Gynae patho Anki Flashcards
Name some organisms commonly involved in female genital infections
Herpes HPV Molluscum congatiosum Chlamydia trachomatis Neisseria gonorrhoeae Trichomonas Candida
what is pelvic inflammatory disease
an infection of the female reproductive organs that most often occurs when STD spreads from vagina to uterus, fallopian tube or ovaries
presenting symptoms of pelvic inflammatory disease
“pelvic painadnexal tendernessfever and vaginal discharge ““An adnexal mass is an abnormal growth that develops near the uterus, most commonly arising from the ovaries, fallopian tubes, or connective tissues. “””
complications of pelvic inflammatory disease (IMPT!!!)
peritonitis adhesions leading to bowel obstructionbacteremiatubal pregnancy (due to blockage of tube)infertility PID commonly associated with ectopic/tubal pregnancy and infertility!! Impt fact.
what is the normal lining epithelium of the vulva
keratinised stratified squamous epithelium wear and tear
what is a bartholin cyst and where does it occur?
due to blockage of the bartholin duct → mucus secreted by the bartholin gland is accumulated → bartholin cyst at vulva
what are the non-neoplastic epithelial disorders of the vulva
lichen sclerosus fibrosis of subepithelial stroma associated with hydropic degeneration and dermal inflammationautoimmune cause pre-neoplasticthinned epidermishydropic degeneration at basal layer sclerotic stromaproduces discolourationlichen simplex chronicus secondary to pruritis hyperkeratosis thickened epidermis (acanthosis) dermal inflammationtreated w/ steroids
what are the benign neoplasms of the vulva
hidradenomacondylomas (benign proliferation secondary to HPV infection)
what are the malignant neoplasms of the vulvar
vulvar intraepithelial neoplasia (VIN)squamous cell carcinoma (SCC)paget’s disease of vulva impt abbreviations:
what is paget’s disease of vulva
in situ carcinoma confined to epithelium origin of cells is from primitive epithelial progenitor cellssquamous epithelium contains single/small groups of glandular cells Try to recall Paget’s disease of the breast and bone as well. They are all very different.
predisposing lesions for development of SCC in vulva
HPV-16 infection (30% of cases)HPV gets localised in native epithelium (classic vulvar intraepithelial neoplasia)dysplasiainvolves entire layer of epitheliumbreak through basement membraneinvasion lichen sclerosussquamous cell hyperplasia from the premalignant lesion called differentiated vulvar intraepithelial neoplasia (differentiated VIN) Recall that CIN and prostatic carcinoma are also HPV 16
what are the congenital abnormalities of the vagina
due to lack of distal fusion of mullerian ducts septum formationcomplete agenesis Either 2 or none.
what is vaginal intraepithelial neoplasia (VaIN) caused by
commonly HPV infection HPV is everywhere in this topic~
what predisposes a woman to the development of clear cell adenocarcinoma (CCA) of the vagina
in utero exposure to diethylstilbestrol (DES)
what is the probable precursor of clear cell adenocarcinoma of the vagina
vaginal adenosis (stratified squamous epithelium develops a few lobules of glands)
microscopic features of clear cell adenocarcinoma of the vagina
vacuolated cytoplasm tumour cells in clusters and gland-like structures
morphological features of embryonal rhabdomyosarcoma of the vagina (aka Sarcoma Botryoides) and risk group
grape-like clusters in the vagina arises in underlying stroma and protrudes into lumen affects infants & children
epithelium of ecto & endocervix
Ecto is stratified squamous epithelium (wear and tear) Endocervix is columnar epithelium (secretory)
what are the risk factors for cervical neoplasia (IMPT!!!)
early age at first intercoursemultiple sexual partners increased parity a male partner with multiple previous sexual partners presence of cancer-associated HPV (serotypes 16 & 18)certain HLA and viral subtypes exposure to oral contraceptives and nicotine genital infections (Chlamydia) Sex, HPV, OCP, Chlamydia
why are some HPV serotypes of higher risk for development of cervical cancer (IMPT!!!)
serotypes: 16 & 18 integrate DNA into host DNA HPV 16 associated with amplification of 3qcell cycle regulation is disrupted by viral oncogenes E6 → p53 E7 → RB Rmb that vaccines directed at HPV can prevent infection!!!
what are the cytologic features of HPV (IMPT!!!)
multinucleationperinuclear haloes (cytoplasm is pushed to the periphery)crinkled nuclei, enlarged note: koilocytosis (halo cells) → CIN I
pathogenesis of cervical neoplasia
steps necessary for cervical cancer development include HPV infectionprogression (~10-20 years) to cervical intraepithelial neoplasia (CIN)invasion
gross morphology of cervical carcinoma
fungating, ulcerating or infiltrative
subtypes of cervical carcinoma
SCC (75-90% of cancer)large cell non-keratinisinglarge cell keratinising small cell (<5%)10-25%: adenocarcinoma, adenosquamous, undifferentiated
what are the different modes of spread of cervical carcinoma
direct local invasion uterus, vaginabladder, rectum (leading to the development of fistulas)lymphaticshematogenous (lungs, liver, bone, brain) Standard answers.
staging of cervical carcinoma and the corresponding local invasion extent
what are the different stages of the endometrial lining + corresponding histological features
proliferative stageglands are tubular lining is stratifiedmitosis is present within the glands and epithelium secretory stagedue to effects of progesteronesecretions present within cytoplasm of glandular cells
what is endometrial hyperplasia
increase in the number of glands relative to the stromaappreciated as crowded glands, often with abnormal shapes
cause of endometrial hyperplasia
unopposed estrogen stimulation
presentation of endometrial hyperplasia
abnormal vaginal bleeding
what are the subtypes of endometrial hyperplasia
based on nuclear atypiasimple hyperplasiacomplex non-atypical hyperplasiacomplex atypical hyperplasia (associated with an increased risk of endometrial carcinoma; PTEN tumour suppressor gene is mutated in approximately 20% of endometrial hyperplasia)
what are the risk factors of endometrial hyperplasia
all associated with increased estrogen secretion → causes endometrium to proliferate obesity (peripheral conversion of androgens to estrogens)menopausepolycystic ovarian syndrome functioning granulosa cell tumours of the ovrary excessive ovarian cortical function (cortical stromal hyperplasia)prolonged administration of estrogenic substances
histologic morphology of simple endometrial hyperplasia
aka cystic hyperplasia atypical hyperplasialining cells look normal but architecture abnormalmorphologically similar to proliferative glandsirregularly dilated glands uncommonly progresses to adenocarcinomas as they can be managed by cyclical hormones
histologic morphology of complex hyperplasia
glandular overcrowding and irregular shapelittle intervening stromal areaepithelial stratification high risk of cancer
what are the 2 types of endometrial carcinoma and causes? (IMPT!!!)
