Repro Pathology Flashcards
Woman presents to your office with vaginal discharge after having unprotected intercourse 3 months earlier. On physical exam there is some adnexal tenderness and a purulent discharge from the cervix. A sample culture from her vagina reveals the following:
What is her diagnosis and how should she be treated?
N. gonorrhea causing PID (recovered in 30-80% of cases)= gram-negative coccus in pairs. Produces endotoxin which attaches to fallopian tube–> narrowed lumen
- 700,000 new cases per year (15% progress to PID)
- Treatment: Ceftriaxone 125 mg dose (plus treatment for Chlamydia if no patient follow-up/ additional infection)
- Alternative: azithromycin 2 gm single dose
A newborn baby presents with conjunctivitis and pneumonia. The mother additionally has swollen Bartholin glands and acute urethritis. Upon physical exam of the mother there is a mucopurulent discharge from her cervix. A pap smear reveals the following:
What is her diagnosis and treatment and what are the complications of this infection?
Chlamydia trachomatis= most commonly reported STD (1 million cases/year). Obligate intracellular parasite; attaches to cervical cells and causes mucorpurulent discharge.
- Leading cause of acute PID. Ascending inflammation causes fibrotic changes in tube.
- Treatment= Doxycycline (100 mg BID x 7 days); Azithromycin (1 gm po single dose); Erythomycin (500 mg QID x 7days)
A woman comes to your office for her annual pap smear and you notice a large red lesion on her cervix. Your patient reports she has had unprotected sex in the last two months. When you ask the patient if she has had any discomfort during sex, she denies any discomfort in the urogenital region. You take a sample of the lesion and find the following:
What is the diagnosis, how is it treated and what are the complications?
Treponema pallidum (syphillis): initial lesion occurs at site of contact and is painless (chancre), causing vulvar, regional lymphadenopathy (3 weeks post-contact).
6 weeks to 6 months after chancre: Can lead to systemic symptoms, lesions (condyloma lata- shown below) which are highly infectious.
Tertiary syphillis can cause CV and CNS complications (can lead to death).
Diagnosis: corkscrew treponema pallidum, serology screen (VDRL/RPR), definitive testing (FTA-ABS/MHA-ATP)
Treatment: < 1 year= benzathine penicillin (tetracycline if allergic); must desensitize allergic patient if pregnant (tetracycline/doxycycline contraindicated in pregnancy)
A woman presents to your office with warty “cauliflower-like” painless lesions on her labia. She reports that she has used protection during sexual intercourse. What is her diagnosis and treatment? What are the major complications of this infection and how is it prevented?
Human papilloma virus.
Serotypes 6 + 11 cause genital warts: henign, exophytic; referred to as condyloma accuminatum (image). Babies born to women with active infection can develop respiratory tract papilloma
Serotypes 16, 18, (+31, 33, 45) can cause malignancies; express proteins that shut down cell regulation (need both to shut off to lead to malignancy). E6= p53, E7= pRb.
70% of cervical/vaginal, 80% anal, 40-50% vulvar malignancies caused by 16 and 18.
Prevention: HPV vaccine, no sexual contact
Treatment for external lesions: patient applied podofilox, imiquod; practicioner applied TCA, podophyllin, surgical removal
Treatment for cervical lesions= ablation (cryosurgery), excision (electrocautery), cold knife
A woman presents to your office with a low grade fever and an extremely painful cluster of blisters on her labia and around her vagina. She reports having unprotected sex with a new partner 1 week ago, but states that he didn’t have any visible sores or marks on his genitalia. What is the diagnosis, treatment, and complications?
Herpes simplex virus type 2 (more common on genitalia than Type 1. Most common STD in USA (50 million cases, 1 million new per year). 90% of carriers unaware they have the disease (can shed when not in active outbreak). Active outbreaks indicate C-section for delivery (or suppression if possible)
Testing: Culture misses most cases; PCR most accurate (not approved as test in USA)
Primary outbreak= parasthesias of vulvar skin, painful shallow lesions, generalized malaise, fevers, 3-7 day incubation period
Treatment: Acyclovir (400mg 3x/day for 7 days), Famciclovir (2540 mg 3x/day for 7 days) or Valacyclovir (1 g 2x/day for 7 days)
Recurrent outbreak: less severe, related to stress, menses, etc (50% of cases recur in 6 months). Must treat within 1 day of symptoms/prodrome for treatment to benefit.
