gestationaltrophoblasticdisease(GTD)

妊娠滋養(yǎng)細(xì)胞疾病2011.7.22

Introductiongestationaltrophoblasticdisease(GTD)areagroupofdiseasesfromtheplacentanourishcellsofthedisease,itincludeshydatidiformmole

,invasivehydatidiformmole,velvetcarcinomaandrareplacentapartsnourishcelltumors.妊娠滋養(yǎng)細(xì)胞疾病(gestationaltrophoblasticdisease，GTD)是一組來(lái)源于胎盤(pán)滋養(yǎng)細(xì)胞的疾病，它包括葡萄胎、侵襲性葡萄胎、絨癌及罕見(jiàn)的胎盤(pán)部位滋養(yǎng)細(xì)胞腫瘤

InadditiontohydatidiformmoleGTDoutsidethecallofpregnancynourishcelltumors(gestationaltrophoblasticneoplasia,GTN)除葡萄胎以外的GTD稱(chēng)之妊娠滋養(yǎng)細(xì)胞腫瘤yearstoimagingdiagnosisGTDmainlydependsonthetypeultrasoundandcolordopplerultrasound.多年來(lái)影像學(xué)診斷GTD主要依賴(lài)B型超聲及彩色多普勒超聲

Magneticresonanceimaging(magneticresonanceimaging,magneticresonanceimaging)reportedless磁共振成像(magneticresonanceimaging，MRI)的相關(guān)報(bào)道較少Clinicalmanifestations

hydatidiformmoleisbenignlesions,accordingtotheorganizationforthefetusorpregnancyembryoniccomposition,willhydatidiformmoledividedintothecompletenessandsomesexhydatidiformmole.葡萄胎屬良性病變，根據(jù)妊娠組織中有無(wú)胎兒或胚胎成分，將葡萄胎分為完全性與部分性葡萄胎Donotunderstandabouttheetiology,morethan40yearsoldorlessthan20yearsold,incidence病因不甚明了，大于40歲或小于20歲，發(fā)病率增高Themainandyunkundefect,andemptytheeggsarefertilized,doublespermtofertiliserelevant主要與孕卵缺損，空卵受精、雙精子受精有關(guān)

Presentedwithpostmenopausalbleedingasthemainsymptomsofpregnancyoftenearly,heavy,reactionlong臨床上以停經(jīng)后陰道出血為主要癥狀，妊娠反應(yīng)往往早、重、長(zhǎng)

Clinicalmanifestations

Abnormaluterinebodycheck,individualscanincreaseaabdominalpainandpregnancy-inducedhypertensionmerger

.體查子宮異常增大，個(gè)別人可有腹痛及合并妊高癥Flavincystincompleteness

hydatidiformmole

incidenceof30-50%黃素囊腫在完全性葡萄胎發(fā)生率為30—50%

TheultrasonicinspectionforthemainmethodandincombinationwithB-HCGabnormalincreases,therushhourextendedandsymptoms,signsmaydiagnosedisease超聲為主要檢查方法，結(jié)合B-HCG異常升高，高峰時(shí)間延長(zhǎng)及癥狀、體征可診斷本病Clinicalmanifestations

Aggressive

hydatidiformmole

clinicalmainlyforirregularvaginalbleeding.侵蝕性葡萄胎臨床主要表現(xiàn)為不規(guī)則陰道出血Abnormaluterineincreases,flavincystpersistandlung,vaginalmetastasesperformance.子宮異常增大，黃素囊腫持續(xù)存在以及肺、陰道轉(zhuǎn)移灶表現(xiàn)。

Choriocarcinomaisahighlymalignanttumorcellsnourish絨毛膜癌是一種高度惡性的滋養(yǎng)細(xì)胞腫瘤50%

hydatidiformmole

secondarytosecondarytoabortion,25%,22.5%,2.5%secondarytotermpregnancysecondarytoectopicpregnancy50%繼發(fā)于葡萄胎，25%繼發(fā)于流產(chǎn)，22.5%繼發(fā)于足月妊娠，2.5%繼發(fā)于異位妊娠

Theclinicalmanifestationsofthevaginalbleeding,amenorrhoea,abdominalpain,uterineabnormalincrease,softandlung,vagina,brainmetastasissymptoms.臨床表現(xiàn)為陰道出血，閉經(jīng)，腹痛，子宮異常增大、質(zhì)軟以及肺、陰道、腦轉(zhuǎn)移癥狀。MRImaging（葡萄胎）