type I: prolonged estrogen stimulationcausesendometrial hyperplasiaovarian estrogen secreting tumours estrogen replacement therapy type II: no association with estrogen cause: no pre-existing endometrial hyperplasia; p53 mutationpoorly differentiated serous type with poor prognosis TLDR type 1 is estrogen related, type 2 is p53
what are the histologic features of endometrial carcinoma (IMPT!!!)
abnormal glands invade underlying myometriumlow grade → squamous nodules
staging of endometrial carcinoma and corresponding extent of spread
what are endometrial leiomyomas (IMPT!!!)
smooth muscle tumours which grow rapidly to form pseudocapsules around them, resulting in an increase in the volume of the endometrium; most common uterine neoplasm no increased mitosisno necrosis BENIGN!!
what are the associations of endometrial leiomyomas
occurs in 20-30% of women >30yo, usually regresses after menopause increases in size with nuclear estrogen receptor stimulations progestins and pregnancy may cause rapid increase in size and hemorrhagic red degeneration (due to infarction)
symptoms and complications of endometrial leiomyomas (IMPT!!!)
abnormal bleedingbladder compressionsudden paininfertilityspontaneous abortion The bleeding can be life threatening level
characteristics of endometrial leiomyosarcoma
increased mitosis necrosisatypica metastasis to lungs/brain 5 year survival 40% Just now is leiomyoma, now is leiomyoSARCOMA, so its malignant!! Whack dem gen path knowledge.
what are the different endometrial stromal neoplasms
endometrial stromal nodule: regular mass, well-encapsulated, no vascular invasion endometrial stromal sarcoma: low/high grade depending on mitotic index undifferentiated sarcoma
what is endometriosis (IMPT!!!)
ectopic endometrial glands and stroma which may undergo cyclic bleeding Responds to menstral changes!!! Its a big clue in hx taking
what are the symptoms and complications of endometriosis (IMPT!!!)
dysmenorrhoea (aka menstrual cramps)pelvic paininfertility precursor to carcinoma!!!!! (endometrioid and clear cell carcinoma)
what is adenomyosis (IMPT!!!)
“ectopic endometrial deposits in the myometrium with an accompanying overgrowth of muscle and connective tissue ““adeno”” = gland ““myosis”” = muscle Gland in muscle! ““Adenomyosis and Endometriosis are not the same condition. Although they can occur together, endometriosis is when endometrial cells (the lining of the uterus) are in a location outside of the uterus. Adenomyosis is when these cells
what are the macroscopic forms of adenomyosis which may occur
diffuse (more common): deposits are confined to inner part of myometrium; foci of endometrium often brownish in colourlocalised: resembling fibroid but with brownish foci
morphological features of adenomyosis
trabeculated, hemorrhage, cyst formation lining epithelium forms diverticulae (outpouches)
what are the causes of abnormal bleeding in girls during prepuberty, adolescence, reproductive, perimenopausal and postmenopausal age respectively?
TLDR, most of the time its anatomical lesions or dysfunctional uterine bleeding
what are the causes of dysfunctional uterine bleeding (DUB) (abnormally heavy uterine bleeding with NO underlying anatomical cause) (IMPT!!!)
“uterine lesions (eg fibroids, polyps, cancer)PID adenomyosisectopic pregnancyhydatidiform moleuterine leiomyoma endometritis (NOT endometriosis)trauma and sexual abuse medications foreign bodies (tampon, condom) ““Abnormal uterine bleeding (AUB) may have various causes, some of them benign. But when AUB is related to changes in hormones that directly affect the menstruation cycle, the condition i
what is a paratubal cyst (aka hydatids of Morgagni) + morphology
remanents of mullerian duct morphology: thin-walled and innocuous
what is hydrosalpinx
blocked fallopian tube that is filled with fluid tubal blockage is usually a result of previous pelvic infection such as PID or endometriosis
what is pyosalpinx
blocked fallopian tube with accumulation of pus in fallopian cavity; usually caused by bacterias chlamydianeisseria gonorrhoeae e. colistaphylococcistreptococci Same concept in renal. pyosalpinx is hydrosalphinx w pus
symptoms, complications & treatment of pyosalpinx
pelvic pain + fever complications: infertility due to residual changes (eg strictures) in the fallopian tube treatment: antibiotics/surgery
what is actinomycotic salpingitis
• inflammation caused by actinomycosis (filamentous, branched, clubbed organism which is gram +ve and non-AFB) • increased incidence in IUCD users • treated with antibiotics
what is an adenomatoid tumour
- most common benign tumour of the fallopian tube - usually asymptomatic
what is an adenomatoid tumour + histologic features of adenomatoid tumour
Most common benign tumor of fallopian tubeinvagination of visceral mesotheliumtubular spaces of varying sizes composed of flattened cells
what is salpingitis isthmica nodosa
nodular thickening of isthmic portion of fallopian tube diverticulae of lining that communicate with the lumen of the fallopian tube causes swellings bilateral in 80% of cases
what are the major complications of salpingitis isthmica nodosa
infertility/ectopic pregnancy due to the compromised lumen of the fallopian tube Key concept: Fallopian tube pathology is always associated with infertility and ectopic pregnancy
what are the non-neoplastic ovarian cysts
follicular cystsmultiple follicular cysts (polycystic ovary syndrome, PCOS/ Stein-Leventhal syndrome)corpus luteal cystsendometriotic cysts
what are follicular cysts
cysts which arise from unruptured follicles/from follicles that ruptured and sealed immediately filled with serous fluid mostly physiological
what are corpus luteal cysts
cystic corpus luteum >2cm associated with menstrual irregularitiesyellowish thick cyst lining
what is a polycystic ovary
ovary with multiple cysts and stromal hyperplasia, persistently in an anovulatory state
what are the symptoms and signs of polycystic ovary
multiple follicles which mature → high estrogen obesity hirsute (hairy)acneamenorrhoea (absence of period)
which are the different cells in the ovaries which ovarian neoplasms can arise from (IMPT!!)
