Gestational trophoblast tumors

Question 1

What are the three major gestational trophoblastic diseases?

Answer 1

• Hydatidiform mole
• Invasive mole
• Choriocarcinoma

Question 2

What are hydatids?

Answer 2

Cysts containing watery fluid

Question 3

What are moles in the context of uterine diseases?

Answer 3

Abnormal masses of tissue in the uterus

Question 4

After fertilization, the ovum differentiates into what? (2)

Answer 4

• an embryo

- trophoblasts that invade the gestational endometrium

Question 5

What are hydatidiform moles?

Answer 5

Developmental abnormality of the placenta resulting from faulty fertilization

Question 6

When do hydatidiform moles usually manifest? How?

Answer 6

• Discordance between uterine size for date, and vaginal bleeding
• vaginal bleeding

Question 7

What are complete moles?

Answer 7

1. empty egg +1 (duplicate later) sperm

2. Empty egg + 2 sperms

Question 8

What are partial moles?

Answer 8

One, non-empty egg + 2 sperm, resulting in 69 xxx, xxy, or xyy

Question 9

What are the gross characteristics of complete moles inside the uterus?

Answer 9

Uterus distended by large, bizarre, gelatinous placental mass

Question 10

What are the characteristics of the villi of complete moles?

Answer 10

All chorionic villi are edematous, with variable degrees of trophoblastic proliferation

Question 11

What are the serum hCG levels with partial complete moles?

Answer 11

Partial = high

Complete = Extremely high for gestational age

Question 12

What are the US findings of complete moles?

Answer 12

“Snowstorm image”

Question 13

How many times should you order hCG levels with a suspected partial or complete moles?

Answer 13

Twice at different times to confirm

Question 14

What are the gross characteristics of the placenta of complete moles?

Answer 14

Bunches of grapes appearance with loss of placental defining features

Question 15

What are the histological characteristics of complete moles?

Answer 15

Large, avascular villi with areas of trophoblastic proliferation

Question 16

What are the uterine characteristics of partial moles?

Answer 16

Uterus may not be enlarged

Question 17

What, generally, are partial moles?

Answer 17

Fertilization of a non-empty ovum by one diploid or two haploid sperm

Question 18

What are the villi characteristics of partial moles?

Answer 18

Some, but not all, villi are edematous (contrast to complete moles)

Question 19

Are the fetal parts present in partial or complete moles?

Answer 19

Partial

Question 20

What are the hCG levels in partial moles?

Answer 20

High, but not as high as complete moles

Question 21

What is the progression rate of partial moles to choriocarcinoma? Complete?

Answer 21

Rare for partial, but more common for complete

Question 22

Extensive cytotrophoblastic hyperplasia is characteristic of complete or partial moles?

Answer 22

Complete

Question 23

What are invasive moles?

Answer 23

Usually complete hydatidiform moles with penetration of villi and trophoblast into the myometrium, possibly extending to the serosal surface

Question 24

What are the complications that can arise from invasive moles? (2)

Answer 24

• Uterine rupture or

- vascular invasion may lead to embolization of vili to the lungs

Question 25

What happen to hCG levels after evacuation of the uterine cavity with a mole? What if it is invasive?

Answer 25

Will drop if not invasive, but will persist elevated with invasive

Question 26

What are the gross characteristics of invasive moles?

Answer 26

Hemorrhagic mass adherent to the uterine wall

Question 27

What are choriocarcinomas? Common or uncommon?

Answer 27

Uncommon, highly malignant neoplasm of trophoblastic cells derived from normal gestations or complete moles

Question 28

What are the clinical s/sx of choriocarcinomas?

Answer 28

Irregular spotting or brown, bloody, foul-smelling fluid

Question 29

What are the characteristics of the villi with choriocarcinomas?

Answer 29

There are none

Question 30

What is the prognosis for choriocarcinomas?

Answer 30

Invade rapidly, and metastasizes widely, but VERY responsive to chemotherapy

Question 31

What are the hCG levels with choriocarcinomas?

Answer 31

Elevated

Question 32

What is the most common source of trophoblast cells that cause choriocarcinomas? (normal pregnancies, spontaneous abortions, complete moles)?

Answer 32

Complete moles

Question 33

What are placental type tumors? What are they composed of? Common or uncommon?

Answer 33

Uncommon, locally invasive tumor of implantation site consisting of intermediate trophoblasts--larger than cytotrophoblasts, but still mononuclear

Question 34

What are the hCG levels with placental site tumors?

Answer 34

LOW

Question 35

What percent of placental site tumors metastasize?

