Gestational trophoblast tumors Flashcards
What are the three major gestational trophoblastic diseases?
- Hydatidiform mole
- Invasive mole
- Choriocarcinoma
What are hydatids?
Cysts containing watery fluid
What are moles in the context of uterine diseases?
Abnormal masses of tissue in the uterus
After fertilization, the ovum differentiates into what? (2)
- an embryo
- trophoblasts that invade the gestational endometrium
What are hydatidiform moles?
Developmental abnormality of the placenta resulting from faulty fertilization
When do hydatidiform moles usually manifest? How?
- Discordance between uterine size for date, and vaginal bleeding
- vaginal bleeding
What are complete moles?
- empty egg +1 (duplicate later) sperm
2. Empty egg + 2 sperms
What are partial moles?
One, non-empty egg + 2 sperm, resulting in 69 xxx, xxy, or xyy
What are the gross characteristics of complete moles inside the uterus?
Uterus distended by large, bizarre, gelatinous placental mass
What are the characteristics of the villi of complete moles?
All chorionic villi are edematous, with variable degrees of trophoblastic proliferation
What are the serum hCG levels with partial complete moles?
Partial = high
Complete = Extremely high for gestational age
What are the US findings of complete moles?
“Snowstorm image”
How many times should you order hCG levels with a suspected partial or complete moles?
Twice at different times to confirm
What are the gross characteristics of the placenta of complete moles?
Bunches of grapes appearance with loss of placental defining features
What are the histological characteristics of complete moles?
Large, avascular villi with areas of trophoblastic proliferation
What are the uterine characteristics of partial moles?
Uterus may not be enlarged
What, generally, are partial moles?
Fertilization of a non-empty ovum by one diploid or two haploid sperm
What are the villi characteristics of partial moles?
Some, but not all, villi are edematous (contrast to complete moles)
Are the fetal parts present in partial or complete moles?
Partial
What are the hCG levels in partial moles?
High, but not as high as complete moles
What is the progression rate of partial moles to choriocarcinoma? Complete?
Rare for partial, but more common for complete
Extensive cytotrophoblastic hyperplasia is characteristic of complete or partial moles?
Complete
What are invasive moles?
Usually complete hydatidiform moles with penetration of villi and trophoblast into the myometrium, possibly extending to the serosal surface
What are the complications that can arise from invasive moles? (2)
- Uterine rupture or
- vascular invasion may lead to embolization of vili to the lungs
What happen to hCG levels after evacuation of the uterine cavity with a mole? What if it is invasive?
Will drop if not invasive, but will persist elevated with invasive
What are the gross characteristics of invasive moles?
Hemorrhagic mass adherent to the uterine wall
What are choriocarcinomas? Common or uncommon?
Uncommon, highly malignant neoplasm of trophoblastic cells derived from normal gestations or complete moles
What are the clinical s/sx of choriocarcinomas?
Irregular spotting or brown, bloody, foul-smelling fluid
What are the characteristics of the villi with choriocarcinomas?
There are none
What is the prognosis for choriocarcinomas?
Invade rapidly, and metastasizes widely, but VERY responsive to chemotherapy
What are the hCG levels with choriocarcinomas?
Elevated
What is the most common source of trophoblast cells that cause choriocarcinomas? (normal pregnancies, spontaneous abortions, complete moles)?
Complete moles
What are placental type tumors? What are they composed of? Common or uncommon?
Uncommon, locally invasive tumor of implantation site consisting of intermediate trophoblasts–larger than cytotrophoblasts, but still mononuclear
What are the hCG levels with placental site tumors?
LOW
What percent of placental site tumors metastasize?
10%
From what type of uterine pregnancy do placental site tumors usually develop? What about choriocarcinomas?
Placental tumors = Normal pregnancies
Choriocarcinomas = complete moles
What are the histological characteristics of placental site trophoblastic tumors?
Cellular atypia with infiltration of the myometrium
What is the transformation zone of the uterus?
The transition from columnar epithelial cells (endocervix) to the squamous epithelial cells (ectocervix) d/t squamous metaplasia
What are the factors that affect the transformation zone? (4)
- Hormone levels
- pH
- Vaginal flora
- Trauma
What is the diagnostic importance of the transformation zone?
Because cervical intraepithelial neoplasia and carcinoma originate in the transformation zone
What is the squamocolumnar junction, and what is its importance with cervical cancer?
Area of transition from the endocervical simple columnar cells, to the ectocervix squamous epithelium.
If infected with HPV, each has a different outcome .
What are the viruses that causes cervical cancer?
HPV 16-18
What are the viral proteins that have oncogenic properties? MOA?
E6 = inhibit p53 E7 = inhibit p53, Rb and p21
Early or late age at sexual debut is a risk factor for cervical cancer 2/2 HPV?
Early
What are the genital infections, besides HPV, that are risk factors for cervical cancer?
HSV-2
HIV
What cells are infected in the cervix that allows for the development of cervical cancer?
Columnar or squamous epithelial tissue in the transitional zone
What are the HPV viruses that cause condyloma lata? (2)
6
11
What are the high risk HPV strains? (5)
16 18 31 33 35
Infection of the squamous cell epithelium with HPV leads to what?
Invasive squamous carcinoma
Infection of the endocervical columnar cell epithelium with HPV leads to what?
Glandular intraepithelial lesions
What are the chances that HPV strains 6, 11, 42-44 progress to cervical cancer?
Rare
What is the relative incidence of HPV infection and the development of invasive carcinoma?
Lots of people are exposed, but few develop invasive carcinoma
What are the morphological features of cervical intraepithelial neoplasia? (3)
- Nuclear atypia and pleomorphism
- Altered nuclear cytoplasmic ratio
- Loss of basal polarity
What are koilocytes? Histological characteristics?
HPV infected cells
Clear nuclear halos d/t loss of cytoplasm
What are the three major layers of the epithelium
- Superficial cells
- Parabasal cells
- Basal cells
Where in the epithelium does mild metaplasia occur? Moderate? Severe? (CIN 1-3)
CIN-1 = basal cells
CIN-2 = parabasal cells
CIN-3 =Superficial cells
What is the difference between CIN3 and carcinoma in situ?
In situ has ALL of the cell involved, whereas CIN-3 has almost all
What is the definition of invasive carcinoma?
Breakage through the epithelium
What is the peak age of invasive cervical cancer?
40-45
What is the most common histological type of invasive cervical cancer? Second more common?
80% is squamous
15% adenocarcinomas
What are the clinical manifestations of cervical cancer?
Asymptomatic–found by pap smear
May have abnormal postcoital vaginal bleeding
What are the gross characteristics of the cervix with cervical cancer?
White, thickened plaque like areas with aberrant vascularity
What are the characteristics of cervical cancer on pap smear?
Huge nuclei in epithelial cells
What stages of cervical cancers have a good prognosis?
Below stage 2
What is stage 0 cervical cancer?
CIN3
What is stage I cervical cancer?
Carcinoma confined to the cervix
What is stage 2 cervical cancer?
Involvement beyond the vagina
What is stage 3 cervical cancer?
Involvement of the pelvic wall and lower 1/3 of the vagina
What is stage 4 cervical cancer?
Extension beyond the pelvis, invasion of the bladder and/or rectum
Distant mets