surface epithelial cells (most common)germ cellssex cord (stroma) ovary: epithelial tumours common testes: germ cell tumours common
which are the ovarian germ cell tumours
dysgerminoma from 3 germ layers (embryonic ectoderm, mesoderm, endoderm)teratomaextraembryonic tissuechoriocarcinoma endodermal sinus tumour (yolk sac tumour) Remember that germ cell tumours are rare in ovaries! More common in testes
what is a dysgerminoma
tumour of undifferentiated germ cells of ovary highly radiosensitive
morphological features of dysgerminoma
large and firm, bosselated(studded) external surface soft and fleshy histologynests of monotonous tumour cells with clear glycogen-filled cytoplasmsheets of germ cells; fibrous septa with lymphocytes
what is a teratoma
a tumour composed of tissues representing 2-3 germ layers
pathogenesis of teratoma
germ cell → embryonic differentiation → neoplastic transformation mature teratoma (can easily identify the different types of tissues)benign: cystic teratoma, struma ovarii (contains thyroid tissue which can therefore lead to hyperthyroidism)malignant: SCC, thyroid immature teratoma (malignant): does not resemble other types of tissue monodermal: single tissue type somatic malignancies: tissue ins
what is an endodermal sinus (yolk sac) tumour + histologic features of endodermal sinus (yolk sac) tumour
differentiation towards yolk sac, highly malignant histologic features: rich in alpha-fetoprotein (AFP)schiller-duval bodies (pseudoglomerular structures containing central fibrovascular core surrounded by tumour)
histologic features of endodermal sinus (yolk sac) tumour
rich in alpha-fetoprotein (AFP)schiller-duval bodies (pseudoglomerular structures containing central fibrovascular core surrounded by tumour)
how to distinguish immature from mature teratomas
presence of immature elements (most often consisting of primitive neuroepithelium)
what are the different types of ovarian surface epithelial tumours + histology (IMPT!!!!)
endocervical differentiation → mucinous tumours columnar cells with apical mucin & basally located nucleus tubal differentiation → serous tumourscuboidal/columnar with cilia on surface endometrial differentiation → endometrioid and clear cell typetransitional/urothelial → brenner tumour Recall that surface epithelial tumours are the most common type of ovarian tumour 80% of EOT are benign and occu
pathogenesis of type I ovarian epithelial tumours
progress from benign → borderline → low-grade carcinomas
pathogenesis of type II ovarian epithelial tumours
arise from inclusion cysts/fallopian tube epithelium that show high grade serous features
histology of mucinous cystadenoma
multiple loculation → formation of multiple cystic spaces within the ovary; filled with mucin columnar cells with apical mucinendocervical differentiation
what are the histological criteria for borderline ovarian neoplasms
epithelial hyperplasia (stratification, formation of tufts)atypia: mild to moderate minimal mitotic activity absence of destructive stromal invasion
morphological features of serous cystadenomas of the ovary
Multiloculated large: contains clear fluidsmall: contains yellowish fluid
what are endometrioid ovarian tumours
carcinomas containing tubular glands resembling endometrium better prognosis than serous carcinoma 15% coexist with endometriosis 20% of all ovarian cancers!!
morphologic features of clear cell ovarian adenocarcinomas (IMPT!!!)
gross: solid/cystichistologic: large sheets of epithelial cells with clear cytoplasm and tubules with hobnail nuclei
morphologic features of brenner tumour
benign gross: solid tumourhistologynests of urothelial-like cells in a dense fibrous stromacoffee bean nuclei (nuclear groove! also seen in PTC)transtitional differentiation
which are the histological types of sex cord/stromal tumours
fibroma: stromal tumours with fibroblaststhecoma: stromal tumours with plump spindle cells with intracellular lipid droplets
what is meig’s syndrome
fibroma - type of sex cord/stromal tumoursascitespleural effusion
what is a granulosa cell tumour
thecoma!!! tumour which secretes estrogen → endometrial hyperplasia & carcinoma malignant due to potential for local spread, rarely distant metastasis
morphological features of granulosa cell tumour
gross: large, focally cystic to solidhistology yellow areas of lipid laden luteinised cells follicular pattern (call-exner bodies)cleaved, elongated nuclei (coffee bean) strong positivity for inhibin
what are sertoli-leydig cell tumours
- rare mesenchymal tumour of low grade malignant potential which resembles embryonic testes - androgen secreting (pt. will present with masculinization) - common in young women
modes of spread of malignant ovarian neoplasms + associated complications
local infiltration into broad ligament urethral obstructionbladder involvementperitoneal spreadascites with malignant cells in fluidperitoneal noduleslymphatic spreadhematogenous spread lung nodules
what is krukenberg tumour (IMPT!!!)
Metastatic tumour in ovary secondary to primary carcinoma at other sitesmullerian: uterus, fallopian tube, peritoneumextra-mullerian: breast, GIT usually bilateral involvement
what are the morphological features of krukenberg tumour (IMPT!!!)
friable and necrotic with vascular invasionovarian surface involvement with nodule formation
definition of spontaneous abortion
loss of pregnancy before 20 weeks of gestation without outside intervention (eg surgery or drugs) - 15% of all known pregnancies - additional 20% abort without notice (means we dk they pregnant)
causes of spontaneous abortion
maternaluterine defects: fibroids, polyps, IUCDendocrine: low progesterone/high estrogensystemic disorders: diabetes, hypertensionfetalchromosomal anomaliesTORCHES infection - Toxoplasmosis, Other (hep B), Rubella, CMV, HSV
when do we do chromosomal analysis for spontaneous abortion
habitual or recurrent abortions (spontaneous sequential loss of 3 or more pre-viable pregnancies)malformed fetus
what is an ectopic pregnancy (IMPT!!!)
implantation of the fetus in any site other than a normal uterine location - usually in fallopian tube - 1:150 pregnancies
what are the predisposing factors to ectopic pregnancy
chronic salpingitis (gonococcal infection) → loss of plicae/fibrosis → obstructionperitubal adhesions due to appendicitis leiomyomas (especially serosal ones)previous surgerybenign cysts and tumours of fallopian tubeIUCD dont forget PID
what are the complications of ectopic pregnancy
rupture hemorrhage → hematosalpinx/hemoperitoneumspontaneous regression of pregnancytubal abortion
clinical features of ectopic pregnancy (IMPT!!!)