Thevolume,anduterinecavityexpansion,expanditsnotetheamountofrelativelyuniformspacecapsuleandalongT1,T2signal,andlongchangenourishcellhyperplasia,withedema,formedtheblistersizedifferabout子宮體積擴(kuò)大，子宮腔擴(kuò)大，其內(nèi)可見(jiàn)大量較均勻的分隔和小囊呈長(zhǎng)T1、長(zhǎng)T2信號(hào)改變，與滋養(yǎng)細(xì)胞增生，絨毛間質(zhì)水腫，所形成大小不等的水泡有關(guān)Thesofttissuemassofuterinecavity,atypical"honeycomb",or"grapes."form,andbytheformationofthewater-blisterstructurearrangementaboutstate宮腔內(nèi)的軟組織腫塊影，呈典型“蜂窩”狀或“葡萄”狀，與所形成的水泡狀結(jié)構(gòu)排列狀態(tài)有關(guān)MRImaging（葡萄胎）

Masscoatedcomplete,endometrialsignalcontinuous,muscularpressureisthinning,andpathologychangelesionsnotinvolvingwombjicengareinagreement.腫塊包膜完整，子宮內(nèi)膜信號(hào)連續(xù)，肌層呈受壓變薄改變，與病理上病變未侵犯子宮肌層相一致。

Uterinecavityandmusclelayerhasnotseentheobviousincreaseofthebloodvessels,thick,authorandinterstitialinnertiresourcesexdisappearbloodvesselsrelevant.structurearrangementaboutstate子宮腔及肌層未見(jiàn)明顯增粗、迂曲的血管，與間質(zhì)內(nèi)胎源性血管消失有關(guān)。MRImaging（葡萄胎）

DWIhighbvalueinthat"honeycomb"mass,or"grapes."shapestructurespreadnotlimitedwithpathologicalchanges,lowdegreeofmalignantcellsarearranged,nottoocrowded,watermoleculesspreadasmoothrelevantDWI高b值時(shí)顯示腫塊內(nèi)“蜂窩”狀或“葡萄”狀結(jié)構(gòu)擴(kuò)散不受限，與病變惡性程度低，細(xì)胞排列不太密集，水分子擴(kuò)散較順暢有關(guān)MRImaging（葡萄胎）Enhancescanningperformanceformultiplerelativelyuniformspacestrengthening,solidcomponentnotstrengthened,andthewater-blisterstructureandexpansionofthebloodsupply.增強(qiáng)掃描表現(xiàn)為多發(fā)較均勻的分隔強(qiáng)化，實(shí)性成分不強(qiáng)化，與擴(kuò)張的水泡狀結(jié)構(gòu)缺乏血供有關(guān)。

hydatidiformmole

benignviewofsizedifferintheblisters,microscopicallynourishcellsdifferentdegree,thehyperplasiaedema,theincreaseinsize,outlinerules,interstitialinnertiresourcesexdisappearbloodvessels,butnotinvolvinguterinemusclelayer

.良性葡萄胎大體觀為大小不等的水泡，鏡下見(jiàn)滋養(yǎng)細(xì)胞不同程度增生，絨毛間質(zhì)水腫，體積增大，輪廓規(guī)則，間質(zhì)內(nèi)胎源性血管消失，但未侵犯子宮肌層

Pathologicalcharacteristics（葡萄胎）

MRImaging（惡性

GTD）

Capsuleincompletesofttissuemass,canshow,a“crumbalsocellular”,or“grapes.”shape,itshowshighsignalwithpathologicalchanges,flakenecrosisrelated包膜不完整的軟組織腫塊，可呈團(tuán)塊狀，亦可呈“蜂窩”狀或“葡萄”狀，其內(nèi)可見(jiàn)片狀高信號(hào)，與病變壞死相關(guān)

Endometrialsignaldiscontinuousmass,infringeuponwombjiceng,anduterinemusclelayerboundaryisnotclear,isoneofthemostimportantfeaturesinGTDmalignant子宮內(nèi)膜信號(hào)不連續(xù)，腫塊侵犯子宮肌層，與子宮肌層界限不清，是惡性GTD的重要特征之一MRImaging（惡性

