Molar pregnancy (Mola hydatidosa) – treatment and pictures
After fertilization of the ovum which normally happens in one of the fallopian tubes, zygote comes down and gets into the uterine cavity. Newly formed embryo must in some way “catch” to the uterine lining. To grow and develop, it needs a nutrients and oxygen, which can result only from maternal blood. An intermediary between mother and fetus is performed by trophoblastic tissue. Trophoblast is formed in the first days after fertilization and has the ability to destroy the uterine lining, so that fetus can be implanted (nested) in the uterus. For this purpose trophoblast forms characteristic structures – horion villi, which resemble countless tiny fingers. Horial villi cut into the lining of the uterus and break blood vessels and literally bath in materal blood. From it they obtain nutrients and oxygen and transmit them to the fetus. At the end of the month trophoblast is transformed into placenta, which takes further feed of the fetus.
Interference in the development of trophoblast (trophoblastic disease) are several. The reason for molar pregnancy is unknown. The risk of this disease increases with each successful pregnancy and with the age of the pregnant woman. The incidence is 1:2000 births, but in some countries –India,Central America, it is 10 times higher. This points to the causative factor of diet and lifestyle. The symptoms are typical and are expressed in bleeding during pregnancy. Separated blood materials are mixed with cluster formations and clear liquid. The uterus is growing faster than usual for this time of pregnancy. The morphology of the disease molar pregnancy is very typical. The uterine cavity is filled with many transparent thin – walled vesicles filled with clear yellowish fluid resembling grapes (raisins). These microscopic grains are highly and swollen horion villi.
Molar pregnancy may be complete or incomplete. Incomplete Mola hydratidosa contains parts of the fetus, horion villi are with normal construction and it is – 69XXY. In complete mola hydratidosa there are no fetal parts, all horion villi are covered with atypical epithelium, which is diploid – 46 XX or 46 XY.
Destructing (invasive) mola – Mola destruens is a complete mola with local destructive growth (such as malignant tumor) and invades the muscle layer of uterine wall. Invasive mola can even very rarely give metastases! Metastases after surgery usually in lungs resolve.
Chorionic carcinoma (chorioncarcinoma, chorionepithelioma) is a malignant tumor derived from cytotrophoblast and syncitiotrophoblast (elements of trophoblastic epithelium). This tumor develops several (3-8) months after a normal pregnancy, abortion or molar pregnancy. It is possible to develop among the cells of teratoma of the ovary and testis. Chorioncarcinoma do not have stroma – connective tissue and supporting their own blood vessels. Its cells are literally bathed in the blood of the woman and feed from it directly.
Among the tumor parenchyma are detected a lot of areas of necrosis and hemorrhages, which gives specific spotted appearance of the tumor. Clinically is manifested in irregular bleeding from uterus and “spotting” with brownish bloody fluor. Early and quickly gives metastases, most commonly in the lungs.
Treatment of molar pregnancy
When timely diagnosis and appropriate chemotherapy for invasive mola or chorioncarcinoma, occurs complete regression of the tumor, even at metastatic sites, in most of the patients!