amenorrhoea for 6-8 weeks (cuz its still pregnancy, so will have amenorrhoea)severe abdominal painvaginal bleeding hemorrhagic shock due to rupture of fallopian tube
diagnosis of ectopic pregnancy (IMPT!!!)
hCG (human chorionic gonadotropin) titres (serum/urine)pelvic ultrasoundendometrial biopsy
what is the chorioamniotic membrane and what epithelium
- fetal side of placenta - lined by trophoblastic tissue
what is chorionic villi
surrounded by trophoblasts unicellular cytotrophoblast (exchange of material through wall)multicellular syncytiotrophoblast The trophoblast is the cells that form the outer layer of blastocyst. They are present for four days of post-fertilization in human beings. They provide nutrients to the embryo and develop into a large part of the placenta which is formed during the first stage of pregnancy.
different sites of placental inflammation + corresponding name
placenta → villitis membranes → chorioamnionitis (on foetal side, surrounding the amniotic sac)umbilical cord → funisitis
sources of infection of placenta
ascending infection (through birth canal)syphilischlamydia streptococcushematogenous (torches → common, look in prenatal checkups) toxoplasmosis others (hepatitis b)rubellacmvhsv
consequences of antenatal infections of placenta
intrauterine growth retardation (low birth weight)premature deliverycongenital abnormalities (eg deafness)
what is toxemia of pregnancy (IMPT!!!)
“systemic syndrome characterised by widespread maternal endothelial dysfunction ““An outdated medical term for pre-eclampsia is toxemia of pregnancy, a term that originated in the mistaken belief that the condition was caused by toxins.”””
what are the symptoms of toxemia of pregnancy (IMPT!!!)
preeclampsia phasediffuse endothelial dysfunction/vasoconstriction → hypertension increased vascular permeability → proteinuria & edemaeclampsia phaseconvulsionsDIVC in liver, kidneys, heart, placenta, brain
what are the complications of toxemia of pregnancy (IMPT!!!)
hypercoagulabilityacute renal failurepulmonary edema high mortality rate
when does toxemia of pregnancy usually occur
- last trimester - primiparas (first pregnancy) can occur in second trimester BUT NOT COMMON
pathogenesis of toxemia of pregnancy
altered placentation → organic/functional obstruction of spiral arterioles → decreased uteroplacental perfusion → compensatory mechanisms lead to preeclampsia and eclampsia
what are the systemic morphological pathologies of toxemia of pregnancy
liverirregular, focal, subscapsular and intraparenchymal hemorrhages gross: punctate, hemorrhageous spread kidneycortical infarction endothelial vessels show swelling and fibrin thrombibrain gross/microscopic foci of hemorrhage along with small-vessel thromboses
what are the acute placental changes in toxemia of pregnancy
infarctionhematomas fibrinoid necrosis of vessels
what is placenta previa
implantation of placenta over or near the internal os, necessitating delivery of placenta before the foetus → antepartum hemorrhage usual implantation is usually higher up on the anterior-posterior side Cesarean section usually performed to avoid antepartum haemorrhage
what is abruptio placentae
premature incomplete/complete separation of normally positioned placenta from uterine wall during pregnancy/before delivery concealed bleeding: between placenta and uterine wallrevealed bleeding: when separation occurs at the edges
what are the consequences of abruptio placentae
severe bleeding → shock, disseminated intravascular coagulationsevere fetal distress → death of the fetus
what is placenta accreta
superficial adhesion of normal placental villi to uterine wall due to absence of decidual plate between villi and myometrium
progression of placenta accreta and potential complications (IMPT!!!!)
accreta: superficial adhesionincreta: chorionic villi goes into wall of myometriumpercreta: placenta goes completely into the uterine wallcomplicationsfirm attachment to uterine wall → failure of placenta to separate in 3rd stage of labour → cannot pull placenta down during delivery severe post-partum hemorrhage → shock Need HYSTERECTOMY to arrest bleeding!!!
what are gestational trophoblastic diseases (IMPT!!!!)
a group of closely related conditions characterized by active abnormal proliferation of trophoblastic cells (outermost layer of cells of the blastocyst that attaches the fertilised ovum to the uterine wall and serves as a nutritive pathway for the embryo) Conditions: - Hydatiform mole (partial & complete)- Invasive mole - Choriocarcinoma
risk factors for trophoblastic diseases
ageincreased risk at extremes of reproductive age (teenagers + woman >40y/o)malignant sequelae frequent in older patients obstetric historyterm pregnancy and live births have protective effect history of previous mole will increase risk half the choriocarcinomas follow molar pregnancy
what is a hydatiform mole (IMPT!!!!)
growth of an abnormal fertilised egg/overgrowth of tissue from placenta → replacement of normal foetal tissue with grape-like clusters in the uterine wall complete: abnormal conceptus without embryo-fetus and with gross hydropic swelling of villipartial: intimate admixture of both normal and abnormal villi. fetal development may be present
what are the clinical features of hydatidiform mole
vaginal bleeding uterus larger than dates (progression of pregnancy)hyperemesis, pulmonary embolisation and hyperthyroidism serology: raised hCG levels (so hCG levels is never diagnostic for pregnancy)
what are the complications of hydatidiform mole
uterine hemorrhage coagulopathy (disseminated intravascular coagulation)infectioncontinued trophoblastic activity → invasive mole/choriocarcinoma
pathogenesis of complete hydatidiform mole (aka androgenetic mole)
results from the fertilisation of an egg in which the nucleus is lost/inactivated mostly 46XX where both X chromosomes are of paternal originfew are 46XY but both chromosomes are still of paternal origin
pathogenesis of partial hydatidiform mole
genetic compositionmaternal chromosome (23X) paternal chromosome2 sperms: 23X + 23Y1 sperm: 46 XY resulting zygote has 69XXY or 69XXX (triploid) Complete is diploid, partial is triploid!!
