Path Pt 5: Gestation and Placenta Flashcards
what is the most common cause of hematosalpinx (blood-filled fallopian tube), and should always be suspected when a tubal hematoma is present?
tubal pregnancy
initially, the embryonal sac, surrounded by immature chorionic villi, implants within the lumen of the fallopian tube. Then what do trophoblastic cells and chorionic vili do?
invade the wall of the fallopian tube as they would do in the uterus during normal pregnancy
- with time, the growth of the gestational sac distends the fallopian tube, causing thinning of the wall and rupture
what does the rupture frequently result in?
massive intraperitoneal hemorrhage, which sometimes is fatal
- less commonly, the tubal pregnancy may undergo spontaneous regression and resorption, or be extruded through the fimbriated end of the tube into the abdominal cavity
what are the 4 microscopic changes seen in the placenta during preeclampsia?
- infarct (larger and more numerous than a normal pregnancy)
- exaggerated ischemic changes (increased synctial knots)
- frequent retroplacental hematomas (due to bleeding and instability of uteroplacental vessels)
- abnormal decidual vessels (may show thrombi)
when present, these lesions take the form of irregular, focal, subscapular, and intraparenchymal hemorrhages
- on histo, there are fibrin thrombi in the portal capillaries and foci of hemorrhagic necrosis
liver lesions during preeclampsia
these lesions are variable
- the glomeruli show marked swelling of endothelial cells, amorphous dense deposits on the endothelial side of the basement membrane, and mesangial cell hyperplasia
- immunofluorescent studies show an abundance of of fibrin in the glomeruli (in advanced cases, fibrin present in glomeruli and capilaries)
kidney lesions during preeclampsia
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if widespread and severe, thrombi in the gloeruli of the kidney’s can produce complete destruction of the cortex in a pattern referred to as what?
bilateral renal cortical necrosis
this organ may have gross or microscopic foci of hemorrhage along with small-vessel thromboses
brain during preeclampsia
- similar changes are often found in the heart and the anterior pituitary gland
the classic appearance is that of a delicate, friable mass of thin-walled, translucent, cystic, grape-like structures consisting of swollen edematous (hydropic) villi
hydatidiform mole
which type of mole do the microscopic abnormalities involve all or most of the villous tissue?
a complete mole
in a complete mole, the chorionic villi are enlarged, scalloped in shape with central cavitation (cisterns) and are covered by extensive trophoblast proliferation that involves the entire circumference of what?
the villi
what is seen in a partial mole?
only a fraction of the villi are enlarged and edematous
- the trophoblastic hyperplasia is focal and less marked than in complete moles
a soft, fleshy, yellow-white tumor that usually has large, pale areas of necrosis and extensive hemorrhage
- histologically, it does not produce chorionic villi and consists entirely of proliferating syncytiotrophoblasts and cytotrophoblasts
- mitoses are abundant and sometime abnormal
choriocarcinoma
what does a choriocarcinoma invade?
the underlying myometrium, frequently penetrating blood vessels, and in some cases it extends out into the uterine serosa and into adjacent structures
these tumors comprise less than 2% of gestational trophoblastic neoplasms
- extravillous trophoblasts that are also called intermediate trophoblasts
- they present as a uterine mass, accompanied by either abnormal uterine bleeding or amenorrhea and moderately elevated hCG
- malignant trophoblastic cells diffusely infiltrating the endomyometrium
placental site prophoblastic tumor (PSTT)
