Enfermedad Trofoblástica Gestacional

Enfermedad Trofoblástica Gestacional DR. CAIN CALVA ZARATE RESIDENTE 1 GRADO DE GINECOLOGIA Y OBSTETRICIA 09 – JULIO - 2009 HOSPITAL DE GINECO-PEDIATRIA N.2 IMSS, HERMOSILLO, SONORA. ASPECTOS CLÌNICOS - SEGUIMIENTO

ESTADISTICAS ,[object Object],[object Object],[object Object],[object Object],PARK W.CHORIOCARCINOMA. A STUDY OF ITS PATHOLOGY. PHILADELPHIA: DAVIS 2001

Enfermedad Trofoblástica Gestacional ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

CLASIFICACIÒN OMS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

ENFERMEDAD TROFOBLASTICA GESTACIONAL CLASIFICACION (Clínica ) BENIGNA MALIGNA Mola Hidatiforme Degeneración molar Mola persistente Degeneración hidrópica Mola invasora Coriocarcinoma METASTASICA Bajo riesgo Alto riesgo REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

Clasificación Variedad de la Enfermedad REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

CITOGENETICA Mola hidatiforme completa: Cr. 46 XX. Ovulo sin Cr. Fecundado por 1 o 2 espermatozoides Duplicación de una célula germinal. Mola hidatiforme Incompleta (Parcial) Ovulo activo fecundado por 2 espermatozoides Cr. 66 XXY. REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

CLASIFICACION CELULAR ,[object Object],[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

Clasificación ,[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

Clasificación ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

SISTEMA DE PUNTUACIÒN FIGO 2000 PUNTUACIÒN 0 1 2 4 EDAD 39 39 EMB. PREVIO MH ABORTO A T PERIODO INTERGENESICO 4 4 - 6 6 – 12 12 HGC ( mu/ml) PRE TX 1OOO 1000-10000 10000-100000 100000 TAMAÑO DEL TUMOR 3-5 5 SITIO METASTASIS BAZO/RIÑON GI CEREBRO NUMERO DE METASTASIS 0 1-4 4-8 8 QUIMIOTX 1 FARMACO 2 ó MAS FARMACOS 0 – 6 : BAJO RIESGO 7 ò MAS: ALTO RIESGO REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

Factores de riesgo ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],HORMONAL CONTRACEPTION AND TROPHOBLASTIC SQUELAE AFTER HIDATIDIFORM MOLE (A GYNECOLOGIC ONCOLOGY GROUP STUDY ). AM J OBSTET GYNECOL 2002;187-217

Clasificación citogenética

MOLA HIDATIFORME ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],HORMONAL CONTRACEPTION AND TROPHOBLASTIC SQUELAE AFTER HIDATIDIFORM MOLE (A GYNECOLOGIC ONCOLOGY GROUP STUDY ). AM J OBSTET GYNECOL 2002;187-217

Características citogenetica ,[object Object]

Características citogenética ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],MOLA COMPLETA REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

Coriadenoma de x truens . MOLA INVASORA ,[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

TUMOR TROFOBLASTICO DEL SITIO PLACENTARIO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

Coriocarcinoma. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

Panorama clínico Síntomas y Signos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PALMER JR. ADVANCES IN THE EPIDEMIOLOGY OF GESTACIONAL TROFOBLASTIC DISEASE. JR REPROD MED. 1994 ;39:155

Cuadro clínico ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PALMER JR. ADVANCES IN THE EPIDEMIOLOGY OF GESTACIONAL TROFOBLASTIC DISEASE. JR REPROD MED. 1994 ;39:155

QUISTES TECALUTEINICOS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],MOTNZ FJ, SCHLAERTH JB, MORROW CP, THE NATURAL HISTORY OF TEHCALUTEIN CYSTS. 2005; 72-247

ESQUEMA INICIAL DE ABORDAJE DE ETG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PALMER JR. ADVANCES IN THE EPIDEMIOLOGY OF GESTACIONAL TROFOBLASTIC DISEASE. JR REPROD MED. 2006 ;39:155

Diagnóstico ,[object Object],[object Object],[object Object],[object Object],[object Object],PALMER JR. ADVANCES IN THE EPIDEMIOLOGY OF GESTACIONAL TROFOBLASTIC DISEASE. JR REPROD MED. 1994 ;39:155

CURVA DE PRODUCCION DE HGCH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PALMER JR. ADVANCES IN THE EPIDEMIOLOGY OF GESTACIONAL TROFOBLASTIC DISEASE. JR REPROD MED. 2006 ;39:155

HORMONA GONADOTROPINA CORIONICA HUMANA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],HORMONAL CONTRACEPTION AND TROPHOBLASTIC SQUELAE AFTER HIDATIDIFORM MOLE (A GYNECOLOGIC ONCOLOGY GROUP STUDY ). AM J OBSTET GYNECOL 2002;187-217

SEGUIMIENTO…………… ,[object Object],[object Object],[object Object],[object Object],[object Object],HORMONAL CONTRACEPTION AND TROPHOBLASTIC SQUELAE AFTER HIDATIDIFORM MOLE (A GYNECOLOGIC ONCOLOGY GROUP STUDY ). AM J OBSTET GYNECOL 2002;187-217

Diagnóstico por USG Imagen “en panal de abejas”.

Diagnóstico por biopsia NIDOS DE TROFOBLASTO Y SINCITIOTROFOBLASTICO

Diagnóstico por biopsia PARED DE QUISTE TECALUTEINICO

ABORDAJE TERAPEUTICO ,[object Object],[object Object]

PROCEDIMIENTO ,[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

Complicaciones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

SITIOS DE MATASTASIS Pulmón 18 81.81 Hígado 13 59.09 Cerebro 9 40.91 Riñón 9 40.91 Vagina-vulva 7 31.81 Bazo 6 27.27 Ganglios linfáticos 5 22.73 Tracto gastrointestinal 4 18.18 Tiroides 2 9.09 Suprarrenal 2 9.09 Ovario 1 4.54 Páncreas 1 4.54 REX C. BENTLEY DEPARTAMENT OF PATHOLOGY , DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NORTH CAROLINA

DX ETG MALIGNA POR CUANTIFICACIÓN DE hGCH SÈRICA (FIGO) POST LUI ,[object Object],[object Object],[object Object],[object Object],[object Object],STATING SISTEM OF THE INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS WITH THE SCORING SISTEM OF THE WHO FOR TROPHOBLASTIC NEOPLASIA

EMBARAZO POST QUIMIOTERAPIA POR ETGM DE BAJO RIESGO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PREGNANCY AFTTER CYTOTOXIC CHEMOTHERAPY FOR GESTACIONAL TROPHOBLASTIC TUMORS, RUSTIN GJ, BOTH M, DENT J, BR MED 1984; 288:103

COMENTARIOS…………………….. ,[object Object]

Enfermedad Trofoblástica Gestacional

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