what are the differences between complete and partial hydatidiform moles
Complete mole is is diploid (only 1 parent involved, its a complete failure) Partial is triploid (partial as in at least got both parents involved, so its not a complete failure!!) Key diff is karyotype! Diploid (androgenetic) vs triploid and the fact that fetus is present in partial mole due to presense of maternal genes
how to differentiate between partial and complete hydatidiform mole
p57 immunohistochemistry p57 is a surrogate marker for the maternal genome p57 negative: complete p57 positive: partial/non-molar
what is an invasive mole
hydatiform mole in which hydropic villi invades the myometrium or blood vessels, or are transported to extrauterine sites invasive mole = invasive hydatiform mole! Recall that invasive mole & choriocarcinoma are complications of hydatiform mole
what is a choriocarcinoma
malignant epithelial tumour arising from trophoblast of any gestational event, commonly from hydatiform mole consists mainly of biphasic proliferation of syncytio-cytotrophoblast Recall that invasive mole & choriocarcinoma are complications of hydatiform mole
characteristics of invasive mole
all from hydatiform moles mostly confined to uteruscan be locally aggresiveinvasion into uterine walls - penetration into myometriummetastasis to lungs (low risk) hydropic villi and trophoblastic proliferationhighly chemosensitivedeath due to uterine perforation or intraperitoneal bleeding
what is gestational choriocarcinoma
aggressive malignant tumour of gestational trophoblast widespread metastasis via blood (vagina, lungs, liver, brain, marrow, etc) but lymphatic uncommon
what are the gross & microscopic features of gestational choriocarcinoma
grosshemorrhagic friable mass in uterine cavity (due to proliferation of trophoblastic tissue )microscopic (typical cancer traits)hemorrhage and necrosisanaplastic trophoblast (atypical with increased mitosis)vascular invasion
clinical features of choriocarcinoma & behaviour & prognostic factors
Clinical - abnormal uterine bleeding (AUB) - distant metastases → hemorrhagic events - serology: hCG levels Behaviour - Previously fatal but now with chemotherapy survival 80-90% Prognostic factors (have the following = bad prognosis) - Distant metastases - Failure of chemotherapy - Choriocarcinoma following term pregnancy
staging of choriocarcinoma
what are the potential causes of acquired infertility in females
uterine cervix problemcorpus uteri problemfallopian tube problemovary problemhormonal problem
what are the infertiliy investigations which can be conducted
hormonal assay: gonotrophic, progesterone, estrogenendometrial sampling laproscopy of fallopian tube hysteroscopy of endometrial cavity hysterosalpingography: injection of dye to see patencymicrobiologic studies
A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Why does the patient complain of heavy menses? (IMPT!!!) Tumour expands the myometrium –> increases surface area of endometrial cavity –> increased shedding What are some differential diagnoses? (IMPT!!!) FIGO PALM-COEIN classification! Or TL
“A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Why does the patient complain of heavy menses? (IMPT!!!) Tumour expands the myometrium –> increases surface area of endometrial cavity –> increased shedding What are some differential diagnoses? (IMPT!!!) FIGO PALM-COEIN classification! Or T
A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Why does the patient complain of heavy menses? (IMPT!!!) Tumour expands the myometrium –> increases surface area of endometrial cavity –> increased shedding What are some differential diagnoses? (IMPT!!!) FIGO PALM-COEIN classification! Or TL
“A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Why does the patient complain of heavy menses? (IMPT!!!) Tumour expands the myometrium –> increases surface area of endometrial cavity –> increased shedding What are some differential diagnoses? (IMPT!!!) FIGO PALM-COEIN classification! Or T
A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Why does the patient complain of heavy menses? (IMPT!!!) […] What are some differential diagnoses? (IMPT!!!) […] What investigations will you perform to come to a diagnosis? To indentify etiology: (IMPT!!!) - Pelvic US - Hysteroscopy - Endo
“A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Why does the patient complain of heavy menses? (IMPT!!!) Tumour expands the myometrium –> increases surface area of endometrial cavity –> increased shedding What are some differential diagnoses? (IMPT!!!) FIGO PALM-COEIN classification! Or T
A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Gross description: - […] - […] - […] Histological features? - Well circumscribed myometrial tumour composed of interlacing bundles (fascicles) of uniform spindled cells with blunt ended nuclei and eosinophilic cytoplasm - No nuclear pleom
A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Gross description: - Large, well-circumscribed firm ovoid mass in myometrium - Tan, whorled appearance, no haemorrhage or necrosis - much smaller intramural nodule of similar nature also seen in opposing myometrium Histological features? - Well
A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Gross description: - Large, well-circumscribed firm ovoid mass in myometrium - Tan, whorled appearance, no haemorrhage or necrosis - much smaller intramural nodule of similar nature also seen in opposing myometrium Histological features? - […
A 45 year old lady complains of heavy menses. Her full blood count shows her to be anaemic. After appropriate investigations, she undergoes a hysterectomy. Gross description: - Large, well-circumscribed firm ovoid mass in myometrium - Tan, whorled appearance, no haemorrhage or necrosis - much smaller intramural nodule of similar nature also seen in opposing myometrium Histological features? - Well
A 45-yr-old woman complains of heavy periods associated with pelvic pain during menstruation for the past 8 months. Gross description: - […] - […] - […] Histological features? - […] Diagnosis? […]
A 45-yr-old woman complains of heavy periods associated with pelvic pain during menstruation for the past 8 months. Gross description: - enlarged uterus, diffusely thickened myometrium with trabeculated appearance - haemorrhage within myometrium - 2 small leiomyomas (fibroids) seen in fundus (not main concern) Histological features? - Presence of endometrial glands and endometrial stroma within th
A 45-yr-old woman complains of heavy periods associated with pelvic pain during menstruation for the past 8 months. She was diagnosed with adenomyosis. How do you distinguish adenomyosis from endometrial adenocarcinoma invading the myometrium? General concept: […] Adenomyosis: […] endometrial adenocarcinoma: […] Why did the pt complain of heavy mensus? Heavy flow is proportional to volume of
A 45-yr-old woman complains of heavy periods associated with pelvic pain during menstruation for the past 8 months. She was diagnosed with adenomyosis. How do you distinguish adenomyosis from endometrial adenocarcinoma invading the myometrium? General concept: Components, architecture, cytology! Adenomyosis: Glands look normal, has stroma, normal cytology endometrial adenocarcinoma: Glands abnorma
A 45-yr-old woman complains of heavy periods associated with pelvic pain during menstruation for the past 8 months. She was diagnosed with adenomyosis. How do you distinguish adenomyosis from endometrial adenocarcinoma invading the myometrium? General concept: Components, architecture, cytology! Adenomyosis: Glands look normal, has stroma, normal cytology endometrial adenocarcinoma: Glands abnorma
A 45-yr-old woman complains of heavy periods associated with pelvic pain during menstruation for the past 8 months. She was diagnosed with adenomyosis. How do you distinguish adenomyosis from endometrial adenocarcinoma invading the myometrium? General concept: Components, architecture, cytology! Adenomyosis: Glands look normal, has stroma, normal cytology endometrial adenocarcinoma: Glands abnorma
21 year old woman with abdominal fullness. Ultrasound detected an ovarian mass, which was resected. What are the differentials? […] Diagnosis? […]
21 year old woman with abdominal fullness. Ultrasound detected an ovarian mass, which was resected. What are the differentials? Tumours/krukenberg, infection, abscess, cysts Diagnosis? Teratoma!
