1、Clinical Features of GTN,非转移GTN:(Non-metastatic Disease) 阴道出血继发贫血； 子宫增大； 卵巢黄素化囊肿 急腹症：子宫穿孔继发感染囊肿扭转囊肿破裂 假孕症状,转移性GTN (Metastatic Disease) 肺80 阴道30 盆腔20 肝10 脑10，为主要死因 其他脾肾消化道骨等 可仅表现为转移灶症状； 转移部位局部出血,Work-up for GTN,血-hCG测定（每周1次）： 4次呈平台状态(10%） 3次升高（10%） 持续异常6个月 除外残留或再次妊娠,胸片：CT/MRI超声组织学证据对于GTT的诊断并非必需,Ultra
2、sound,Chest X-Ray,The Staging of GTN （FIGO 2000）,Modified WHO Risk Factor Scoring System,Low-risk: 7. High-risk: 7.,Chemotherapy (Cure rate 92%) Low risksingle drug, i.e. MTX or Act-D or VP-16. High risk or resistanceEMA-CO, or based on 5-Fu Regression疗程结束18天内血 -hCG下降至少1个对数 停药指征 低危： 血-hCG连续3周阴性后1疗程
3、高危： 血-hCG阴性，症状体征消失23疗程 手术放疗为辅Salvage chemotherapy：EP-EMA，PVB，BEP，VIP等,Management of GTN,EMA/CO,Etoposide, high-dose Methotrexate with citrovorin (folinic acid) rescue, Actinomycin D, Cyclophosphamide, Vincristine Oncovin),Surgery： Hysterectomy. Surgical removal of lesions in uterus. Pulmonary lobect
4、omy.Radiation For mets in the liver or brain For chemo-resistant lesion in the lung,Management of GTN (Cont.),Follow-up of GTN,Similar to hydatidiform mole；Time to visit： Every mon in the first 3 mons. Every 6 mons till 1 y. Once a year till 5 y. Every 2 y thereafter,PSTT,Rarely seen Good prognosis
5、The mass may protrude into the uterine cavity, or limited in the myometrium. 中间型滋养细胞，无绒毛结构 IHC: hCG，hPL,Sonographic appearance of PSTT,Nonspecific, similar to uterine myoma and other GTT.,Management of PSTT,Histologic exam is necessary.Hysterectomy is the first choice.EMA-CO is recommended for those
6、 with high risk factors.,High risk factors： MI5/HP Interval months from index pregnancy 24 Extrauterine metastasis,Summary,妊娠滋养细胞肿瘤（GTN）包括侵蚀性葡萄胎和绒毛膜癌，胎盘部位滋养细胞肿瘤（PSTT）为一特殊类型GTT。除子宫病灶症状外，还需注意转移症状诊断主要根据血-hCG等辅助检查，组织学依据非必需是化疗能达治愈的肿瘤对非转移或低危型转移者，单药化疗即可显效,Quiz & Discussion,QUIZ,下列哪种情况需考虑GTD的可能性？A. Persiste
7、nt abnormal bleeding following normal pregnancy, abortion, or ectopic pregnancy.B. The finding of pulmonary nodules on chest radiograph after normal pregnancy.C. A young woman with an unknown primary neoplasm. D. A young woman with poorly explained hyperthyroidism.,GTD最常继发于下列哪种情况？A. Molar pregnancyB
8、. Normal pregnancyC. AbortionD. Ectopic pregnancy.,监测和随访GTD时需检测下列哪个指标？A. CA125B. -HCGC. AFPD. hPL,下列叙述哪些是正确的？A. Partial moles are of paternal origin, are diploid, and carry a 20% risk of GTD sequelae. B. Complete moles are of maternal and paternal origin, are triploid, and rarely are followed by GTD
9、.C. Partial moles require the same follow-up for potential malignant sequelae as a complete mole. D. The diagnosis of a molar pregnancy can be established with ultrasonography and may coexist with a normal pregnancy.,下列哪种方法处理葡萄胎最安全有效？A. HysterectomyB. Suction curettageC. ChemotherapyD. Radiotherapy,
10、下面哪种情况不是葡萄胎的并发症？ A. Anemia B. Toxemia C. Hypothyroidism D. Hyperemesis gravidarum E. Cardiac failure F. Pulmonary insufficiency.,有关低危与高危型GTD的描述，下列哪些是正确的？ A. Low-risk categories receive single agent chemotherapy, usually methotrexate. B. High-risk patients receive combination chemotherapy, usually EM
11、A/CO. C. Low-risk patients have a cure rate of less than 90%. D. Patients with high-risk metastatic GTD can not be treated.,GTD的患者治疗结束后需避孕多长时间才能再怀孕？A. 2 months.B. 6 to 12 months. C. 1 to 2 years.D. 3 to 5 years.,(Doubilet P, Benson C: Atlas of Ultrasound and Obstetric Gynecology. Philadelphia, Lippi
12、ncott Williams and Wilkins, 2003.),Case Review,References,Soper JT, Mutch DG and Schink JC. Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53. Gynecologic Oncology. 2004, 93: 575-585. Treatment algorithm. Diagnostic and therapeutic to gestational trophoblast
13、ic disease as practiced at the University of Texas M.D. Anderson Cancer Center. HCG, human chorionic gonadotropin. (Modified from Kudela AP, Freedman RS, Kavanagh JJ: Gestational trophoblastic tumors. In Pazdur R, Coia LR, Hoskins WJ, Wagman LD: Cancer Management: A Multidisciplinary Approach, 7th e
14、d. New York, The Oncology Group, 2003, p 230. From Eifel PJ, Gershenson DM, Kavanagh JJ, Silva EG: Gynecologic Cancer (M.D. Anderson Cancer Center Series, Buzdar AU, Freedman RS, eds). New York, Springer, 2006, p 235.) Crum CP and Lee KR. Diagnostic Gynecologic and Obstetric Pathology, 2007. Berkowi
15、tz RS and Goldstein DP. Gestational Trophoblastic Disease. in Novaks Gynecology, 14th eds. 2007. Kavanagh JJ and Gershenson DM. Chapter 35 Gestational Trophoblastic Disease : Hydatidiform Mole, Nonmetastatic and Metastatic Gestational Trophoblastic Tumor: Diagnosis and Management in Katz: Comprehensive Gynecology, 5th ed. 2007. 谢幸. 妊娠滋养细胞疾病. 妇产科学第7版, 乐杰主编. 2008.,
