妊娠滋养细胞疾病2011.7.22

gestationaltrophoblasticdisease(GTD)

妊娠滋养细胞疾病2011.7.22

Introductiongestationaltrophoblasticdisease(GTD)areagroupofdiseasesfromtheplacentanourishcellsofthedisease,itincludeshydatidiformmole

,invasivehydatidiformmole,velvetcarcinomaandrareplacentapartsnourishcelltumors.妊娠滋养细胞疾病(gestationaltrophoblasticdisease，GTD)是一组来源于胎盘滋养细胞的疾病，它包括葡萄胎、侵袭性葡萄胎、绒癌及罕见的胎盘部位滋养细胞肿瘤

InadditiontohydatidiformmoleGTDoutsidethecallofpregnancynourishcelltumors(gestationaltrophoblasticneoplasia,GTN)除葡萄胎以外的GTD称之妊娠滋养细胞肿瘤yearstoimagingdiagnosisGTDmainlydependsonthetypeultrasoundandcolordopplerultrasound.多年来影像学诊断GTD主要依赖B型超声及彩色多普勒超声

Magneticresonanceimaging(magneticresonanceimaging,magneticresonanceimaging)reportedless磁共振成像(magneticresonanceimaging，MRI)的相关报道较少Clinicalmanifestations

hydatidiformmoleisbenignlesions,accordingtotheorganizationforthefetusorpregnancyembryoniccomposition,willhydatidiformmoledividedintothecompletenessandsomesexhydatidiformmole.葡萄胎属良性病变，根据妊娠组织中有无胎儿或胚胎成分，将葡萄胎分为完全性与部分性葡萄胎Donotunderstandabouttheetiology,morethan40yearsoldorlessthan20yearsold,incidence病因不甚明了，大于40岁或小于20岁，发病率增高Themainandyunkundefect,andemptytheeggsarefertilized,doublespermtofertiliserelevant主要与孕卵缺损，空卵受精、双精子受精有关

Presentedwithpostmenopausalbleedingasthemainsymptomsofpregnancyoftenearly,heavy,reactionlong临床上以停经后阴道出血为主要症状，妊娠反应往往早、重、长

Clinicalmanifestations

Abnormaluterinebodycheck,individualscanincreaseaabdominalpainandpregnancy-inducedhypertensionmerger

.体查子宫异常增大，个别人可有腹痛及合并妊高症Flavincystincompleteness

hydatidiformmole

incidenceof30-50%黄素囊肿在完全性葡萄胎发生率为30—50%

TheultrasonicinspectionforthemainmethodandincombinationwithB-HCGabnormalincreases,therushhourextendedandsymptoms,signsmaydiagnosedisease超声为主要检查方法，结合B-HCG异常升高，高峰时间延长及症状、体征可诊断本病Clinicalmanifestations

Aggressive

hydatidiformmole

clinicalmainlyforirregularvaginalbleeding.侵蚀性葡萄胎临床主要表现为不规则阴道出血Abnormaluterineincreases,flavincystpersistandlung,vaginalmetastasesperformance.子宫异常增大，黄素囊肿持续存在以及肺、阴道转移灶表现。

Choriocarcinomaisahighlymalignanttumorcellsnourish绒毛膜癌是一种高度恶性的滋养细胞肿瘤50%

hydatidiformmole

secondarytosecondarytoabortion,25%,22.5%,2.5%secondarytotermpregnancysecondarytoectopicpregnancy50%继发于葡萄胎，25%继发于流产，22.5%继发于足月妊娠，2.5%继发于异位妊娠

Theclinicalmanifestationsofthevaginalbleeding,amenorrhoea,abdominalpain,uterineabnormalincrease,softandlung,vagina,brainmetastasissymptoms.临床表现为阴道出血，闭经，腹痛，子宫异常增大、质软以及肺、阴道、脑转移症状。MRImaging（葡萄胎）

Thevolume,anduterinecavityexpansion,expanditsnotetheamountofrelativelyuniformspacecapsuleandalongT1,T2signal,andlongchangenourishcellhyperplasia,withedema,formedtheblistersizedifferabout子宫体积扩大，子宫腔扩大，其内可见大量较均匀的分隔和小囊呈长T1、长T2信号改变，与滋养细胞增生，绒毛间质水肿，所形成大小不等的水泡有关Thesofttissuemassofuterinecavity,atypical"honeycomb",or"grapes."form,andbytheformationofthewater-blisterstructurearrangementaboutstate宫腔内的软组织肿块影，呈典型“蜂窝”状或“葡萄”状，与所形成的水泡状结构排列状态有关MRImaging（葡萄胎）

Masscoatedcomplete,endometrialsignalcontinuous,muscularpressureisthinning,andpathologychangelesionsnotinvolvingwombjicengareinagreement.肿块包膜完整，子宫内膜信号连续，肌层呈受压变薄改变，与病理上病变未侵犯子宫肌层相一致。

Uterinecavityandmusclelayerhasnotseentheobviousincreaseofthebloodvessels,thick,authorandinterstitialinnertiresourcesexdisappearbloodvesselsrelevant.structurearrangementaboutstate子宫腔及肌层未见明显增粗、迂曲的血管，与间质内胎源性血管消失有关。MRImaging（葡萄胎）