“21 year old woman with abdominal fullness. Ultrasound detected an ovarian mass, which was resected. She was diagnosed with teratoma. Where else can teratomas occur? […] A teratoma belongs to the ““germ cell tumour”” family of tumours in the ovary. What are the other two main families? […]”
“21 year old woman with abdominal fullness. Ultrasound detected an ovarian mass, which was resected. She was diagnosed with teratoma. Where else can teratomas occur? Testes, (ovaries), brain, mediastinum, sacral coccegeal, etc (midline) A teratoma belongs to the ““germ cell tumour”” family of tumours in the ovary. What are the other two main families? Epithelial ovarian tumours, sex-cord stromal t
60 year old woman with a previous history of gastric carcinoma (diffuse/signet ring type) now presents with ovarian enlargement on ovarian ultrasound. If the ovarian tumour is in fact a metastatic gastric tumour, what term is used to call this? […]
60 year old woman with a previous history of gastric carcinoma (diffuse/signet ring type) now presents with ovarian enlargement on ovarian ultrasound. If the ovarian tumour is in fact a metastatic gastric tumour, what term is used to call this? Krukenberg tumour
35 year old woman with a known history of pelvic inflammatory disease (PID) presents with fever, abdominal pain, and vaginal discharge. What is PID? […]
35 year old woman with a known history of pelvic inflammatory disease (PID) presents with fever, abdominal pain, and vaginal discharge. What is PID? an infection of the female reproductive organs that most often occurs when STD spreads from vagina to uterus, fallopian tube or ovaries
3 female patients all present with raised beta-hCG levels. What are the differentials? […] […] […] […]
3 female patients all present with raised beta-hCG levels. What are the differentials? Pregnancy ectopic pregnancy partial/complete hydatidiform moles choriocarcinoma If male patient with raised beta-hCG, its testicular tumour!!
65 year old woman presents with post menopausal vaginal bleeding. What are the differentials? […]
65 year old woman presents with post menopausal vaginal bleeding. What are the differentials? Atrophic vaginitis, malignancy
A 35-yr-old woman who had history of multiple sex partners in the past was found on routine gynaecological check-up to have an abnormal PAP smear. She was otherwise asymptomatic. Biopsy of the cervix was performed Diagnosis? […]
A 35-yr-old woman who had history of multiple sex partners in the past was found on routine gynaecological check-up to have an abnormal PAP smear. She was otherwise asymptomatic. Biopsy of the cervix was performed Diagnosis? CIN
A 35-yr-old woman who had history of multiple sex partners in the past was found on routine gynaecological check-up to have an abnormal PAP smear. She was otherwise asymptomatic. Biopsy of the cervix was performed. She was diagnosed with CIN What is CIN and how is it classified? […] Describe the key histological features of the biopsy which shows CIN III - […] - […] - […] How do you distin
“A 35-yr-old woman who had history of multiple sex partners in the past was found on routine gynaecological check-up to have an abnormal PAP smear. She was otherwise asymptomatic. Biopsy of the cervix was performed. She was diagnosed with CIN What is CIN and how is it classified? Cervical intraepithelial neoplasia is a premalignant disease involving squamous mucosa of the uterine cervix. There are
A 50-yr-old woman noticed post-coital bleeding 6 months ago. She now has intermittent spotting and vaginal discharge. An ulcerated exophytic growth was seen in the cervix. A PAP smear was taken followed by definite surgery. She was diagnosed with cervical SCC. (vvvvv IMPT!!!!) What are the histological features that indicate Malignancy? - Architecture: […] - Cytology: […] Squamous differentiat
“A 50-yr-old woman noticed post-coital bleeding 6 months ago. She now has intermittent spotting and vaginal discharge. An ulcerated exophytic growth was seen in the cervix. A PAP smear was taken followed by definite surgery. She was diagnosed with cervical SCC. (vvvvv IMPT!!!!) What are the histological features that indicate Malignancy? - Architecture: invasion through basement membrane, irregula
What is DES ?
