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Gyne Flashcards

1
Q

Gross and micro features of polycystic overian disease

A

Gross - rounded and enlarged ovaries, usually bilateral
- multiple small subcortical follicles, typically similar in size
Micro - fibrous and thick ovarian capsule
- Hyperplastic ovarian stroma
- No stigmata of prior ovulation

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2
Q

Nonneoplastic cysts of ovary and histology of each

A

Epithelial inclusion cyst - single layer of flat to columnar epithelium +/- cilitated. <1cm (if >1cm, then called serous cystadenoma)
Follicular cyst - uniloculated with inner layer composed of granulosa cells and outer layer theca cells
Corpus luteum cyst - luteinized granulosa cells with outer layers of luteinized theca cells
Endometriotic cyst - lined by endometrial glandular epithelium, underlying endometrial stroma, hemosiderin laden macs
Polycystic ovarian disease - fibrous and thick capsule, hyperplasia ovarian stroma
Hyperreactio luteinalis - multiple follicular cysts with luteinized theca and granulosa layers, edema, luteinized stroma

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3
Q

Histologic types of epithelial neoplasms of the ovary

A

Serous - benign, borderline, low grade, high grade
Endometrioid - benign, borderline, malignant
Clear cell - benign, borderline, malignant
Mucinous - benign, borderline, malignant
Seroumucinous - benign, borderline, malignant
Brenner - benign, borderline, malignant
Others: mesonephric-like adenocarcinoma, undifferentiated and dediff CA, carcinosarcoma, mixed carcinoma

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4
Q

Diagnosis of mixed carcinoma

A

Essential: presence of at least 2 ovarian carcinoma histological types with components showing distinct and unequivocal differences by histomorphology
Desirable: differences between the two areas based on ancillary studies

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5
Q

Importance of accurate classification of epithelial tumors of the ovary

A

Present at different stages
Require different treatment/adjuvant therapy
Respond differently to chemo
Different prognosis and survival
Different molecular

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6
Q

CAP protocol requirements for ovarian/fallopian tube resections

A

History
Procedure
Specimen integrity
Tumor site
Tumor size
Histologic type, grade
Ovarian surface involvement
Fallopian tube surface involvement
Implants
Other tissue involvement
Largest extrapelvic peritoneal focus
Peritoneal/ascitic fluid involvement
Chemotherapy response scpre
Regional LN status
Distant sites involved

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7
Q

Importance of ovarian integrity and rupture

A

Rupture may spill malignant cells into abdominal cavity, which may influence treatment
There may be small surface carcinomas
Important to note, in cases when there are benign/borderline/malignant areas, which has ruptured

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8
Q

Omentum grossing

A

If tumor identifiable, submit representative sections
For borderline or immature teratoma with grossly apparent implants, submit multiple sections
Take 1 per 2cm of normal omentum

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9
Q

Importance of LVI in ovarian carcinomas

A

Does not impact staging
No prognostic significance
May raise suspicion for metastatic disease to the ovary in cases such as mucinous CA

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10
Q

AJCC T staging for ovary, fallopian tube, primary peritoneal CA

A

pT1: Limited to ovaries
pT1a: limited to 1 ovary
pT1b: limited to both ovaries
pT1c: Limited to one or both ovaries with any of the following: surgical spill, capsule rupture, surface involvement, malignant ascites
pT2: Tumor involves 1-2 ovaries/FTs with pelvic extension below pelvic brim or primary peritoneal CA
pT3: Essentially pT2 with mets outside the pelvis/retroperitoneal LNs

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11
Q

AJCC N staging for ovary, fallopian tube, primary peritoneal CA

A

pN0(i+): ITCs </=0.2mm
pN1: Pos retroperitoneal nodes only
pN1a: met up to 10mm
pN1b: met greater than 10mm

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12
Q

AJCC M staging for ovary, fallopian tube, primary peritoneal CA

A

pM1a: Pleural effusion with + cytology
pM1b: liver of splenic parenchymal metws, mets to extrabdominal LNs, transmural involvement of bowel

