Cystic mole is a type of trophoblastic disease, which is characterized by the growth of chorionic villi in the uterine wall in the absence of normal embryonic tissue or the partial presence of elements of a non-viable fetus. This pathology occurs in case of violation of the process of physiological fertilization of a mature egg with a normal set of chromosomes by one mature haploid spermatozoon. A cystic drift has the appearance of a polycystic formation, the cysts of which are filled with a clear liquid. It is often compared to "a bunch of grapes".
All trophoblastic diseases are characterized by rapid growth and rapid progression of pathology, invasiveness, and a high risk of malignancy. Therefore, when a mole is verified, treatment should be started immediately. Otherwise, the woman is in serious danger: severe uterine or internal bleeding, and the formation of a malignant tumor, which in the final stage can lead to death.
- Causes of hydatidiform mole
- Types of hydatidiform mole
- Symptoms of hydatidiform mole
- Diagnosis of hydatidiform mole
- Methods of treatment of hydatidiform mole
- Consequences of hydatidiform mole
Causes of hydatidiform mole
The cystic drift can be attributed to the pathological "products of conception" since its formation requires a defective egg and sperm. In what cases does the fusion of two germ cells contribute to the formation of this trophoblast pathology:
- When one spermatozoon enters a nuclear-free egg.
- In the case of penetration of two haploid or one diploid sperm into a normal mature egg.
- Loss of the mother's genetic material in the egg due to abnormal gestation results in a doubling of the father's genetic material.
What is happening? Since the resulting zygote (the result of the fusion of the sperm and the egg) does not own the mother's genetic information, those chromosomes that are present are doubled to restore the diploid set of chromosomes. As a result, an embryo is formed that owns a double set of the father's chromosomes: 46 XX or 46 XY. This condition is called a complete hydatidiform mole. With partial hydatidiform drift, an egg with a single set of unpaired chromosomes is simultaneously fertilized by 2 spermatozoa, which leads to triploidy - 69 XXX, 69 XXY, 69 XYU.
Unfortunately, until that time it was not possible to establish specific and reasonable causes of this pathology. There are several hypothetical factors that increase the risk of hydatidiform mole:
- bacterial, a viral, or parasitic infection of the genital organs;
- hormonal imbalance (in particular, estrogen deficiency);
- ectopic pregnancy;
- early or late pregnancy;
- the presence of a cystic drift in history;
- a large number of births in a woman;
- deficiency of vitamin A in the diet;
- consanguineous sexual relations.
Types of hydatidiform mole
Cystic drift differs in the degree of transformation of the trophoblast:
- A complete cystic mole is characterized by a change in the tissue of the entire trophoblast and the absence of normal embryonic and placental tissues. Pathology develops in the absence of genetic material from the mother's side in the embryo when the paternal haploid chromosome set is doubled.
- The partial hydatidiform mole may contain non-viable elements of placental and embryonic tissue against the background of partial restructuring of the chorionic villi. It occurs mainly when a normal or defective ovum is diasporic, the ovum is fertilized by a sperm with a diploid set of chromosomes.
- Destructive (invasive) cystic mole is a rare form of the disease when chorionic villi grow into neighboring tissues (all layers of the uterine wall, vagina, and abdominal organs). At the same time, altered trophoblast tissues become a source of life-threatening uterine and internal bleeding, a substrate for the malignant transformation of cells and the formation of choriocarcinoma.
Symptoms of hydatidiform mole
In the first weeks of pregnancy, the cystic drift does not give itself away and is hidden under the clinical picture of normal physiological pregnancy: delayed menstruation, nausea, vomiting, and subjective signs. But as this pathology progresses, characteristic symptoms develop, namely:
- discharge from the genital tract of dark blood with clots and "bubbles";
- constant nausea, repeated and tiring vomiting;
- increased secretion of saliva;
- lower abdominal pain;
- signs of anemia: pallor of the skin and mucous membranes, fatigue, dizziness, the appearance of "flies" before the eyes;
- preeclampsia, eclampsia;
- high blood pressure;
- the discrepancy between the size of the uterus and the expected duration of pregnancy;
- absence of objective signs of pregnancy: during palpation of the uterus, small structures of the fetal body are not palpable, there are no movements of the fetus and its heartbeat, and with sonography, in the uterine cavity, only a polycystic formation is visualized.