- Diethylstilbestrol - Nonsteroidal oestrogen medication • Used to prevent miscarriage & premature labour • BANNED due to direct correlation to clear cell adenocarcinoma of the vagina
Cervical Screen Singapore (CSS) Screening programme which aims to encourage women aged […] who […] to go for […] once every […] years
Cervical Screen Singapore (CSS) Screening programme which aims to encourage women aged 25-69 who ever had sex to go for Pap smears once every 3 years Every year, about 200 women are detected with cervical cancer and about 100 die from the disease
Endometrial Carcinoma mainly arises in […]
Endometrial Carcinoma mainly arises in postmenopausal women
clear cell adenocarcinoma (CCA) of the vagina what predisposes a woman to the development of clear cell adenocarcinoma (CCA) of the vagina? […] what is the probable precursor of clear cell adenocarcinoma of the vagina? […] microscopic features of clear cell adenocarcinoma of the vagina […]
clear cell adenocarcinoma (CCA) of the vagina what predisposes a woman to the development of clear cell adenocarcinoma (CCA) of the vagina? in utero exposure to diethylstilbestrol (DES) what is the probable precursor of clear cell adenocarcinoma of the vagina? vaginal adenosis (stratified squamous epithelium develops a few lobules of glands) microscopic features of clear cell adenocarcinoma of the
what is a dysgerminoma […] morphological features of dysgerminoma […]
what is a dysgerminoma tumour of undifferentiated germ cells of ovary morphological features of dysgerminoma large and firm, bosselated external surface soft and fleshy histologynests of monotonous tumour cells with clear glycogen-filled cytoplasmsheets of germ cells; fibrous septa with lymphocytes
what is adenomyosis (IMPT!!!) […] what are the macroscopic forms of adenomyosis which may occur - […] (more common): deposits are confined to inner part of myometrium; foci of endometrium often brownish in colour - […]: resembling fibroid but with brownish foci morphological features (histo description) of adenomyosis trabeculated, hemorrhage, cyst formation; lining epithelium forms divertic
“what is adenomyosis (IMPT!!!) ectopic endometrial deposits in the myometrium with an accompanying overgrowth of muscle and connective tissue what are the macroscopic forms of adenomyosis which may occur - diffuse (more common): deposits are confined to inner part of myometrium; foci of endometrium often brownish in colour - localised: resembling fibroid but with brownish foci morphological featur
what is adenomyosis (IMPT!!!) ectopic endometrial deposits in the myometrium with an accompanying overgrowth of muscle and connective tissue what are the macroscopic forms of adenomyosis which may occur - diffuse (more common): deposits are confined to inner part of myometrium; foci of endometrium often brownish in colour - localised: resembling fibroid but with brownish foci morphological feature
“what is adenomyosis (IMPT!!!) ectopic endometrial deposits in the myometrium with an accompanying overgrowth of muscle and connective tissue what are the macroscopic forms of adenomyosis which may occur - diffuse (more common): deposits are confined to inner part of myometrium; foci of endometrium often brownish in colour - localised: resembling fibroid but with brownish foci morphological featur
endometrial hyperplasia - increase in the number of glands relative to the stroma - appreciated as crowded glands, often with abnormal shapes cause of endometrial hyperplasia: unopposed estrogen stimulation presentation of endometrial hyperplasia: abnormal vaginal bleeding risk factors of endometrial hyperplasia all associated with increased estrogen secretion → causes endometrium to proliferate o
endometrial hyperplasia - increase in the number of glands relative to the stroma - appreciated as crowded glands, often with abnormal shapes cause of endometrial hyperplasia: unopposed estrogen stimulation presentation of endometrial hyperplasia: abnormal vaginal bleeding risk factors of endometrial hyperplasia all associated with increased estrogen secretion → causes endometrium to proliferate o
endometrial hyperplasia - increase in the number of glands relative to the stroma - appreciated as crowded glands, often with abnormal shapes cause of endometrial hyperplasia: unopposed estrogen stimulation presentation of endometrial hyperplasia: abnormal vaginal bleeding risk factors of endometrial hyperplasia all associated with […] → causes endometrium to proliferate […][…] […] […] [
endometrial hyperplasia - increase in the number of glands relative to the stroma - appreciated as crowded glands, often with abnormal shapes cause of endometrial hyperplasia: unopposed estrogen stimulation presentation of endometrial hyperplasia: abnormal vaginal bleeding risk factors of endometrial hyperplasia all associated with increased estrogen secretion → causes endometrium to proliferate o
endometrial hyperplasia - […] - appreciated as […] glands, often with abnormal shapes cause of endometrial hyperplasia: […] presentation of endometrial hyperplasia: […] risk factors of endometrial hyperplasia all associated with increased estrogen secretion → causes endometrium to proliferate obesity (peripheral conversion of androgens to estrogens)menopause polycystic ovarian syndrome fun
endometrial hyperplasia - increase in the number of glands relative to the stroma - appreciated as crowded glands, often with abnormal shapes cause of endometrial hyperplasia: unopposed estrogen stimulation presentation of endometrial hyperplasia: abnormal vaginal bleeding risk factors of endometrial hyperplasia all associated with increased estrogen secretion → causes endometrium to proliferate o
what is toxemia of pregnancy (IMPT!!!) = pre-eclampsia; systemic syndrome characterised by widespread maternal endothelial dysfunction when does toxemia of pregnancy usually occur last trimester of first pregnancy what are the symptoms of toxemia of pregnancy (IMPT!!!) preeclampsia phasediffuse endothelial dysfunction/vasoconstriction → hypertension increased vascular permeability → proteinuria &
what is toxemia of pregnancy (IMPT!!!) = pre-eclampsia; systemic syndrome characterised by widespread maternal endothelial dysfunction when does toxemia of pregnancy usually occur last trimester of first pregnancy what are the symptoms of toxemia of pregnancy (IMPT!!!) preeclampsia phasediffuse endothelial dysfunction/vasoconstriction → hypertension increased vascular permeability → proteinuria &
what is toxemia of pregnancy (IMPT!!!) = pre-eclampsia; systemic syndrome characterised by widespread maternal endothelial dysfunction when does toxemia of pregnancy usually occur last trimester of first pregnancy what are the symptoms of toxemia of pregnancy (IMPT!!!) preeclampsia phase[…] […] eclampsia phase[…][…] what are the complications of toxemia of pregnancy (IMPT!!!) hypercoagulab
what is toxemia of pregnancy (IMPT!!!) = pre-eclampsia; systemic syndrome characterised by widespread maternal endothelial dysfunction when does toxemia of pregnancy usually occur last trimester of first pregnancy what are the symptoms of toxemia of pregnancy (IMPT!!!) preeclampsia phasediffuse endothelial dysfunction/vasoconstriction → hypertension increased vascular permeability → proteinuria &
what is toxemia of pregnancy (IMPT!!!) […] when does toxemia of pregnancy usually occur […] what are the symptoms of toxemia of pregnancy (IMPT!!!) preeclampsia phasediffuse endothelial dysfunction/vasoconstriction → hypertension increased vascular permeability → proteinuria & edema eclampsia phaseconvulsionsDIVC in liver, kidneys, heart, placenta, brain what are the complications of toxemia o
