Hydatid cyst

Routine ultrasound at 15 weeks of gestation. Diagnosis, complications and management. Sunday Ultra feast.

27 yr female with minor spotting and lower abdominal pain in pregnancy

GESTATIONAL TROPHOBLASTIC DISEASE /GESTATIONAL TROPHOBLASTIC TUMOUR /HYDATIDIFORM MOLE/MOLAR PREGNANCY is uncontrolled proliferation of trophoblasts in utero. these trophoblasts form placenta during pregnancy. TYPES : There are 5 closely related tumours. 1)HYDATIDIFORM MOLE (benign ). 2)INVASIVE MOLE (malignant ). 3)CHORIOCARCINOMA (malignant ). 4)PLACENTAL SITE TROPHOBLASTIC TUMOUR (Malignant ). 5)EPITHELIOID TROPHOBLASTIC TUMOUR. (malignant ). trophoblast is the membrane that forms the wall of the blastocyst in the early development of fetus. GTT arise from these trophoblastic cells. CAUSE : Risk factors : *woman <20 or >35 years. *Asian ethnicity. Hydatidiform moles are abnormal conceptions with excessive placental development. COMPLETE HYDATIDIFORM MOLE have no fetal tissue and no maternal DNA. as a result of a maternal ovum with no functional DNA. This is due to a single spermatozoa which duplicates and fertilises an empty ovum/two separate spermatozoa fertilise an empty ovum. PARTIAL HYDATIDIFORM MOLE : PHM have fetus /fetal cells . this occurs due to dispersion fertilisation of a normal ovum . they are triploid, containing one set of maternal haploid genes and two sets of paternal haploid genes. DIAGNOSIS : * Clinical history of missed periods. *positive pregnancy test. * irregular first trimester bleeding. * uterus large for dates. * pain from theca lutein cysts -hyperstimulation by high HCG levels. * vaginal passage of vesicular products. *exaggerated pregnancy symptoms. -hyperemesis. -hyperthyroidism. -early pre eclampsia. * snow storm appearance on ultrasound in CHM. * there can be a fetus in PHM. MANAGEMENT : *surgical evacuation /GA. * histological examination of products of conception to confirm the diagnosis. INDICATIONS FOR CHEMOTHERAPY : * serum HCG levels >20,000 IU /L after 4 weeks of evacuation. * static /rising HCG tires after uterine evacuation in the absence of new pregnancy. * persistent symptoms of pain and bleeding. * evidence of metastasis. * histological diagnosis of chorio carcinoma. AFTER CARE : * woman should be advised not to conceive until HCG levels are normal for 6 months. *barrier contraception is advised till serum hcg is normal. *serum HCG is checked every fortnightly until levels are normal ( < 4 IU /L ). * following this, urinary hcg is checked every month until one year post evacuation.,then every three months in the second year of follow up. *patients who do not have normal HCG levels by 8 weeks post evacuation need two year follow up.

identify the classical gross specimen - also comment on the definitive host of this organism

An 85 year old female presented with a blisters. The rash began 1 week ago on her right hand, but it has progressed to her arm, upper chest, and abdomen. The rash is painless but intensely itchy, and it limits her ability to complete routine tasks. What is the diagnosis and treatment for this.