Advances in the treatment of pregnancy-related placental tumors

2024-09-14 13:00:07

Pelvic MRI showing an invasive mole in a 40-year-old patient with uterine arteries. PIERRE-ADRIEN BOLZE

These are little-known female tumors, all the more cruel because they occur while waiting for the “happy event”. In almost one in a thousand pregnant women in the West (and almost one hundred in Asia), in fact, a tumor develops from the placenta, an important organ that ensures the transformation between the blood of the mother and that of the fetus.

During these pathological pregnancies, precancerous lesions, called “hydatidiform moles”, develop from a layer of cells, the trophoblast, which, normally, surrounds the fetus and produces many villi which form the birth canal. -child in the womb.

These moles result from an abnormal combination, often linked to an excess of chromosomal material of paternal origin, resulting in either the absence of a pregnancy or an unsustainable pregnancy. Thus, when one or two sperms turn an egg into an unfertilized egg, no embryo is created but a mole increases. And when two sperm (or one foreign sperm) fertilizes a normal egg, an embryo begins to grow, but it cannot survive for a long time.

Instant pregnancy

Even if there is no embryo, the pregnancy test is positive because the placenta is producing large amounts of the “pregnancy hormone,” or human chorionic gonadotropin (hCG). Usually, these moles are found during the ultrasound of the first or second month. « Then it is necessary to carry it out of the uterus by stimulation. [curetage] »explains Professor Pierre-Adrien Bolze, gynecological surgeon at the Lyon-Sud hospital (Hospice Civils de Lyon), which hosts the National Reference Center for Trophoblastic Diseases.

It happens that these moles cause spontaneous abortion, but usually without removing the entire tumor mass. Then the woman showed persistent bleeding which prompted her to contact him. After ultrasound and aspiration, the diagnosis is confirmed by histological analysis of the removed tissues.

Almost nine times out of ten, there is no repetition. However, this must be confirmed by measuring the level of hCG for six months; if it does not arise, no tumor has been reproduced. In 10% to 15% of cases, however, the mole develops into a “gestational trophoblastic tumor,” from precursor cells that persist in the uterus. This concerns around 130 women per year in France, out of 950 to 1,000 women who develop a hydatidiform mole each year.