Horionkartsinoma – the trofoblastichesky tumor developing as a result of malignant transformation of an epithelium of a horion. The clinic of a horionkartsinoma is characterized by bloody, serous or purulent allocations from a genital tract, pains in the bottom of a stomach; at metastasis – symptomatology from appropriate authorities. Diagnostics of a horionkartsinoma demands determination of the HG level and trofoblastichesky globulin in blood, carrying out the histologic analysis of scrape, ultrasonography. Treatment of a horionkartsinoma can include chemotherapy, surgical intervention.
Horionkartsinoma (or a horionepitelioma) treats malignant forms of a trofoblastichesky disease which meets 0,5-8,3 cases on 1000 childbirth. Most often development of a horionkartsinoma is preceded by a puzyrny drift (40% of observations), abortion (25%), childbirth (22,5%), extra-uterine pregnancy (2,5%). Less often the teratogenny horionkartsinoma which are not connected with pregnancy meet. In rare instances perhaps simultaneous combination of a puzyrny drift and horionkartsinoma.
Horionkartsinoma is formed of structures of a trofoblast, sintsitialny fabric a horiona, sometimes – of germinal cages of gonads. On macroscopic structure of a horionkartsinom represents the dark hemorrhagic mass of a soft consistence with zones of ulcerations and disintegration. At a microscopic research of a horionkartsinoma chaotic proliferation of fabric of a trofoblast, lack of a stroma, vessels and a horiona is defined; existence of cells of Langkhans and sintsitialny elements.
Usually the horionkartsinoma settles down in a uterus body (in a zone of the previous implantation of an embryo) where can have submukozny (83%), intramuralny – (5, 6%) or subserous (7%) localization. At an extra-uterine form primary centers of a horionkartsinoma can come to light in ovaries and uterine tubes (1-4%); brain, lungs, vagina (17%).
Classification of a horionkartsinoma
In the place of development of primary center the gynecology allocates an ortotopny, geterotopny and teratogenny horionkartsinoma. At an ortotopny horionkartsinoma the tumor is localized in the place of the previous implantation of fetal egg – a uterus, pipes, an abdominal cavity. In process of the progressing the horionkartsinoma sprouts and spreads in a vagina, a parametry, big epiploon, a bladder, a direct or sigmovidny gut, lungs.
Horionkartsinoma with geterotopny localization initially comes to light out of a zone of implantation of an embryo, is more often – in walls of a vagina, lungs, a brain. The Teratogenny horionkartsinoma is not connected with the previous pregnancy and belongs to the mixed tumors of embryonic genesis. An arrangement teratogenny a horionkartsiny ekstragonadno - in an epifiza, lungs, a sredosteniye, a stomach, zabryushinny space, a bladder.
In a stadirovaniye of a horionkartsinoma adhere to the WHO classification, allocating the IV stages:
- I – localization of a horionkartsinoma is limited to a uterus
- II – growth of a tumor extends out of uterus limits, but is limited to genitals
- III – come to light metastasises in lungs
- The IV stage - metastasises other bodies, except lungs come to light.
Reasons of development of a horionkartsinoma
Question of the reasons of development of a horionkartsinoma as other forms of a trofoblastichesky disease, demands further studying. As the leading etiopatogenetichesky link virus transformation of a trofoblast, immunosuppressive effect of hormones of pregnancy (HG, progesterone, estrogen), metabolic violations, the immunological conflict, deficiency of protein, increase in enzymatic activity of a gialuronidaza is considered.
On development of a horionkartsinoma refer pregnant women to categories of risk 40 years are more senior; povtornoberemenny; the women having abortions, spontaneous termination of pregnancy, extra-uterine pregnancy in the anamnesis; the patients who transferred a puzyrny drift. Horionkartsinoma is more often diagnosed for inhabitants of the Asian region.
