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OB/GYN > Gestational trophoblast tumors > Flashcards

Gestational trophoblast tumors Flashcards

1
Q

What are the three major gestational trophoblastic diseases?

A
  • Hydatidiform mole
  • Invasive mole
  • Choriocarcinoma
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2
Q

What are hydatids?

A

Cysts containing watery fluid

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3
Q

What are moles in the context of uterine diseases?

A

Abnormal masses of tissue in the uterus

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4
Q

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

A
  • an embryo

- trophoblasts that invade the gestational endometrium

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5
Q

What are hydatidiform moles?

A

Developmental abnormality of the placenta resulting from faulty fertilization

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6
Q

When do hydatidiform moles usually manifest? How?

A
  • Discordance between uterine size for date, and vaginal bleeding
  • vaginal bleeding
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7
Q

What are complete moles?

A
  1. empty egg +1 (duplicate later) sperm

2. Empty egg + 2 sperms

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8
Q

What are partial moles?

A

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

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9
Q

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

A

Uterus distended by large, bizarre, gelatinous placental mass

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10
Q

What are the characteristics of the villi of complete moles?

A

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

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11
Q

What are the serum hCG levels with partial complete moles?

A

Partial = high

Complete = Extremely high for gestational age

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12
Q

What are the US findings of complete moles?

A

“Snowstorm image”

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13
Q

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

A

Twice at different times to confirm

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14
Q

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

A

Bunches of grapes appearance with loss of placental defining features

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15
Q

What are the histological characteristics of complete moles?

A

Large, avascular villi with areas of trophoblastic proliferation

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16
Q

What are the uterine characteristics of partial moles?

A

Uterus may not be enlarged

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17
Q

What, generally, are partial moles?

A

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

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18
Q

What are the villi characteristics of partial moles?

A

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

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19
Q

Are the fetal parts present in partial or complete moles?

A

Partial

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20
Q

What are the hCG levels in partial moles?

A

High, but not as high as complete moles

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21
Q

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

A

Rare for partial, but more common for complete

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22
Q

Extensive cytotrophoblastic hyperplasia is characteristic of complete or partial moles?

A

Complete

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23
Q

What are invasive moles?

A

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

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24
Q

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

A
  • Uterine rupture or

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

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25
Q

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

A

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

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26
Q

What are the gross characteristics of invasive moles?

A

Hemorrhagic mass adherent to the uterine wall

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27
Q

What are choriocarcinomas? Common or uncommon?

A

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

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28
Q

What are the clinical s/sx of choriocarcinomas?

A

Irregular spotting or brown, bloody, foul-smelling fluid

29
Q

What are the characteristics of the villi with choriocarcinomas?

A

There are none

30
Q

What is the prognosis for choriocarcinomas?

A

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

31
Q

What are the hCG levels with choriocarcinomas?

A

Elevated

32
Q

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

A

Complete moles

33
Q

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

A

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

34
Q

What are the hCG levels with placental site tumors?

A

LOW

35
Q

What percent of placental site tumors metastasize?

A

10%

36
Q

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

A

Placental tumors = Normal pregnancies

Choriocarcinomas = complete moles

37
Q

What are the histological characteristics of placental site trophoblastic tumors?

A

Cellular atypia with infiltration of the myometrium

38
Q

What is the transformation zone of the uterus?

A

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

39
Q

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

A
  • Hormone levels
  • pH
  • Vaginal flora
  • Trauma
40
Q

What is the diagnostic importance of the transformation zone?

A

Because cervical intraepithelial neoplasia and carcinoma originate in the transformation zone

41
Q

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

A

Area of transition from the endocervical simple columnar cells, to the ectocervix squamous epithelium.

If infected with HPV, each has a different outcome .

42
Q

What are the viruses that causes cervical cancer?

A

HPV 16-18

43
Q

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

A 
E6 = inhibit p53
E7 = inhibit p53, Rb and p21
44
Q

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

A

Early

45
Q

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

A

HSV-2

HIV

46
Q

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

A

Columnar or squamous epithelial tissue in the transitional zone

47
Q

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

A

6

11

48
Q

What are the high risk HPV strains? (5)

A 
16
18
31
33
35
49
Q

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

A

Invasive squamous carcinoma

50
Q

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

A

Glandular intraepithelial lesions

51
Q

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

A

Rare

52
Q

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

A

Lots of people are exposed, but few develop invasive carcinoma

53
Q

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

A
  • Nuclear atypia and pleomorphism
  • Altered nuclear cytoplasmic ratio
  • Loss of basal polarity
54
Q

What are koilocytes? Histological characteristics?

A

HPV infected cells

Clear nuclear halos d/t loss of cytoplasm

55
Q

What are the three major layers of the epithelium

A
  • Superficial cells
  • Parabasal cells
  • Basal cells
56
Q

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

A

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

57
Q

What is the difference between CIN3 and carcinoma in situ?

A

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

58
Q

What is the definition of invasive carcinoma?

A

Breakage through the epithelium

59
Q

What is the peak age of invasive cervical cancer?

A

40-45

60
Q

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

A

80% is squamous

15% adenocarcinomas

61
Q

What are the clinical manifestations of cervical cancer?

A

Asymptomatic–found by pap smear

May have abnormal postcoital vaginal bleeding

62
Q

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

A

White, thickened plaque like areas with aberrant vascularity

63
Q

What are the characteristics of cervical cancer on pap smear?

A

Huge nuclei in epithelial cells

64
Q

What stages of cervical cancers have a good prognosis?

A

Below stage 2

65
Q

What is stage 0 cervical cancer?

A

CIN3

66
Q

What is stage I cervical cancer?

A

Carcinoma confined to the cervix

67
Q

What is stage 2 cervical cancer?

A

Involvement beyond the vagina

68
Q

What is stage 3 cervical cancer?

A

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

69
Q

What is stage 4 cervical cancer?

A

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

Distant mets

OB/GYN (33 decks)

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