Cystic drift

cystic drift
Cystic drift (perforation of the uterus)

Cystic drift is a pathological change the ovum characterized by excessive proliferation of epithelial chorionic villi with sudden swelling of the stroma. The etiology is not known. Macroscopically gallbladder drift represents bubbles clusters of various sizes with clear content (Fig.). Blood vessels in the chorionic villi molar missing. In the complete degeneration of the chorion the embryo dies.
After of a molar in 5-10% of cases in women is observed chorionepithelioma (see).
There are 4 form of a molar: 1) benign cystic skid, without proliferation of chorionic epithelium; 2) "potentially malignant" cystic drift with reasonable proliferation of chorionic epithelium; 3) "apparently" ("quite possible"), malignant gallbladder drift with sharply expressed proliferation of chorionic epithelium; 4) destroywi puzarnyi shipping (rare form), is characterized by the tendency to growth of a molar through the veins of cancer with invasion of the muscle layer (not cancerous growth - NAP do not germinate of blood vessels.
Often molar very early, already in the first half of pregnancy, symptoms of late toxicosis with significant albuminuria, oedema and hypertension.
In connection with conversion of the chorionic villi in the bubbles of the uterus is growing rapidly, so that the size it more than normal and does not correspond to the term of pregnancy. On the third or fourth month, sometimes later, there bleeding, first minor; soon the bleeding increases and start back part (bubbles) of a molar. Bleeding lead to significant anemia, and at strengthening can be dangerous to a woman's life.
Cystic skid accompanied by a sharp increase in the content in the urine of chorionic gonadotropin, so the reaction of Elgama-Condeca (see Elgama-Condeca reaction) in the first three months of pregnancy is positive even when diluted urine is 100-200 times.
Recognition of a molar should be based on the above symptoms (excessive value of the uterus, no small parts of the ovum, late toxicosis in the first half of pregnancy spotting). Every pregnant with suspected gallbladder skid be hospitalized in the delivery or the gynecology Department. If a pregnant with a molar comes with heavy bleeding, which already parts of a molar, when the value of the uterus to 3 months and neck, letting two fingers, you should try to insert fingers into the uterus and, fixing her bottom outer arm, producing digital removal of the rests of a molar. When closed, the neck should tight tamponiruut vaults and vagina with a sterile bandage. For uncomplicated bubble entry and pregnancy up to 12 weeks is possible destruction of a molar by curettage blunt curette. For large pregnancy scraping contraindicated. Removal of a molar spend the stimulation of uterine contractions by introducing (drip) 10 IU of oxytocin in 500 ml of 5% glucose solution. If you increase the size of the uterus to 24 weeks of pregnancy required hysterectomy (see). Indication for immediate hysterectomy without curettage are metastases in the lungs or in the vagina, perforation of the uterus molar, and the age of the patient over the age of 45.
Every woman, who had cystic skid, should be under close clinical observation for 2 years with monthly turnout in the first year and every 2-3 months in the second year; at the slightest suspicion on the possible development of horionepitelioma shown supervision and treatment in the hospital.

Cystic drift is a disease of the ovum characterized by excessive proliferation of epithelial villi and Vodyanoy occur stroma.
The etiology and pathogenesis is not clear. The higher titer of gonadotropic hormones molar on the basis of studies of ultra structures connected with the increase of mass of the active hormone respect of syncytium, not with increased secretion of cytotrophoblast. A possible link between the occurrence of a molar and peculiarities diet regime. Cystic drift occurs more frequently in many parous women.
Pathological anatomy. Macroscopically gallbladder drift represents bubbles clusters of various sizes with clear content (Fig. 1). A large part botryoidal formations loosely into the uterus, as increasing in size bubbles almost continuously separated from its walls.
The bubbles are pathologically changed the chorionic villi with sharp stromal edema (Fig. 2). Due to degenerative changes among cells in the stroma find major cellular elements with dark grained or mesh protoplasm and large round nuclei (cells Kalecki). A distinctive feature of CVS molar is absence of blood vessels.
In accordance with the extent of the defeat of the ovum allocate the full and partial gallbladder skidding. When fully bubble entry Rorion changes typically in the early stages of pregnancy, turning the whole chorion, and the embryo dies and resolved. Partial gallbladder skid formed more often after 3 months of pregnancy. The opportunity of preservation of the viability of the fetus with partial bubble entry is determined by the volume of defeat chorion. When rebirth less than one third of the placenta may live birth of a viable fetus.
In accordance with the structural features of chorionic epithelium there are three forms of a molar: 1) the so-called benign P. C., without proliferation of chorionic epithelium; 2) "potentially malignant" P. C. with reasonable proliferation of chorionic epithelium and 3) "apparently" ("quite possible"), malignant P. C. with sharply expressed proliferation (Fig. 3) chorionic epithelium in all areas P. C. and anaplasia chorionic epithelium. A relatively rare so-called destroywi gallbladder drift (Fig. 4) differs pronounced tendency to growth through the veins of cancer with invasion of the muscular layer, and sometimes sprouting in thickness wide uterine ligaments. Distribution destroyuser P. C. for vessels not an indication of malignant growth (NAP do not germinate of blood vessels. The emergence destroyuser of a molar associated with a decrease in the protective properties of the uterus and impossibility due to this to resist proteolytic properties trophoblast.
Sometimes there are metastases in the vaginal wall. Often the development of P. C.
Accompanied by the emergence of bilateral, less unilateral luteal ovarian cysts - various sizes of thin-walled formations filled with clear content. Sometimes luteal ovarian cyst find after 2-3 weeks after the removal of a molar. Reverse their development, as the development of vaginal cancer, see within a few months after the removal P. C.