Treatment: more than 6 occurences per year (decreases outbreaks by 75%)
Lymphatic drainage of female genitalia:
Vulva
Vagina
Uterus
Vulva, distal 1/3 vagina= inguinal
Proximal 2/3 vagina, uterus= internal
* Patterns of infection spread, metastatic spread vary based on lymphatic drainage
Normal vulva skin
A post-menopausal woman comes to your clinic complaining of dyspareunia (pain on sex) and vaginal dryness and itchiness. On clinical exam, her external genitalia appears dry, there is pigmentation loss, and evidence of scratching. What is her diagnosis, what is the treatment, and what are the complications of her condition?
Lichen sclerosis: inflammatory disorder of vulva, seen mostly in post-menopausal women. Associated with autoimmune disorders (vitiligo, pernicious anemia, thyroiditis). See whitish plaques, atrophy, parchment-like skin.
Histology: hyperkeratosis of vulvar skin, loss of rete ridges, devleopment of acellular homogenous zone of superficial dermis
Treatment: topical steroids (for itching), lubricant (for intercourse), topical estrogen cream
Complications: 15% risk for subsequent squamous cell carninoma of vulva
A woman with a recently diagnosed STD comes to your office complaining of swelling and pain in her labia. On exam you notice swelling on her labia near the introitus. What is your diagnosis and treatment?
Bartholin gland cyst: Bartholin glands produce mucoid secretions to lubricate vestibule. May become obstructed, secondarily infected with STD (chlamydia, e. coli, staph) and form abcess.
Treatment: Incision, drainage, antibiotics
An older woman is referred to your for biopsy of vulvar tissue (below). What is the condition and what may have caused it? What are the complications?
Vulvar intraepithelial neoplasia: preneoplastic condition that can lead to squamous cell carcinoma
3% of all gyn cancers, typically seen in women >60 years
70% unrelated to HPV (like this example) more likely to progress to carcinoma than HPV-type
~25% related to HPV (below) serotype 16. See koilocytes, warty basaloid cancer (caused by “high risk” HPV 16)
Grading system: I= mild (least atypia), II= moderate, III= severe (but still non-invasive)
A non-sexually active post-menopausal woman presents with a lesion on her vulva (pictured below). Based on histology, what is her diagnosis, and what may have caused this?
Vulvar squamous cell carcinoma: tumors exophytic or ulcertive (can invade neighboring structures- vagina, rectum). Can spread to inguinal, femoral, pelvic lymph nodes.
See keratin pearl formation
*Verrucous carcinoma= caused by HPV 6 or 11; well-differentiated, grows slowly, better prognosis
An older woman comes to your office complaining of an itching/burning sensation in her vagina with no history of recent sexual contact. On exam, the skin appears red, moist, and there is a sharp demarcation between affected and unaffected skin. What does she have and what are her risk factors?
Extramammary Paget Disease: seen in older women. Histology: large, atypical cells with abundant clear cytoplasm (abundant mucin)- infiltrate adnexa and skin.
*Rarely associated with underlying carcinoma
A mother is very concerned about her 2 year old girl that she has brought to your clinic. She says that while changing her diaper she noticed some bleeding, redness and swelling around her daughter’s vagina. You examine the girl and find the following:
What is your diagnosis and how is it treated?
Embryonal rhabdomyosarcoma: rare condition presenting in girls under 4 years. See vaginal bleeding.
Tumor= polypoid, derived from mesenchymal cells; spindle cells containing cross-striations (histology) indicating skeletal muscle origin
Tumor can metastasize- need to treat with radical surgery, chemotherapy
You recieve the following tissue biopsy from a 75 year old woman. The biopsy was taken from the upper third of her anterior vaginal wall. What is your diagnosis and what is the prognosis?
Vaginal squamous cell carcinoma= most common malignancy of the vagina (90%). Often arises from pre-existing vaginal intraepithelial neoplasia (VAIN).