GTD）

Uterinecavitymassandaroundandmuscularlayerappearedalotofthick,theauthorincreasebloodflowinT1Wemptysignal,ondisplaytheclear,thistumoritselfthebiologicalcharacteristicsofthecanceritselfisconcerned,noinherentbloodvessels,butratherondamagebloodvesselswithnutrients,andnearbyabnormalhighHCGhormonelevelstimulation,thebloodvesselsoftheoriginalmakeuterineleveldisordersandevenappeartypical"bloodlake"shapeperformance腫塊周?chē)白訉m腔內(nèi)及肌層出現(xiàn)大量增粗、迂曲的血管流空信號(hào)，于T1WI上顯示最清楚，此與腫瘤本身的生物學(xué)特性有關(guān)，該腫瘤本身無(wú)固有的血管，而是依賴(lài)破壞鄰近血管獲取營(yíng)養(yǎng)，加之異常高的HCG激素水平刺激，使子宮原來(lái)的血管層次紊亂，甚至出現(xiàn)典型的“血湖”狀表現(xiàn)MRImaging（惡性

GTD）

DWIhighbvalueshowslimitedspreaddiseasemalignantdegreeishigh,densecellsarearranged,watermoleculesspreadnotsmoothrelevant.DWI高b值時(shí)顯示擴(kuò)散受限，與病變惡性程度高，細(xì)胞排列密集，水分子擴(kuò)散不順暢有關(guān)。Ifthewombjicengoroutsidetheuterustissuewater-blisterthing,seemicroscopicseeforaggressive

hydatidiformmole

fluff若子宮肌層或子宮外組織中見(jiàn)水泡狀物，鏡檢見(jiàn)絨毛為侵襲性葡萄胎

Onlypiecenourishcellsinfiltrationandhemorrhage,necrosisandabsolutelynonefluffthestructureforflockingcarcinoma僅為成片滋養(yǎng)細(xì)胞浸潤(rùn)及出血壞死，而完全不見(jiàn)絨毛結(jié)構(gòu)者為絨癌

Pathological（惡性

GTD）

DifferentialdiagnosisMagneticresonanceimaging(MRI)fordifferentiatingbenignPuTaoTaiandaggressive

hydatidiformmole

andclothwithsoftnapismorebeautiful,ultrasoniccancerbutforaggressivePuTaoTaiandidentificationofflockingcanceralsodependsontheclinicalandpathologicaldiagnosis

MRI對(duì)于鑒別良性葡萄胎與侵襲性葡萄胎及絨癌較超聲更佳，但對(duì)于侵襲性葡萄胎與絨癌的鑒別還有賴(lài)于臨床及病理診斷

Stillshouldidentifywiththefollowingdisease還應(yīng)與以下疾病鑒別Differentialdiagnosis

Endometrialcarcinoma子宮內(nèi)膜癌:Withendometrialuneventhickeningshowingtheendometrialsignalirregular,discontinuousandtumordeepabnormalsignalsofinfringementtogivepriority子宮內(nèi)膜癌以子宮內(nèi)膜不均勻增厚所表現(xiàn)出的子宮內(nèi)膜信號(hào)不規(guī)則、不連續(xù)和腫瘤向深部侵犯的異常信號(hào)為主

ThecharacteristicofmalignantGTDbloodflow“empty”signalandmorehelptoidentifykitchenbleeding惡性GTD特征性的“血管流空”信號(hào)和多灶出血有助鑒別TheenhancedduetoabnormalbloodsupplyGTDmalignantareveryabundant,causeitsabnormalstrengthenthanendometrialcancer.增強(qiáng)后由于惡性GTD異常血供非常豐富，造成其異常強(qiáng)化程度高于子宮內(nèi)膜癌。Differentialdiagnosis

Adenomyosis子宮腺肌癥:Theincreasedtodifferentextent,smoothcontour,sometimesvisibleuterinelayeredstructuredeformation子宮有不同程度的增大，輪廓光滑，有時(shí)可見(jiàn)子宮分層結(jié)構(gòu)變形

Lesionsperformanceforbelt,limitationsorthickeningdiffusethemuscularlayerbelt,T2WIfocalsamplesignalcanbemingledwithfocalhighsignal病灶表現(xiàn)為結(jié)合帶彌漫性、局限性增厚或外肌層結(jié)合帶樣信號(hào)灶，T2WI可混雜有局灶性高信號(hào)

Whenableeding,T1WIalsocanbemixedfocalhighsignaloven.當(dāng)有出血時(shí)，T1WI也可混雜局灶性高信號(hào)灶。Theenhancedsuchlesionsaresamplestrengtheningbelt增強(qiáng)后病灶呈結(jié)合帶樣強(qiáng)化Differentialdiagnosis