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13
Q

Most common histologic subtype of familial ovarian CA and common mutations associated with it

A

High grade serous
BRCA1/2

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14
Q

How to submit Ovary and FTs in patients with BRCA mutations or suspected increased risk of HBOT

A

Ovarian and tubal tissue should be serially sectioned and submitted in toto
FTs submitted according to SEE-FIM protocol

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15
Q

Types of serous neoplasms of ovary and their histologic characteristics

A

Serous cystadenoma, cystadenofibroma, adenofibroma, surface papilloma : cystic or papillary with broad papillae and/or small glands in prominent fibromatous stroma or as small simple papillae on surface
Serous borderline tumors: Hierarchical branching papillae with variable amounts of stroma in cores, stratified epithelial lining with tufting/cell detachment, mild to moderate atypia
- implant = extraovarian disease, noninvasive
- autoimplant = desmoplastic implant on ovarian surface
- SBT with microinvasion: <5mm
SBT, micropap/cribriform subtypes: area of pure micropap/crib growth >5mm, elongated micropap at least 5x longer than wide, with medusa head appearance. Small punched out crib spaces
LGSC: SBT with extraovarian invasion (invasive implant), variety of patterns (small nests, glands, papillae, micropap, inverted macropap)
- frequently free-floating within unlined clear spaces
- Psammoma bodies, mid-mod atypia, rare necrosis
- Coexisting SBT
HGSC: Heterogenous patterns, significant atypia, markedly increased mits, atypical mits, necrosis and multinucleated cells

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16
Q

Difference in management of various types of serous neoplasms

A

Benign: unilateral oophorectomy
Borderline: removal of all visible disease with peritoneal and omental sampling, no retroperi LN sampling
LGSC: THBSO, omentectomy, LN dissection, resect all visible disease, postoperative chemo depending on stage
HGSC: neoadjuvant therapy as required, surgery, chemo

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17
Q

Prognosis of each type of serous neoplasms

A

Benign: 100% survival
Borderline: depends on stage
- Stage I: good
- Advanced stage: 4-7% develop LGSC, rarely HGSC
LGSC: depends on stage
- Early: good
- Advanced: poor
HGSC: generally poor

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18
Q

Poor prognostic features in SBT

A

Micropap/crib subtype
Advanced stage
Bilaterality
Ovarian surface involvement
Residual disease after surgery

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19
Q

Significance of SBT in LNs

A

1/3 of pts with SBT who have LND
Must exclude: endosalpingiosis, psammomatous calcs with no epithelial cells, nodal mesothelial hyperplasia, metastatic LGSC
More common in subcapsular sinuses
Not considered an adverse prognostic factor

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20
Q

Classification of endometrioid tumors of ovary

A

Benign: cystadenoma or cystadenofibroma
Borderline
Malignant

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21
Q

Benign finding in ovary associated with endometrioid neoplasms

A

Endometriosis

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22
Q

Morphologic features of each type of ovarian endometrioid neoplasm

A

Cystadenoma - cyst lined by endometrial epithelium, no stroma, associated with endometriosis, mucinous metaplasia
Cystadenofibroma - Endometrial epithelium within fibromatous stroma
Borderline tumor - Two growth patterns, adeofibromatous (more common) and intracystic
- Adenofibromatous - background of endometrioid adenofibroma, crowded glands (resembling EAH), mild-mod atypia, squamous metaplasia
- Intracystic - simple papillary architecture protruding into endometriotic cyst
- microinvasion
Carcinoma - morphologic resemblance to endomertioid carcinoma of uterus
- back to back glands, destructive invasion, associated with squamous, mucinous differentation, endometriosis