Peak incidence in 70s and 80s
May correlate to HPV infection
Prognosis is related to timing of diagnosis (staging)
Normal Ectocervix
A young woman is in your office for a pap smear. Upon examining the cervix, you note that it is hyperemic and has points of focal erosion. On histologic specimen, this is what you see:
Chronic cervicitis: chronic exposure to bacteria in the vagina (STDs). Mucosa hyperemic, focal erosion visible, lymphocytes and plasma cells with germinal centers, squamous metaplasia.
*Infection can eventually invade glandular tissue
Endocervix: note glands (beyond transition zone)
This is where HPV infections can penetrate into the cervix (no squamous epithelium blocking passage into basal cells where HPV infections live
Here is a histologic sample of the cervix of a sexually active young woman. What is notable about the sample?
Koilocytes from HPV infection: HPV has invaded basal cells. Crinkled, irregular nuclei with “normal maturation” of cells. Contrasting from normal:
A woman presents to your office with a slightly bloody vaginal discharge. Upon examination you notice there seems to be small nodules within the endocervix. What is your diagnosis?
Endocervical polyps= benign, arising within endocervix; can cause vaginal bleeding or discharge. Polyps lined with mucinous columnar epithelium with foci of squamous metaplasia, mucosal erosion
Treatment: excision, curettage
A pathologist has just recieved a sample from a young sexually active woman who had a biopsy of her endometrium taken following concern about irregular bleeding. The pathologist is confused about the prognosis of the individual based on the histologic sample. What information was he not given?
Microglandular hyperplasia= benign but often confused with well-differentiated adenocarcinoma. Normal in pregnancy or when taking OCP (progesterone enhanced states).
Closely packed glands with no intervening stroma, neutrophilic infiltrate
The following sample was taken from the cervix of a 35 year old woman. What is the diagnosis and treatment?
Cervical in situ neoplasia: Squamous neoplasia arizing at the squamocolumnar junction (transformation zone)
Invasiveness peaks between age 40 and 60, while in-situ (CIN) is in patients under 40
The most common cause is HPV infection (16 and 18), correlating with multiple partners and early age of coitus, cigarette smoking. HPV in 70% invasive squamous carcinomas
Low grade CIN= episomal virus replicates and accumulates in cytoplasm–> koilocyte; causes cell death
- see clearing of cytoplasm, minimal atypia of nucleus
High grade CIN (below)= virus integrates into genome–> viral protein production–> inactivation of tumor suppressor genes (p53 and pRb) * takes ~ 10 years to progress from low to high grade
- prominent nuclear atypia, full thickness maturation abnormalities
Treatment: culposcopy/removal of lesion tissue to prevent progression
Prognosis: 90% survival in developed nations
What is the concern regarding the histologic specimen below?
Microinvasive carcinoma: small nests of cells just barely penetrating epithelial basement membrane. Can invade vessels or metastasize to lymph nodes.
A woman presents to your office for a pap smear after not having one for 10 years. She noticed some bleeding and discomfort with intercourse. Upon exam, you find the following:
Fully invasive carcinomas are exophytic/ ulcerating, and can be keratinizing or non-keratinizing. It can invade adjacent structures (parametrium, bladder, rectum) causing ureter obstrauction and fistula formation. Lymph spread to paracervical, hypogastric, external iliac lymph nodes
Following a diagnosis of cervical cancer, a biopsy is taken from a 60 year old woman and the following histopathology is found. What has occured and what is the prognosis?
Adenocarcinoma: typically arives from the transition zone and extend into endocervical canal. High grade CIN is present in ~40% of cases.
Survival rates are lower than squamous cancers.
Mean age= 56 years
Liquid-based normal pap smear
Pink= superficial
Blue= deeper cells
Dark blue= glandular cells
Pap smear (normal) slide
Atrophic cervical tissue on pap slide (basilar cells prominent- can also be sign of neoplasia in younger patients)
cervical gland tissue sample
Liquid-based cervical gland prep
A sexually active woman comes to your office complaining of a frothy-green discharge and vulvar irritation. Upon examination of her cervix, you notice red petechiae and a frothy discharge. What is her diagnosis and what is the treatment?
