderness, parauterine masses, and metastatic nodules.

4. HCG in urine and blood gradually increases.

5. If there is metastasis, a cotton ball-like shadow can be seen on the lung X-ray.

6. Diagnostic curettage: if the blisters are scraped, the benign and malignant cannot be identified, and the changes in blood HCG need to be observed. If the scraped tissue is villous, it is of diagnostic significance, and no complete villi can be found under the microscope. It can be seen that the proliferated trophoblast cells invade the uterine myometrium and blood vessels, accompanied by large necrosis and bleeding, which can be diagnosed as choriocarcinoma in combination with the medical history.

7. People with neurological symptoms, such as transient ischemic symptoms (fall, blindness, aphasia), or headaches, vomiting, hemiplegia and convulsions. Fundus, EEG, and CT scans should be performed.

8. Suspected liver and kidney metastases, such as liver pain, hepatosplenomegaly, jaundice, and kidney enlargement, hematuria, etc. should be examined by liver and kidney ultrasound and CT.

9. Clinical staging. Stage : The lesion is confined to the uterus. Stage II: Proximal metastasis; Stage IIA: metastasis to the uterus or appendix; Stage IIB: Vaginal metastasis. Stage III: lung metastases. Stage A: single metastasis, no more than 3cm in diameter, or the total area of multiple metastases does not exceed one and a half of one side of the lung; stage B: lung metastasis exceeds the scope of stage A. Stage : extensive metastasis throughout the body: such as brain, liver, kidney, intestine, skin, etc.

Trophoblastic tumor treatment

1. Hydatidiform mole treatment

Although hydatidiform moles are benign, they can be dangerous if not handled properly. Once the hydatidiform mole is diagnosed, it should be removed in time. At present, the method of suction is used. Its advantages are shorter operation time, less bleeding, and less dangers such as perforation, which is safer.

2. Treatment of malignant trophoblastic tumors

Invasive hydatidiform moles and choriocarcinomas are far more harmful than benign hydatidiform moles. Once diagnosed, they need to be treated in time. In the past, the method of surgical removal of the uterus was very poor, especially for choriocarcinoma.

Trophoblastic tumor prognosis

Except for some early cases, some patients whose disease is limited to uterine non-metastasis can survive. All patients with metastases die within 6 months after diagnosis, and the overall mortality rate is above 90%. In order to improve the curative effect, radiotherapy is added after the operation. Although it has a certain synergistic effect on tumors in some parts, the effect is still poor for later cases.