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23
Q

Grading of endometrioid adenocarcinoma of the ovary

A

FIGO: same as uterus

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24
Q

Molecular alterations in endometrioid carcinoma

A

ARID1A
PTEN
PIK3CA
MMR
CTNNB1
TP53 in high grade
KRAS

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25
Prognosis of each type of ovarian endometrioid tumot
Benign: excellent Borderline: excellent Malignant: better than serous Commonly presents as Stage I disease, higher the stage worse the prognosis
26
Metastatic endometrial endometrioid carcinoma to ovary vs synchronous ovarian and endometrial primaries
Superficial myometrial invasion in synchronous, deep in metastatic Absent LVI in synchronous, present in metastatic Endometriosis present in synchronous Ovarian involvement parenchymal, solitary, unilateral in synchronous Ovarian involvement surface, small, multinodular, bilatearl in mets Tumor spread in other locations in metastatic
27
Clinical sig of metastatic vs synchronous endometrial and ovarian endometrioid CA
Synchronous primary associated with excellent prognosis when tumor limited to endometrium and ovary
28
Types of clear cell neoplasms of ovary
Clear cell cystadenoma or cystadenofibroma Clear cell borderline (rare) Clear cell carcinoma
29
Associated benign finding for clear cell carcinoma of ovary
Endometriosis
30
Morphology of clear cell carcinoma of ovary
Varied patterns: solid, papillary, tubulocystic, mixed Hobnailed cells with relatively uniform hyperchromatic nuclei, prominent nucleoli Clear or eosinophilic cytoplasm with relatively low mitotic activity Presence of hyaline globules or psammoma bodies Hyalinized stroma
31
DDx of clear cell carcinoma of ovary
Serous CA Endometrioid CA with clear cell changes Yolk sac tumor Dysgerminoma Metastatic clear cell CA from extraovarian site Steroid cell tumors
32
Morphological features of ovarian mucinous borderline tumor
Cysts lined by GI-type mucinous epithelium: stratification, tufting, villous, slender filiform papillae Mild to mod cytologic atypia Epithelial prolif >10% tumor volume Associated with mucinous cystadenoma, brenner, or mature cystic teratoma Mural nodules
33
Differentiate primary ovarian tumor from metastatic
Primary: unilateral, single large mass, mainly parenchymal involvement, no hx, IHC compatible with ovary Mets: bilateral, multiple small foci or single cells, surface and parenchymal involvement, extensive LVI, pools of mucin, hx, dirty necrosis, IHC compatible with extraovarian
34
Clinical features of adult granulosa cell tumors
Pts middle-aged to postmenopausal Amenorrhea, postmenopausal bleeding Frequently estrogen-secreting - associated with endometrial hyperplasia and carcinoma (androgenic changes rare) Hemoperitoneum May have elevated serum B-inhibin Early stage have good prognosis
35
Gross and microscopic findings of adult granulosa cell tumors
Gross - unilateral, average size 10cm, solid and cystic, soft yellow/tan-hemorrhagic Micro - varied architectural patterns with granulosa cells (ovoid cells with grooves +/- Call-Exner bodies), low mitotic activity
36
Molecular of Adult granulosa cell tumor
FOXL2 mutation
37
DDx of adult granulosa cell tumor
Poorly diff or undiff CA Endometrioid adenoCA Smell cell carcinoma ESS Thecoma and cellular fibroma Stromal tumors with minor sex cord elements Large solitary luteinized follicle cyst of pregnancy Yolk sac tumor
38
Adult granulosa cell tumors vs juvenile granulosa cells tumors
AGCTs: perimenopausal women, somatic FOXL2 mutation, solid and cystic, many patterns with prominent grooving, low mitotic rate - SF1+ WT1+ CD99+ CD56+ inhibin+/-, calretinin+, FOXL2+ - EMA negative JGCTs: mean pt age 13, rarely associated with Maffucci, Ollier, DICER, TSC - Nodular or diffuse, widely variable nuclear atypia, hyperchromatic, rarely grooved, rare Call-Exner bodies - Presence of immature follicles - variable mitotic rate, higher than AGCTs - SF1+ WT1+ EMA+ CD99+
