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Reproductive Pathology > Disorders of Pregnancy > Flashcards

Disorders of Pregnancy Flashcards

1
Q

What is an ectopic pregnancy?

A

a pregnancy in which the fetus develops outside the uterus typically in a fallopian tube
- Ectopic pregnancy should be considered in the differential diagnosis of acute abdominal pain in a woman of childbearing age.

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2
Q

What are gestational trophoblastic diseases?

A

a group of tumours that form during abnormal pregnancies

- have a placental origin

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3
Q

Name gestational trophoblastic diseases?

A
  1. Hydatidiform Mole
    - Complete
    - Partial
  2. Invasive Mole
  3. Choriocarcinoma
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4
Q

What is the aetiology of gestational trophoblastic diseases?

A

paternal genetic material

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5
Q

What is the epidemiology of complete hydatidiform mole?

A

1 in 1000 pregnancies

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6
Q

Describe the formation of a complete hydatidiform mole?

A

“Empty” ovum fertilised by normal sperm

- no maternal chromosomes

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7
Q

What is the clinical presentation of a complete mole?

A
  1. Abnormal trophoblast proliferation
  2. Chorionic villi enlarged – oedematous
  3. Raised human chorionic gonadotrophin (HCG) level
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8
Q

Describe a complete mole?

A
  • Placental overgrowth
  • Grape-like vesicles
  • No embryo
  • Grows rapidly
    > large for dates
  • Bleeding
  • USS – abnormal cysts
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9
Q

What is the microscopic morphology of an early complete mole (8 weeks)?

A
  • Variable villous oedema
  • Cistern formation
  • Marked atypia and non-polar hyperplasia of biphasic trophoblast
  • Hypercellular stroma
  • Stromal vessels appear diminished
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10
Q

What are the complications of a complete mole?

A
  1. Persistent trophoblastic disease
  2. Constantly rising HCG
  3. Invasive Mole
  4. Choriocarcinoma
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11
Q

What is the treatment of a complete mole?

A

Curettage

  • 80 – 90% do not recur
  • 10% develop into invasive moles
  • 2.5% develop into choriocarcinoma
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12
Q

Describe the follow up treatment for a complete mole?

A

Monitor serial HCG levels

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13
Q

Describe the formation of a partial hydatidiform mole?

A
  1. Occurs when an ovum is fertilised by two haploid sets of paternal chromosomes
    - may occur with dispermy when two sperms fertilise a single ovum
  2. when diploid sperm fertilises an ovum
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14
Q

Describe the features of the partial mole?

A
  • Triploid
  • Identified histologically in POC
  • Usually one maternal and two paternal haploid sets of chromosomes
  • XXX, XXY, XYY
  • Fetus may be present
  • Not all villi abnormal
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15
Q

Describe what happens in a partial mole?

A
  • Result is triploidy with 69 chromosomes
  • since a maternal set of chromosomes is present, a fetus develops, but it is malformed
  • pregnancy rarely goes to term
  • choriocarcinoma is a rare outcome of a partial mole
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16
Q

Describe the microscopic morphology of a partial mole?

A
  • scattered grape like villi
  • Minimal trophoblastic hyperplasia
  • oedematous villi “scalloped” borders
  • Numerous trophoblastic invaginations and inclusions
17
Q

What is an invasive mole?

A

malignant transformation of trophoblastic tissue after molar evacuation

18
Q

Describe an invasive mole?

A

Abnormal molar villi within myometrium and myometrial vessels
- Risk of perforation

19
Q

What is a choriocarcinoma?

A

Rare Malignant trophoblast

  • 50% arise in hydatidiform mole
  • 25% in previous abortions
  • 22% in normal pregnancies
  • 3% in ectopic pregnancies
20
Q

Describe a choriocarcinoma?

A
  • Large soft, yellow/white tumour with haemorrhage and necrosis
  • Proliferation of cytotrophoblasts and syncytiotrophoblasts
  • Invades myometrium
  • Systemic metastasis
  • High mortality without chemo-Rx (which can cure)
21
Q

Describe the gross appearance of a choriocarcinoma?

A

hemorrhagic mass in the endometrium

22
Q

Describe the microscopic morphology of the choriocarcinoma?

A

Biphasic pattern

  • Cytotrophoblast
  • Multinucleated syncytiotrophoblast

Reproductive Pathology (8 decks)

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