Answer 35

10%

Question 36

From what type of uterine pregnancy do placental site tumors usually develop? What about choriocarcinomas?

Answer 36

Placental tumors = Normal pregnancies Choriocarcinomas = complete moles

Question 37

What are the histological characteristics of placental site trophoblastic tumors?

Answer 37

Cellular atypia with infiltration of the myometrium

Question 38

What is the transformation zone of the uterus?

Answer 38

The transition from columnar epithelial cells (endocervix) to the squamous epithelial cells (ectocervix) d/t squamous metaplasia

Question 39

What are the factors that affect the transformation zone? (4)

Answer 39

- Hormone levels - pH - Vaginal flora - Trauma

Question 40

What is the diagnostic importance of the transformation zone?

Answer 40

Because cervical intraepithelial neoplasia and carcinoma originate in the transformation zone

Question 41

What is the squamocolumnar junction, and what is its importance with cervical cancer?

Answer 41

Area of transition from the endocervical simple columnar cells, to the ectocervix squamous epithelium. If infected with HPV, each has a different outcome .

Question 42

What are the viruses that causes cervical cancer?

Answer 42

HPV 16-18

Question 43

What are the viral proteins that have oncogenic properties? MOA?

Answer 43

``` E6 = inhibit p53 E7 = inhibit p53, Rb and p21 ```

Question 44

Early or late age at sexual debut is a risk factor for cervical cancer 2/2 HPV?

Answer 44

Early

Question 45

What are the genital infections, besides HPV, that are risk factors for cervical cancer?

Answer 45

HSV-2 | HIV

Question 46

What cells are infected in the cervix that allows for the development of cervical cancer?

Answer 46

Columnar or squamous epithelial tissue in the transitional zone

Question 47

What are the HPV viruses that cause condyloma lata? (2)

Answer 47

6 | 11

Question 48

What are the high risk HPV strains? (5)

Answer 48

``` 16 18 31 33 35 ```

Question 49

Infection of the squamous cell epithelium with HPV leads to what?

Answer 49

Invasive squamous carcinoma

Question 50

Infection of the endocervical columnar cell epithelium with HPV leads to what?

Answer 50

Glandular intraepithelial lesions

Question 51

What are the chances that HPV strains 6, 11, 42-44 progress to cervical cancer?

Answer 51

Rare

Question 52

What is the relative incidence of HPV infection and the development of invasive carcinoma?

Answer 52

Lots of people are exposed, but few develop invasive carcinoma

Question 53

What are the morphological features of cervical intraepithelial neoplasia? (3)

Answer 53

- Nuclear atypia and pleomorphism - Altered nuclear cytoplasmic ratio - Loss of basal polarity

Question 54

What are koilocytes? Histological characteristics?

Answer 54

HPV infected cells | Clear nuclear halos d/t loss of cytoplasm

Question 55

What are the three major layers of the epithelium

Answer 55

- Superficial cells - Parabasal cells - Basal cells

Question 56

Where in the epithelium does mild metaplasia occur? Moderate? Severe? (CIN 1-3)

Answer 56

CIN-1 = basal cells CIN-2 = parabasal cells CIN-3 =Superficial cells

Question 57

What is the difference between CIN3 and carcinoma in situ?

Answer 57

In situ has ALL of the cell involved, whereas CIN-3 has almost all

Question 58

What is the definition of invasive carcinoma?

Answer 58

Breakage through the epithelium

Question 59

What is the peak age of invasive cervical cancer?

Answer 59

40-45

Question 60

What is the most common histological type of invasive cervical cancer? Second more common?

Answer 60

80% is squamous | 15% adenocarcinomas

Question 61

What are the clinical manifestations of cervical cancer?

Answer 61

Asymptomatic--found by pap smear May have abnormal postcoital vaginal bleeding

Question 62

What are the gross characteristics of the cervix with cervical cancer?

Answer 62

White, thickened plaque like areas with aberrant vascularity

Question 63

What are the characteristics of cervical cancer on pap smear?

Answer 63

Huge nuclei in epithelial cells

Question 64

What stages of cervical cancers have a good prognosis?

Answer 64

Below stage 2

Question 65

What is stage 0 cervical cancer?

Answer 65

CIN3

Question 66

What is stage I cervical cancer?

Answer 66

Carcinoma confined to the cervix

Question 67

What is stage 2 cervical cancer?

Answer 67

Involvement beyond the vagina

Question 68

What is stage 3 cervical cancer?

Answer 68

Involvement of the pelvic wall and lower 1/3 of the vagina

Question 69

What is stage 4 cervical cancer?

Answer 69

Extension beyond the pelvis, invasion of the bladder and/or rectum Distant mets