Placenta

Question 1

Hydatidiform moles treatment

Answer 1

uterus evacuation AND serial B-hCG titers

If B-hCG titers plateau or increase&raquo_space; gestational trophoblastic neoplasia dx + chemo (clinical diagnosis & staging)

Question 2

Partial hydatidiform mole

Answer 2

Diandric (paternal) triploidy

Higher risk of progression to gestational trophoblastic neoplasia (vs. complete moles)

Most commonly present as missed abortions, and may be missed by both clinician and pathologist

Shows less trophoblastic proliferation than complete moles

Question 3

Placental site trophoblastic tumor

Answer 3

Commonly after a term pregnancy

Composed entirely only of intermediate trophoblasts

Histology:

• monotonous - eosinophilic to amphophilic cytoplasm
• wrinkled and hyperchromatic nuclei - LVI common
• chorionic villi and syncytiotrophoblasts are absent
• deep myometrial invasion with splitting of muscle fibers
• Less hemorrhage and necrosis than choriocarcinoma

Positive for human placental lactogen

Tx: hysterectomy; however some are very aggressive