39
What to do with an immature teratoma at frozen section
Indicate to surgeon that immature component is seen and grade if possible Indicate if any other GCT component is present
40
Most common immature component in an immature teratoma
Immature neuroepithelium
41
WHO grading of immature teratoma
Graded based on amount of immature neuroepithelium Grade 1: At most 1 4x field on any slide Grade 2: 1-3 4x fields Grade 3: >3 4x fields
42
Prognosis of immature teratoma
Depends on stage and grade of primary and any metastatic tumor 5 year overall survival >90%
43
Reporting parameters for immature teratoma
Procedure Specimen integrity Primary tumor site Ovarian surface involvement Tumor size Presence of other germ cell components Presence of other malignancy arising from teratoma Histologic grade Implants Extent of extraovarian involvement Peritoneal ascitic fluid Pleural fluid Regional LNs Pathologic stage classification
44
Types of malignancy that can arise from teratomas
Any type of malignancy an arise from the different cell lineages Most common is SCC
45
Tumors in female genital tract that can have heterologous elements
Teratoma Carcinosarcoma Endometrioid adenocarcinoma Adenosarcoma Sertoli-Leydig cell tumor Gynandroblastoma
46
Histologic patterns of yolk sac tumors
Microcystic or reticular Endodermal sinus Solid Alveolar-glandular Polyvesicular vitelline Myxomatous Papillary Microcystic
47
IHC for ovarian GCTs
Yolk sac tumor: SALL4+ AFP+ CAM5.2+ Glypican-3+ - OCT4- D2-40- CD117+/- Dysgerminoma: SALL4+ OCT4+_ CD117+ D2-40+ - AFP- CK- (or weak) Embryonal CA: SALL4+ OCT4+ CAM5.2+ CD30+ - CD117- D2-40- Choriocarcinoma: SALL4+ B-HCG+
48
Yolk sac tumor vs clear cell carcinoma of ovary on histology
Both: can be tubulocystic, papillary, solid with clear cytoplasm and hyaline globules YST: No association with endo, more crazy patterns possible, schiller-duval bodies CCC: Hobnail, cuboidal cells, stromal hyalinization and myxoid stroma, can have eosinophilic cytoplasm
49
Common types of salpingitis, their etiology and complications
Acute salpingitis - young females with ascending infection (chlamydia and gonorrhea) or polymicrobial PID. Complications of infertility and ectopic pregnancy Chronic salpingitis - resolving acute salpingitis, Complicated by hydrosalpinx Granulomatous salpingitis - TB, fungal, Crohns, Sarcoid. Complications infertility and ectopic preg Salpingitiis isthmica nodosum - young females, unclear etology. Complications infertility and ectopic preg
50
Significance of FTs in origin of ovarian CA
FT may be primary source for a significant number of HGSCs involving ovary, FT, peritoneum 50% of cases with pelvic serous CA have STIC lesion
51
Morphological and IHC features of STIC
Discretely different population of epithelial cells replacing the normal tubal mucosa Epithelial stratification Increased NC ratio wtih rounded hyperchromatic nuclei, loss of polarity, prominent nucleoli Absence of ciliated cells Increased mits, possibly with abnormal mits Abnormal p53 and increased Ki67
52
p53 signature lesion vs tubal intraepithelial lesion and clinical significance
p53 sig lesion has at least 12 consecutive morphologically benign but abnormal p53 IHC with low Ki67 Tubal intraepithelial lesion in transition (TILT) has abnormal p53 IHC with features intermediate between p53 signature and STIC
53
Pathological changes or complications associated with IUDs
Actinomyces infection Endometritis Squamous metaplasia Uterine perforation or laceration (rare)
54
Types of endometrial metaplasia
