Résumé
Les maladies trophoblastiques gestationnelles regroupent plusieurs entités cliniques et anatomopathologiques différentes. Le traitement des môles hydatiformes complètes (MHC) et partielles fait appel à l’évacuation de l’utérus par aspiration, et impose une surveillance de l’évolution des hCG. En cas de diagnostic de tumeur trophoblastique gestationnelle (TTG), basée sur la non-normalisation des hCG ou sur un aspect histologique de choriocarcinome, un traitement médical s’imposera. Le choix de ce traitement nécessite un bilan d’extension préalable, permettant le calcul du score FIGO. Si les tumeurs classées à bas risque pourront être prises en charge par du méthotrexate seul, les formes à haut risque justifieront une polychimiothérapie. Cet article de synthèse essaie de présenter les bases du diagnostic et de la prise en charge des maladies trophoblastiques, en abordant également des situations plus rares comme les tumeurs du site d’implantation et les grossesses gémellaires.
Abstract
The gestational trophoblastic diseases are a spectrum of different clinical and pathological-defined affections. Treatment of complete and partial hydatidiform moles is dilatation-suction evacuation. It is necessary to control the evolution of hCG thereafter. In case of gestational trophoblastic neoplasia (GTN), defined on abnormal evolution of hCG or on a pathological diagnosis of choriocarcinoma, a medical treatment will be necessary. Choice of regimen will be done after different radiological exams, through a FIGO score assessment. In case of low risk GTN, methotrexate will be the usual treatment. High risk GTN will need polychemotherapy regimens. This article tries to give the essential points on diagnosis and treatment in gestational trophoblastic diseases, but also on more rare diseases such as placental site tumor or twin pregnancy with normal fetus and complete mole.
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Massardier, J., Schott-Pethelaz, A.M., Hajri, T. et al. Les grossesses môlaires. Rev. med. perinat. 3, 163–171 (2011). https://doi.org/10.1007/s12611-011-0149-1
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DOI: https://doi.org/10.1007/s12611-011-0149-1