what is toxemia of pregnancy (IMPT!!!) = pre-eclampsia; systemic syndrome characterised by widespread maternal endothelial dysfunction when does toxemia of pregnancy usually occur last trimester of first pregnancy what are the symptoms of toxemia of pregnancy (IMPT!!!) preeclampsia phasediffuse endothelial dysfunction/vasoconstriction → hypertension increased vascular permeability → proteinuria &
what is toxemia of pregnancy (IMPT!!!) = pre-eclampsia; systemic syndrome characterised by widespread maternal endothelial dysfunction when does toxemia of pregnancy usually occur last trimester of first pregnancy what are the symptoms of toxemia of pregnancy (IMPT!!!) preeclampsia phasediffuse endothelial dysfunction/vasoconstriction → hypertension increased vascular permeability → proteinuria &
what is toxemia of pregnancy (IMPT!!!) = pre-eclampsia; systemic syndrome characterised by widespread maternal endothelial dysfunction when does toxemia of pregnancy usually occur last trimester of first pregnancy what are the symptoms of toxemia of pregnancy (IMPT!!!) preeclampsia phasediffuse endothelial dysfunction/vasoconstriction → hypertension increased vascular permeability → proteinuria &
what are endometrial (myometrium) leiomyomas (IMPT!!!) smooth muscle tumours which grow rapidly to form pseudocapsules around them, resulting in an increase in the volume of the endometrium; most common uterine neoplasm no increased mitosisno necrosis BENIGN!! symptoms and complications of endometrial leiomyomas (IMPT!!!) abnormal bleeding - can be life threatening level bladder compressionsudden
what are endometrial (myometrium) leiomyomas (IMPT!!!) smooth muscle tumours which grow rapidly to form pseudocapsules around them, resulting in an increase in the volume of the endometrium; most common uterine neoplasm no increased mitosisno necrosis BENIGN!! symptoms and complications of endometrial leiomyomas (IMPT!!!) abnormal bleeding - can be life threatening level bladder compressionsudden
what are endometrial (myometrium) leiomyomas (IMPT!!!) […] symptoms and complications of endometrial leiomyomas (IMPT!!!) abnormal bleeding - can be life threatening level bladder compressionsudden paininfertilityspontaneous abortion associations of endometrial leiomyomas occurs in 20-30% of women >30yo, usually regresses after menopause increases in size with nuclear estrogen receptor stimulati
what are endometrial (myometrium) leiomyomas (IMPT!!!) smooth muscle tumours which grow rapidly to form pseudocapsules around them, resulting in an increase in the volume of the endometrium; most common uterine neoplasm no increased mitosisno necrosis BENIGN!! symptoms and complications of endometrial leiomyomas (IMPT!!!) abnormal bleeding - can be life threatening level bladder compressionsudden
what are endometrial (myometrium) leiomyomas (IMPT!!!) smooth muscle tumours which grow rapidly to form pseudocapsules around them, resulting in an increase in the volume of the endometrium; most common uterine neoplasm no increased mitosisno necrosis BENIGN!! symptoms and complications of endometrial leiomyomas (IMPT!!!) […] associations of endometrial leiomyomas occurs in 20-30% of women >30yo
what are endometrial (myometrium) leiomyomas (IMPT!!!) smooth muscle tumours which grow rapidly to form pseudocapsules around them, resulting in an increase in the volume of the endometrium; most common uterine neoplasm no increased mitosisno necrosis BENIGN!! symptoms and complications of endometrial leiomyomas (IMPT!!!) abnormal bleeding - can be life threatening level bladder compressionsudden
hydatidiform mole what is a hydatiform mole (IMPT!!!!) growth of an abnormal fertilised egg/overgrowth of tissue from placenta → replacement of normal foetal tissue with grape-like clusters in the uterine wall clinical features of hydatidiform mole - vaginal bleeding - uterus larger than dates (progression of pregnancy) - hyperemesis (severe nausea and vomiting during pregnancy), pulmonary embolis
hydatidiform mole what is a hydatiform mole (IMPT!!!!) growth of an abnormal fertilised egg/overgrowth of tissue from placenta → replacement of normal foetal tissue with grape-like clusters in the uterine wall clinical features of hydatidiform mole - vaginal bleeding - uterus larger than dates (progression of pregnancy) - hyperemesis (severe nausea and vomiting during pregnancy), pulmonary embolis
hydatidiform mole what is a hydatiform mole (IMPT!!!!) growth of an abnormal fertilised egg/overgrowth of tissue from placenta → replacement of normal foetal tissue with grape-like clusters in the uterine wall clinical features of hydatidiform mole - vaginal bleeding - uterus larger than dates (progression of pregnancy) - hyperemesis (severe nausea and vomiting during pregnancy), pulmonary embolis
hydatidiform mole what is a hydatiform mole (IMPT!!!!) growth of an abnormal fertilised egg/overgrowth of tissue from placenta → replacement of normal foetal tissue with grape-like clusters in the uterine wall clinical features of hydatidiform mole - vaginal bleeding - uterus larger than dates (progression of pregnancy) - hyperemesis (severe nausea and vomiting during pregnancy), pulmonary embolis
hydatidiform mole what is a hydatiform mole (IMPT!!!!) […] clinical features of hydatidiform mole […] complications of hydatidiform mole - uterine hemorrhage - coagulopathy (disseminated intravascular coagulation) - infection - continued trophoblastic activity → invasive mole/choriocarcinoma what are the differences between complete and partial hydatidiform moles - Complete mole is diploid (on
hydatidiform mole what is a hydatiform mole (IMPT!!!!) growth of an abnormal fertilised egg/overgrowth of tissue from placenta → replacement of normal foetal tissue with grape-like clusters in the uterine wall clinical features of hydatidiform mole - vaginal bleeding - uterus larger than dates (progression of pregnancy) - hyperemesis (severe nausea and vomiting during pregnancy), pulmonary embolis
what is choriocarcinoma? malignant epithelial tumour arising from trophoblast of any gestational event, commonly from hydatiform moleconsists mainly of biphasic proliferation of syncytio-cytotrophoblast widespread metastasis via blood (vagina, lungs, liver, brain, marrow, etc) clinical features of choriocarcinoma abnormal uterine bleeding (AUB) distant metastases → hemorrhagic events serology: hCG
what is choriocarcinoma? malignant epithelial tumour arising from trophoblast of any gestational event, commonly from hydatiform moleconsists mainly of biphasic proliferation of syncytio-cytotrophoblast widespread metastasis via blood (vagina, lungs, liver, brain, marrow, etc) clinical features of choriocarcinoma abnormal uterine bleeding (AUB) distant metastases → hemorrhagic events serology: hCG
what is choriocarcinoma? […] arising from trophoblast of any gestational event, commonly from […]consists mainly of biphasic proliferation of syncytio-cytotrophoblast widespread metastasis via […] clinical features of choriocarcinoma […] […] serology: […] what are the gross & microscopic features of gestational choriocarcinoma grosshemorrhagic friable mass in uterine cavity (due to pro
what is choriocarcinoma? malignant epithelial tumour arising from trophoblast of any gestational event, commonly from hydatiform moleconsists mainly of biphasic proliferation of syncytio-cytotrophoblast widespread metastasis via blood (vagina, lungs, liver, brain, marrow, etc) clinical features of choriocarcinoma abnormal uterine bleeding (AUB) distant metastases → hemorrhagic events serology: hCG