Tubal Squamous Eosinophilic Mucinous Papillary syncytial Papillary Hobnail Secretory
55
Nonmalignant causes of uterine bleeding
Pregnancy Atrophy Anovulatory cycles Exogenous hormone use Benign neoplastic
56
Causes of hyperestrogenic state
Exogenous estrogens such as estrogen replacement therapy Endomgenous hyperestrogenism such as polycystic ovarian syndrome Obesity (peripheral conversion of androgens to estrogens) Estrogen secreting tumor, such as ovarian functional granulosa cell tumor
57
WHO classification of endometrial hyperplasia and risk of developing carcinoma for each
Hyperplasia without atypia: 3-4x increased risk Atypical hyperplasia: 14x Endometrial intraepithelial neoplasia: 45x
58
DDx of endometrial hyperplasia
DDx: well diff adenoCA, secretory endometrium, endometrial polyp, metaplsaia, endometrial gland and stromal breakdown
59
Endometrial hyperplasia vs well diff CA
Architecture - CA has higher complexity with solid areas, fused glands, cribriform glands, desmoplastric stroma Cytology - not really helpful
60
Precursor lesion for endometrial serous carcinoma and its histologic/IHC features
Serous endometrial intraepithelial CA: often on surface of polyp or lining preexisting endometrial glands in background of atrophic endometrium, composed of cwells with marked cytologic atypia IHC: p53 abnormal, increased Ki67, p16 diffusely pos or completely null
61
DDx polypoid lesion of endometrial cavity
Benign endometrial polyp Secretory endometrium Atypical polypoid adenomyoma Polyp with atypical hyperplasia or EIN Adenosarcoma Polyp with area of carcinoma Carcinosarcoma
62
Clinical presentation and implications of diagnosis for atypical polypoid adenomyoma
Occurs in premenopausal and nulliparous females and may be associated with infertility High recurrence rate if incompletely excised Risk of developing endometrioid adenocarcinoma similar to AEH
63
Hereditary syndromes that cause familial endometrial carcinoma
Lynch syndrome Cowden syndrome Li-Fraumeni
64
Why screen for Lynch in pts with endometrial CA and how is screening done
Lifetime risk for endometrial CA up to 60%, may be sentinel cancer that develops before CR FHx alone has poor predictive value Pts should be considered for genetic counselling IHC: MLH1, PMS2, MSH2, MSH6
65
WHO histologic classification of endometrial CA
Endometrioid adenocarcinoma, NOS - POLE mutated - MMRd - p53 mutated - NSMP Mucinous CA, intestinal type Serous CA Clear cell adenoCA Mixed cell carcinoma Mesonephric-like adenocarcinoma SCC Undiff Carcinosarcoma
66
Define Mixed carcinoma in endometrial setting
Two or more distinct subtypes of endometrial CAs identified in which at least one component is either serous or clear cell - dediff carcinoma and carcinosarcoma are excluded Can also apply to any percentage of high grade carcinoma Major and minor types should be specified
67
When to classify endometrial tumors as "carcinoma, subtype cannot be determined"
High grade tumor with ambiguous features (histology and IHC)
68
Reporting criteria for endometrial CA resections
Procedure and specimen integrity Tumor size, histologic type, grade Myometrial invasion Involvement of Uterine serosa, LUS, cervical stroma, other tissues/organs, ascitic fluid LVI Margins Regional LNs Distant Mets AJCC stage vs FIGO stage
69
Importance of reporting procedure and specimen integrity
Some laparoscopic procedures may result in venous tumor emboli that are likely iatrogenic Unexpected endometrial CA in morcellated specimens can risk spreading tumor cells to pelvis and peritoneal cavity Different procedures may have different margins
70
Grading methods for common types of endometrial tumors
