Recently, the gynecological clinic of The People's Hospital of Chenghai District of Shantou City received a patient with "mole". The patient had been cleared twice in other medical institutions at the beginning of June this year, and continued to bleed for more than 1 month after the operation, and after re-examination, the blood HCG rebound increased, so the patient went to The People's Hospital of Chenghai District of Shantou City for treatment.
"The early symptoms of 'mole' are like pregnancy, but they are not a normal pregnancy, but a disease." Lin Lan, an obstetrician and gynecologist at the hospital, told reporters that the patient's pregnancy looks like a bunch of grape seeds, and the disease is named after it. Although not a normal pregnancy, the disease can cause the uterus to enlarge and bleed abnormally, and the blood hCG value, which is familiar with and most commonly used by obstetricians and gynecologists to determine whether to be pregnant, will also increase, looking a lot like pregnancy.
Professor Wang Lijuan of Sun Yat-sen Memorial Hospital treated the patient. Courtesy of respondents
The receiving physician of the hospital inquired about the patient's medical history in detail, and performed a gynecological examination for him, initially considering it as gestational trophoblastic disease, erosive molar or chorionic carcinoma, and after contacting the ultrasound department, he underwent vaginal ultrasound, and finally diagnosed as erosive mole, unfluded carcinoma, chest CT examination, and found multiple lung metastatic lesions.
It is understood that the so-called pregnancy trophoblastic disease refers to a group of diseases derived from placental trophoblasts, including benign mole mole and malignant trophoblastic diseases. In this case, the patient suffers from erosive mole, also known as malignant mole, whose lesions can invade the muscular layer or reach the outside of the uterus, and the edema villi can affect the vagina, vulva, broad ligament, or pelvic cavity. If molar tissue penetrates the uterine wall, it can cause massive intra-abdominal hemorrhage or invade the broad ligament to form a parauterine mass. Erosive moles can also be transferred to the vagina, lungs, and even the brain through blood circulation, forming metastatic moles. Depending on the site of metastasis, it can cause corresponding symptoms and a poor prognosis.
Considering that patients still have reproductive requirements, Xu Shaomin, director of the Obstetrics and Gynecology Department of the hospital, took the lead in setting up a special disease treatment team, and repeatedly connected with Wang Lijuan, an authoritative expert on trophoblastic tumor of Sun Yat-sen Memorial Hospital of the Specialized Alliance Hospital, to communicate and finally diagnose and determine the treatment plan. The chemotherapy program was followed up by Physician Lin Lan, who returned from a gynecological oncology specialty at Sun Yat-sen Memorial Hospital.
After two courses of chemotherapy, on December 8, the patient's blood HCG had dropped to 3.6 IU/L, and during the chemotherapy, the patient's liver and kidney function was normal, there was no bone marrow suppression, and there was no weight loss. This means that patients only need to consolidate 2-3 courses of chemotherapy to enter the regular follow-up phase.
Epidemiological surveys show that the incidence of molars in Some parts of China and Asia is 2 in 1000 pregnancies, while in Europe and North America the incidence is usually less than 1 in 1000 pregnancies. Trophoblastic diseases are less common in the field of gynecologic oncology. "In the past, such diseases could only be treated in shantou city hospitals and even in guangzhou cancer hospitals." Lin Lan told reporters that the hospital and Sun Yat-sen Hospital of Sun Yat-sen University have established a gynecological joint diagnosis and treatment center, relying on the experience and technology of higher-level hospitals, the people of Chenghai District can enjoy the diagnosis and treatment technology of provincial hospitals at the "doorstep".
Lin Lan reminded that the common symptoms of erosive mole are vaginal bleeding, abnormal enlargement of the uterus, symptoms related to metastatic lesions, abdominal pain, etc. For patients after treatment, timely and regular follow-up is also extremely important, and it is necessary to follow the doctor's advice and beware of the rebound of the disease.
[Reporter] Wang Hanqi
[Correspondent] Chen Jianxing
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【Author】 Wang Hanqi
【Source】 Southern Press Media Group South + client