13. Clinical risk factors for molar pregnancy Outside North America( occasionally has this disease) Birthplace Vitamin A deficiency Diet prior spontaneous abortion prior hydatidiform mole Reproductive history >40 <15 Age (extremes of reproductive years)
14.
15. Comparative Pathologic Features of Complete and Partial Hydatidiform Mole Hyperplasia mild and focal Hyperplasia usually present to variable degrees Trophoblast Usually present None present Fetal tissue blood cells present they contain no fetal blood cells vessels Normal adjacent villi may be present All villi hydropin; no normal adjacent villi Villi Usually triploidy 69XXX most common. Usually diploid 46XX Karyotype Partial Mole Complete Mole Feature
22. Color Dopplor facilitates visualization of the enlarged spiral arteriesclose proximity to the “ snow storm” appearance
23. Color Doppler image of a hydatidiform mole and surrounding vessels. The uterine artery is easily identified from its anatomical location.
24.
25. Dopplor waveform analysis demonstrates low vascular resistance(RI=0.29) in the spiral arteries, much lower than that obtained in normal early pregnancy
29. Here is a partial mole in a case of triploidy. Note the scattered grape-like masses with intervening normal-appearing placental tissue.
30. Large bilateral theca lutein cysts resembling ovarian germ cell tumors. With resolution of the human chorionic gonadotropin(HCG) stimulation, they return to normal-appearing ovaries.
46. A case of invasive mole: inside the uterine cavity the typical “ snow storm” appearance can be detected, The location of blood flow suggest an invasive mole.
47. The same patient owing to the myometrial invasion. Reduced vascular resistance is detected in the uterine artery.
48. Transvaginal color Doppler scan of a patient with invasive mole Following uterine curettage, Persistent color signals within the myometeriun
62. WHO Prognostic Scoring System 0-4 low risk, 5-7 intermediate risk, >8 high risk for death 2 or more Single drug — — Previous (treatment) 8 4-8 1-4 — No. of metastasis Brain GI tract, liver Spleen, kidney Lung Sites of metastasis — >5 3-5 <3 Largest tumor(cm) >10 5 10 4 -10 5 10 3 -10 4 <10 3 Initial hCG(mIU/ml) >12 7-12 4-6 <4 Interval (months) of treatment — Term pregnancy Abortion, ectopic Hydatidiform mole Pregnancy history — — >39 ≤ 39 Age(years) 4 2 1 0 Prognostic factor Score
63. FIGO Staging System for Gestational Trophoblastic Tumors All other metastatic sites Ⅳ Extends to the lungs with or without genital tract Ⅲ Extends to the adnexae, outside the uterus, but limited to the genital structures Ⅱ Limited to uterine corpus Ⅰ Description Stage
67. IIIa<3cm or locate in half lung IIIb disease beyond IIIa
68.
69.
70.
71.
72.
73.
74.
75. EMA-CO Chemotherapy for poor Prognostic Disease (Repeat every 15 days as toxicity permits) IV on day8 1mg/M 2 Oncovin (vincristine) IV on day8 600mg/M 2 Cyclophosphamide 15mg IM or p.o. q 12 hours×4 starting 24 hours after starting methotrexate Folinic acid IV daily×2 days 0.5mg Actinomycin D IV losding dose, then 200mg/M2 over 12 hours day 1 100mg/M 2 Methotrexate IV daily×2 days (over 30-45 minutes) 100mg/M 2 Etoposide(VP-16)