Endometrioid uses FIGO - FIGO 1: at most 5% nonsquamous solid growth - FIGO 2: 6-50% solid - FIGO 3: >50% solid - if severe nuclear atypia, upgrade by 1 though consider serous Mucinous CA uses FIGO Serous, clear cell, small cell, large cell NEC, undiff, dediff, carcinosarcoma - high grade by definition Mixed CA: highest grade should be assigned
71
Types of endometrial CA associated with poor prognosis
Serous carcinoma Clear cell carcinoma Undifferentiated CA Dediff CA Carcinosarcoma Small cell and large cell neuroendocrine CA
72
Histologic prognostic factors in endometrial CA limited to uterine corpus
Tumor type Tumor grade LVI Depth of myometrial invasion
73
AJCC T staging for endometrial CA
pT1a: limited to endometrium or invading <1/2 myometrium pT1b: Involving 1/2 or more of myometrium pT2: Invading stromal connective tissue of cervix pT3a: Involving serosa/adnexa pT3b: Vaginal or parametrial involvement pT4: Bladder or bowel mucosa
74
AJCC N staging for endometrial CA
pN0(i+): ITCs 2mm pN2: mets to paraaortic LNs pN2mi: 0.2 - 2.0 mm pN2a: >2mm
75
Histologic subtypes of leiomyoma
Cellular Mitotically qactive Epithelioid Myxoid With sympastic change Lipoleiomyoma FH-deficient Hydropic Apoplectic Dissecting Diffuse leiomyomatosis
76
Gross features of leiomyoma vs leiomyosarcoma of uterus
Leiomyoma - range widely in size, usually multiple, sharply circumscribed and unencapsulated, firm white whorled cut surface, with or without degeneration Leiomyosarcoma - Larger size, usually single, poorly circumscribed/demarcated, hemorrhagic, soft/necrotic "fish flesh" texture, locally invasive growth
77
Histologic criteria for spindle cell type leiomyosarcoma
2/3 of: - Diffuse moderate to severe cytologic atypia - True tumor cell necrosis (coagulative) - Increased mits ( at least 10/10 hpf)
78
Histologic criteria for epithelioid cell type leiomyosarcoma
2/3 of: - Diffuse moderate to severe cytologic atypia - True tumor cell necrosis (coagulative) - Increased mits ( at least 4/10 hpf)
79
Histologic criteria for myxoid leiomyosarcoma
Predominantly myxoid smooth muscle tumor with significant cytologic atypia or tumor cell necrosis AND >1 mit/10hpf
80
Define STUMP
Smooth muscle tumor of uncertain malignant potential - Uncertainty of type of smooth muscle differentiation - Uncertainty of benign behaviour due to lack of adequate clinicopathologic information - Uncertainty of mitotic index - Uncertainty of presence of type of tumor necrosis
81
Gross features of endometrial stromal tumors
ESN: well-circumscribed yellow/soft, usually solitary LGESS: poorly circumscribed/demarcated, diffuse permeative growth, intravascular tumor plugs HGESS: bulky, intracavitary or intramural, tan-yellow, fleshy masses, often hemorrhage/necrosis Undiff uterine sarcoma: large intracavitary or intramural, tan-yellow, fleshy masses with hemorrhagic/necrosis
82
Histologic features of endometrial stromal nodule
Circumscribed At most 3 fingerlike projections <3mm from margin Bland round to oval small cells with scant cytoplasm, inconspicuous nucleoli
83
Histologic features of LGESS
Similar cytology to ESN but >3 fingerlike projections >3mm Permeative growth with LVI Can have necrosis Low mitotic activity
84
Histologic features of HGESS
Permeative, infiltrative growth, LVI, high mitotic rate, necrosis Nests of round cells with eosinophilic cytoplasm, high grade nuclei, scant to moderate cytoplasm
85
Histologic features of undiff uterine sarcoma
Destructive pattern of invasion, sheets of uniform or pleomorphic epithelioid and/or spindled cells Brisk mitotic activity, easily identified necrosis, LVI
86
IHC LGESS vs HGESS
LGESS: ER+ PR+ CD10+ SMA+ HGESS: Cyclin D1+ CD117+ CD99+ CD10- ER/PR-
87
T-staging for uterine sarcoma
pT1: limited to uterus pT1a: at most 5 cm in greatest dimension pT1b: >5cm pT2a: involves adnexa pT2b: involves other pelvic tissues pT3a: infiltrates abdominal tissues in one site pT3b: infiltrates abdominal tissues in >1 site pT4: invades bladder or rectum