Over and symptoms. The most frequent symptoms P. C. are: 1) spotting, often scant, dark with nesvertawateisa blood (the bleeding is common); 2) abdominal pain; 3) anemia; 4) occasionally bubbling; 5) change of texture and size of the uterus. The inconsistency with the pregnancy (found in 2/3 of the cases): one-third of patients, the value of the uterus exceeds the respective period of pregnancy, in third behind in size and a third corresponds to the period of pregnancy. The consistency of the uterus uneven, there is pseudofructus, part of the ovum and heartbeat are defined; 6) toxicosis of pregnancy.
Among the complications of a molar most terrible is the transition to the horionepiteliome (see). Due to the deportation of CVS might infarction, sometimes mimics the TB process. Sometimes there perforation of the uterus, torsion legs of ovarian cysts.
The diagnosis is based on a characteristic clinical symptoms, recognition facilitated the appearance of genital tract bubbles and confirmed by the data of hormonal reactions. When interpreting the results of hormonal studies should be considered convincing data regarding P. C. in case of positive reaction of Elgama - Condeca (see Elgama-Condeca reaction) in dilution of urine greater than 1 : 100. If the titer is below 1 : 100 more common diagnostic errors. Recently there have been signs of a greater feasibility of using a more sensitive test-object for hormonal reactions, in particular castrated white rats.
After removing P.Z. level gonadotropinov markedly reduced in the second week, the reaction of Elgama - Condeca becomes negative after 30 days. In some cases, the positive reaction of Elgama-Condeca held for a few months, which is associated with a slow reverse development of the luteal cyst filled with fluid with a high content of chorionic gonadotropin.
Treatment is determined by the period of pregnancy and peculiarities of clinical course, in particular the appearance of the symptoms of germination of the uterus destroyuser P. C., that allows to suspect the transition process in the horionepiteliome.
For uncomplicated bubble entry and pregnancy up to 12 weeks may instrumental its removal by a stupid curettes with subsequent introduction of oksitotsicheskogo substances. Scraping carry out extremely carefully (the risk of bleeding!). For large pregnancy scraping contraindicated. Removal of a molar spend the stimulation of uterine contractions by introducing (drip) 10 IU of oxytocin in 500 ml of 5% glucose. In the absence of effective introduction
oxytocin can be repeated three times (for 3 days), at the same time to make the expansion of the cervical canal and finger destruction P. C. To stimulate recommended the appointment of quinine 0.1 g in 15 minutes (up to 8 times) and subcutaneous introduction of pituitrin 0.3 ml after 30 minutes (up to 8 times). Dose of pituitrin should not exceed 3 ml increase In size of uterine up to 24 weeks of pregnancy need a hysterectomy. Indication for immediate hysterectomy without curettage are metastases in the lungs or in the vagina, perforation of the uterus of a molar, and the age of the patient over the age of 45.
To ensure destroyuser of a molar successfully used chemotherapeutic agents from the group of antimetabolites (in particular, antimetabolites folic acid) - methotrexat or amethopterin. The use of folic acid antagonists is the lack of nucleic acids and thereby inhibits tumor growth. Metotrexat applied oral and parenteral. Inside appoint 25 mg per day for five days - 125 mg on course with breaks for 2-3 weeks or appoint daily 10 mg before the appearance of toxic effects or reverse tumor development. Parenteral enter and 10 mg intramuscularly. Toxic effects in the application of methotrexate are complications from the blood (anaemia, lakopenia, thrombocytopenia), gastrointestinal tract (stomatitis, glossitis, nausea, vomiting); sometimes there are violations of the liver. Toxic effects are reversible, specific treatment is not required, however, to resume treatment should only after their complete disappearance. During treatment required blood tests, x-rays of the lungs.
After suffering of a molar should be strictly systematic observation for 2 years with a dynamic definition of the title gonadotroponah hormones, x-rays of the lungs. Especially endangered in relation to the possible development of the chorion-epithelioma.

Fig. 1. Cystic skidding; a bunch of bubbles.
Fig. 2. Swelling of the chorionic villi.
Fig. 3. Expressed proliferation of chorionic epithelium.
Fig. 4. Destroywi puzarnyi shipping (intravenous form).