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RGU Exam 2 > Placental Pathology > Flashcards

Placental Pathology Flashcards

1
Q

Placenta previa

A
  • Placenta implants on the lower uterine segment or the cervix
  • It may completely cover the internal cervical os and can cause fatal hemorrhage during the delivery of the fetus and a cesarean section must be performed
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2
Q

Placenta accreta

A
  • Caused by partial or complete absence of the decidua
  • The villi adheres directly to the mayometrium thus preventing placental separation at birth
  • May result in massive placental bleeding at birth
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3
Q

Placental infections

A
  • Can occur by the ascending or hematogenous routes

*ascending: thru the birth canal

*hematogenous route: transplacental route

  • Ascending are more common and are usually bacterial in origin and may lead to premature rupture of the membranes and preterm delivery
  • Amniotic fluid may be cloudy w/ a purulent exudate
  • The chorion-amnion has a polymorphonuclear cell infiltrate w/ edema and congestion of the vessels
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4
Q

TORCH infections

A
  • Placental infections
  • Infections of toxoplasmosis, rubella, cytomegalovirus, herpes simplex, may have syphilis, TB or listeriosis
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5
Q

Chronic villitis

A
  • May be assoc. w/ intrauterine growth retardation and stillbirths
  • Cause unknown but may be linked to unknown organisms or abnormal immune reactions
  • Found in 1-9% of all placentas
  • May be assoc. w/ chronic chorioamnionitis
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6
Q

Inflammation of the placental maternal side histology

A
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7
Q

Inflammation of the umbilical vessels histology

A
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8
Q

Listeria infection w/ necrotizing villitis

A
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9
Q

Acute funisitis

A
  • Acute inflammation of the umbilical cord
  • Sign of fetal inflammatory response
  • Begins as a discrete multifocal process which will coalesce
  • See acute inflammation of the umbilical cord
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10
Q

Funisitis histology

A
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11
Q

Placental infarct

A
  • Area of villous necrosis due to local obstruction of the maternal uteroplacental circulation
  • Fresh infarct is dark red and firmer than surrounding tissue
  • Crowding of villi w/ congestion of the villous vessels
  • Older lesions appear as a hard, white mass of granular appearance and ghost villi
  • May be caused by abruptio placentae
  • Infarcts may increase in number and severity in cases of preeclamptic toxemia, hypertension, Rh incompatibility
  • High number of infarcts are assoc. w/ a high incidence of neonatal asphyxia, low birth weight and intrauterine demise
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12
Q

Old placental infarct gross appearance

A
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13
Q

Ghosts of chronic villi in an infarct histology

A
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14
Q

Gestational trophoblastic disease

A
  • Group of diseases related to normal or abnormal gestation
  • Common denominator is the proliferation of the trophoblast
  • Disorders differ in appearance and clinical significance:

*complete mole

*partial mole

*invasive mole

*choriocarcinoma

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15
Q

Complete mole

A
  • Caused by abnormal gametogenesis and fertilization
  • Nuceli contain only paternal chromosomes
  • Cytoplasmic DNA is maternally derived
  • Most cases have a normal chromosomal number
  • Most cases are 46XX, the remainder are 46XY
  • Greater incidence in South-east Asia
  • Uterus is dispropotionately large for the stage of pregnancy
  • Serum hCG levels continue to rise after the 14th week
  • Evidence of toxemia is often found such as hypertension, edema, albuminuria
  • Hyperthyroidism develops from the thyroid stimulating effects of the molar tissue
  • Vaginal bleeding may be present
  • Grossly looks like a “bunch of grapes”
  • Swollen villi distend the uterus
  • Usually see no identifiable embryo, cord or amniotic membranes since the embryo dies so early in development
  • Microscopically have trophoblastic hyperplasia and vesicular swelling
  • hCG and PLAP present in tissue
  • Lack p57 which is a cell cycle inhibitor seen in partial moles
  • Expression of myc, ras and sis
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16
Q

Complete mole with swollen villi gross appearance

A
17
Q

Complete mole gross appearance

A
18
Q

Complete mole-villi in myometrium histology

A
19
Q

Complete mole with stromal edema and trophoblastic reaction

A
20
Q

Partial moles

A
  • Accounts for 15-35% of all moles
  • Unlike a complete mole this is often assoc. w/ the presence of an embryo
  • Volume of placental tissue is relatively normal w/ some vesicular villi
  • Many of the villi have an irregular scalloped outline w/ vessels containing mucleated fetal red blood cells
  • Fibrosis of the villous stroma is common
  • Trophoblastic proliferation is present
  • Pos. for p57
  • Most are triploid (69XXX or 69XXY)
  • Serum hCG levels are elevated but tend to be relatively low
  • Risk of development of choriocarcinoma is low
21
Q

Partial mole with fetus gross appearance

A
22
Q

Partial mole with scalloping of villi histology

A
23
Q

Invasive mole

A
  • A mole, usually a complete mole, where the villi penetrate deeply into the myometrium and/or its blood vessels
  • The penetration may lead to significant hemorrhage
  • Uterine perforation may occur
  • Vascular invasion may cause trophoblastic nodules to travel outside the uterus to the lungs, brain or spinal cord
  • These nodules may in turn hemorrhage
  • Differentiated from a usual mole in that it invades the myometrium
  • Differentiated from a choriocarcinoma in that it contains villi
24
Q

Choriocarcinoma

A
  • Most aggressive form of gestational trophoblastic disease
  • Most cases occur following a complete mole
  • Forms soft red, hemorrhagic, round nodular tumor masses
  • Clusters of cytotrophoblast separated by masses of syncytiotrophoblast resulting in a dimorphous pattern
  • Hemorrhage and necrosis is present
  • Villi are absent
  • Cells are pos. for hCG and keratin
  • If untreated it metastasizes via the hematogenous route to the bowel, lung, brain, liver and kidney
  • With appropriate therapy the cure rate is high
25
Q

Choriocarcinoma gross appearance

A
26
Q

Syncytiotrophoblasts and cytotrophoblasts histology

A
27
Q

Placental site trophoblastic tumor (PSTT)

A
  • Rare form of trophoblastic disease
  • ~75% of cases follow a normal pregnancy
  • 5% have had a previous molar pregnancy
  • Presents as a myometrial mass which may be well defined or ill defined
  • Uterine penetration is deep and perforation can occur
  • Contain large trophoblastic cells w/ abundant eosinophilic cytoplasm and nuclear pleomorphism
  • Invades the myometrium and blood vessels
  • Hysterectomy is usually an adequate treatment but some may be lethal
28
Q

PSTT - cells in myometrium histology

A
29
Q

PSTT gross appearance

A

RGU Exam 2 (21 decks)

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