88
Classification of epithelial-mesenchymal uterine neoplasms
Carcinosarcoma - poor prognosis Adenosarcoma - low malignant potential, poor prognosis if recurrent Carcinofibroma - uncertain prognosis as uncommon Adenofibroma - Benign, may recur Adenomyoma - benign, may recur
89
Define sarcomatous overgrowth in uterine adenosarcoma
Presence of pure sarcomas, usually high grade and without epithelial component, occupying at least 25% of tumor
90
Types of GTD
Hydatidiform mole - Complete - Partial - Invasive Nonmolar lesions - placental site trophoblastic tumor - Epithelioid trophoblastic tumor - Gestational choriocarcinoma - Benign trophoblastic lesions -- Exaggerated implantation site reaction -- Placental site nodule/atypical placental site nodule -- mixed trophoblastic tumors
91
Hydatidiform mole complete vs partial
Complete: empty ovum, diploid, markedly increased B-HCG, "snow storm" U/S, large edematous villi with circumferential trophoblastic proliferations, trophoblastic atypia, no fetal parts, p57- in villous cytotrophoblasts and villous stromal cells Partial - Normal ovum, triploid, normal to mod increased B-HCG, Uterus small for dates, 2 populations of villi (changes lesser than complete), trophoblastic atypia absent, fetal parts present, p57+
92
Cause of complete mole
Fertilization of empty ovum by 2 sperm or by 1 sperm with duplication
93
Cause of partial mole
Fertilization of normal haploid ovum by 2 sperm with haploid set of chromosomes or by a sperm with diploid set (diandric)
94
Treatment and prognosis for molar pregnancy
After evacuation, serial B-HCG to monitor for development of persistent GTD Risk for persistent GTD: 15-20% complete, 0.5-5% for partial Risk of chorioCA: 2-3% complete, <0.5% partial
95
Most common type of persistent GTD after molar pregnancy
Invasive mole
96
Hydatidiform mole vs hydropic abortus
Clinical presentation, B-HCG, rads Morphology: Hydropic abortus - no gross abnormality, smooth villi with nild hydrops, no sig trophoblastic prolif, no atypia, no trophoblastic inclusions p57 IHC - present in hydropic abortus Ploidy - diploid DNA microsatellite marker analysis
97
Histology and IHC for placental site trophoblastic tumor
Histology - large, pleomorphic implantation-site intermediate trophoblastic cells forming confluent sheets or single cells, with infiltrative growth, scattered multinucleated cells,low mits, vascular invasion, fibrinoid deposits and dissection of smooth muscle IHC: hPL++, CD10+, MUC4+, p63-, Ki67 10-30%
98
DDx of placental site trophoblastic tumor
Exaggerated placental site Choriocarcinoma SCC, undifferentiated carcinoma Epithelioid trophoblastic tumors Epithelioid smooth muscle tumor Placental site nodule and plaque
99
Prognosis for placental site trophoblastic tumor
25-30% of pts develop recurrent disease or mets and about half of those may die of disease
100
Poor prognostic features for placental site trophoblastic tumor
Clear cytoplasm Deep myometrial invasion Large tumor size Necrosis High mitotic count Advanced stage At least 48 months since antecedent pregnancy Age >40
101
Placental site trophoblastic tumor vs epithelioid trophoblastic tumor
PSTT: implantation-site intermediate trophoblasts similar to exagerated placental site ETT: chorionic type intermediate trophoblasts, similar to placental site nodule Both have similar clinical presentation and patient prognosis
102
IHC for trophoblastic lesions
Placental site nodule: p63+, low Ki67, focal Cyclin E placental site trophoblastic tumor: HPL+ mod ki67, CD146+ Epithelioid trophoblastic tumor: p63+ CyclinE+, mod Ki67 Choriocarcinoma: HPL+ HCG+, High Ki67
103

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