When the tissue of the hydatidiform drift grows into neighboring organs, an "acute abdomen" clinic may occur.
Diagnosis of hydatidiform mole
The only common sign of physiological pregnancy and the hydatidiform mole is an elevated level of human chorionic gonadotropin (hCG). But with the trophoblastic disease, the level of this hormone significantly exceeds the indicators characteristic of physiological pregnancy.
In the early stages of pregnancy, a mole may be asymptomatic, so women do not go to an obstetrician. But already at the first screening ultrasound, this pathology can be detected.
Diagnosis of cystic drift includes:
- Examination by an obstetrician-gynecologist. A rapid increase in the size of the uterus in relation to the gestational age may indicate a mole.
- Ultrasound is the "gold standard" for diagnosing trophoblastic disease. On sonography, there are no signs of an embryo; instead, a characteristic picture of a "snowstorm" is visualized in the uterus - a polycystic homogeneous formation.
- With cardiotocography (CTG), the fetal heartbeat is not recorded.
- In some cases, a hysteroscopy is performed.
- Diagnostic laparoscopy is used to diagnose invasive tissue growth of a hydatidiform mole.
- After removal of the cystic drift, its tissue is subject to mandatory histological examination.
- If a malignant degeneration of trophoblast tissue is suspected, a woman undergoes a blood test for specific tumor markers.
Bubble drift is characterized by a high risk of malignancy of trophoblast cells and the formation of chorionepithelioma and choriocarcinoma. These tumors can metastasize to other organs: the brain, lungs, and liver. To exclude foci of secondary spread, additional imaging methods of examination are used: abdominal ultrasound, chest x-ray, CT, and MRI.
Trophoblastic disease is a direct indication of surgical intervention. In the preoperative period, a woman should undergo a laboratory and instrumental examination program:
- general analysis of blood and urine;
- chest x-ray;
- blood test for syphilis;
- biochemical blood test (creatinine, urea, liver tests);
- ECG, if necessary - echocardiography.
After radical treatment of a mole, a woman needs to determine the level of free chorionic gonadotropin (b-hCG) in venous blood every week, and do sonography of the pelvic organs and an x-ray of the chest every two weeks.
Methods of treatment of hydatidiform mole
Bubble drift is a pathological neoplasm that needs to be disposed of. In some situations, this happens on its own (by the "birth" of a hydatidiform mole). But in most cases, an artificial removal method is used using vacuum aspiration or curettage of the uterine cavity. To extract a small formation, as well as to control after vacuum aspiration, curettage of the uterine cavity is used.
To eliminate the destructive hydatidiform mole, volumetric surgical interventions are used. The most common hysterectomy is the removal of the uterus without appendages. In case of invasive growth of hydatidiform mole and its germination into the abdominal cavity, laparoscopic operations are performed. In the postoperative period, such patients have often prescribed a course of chemotherapy and radiation therapy.
Consequences of hydatidiform mole
In the absence of correct treatment, a hydatidiform mole can cause the development of severe complications and lead to:
- malignancy of cystic mole with the formation of a malignant tumor: chorionepithelioma or choriocarcinoma;
- uterine and internal bleeding;
- intrauterine infections;
- infectious complications (septicemia);
Often, after suffering a hydatidiform drift, problems appear with the subsequent onset of pregnancy and childbirth. To preserve the reproductive potential of a woman, all possible risk factors should be excluded, gynecological examinations should be performed regularly, pregnancy should be carefully planned, and conceptual prevention of genetic diseases and congenital malformations in the unborn child should be carried out.
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