Gestational trophoblastic disease

　　It can be considered that there is a certain connection between these diseases, benign hydatidiform mole may continue to develop to invasive hydatidiform mole and choriocarcinoma. Choriocarcinoma can also occur directly after hydatidiform mole, term pregnancy, abortion, or ectopic pregnancy, in addition to the above-mentioned途径 coming from. Gestational trophoblastic tumor (gestational trophoblastic tumor, GTr) refers to all lesions in GTD except hydatidiform mole. Hydatidiform mole is often considered to be caused by the degeneration of extraembryonic tissue and the abnormal development of the trophoblast, and therefore is a benign chorionic villous lesion.

　　1. Complete hydatidiform mole:It has the potential risk of local invasion and/or distant metastasis. The incidence of local invasion and/or distant metastasis after evacuation of hydatidiform mole is about 15% and 4% respectively.

　　2. Partial hydatidiform mole:Low tendency to malignancy, with a probability of developing persistent hydatidiform mole about 4%, and generally not metastasizing. Malignancy should be the most common complication.

　　High-risk factors include:

　　① HCG > 100000U/L

　　② The uterine volume is significantly larger than the corresponding gestational age; the diameter of the luteinized ovarian cyst is >6cm

　　④ Age > 40 years

　　⑤ The regression pattern of HCG in recurrent hydatidiform mole:

　　⑥ Nine weeks after evacuation, HCG returns to normal, at most

　　⑦ Three months after the complete expulsion of hydatidiform mole, HCG remains positive, which is called persistent hydatidiform mole or persistent gestational trophoblastic tumor.

　　1. The common manifestation of hydatidiform mole is the rapid enlargement of the uterus within 10-16 weeks after pregnancy, which is larger than the expected gestational age.

　　2. Vaginal bleeding, lack of fetal movement, no fetal heartbeat, and severe nausea and vomiting are common.

　　3. The expulsion of vesicular tissue resembling grapes suggests this diagnosis, and it is confirmed by tissue examination.

　　4. Pelvic ultrasound examination is helpful for diagnosis.

　　5. Human chorionic gonadotropin (hCG) is produced by the proliferative trophoblastic tissue, and a high level of serum hCGβ subunit (β-hCG) is helpful for the diagnosis of gestational trophoblastic disease.

　　6. Complications of partial or complete hydatidiform mole include intrauterine infection, sepsis, hemorrhage, preeclampsia, and development into persistent gestational trophoblastic disease.

　　7. Tumor of trophoblasts in the placental site, due to its location in the muscular layer, tends to cause bleeding; it can infiltrate adjacent tissues and occasionally metastasize to distant sites.

　　8. Choriocarcinoma is highly malignant and widely metastasizes early through the venous and lymphatic systems.

　　Trophoblasts are accessory structures of the fetus, which can be regarded as a xenograft in the mother, and their pathological characteristics and biological behavior are different from those of other tumors. The structurally benign hydatidiform mole has a more obvious invasive force than normal villi, which may lead to invasive growth and extrauterine metastasis. On the other hand, extremely malignant choriocarcinoma, most patients can be completely relieved after chemotherapy, which is undoubtedly related to the strong immune rejection potential of this type of patients against paternal antigens in the tumor.

　　The incidence of hydatidiform mole in China is not low, but the possibility of it developing into malignant hydatidiform mole and choriocarcinoma is relatively small. The cure rate of hydatidiform mole is almost 100%, and although choriocarcinoma has a high degree of malignancy, its efficacy is very significant if it is detected and treated early. Some cases can be cured without hysterectomy, but with chemotherapy alone, and there is still a possibility of giving birth to children after recovery. Therefore, if women of childbearing age find vaginal bleeding after the expulsion of hydatidiform mole, or irregular vaginal bleeding after abortion or childbirth, they should be vigilant about malignant gestational trophoblastic tumors and go to the hospital for relevant examinations in a timely manner:

　　1. Human chorionic gonadotropin (HCG) determination.

　　2. Ultrasound examination.

　　3. CT scan.

　　4. Magnetic resonance imaging (MRI) examination.

　　5. X-ray examination.

　　6. Flow cytometry (FCM) examination.

　　The dietary selection for patients with gestational trophoblastic disease should meet the following requirements:

　　① Fresh and hygienic foods should be chosen.

　　② The variety of dishes should be rich, and it is best to have 'everything' in one meal, avoiding eating the same thing repeatedly.

　　③ The ratio of main and side dishes should be 1:1, and the main dishes should alternate between rice, noodles, and coarse grains, with a certain amount of coarse grains. The ratio of vegetables, fruits, and protein-rich foods in side dishes should be 5:1.

　　④ The ratio of animal protein to plant protein in protein foods should be half and half, and avoid sweet and processed foods.

　　⑤ The fat intake should not exceed 50g per day, eat less meat, more fish and legumes, and try to choose foods that are beneficial to anti-cancer and cancer prevention.

　　1. There is little difference in diet between patients with gestational trophoblastic disease. Patients in the early stage of the disease are no different from healthy people, and they can eat whatever they want without 'taboos'. Patients in the late stage often lack appetite or have difficulty eating, and the food they eat should have enough calories and protein, rich vitamins, and low in fat and sugar, following the principle of easy digestion and absorption.

　　2. In terms of food form, in addition to variety and reducing repetition, there should also be milk and fruit, but this also requires respect for the patient's dietary habits, and never force them to eat things they are not accustomed to.

　　3. For patients with lack of appetite, the best way to get them to eat is through language induction. You can start with their favorite food, a variety of delicacies, and describe the appearance and deliciousness of the food one by one to evoke their pleasant memories, thereby making the decision to taste. Even if they eat very little, it is very beneficial to the body, and by trying several different ones, you can achieve the purpose of supplementing nutrition.

　　Generally, if the blood hCG has not reached the normal value two months after the expulsion of hydatidiform mole, it should be treated as invasive hydatidiform mole. Trophoblasts are accessory structures of the fetus and can be considered as a xenograft in the mother, with pathological characteristics and biological behavior different from other tumors. The structurally benign hydatidiform mole has a more obvious invasive force than normal villi, which may further lead to invasive growth and extrauterine metastasis. On the other hand, extremely malignant choriocarcinoma, most patients can be completely relieved after chemotherapy, which is undoubtedly related to the strong immune rejection potential of this type of patients against paternal antigens in the tumor.