Horionkartsinoma can develop along with pregnancy, soon after the termination of a gestation or to arise several years later after pregnancy. In the beginning 80% of patients have bloody allocations of various intensity and duration. The periodic independent termination of bleedings and inefficiency of a separate medical and diagnostic scraping is specific. Bleeding, as a rule, begins soon after medical abortion, childbirth, an abortion; sometimes – after a long delay monthly or in an intermenstrual interval. Along with blood allocations at a horionkartsinoma allocation serous is possible or purulent is more white, connected with a necrosis or infection of tumoral knot.
The repeating bleedings lead to an anemization; intoxication is followed by fever and oznoba. Quite often the nagrubaniye of mammary glands with allocation from nipples of a molozivopodobny secret comes to light. At germination tumoral body weights of a uterus note emergence of a pain syndrome in the bottom of a stomach and a waist. Existence of metastasises in lungs is demonstrated by cough and a blood spitting; in a brain – neurologic symptoms (deterioration in sight, a headache, dizziness, motive violations). At a horionkartsinoma there is a metastatic damage of lungs (45-50%), vaginas (35%), appendages, a neck of a uterus, a brain more often. In ovaries at a horionkartsinoma tekalyuteinovy cysts quite often come to light.
Diagnostics of a horionkartsinoma
As malospetsifichna horionkartsinoma symptoms, the importance is attached to objective diagnostics. When studying the anamnesis connection with the previous pregnancy, a puzyrny drift is considered. Carrying out a gynecologic research allows to find existence of the cyanotic knots sprouting in a vagina; at development of a horionkartsinoma against the background of pregnancy increase in the sizes of a uterus in comparison with gestational term is noted.
By means of ultrasonography increase in a uterus, existence in a uterus of melkokistozny fabric, bilateral tekalyuteinovy cysts comes to light. The tumoral knot of a horionkartsinoma can have the sizes from several centimeters to the sizes of the head of the adult. With the specifying purpose the gisterografiya – a x-ray research of a uterus is applied.
Carrying out a diagnostic scraping of a cavity of a uterus happens to a histologic research of scrape not always informative as micromedicines often contain blood clots, nekrotizirovanny fabrics of endometrium and single elements of a trofoblast. For horionkartsiny detection of atypical cages of a sintsitiotrofoblast in scrape testifies. Carrying out a cytologic research of dabs prints from the struck tissues of a vagina, vulva, uterus neck, and also a biopsy of these sites is possible.
Horionkartsinoma is difficult to be differentiated from a trofoblastichesky tumor of the placentary platform and an invasive puzyrny drift which also differ in infiltriruyushchy growth. Definition of the increased maintenance of HGCh, AFP and trofoblastichesky β-globulin in blood serum which it is superfluous is a typical diagnostic sign of a horionkartsinoma are produced by a tumor. By means of a X-ray analysis, a tomography of lungs and KT of a brain existence of metastasises of a horionkartsinoma in the remote bodies is defined.
Treatment of a horionkartsinoma
As the leading method of treatment of a horionkartsinoma serves mono - or polychemotherapy. Medicines of the first line are a methotrexate, cisplatinum, calcium , D, , , , etc. which are appointed independently or in various combinations repeated courses for 8-15 days.
Resort to surgical treatment of a horionkartsinoma at the menacing bleeding, risk of perforation of a uterus, septic states, inefficiency of chemotherapy, considerable damage of a uterus and ovaries. As the recommended volume of intervention serves removal of a uterus: a hysterectomy (in the absence of metastasises at young women) or a pan-hysterectomy (at women 40 years are more senior). Removal of a horionkartsinoma is supplemented further with chemotherapeutic treatment. As criterion of an izlechennost serves normalization of the HG level in three analyses made at an interval of 1 week.
Prevention and the forecast at a horionkartsinoma
During remission regular control of HG caption is necessary (1 time in 2 weeks within 3 months, further – 1 time in 6 months within 2 years); carrying out a X-ray analysis of lungs (each 3 months within a year). It is long, not less than for 1 year, to the patient hormonal contraception the COOK is appointed.
Carrying out preventive chemotherapy is shown to patients with the puzyrny drift having high risk of transformation in horionkartsiny. Existence of metastasises reduces a possibility of treatment to 70%. At a horionkartsinoma of ovaries which badly responds to chemotherapy, the forecast practically always adverse.