DWIhighbvalueinthat"honeycomb"mass,or"grapes."shapestructurespreadnotlimitedwithpathologicalchanges,lowdegreeofmalignantcellsarearranged,nottoocrowded,watermoleculesspreadasmoothrelevantDWI高b值时显示肿块内“蜂窝”状或“葡萄”状结构扩散不受限，与病变恶性程度低，细胞排列不太密集，水分子扩散较顺畅有关MRImaging（葡萄胎）Enhancescanningperformanceformultiplerelativelyuniformspacestrengthening,solidcomponentnotstrengthened,andthewater-blisterstructureandexpansionofthebloodsupply.增强扫描表现为多发较均匀的分隔强化，实性成分不强化，与扩张的水泡状结构缺乏血供有关。

hydatidiformmole

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

.良性葡萄胎大体观为大小不等的水泡，镜下见滋养细胞不同程度增生，绒毛间质水肿，体积增大，轮廓规则，间质内胎源性血管消失，但未侵犯子宫肌层

Pathologicalcharacteristics（葡萄胎）

MRImaging（恶性

GTD）

Capsuleincompletesofttissuemass,canshow,a“crumbalsocellular”,or“grapes.”shape,itshowshighsignalwithpathologicalchanges,flakenecrosisrelated包膜不完整的软组织肿块，可呈团块状，亦可呈“蜂窝”状或“葡萄”状，其内可见片状高信号，与病变坏死相关

Endometrialsignaldiscontinuousmass,infringeuponwombjiceng,anduterinemusclelayerboundaryisnotclear,isoneofthemostimportantfeaturesinGTDmalignant子宫内膜信号不连续，肿块侵犯子宫肌层，与子宫肌层界限不清，是恶性GTD的重要特征之一MRImaging（恶性

GTD）

Uterinecavitymassandaroundandmuscularlayerappearedalotofthick,theauthorincreasebloodflowinT1Wemptysignal,ondisplaytheclear,thistumoritselfthebiologicalcharacteristicsofthecanceritselfisconcerned,noinherentbloodvessels,butratherondamagebloodvesselswithnutrients,andnearbyabnormalhighHCGhormonelevelstimulation,thebloodvesselsoftheoriginalmakeuterineleveldisordersandevenappeartypical"bloodlake"shapeperformance肿块周围及子宫腔内及肌层出现大量增粗、迂曲的血管流空信号，于T1WI上显示最清楚，此与肿瘤本身的生物学特性有关，该肿瘤本身无固有的血管，而是依赖破坏邻近血管获取营养，加之异常高的HCG激素水平刺激，使子宫原来的血管层次紊乱，甚至出现典型的“血湖”状表现MRImaging（恶性

GTD）

DWIhighbvalueshowslimitedspreaddiseasemalignantdegreeishigh,densecellsarearranged,watermoleculesspreadnotsmoothrelevant.DWI高b值时显示扩散受限，与病变恶性程度高，细胞排列密集，水分子扩散不顺畅有关。Ifthewombjicengoroutsidetheuterustissuewater-blisterthing,seemicroscopicseeforaggressive

hydatidiformmole

fluff若子宫肌层或子宫外组织中见水泡状物，镜检见绒毛为侵袭性葡萄胎

Onlypiecenourishcellsinfiltrationandhemorrhage,necrosisandabsolutelynonefluffthestructureforflockingcarcinoma仅为成片滋养细胞浸润及出血坏死，而完全不见绒毛结构者为绒癌

Pathological（恶性

GTD）

DifferentialdiagnosisMagneticresonanceimaging(MRI)fordifferentiatingbenignPuTaoTaiandaggressive

hydatidiformmole

andclothwithsoftnapismorebeautiful,ultrasoniccancerbutforaggressivePuTaoTaiandidentificationofflockingcanceralsodependsontheclinicalandpathologicaldiagnosis

MRI对于鉴别良性葡萄胎与侵袭性葡萄胎及绒癌较超声更佳，但对于侵袭性葡萄胎与绒癌的鉴别还有赖于临床及病理诊断

Stillshouldidentifywiththefollowingdisease还应与以下疾病鉴别Differentialdiagnosis

Endometrialcarcinoma子宫内膜癌:Withendometrialuneventhickeningshowingtheendometrialsignalirregular,discontinuousandtumordeepabnormalsignalsofinfringementtogivepriority子宫内膜癌以子宫内膜不均匀增厚所表现出的子宫内膜信号不规则、不连续和肿瘤向深部侵犯的异常信号为主

ThecharacteristicofmalignantGTDbloodflow“empty”signalandmorehelptoidentifykitchenbleeding恶性GTD特征性的“血管流空”信号和多灶出血有助鉴别TheenhancedduetoabnormalbloodsupplyGTDmalignantareveryabundant,causeitsabnormalstrengthenthanendometrialcancer.增强后由于恶性GTD异常血供非常丰富，造成其异常强化程度高于子宫内膜癌。Differentialdiagnosis

Adenomyosis子宫腺肌症:Theincreasedtodifferentextent,smoothcontour,sometimesvisibleuterinelayeredstructuredeformation子宫有不同程度的增大，轮廓光滑，有时可见子宫分层结构变形

Lesionsperformanceforbelt,limitationsorthickeningdiffusethemuscularlayerbelt,T2WIfocalsamplesignalcanbemingledwithfocalhighsignal病灶表现为结合带弥漫性、局限性增厚或外肌层结合带样信号灶，T2WI可混杂有局灶性高信号

Whenableeding,T1WIalsocanbemixedfocalhighsignaloven.当有出血时，T1WI也可混杂局灶性高信号灶。Theenhancedsuchlesionsaresamplestrengtheningbelt增强后病灶呈结合带样强化Differentialdiagnosis