Trichomonas: most common curable STD in US (3 million women per year). Can cause urinary urgency, dyspareunia, puritis, strawberry cervix
Diagnosis: Unicellular protozoan flagellated parasite (sexually transmitted), seen on culture, DNA probe (PCR)
pH high (>5)
Treatment: Metronidazole 2 gm by mouth (partners must also be treated); fomites must be disinfected
* risk for preterm delivery/smaller babies increased
Candida Albicans (yeast infection): seen at any age; increased risk in poorly controlled diabetes (excess glucose in urine), recent antibiotic use, immune system suppression. Approximately 75% of women have one episode in lifetime
Diagnosis: vaginal, vulvar itch, erythema of vulva and vagina, wet mount with budding yeast/hyphae. low pH (<4)
Treatment: topical antifungal (80% effective) from azole family. Oral fluconazole (single dose)
Prognosis: 5% will have recurrent candida vulvovaginitis which can cause debilitating itching/irritation
A 35 year old woman presents to your office with a malodorous yellow discharge that she states is worse after intercourse (she states it “smells like fish”). She also reports douching after sexual intercourse. A pap smear of her vagina reveals the following:
Bacterial vaginosis “Clue cells”: normal vaginal epithelial cells covered in bacteria (due to imbalance of bacteria following douching, intercourse, etc.) Common bacterial infection is gardnerella (overgrowth)
Treatment: Metronidazole (500 mg twice a week for 5 days). Oral or vaginal clindamycin
Prognosis: Recurrent, difficult to eradicate
* Can increase risk of preterm labor or post-surgical infections in hysterectomies
Pap smear of actinomyces
Herpes Simplex Virus 2: Liquid based pap of HSV (multinucleated giant cells with inclusions, “halo” cytoplasm)
A 65 year old woman presents to your clinic complaining of difficulty enjoying sex due to dryness and intermittent bloody discharge. Her pelvic exam reveals the following vaginal wall structure. What is her diagnosis and treatment?
Atrophic vaginitis: only normal in post-menopausal women or breast-feeding post-partum women due to low estrogen levels (in younger women could be sign of malignancy due to lack of cellular development)
Diagnosis: vaginal irritation, discharge, dryness. Vagina narrowed with absence of normal ruggae, pallor of mucosa. Petechiae and lacerations may be visible. Parabasal cells on slide (loss of epidermal layers).
Treatment: Non-hormonal OTC lubricants (KY jelly), systemic ERT (premarin), local ERT (creams, tablets, rings)
Prognosis: will wax and wane over time, but eventually progresses. Not pathologic; treatment mainly for symptom control
Low grade squamous intraepithelial lesion: see koilocytes, nuclear enlargement, multinucleation, hyperchromasia, perinuclear cytoplasmic clearing/halos
Encompasses HPV, CIN (cervical intraepithelial neoplasia) 1, mild dysplasia
* 15-30% incidence of high grade lesion on colposcopy- therefore all should be evaluated. If colposcopy is same as pap, the diagnosis is CIN 1
High grade squamous intraepithelial lesion (HSIL)= immature cells, variation in size and shape of nucleus, irregular nuclear membrane, uneven distribution of chromatin
Biopsy sample shows lack of clear differentiation in layers of cells, enlarged nuclei
Encompasses moderate/severe dysplasia: CIS, CIN 2, CIN 3
* ALL should undergo colposcopic evaluation + immediate excision of transformation zone in some cases (cold knife, LEEP). 70% incidence of high-grade lesion on colposcopy, 1-2% incidence of cervical cancer
High grade squamous intraepithelial lesion (HSIL)
If woman has ASCUS (Atypical squamous cells of undetermined significance), perform hr-HPV DNA testing to determine if she has a high risk HPV type, which indicates if it will progress to HSIL. If she has high risk type, take colposcopy, which will demonstrate if presence of HSIL
Cervical squamous cell carcinoma: see keratinized dense cytoplasm, cell pleomorphism (elongated, tadpole, oval), irregular nuclear size and shape, india ink chromatin
A 45 year-old woman presents to your office with irregular menstrual bleeding. You perform endocervical curretage and endometrial biopsy and find the following:
Endocervical adenocarcinoma: glandular tissue structures demonstrating variation in size, irregular chromatin distribution, nucleoli, tumor necrosis
A 60 year-old woman presents with post-menopausal bleeding. You perform an endometrial biopsy and find the following cell types:
Endometrial adenocarcinoma: 70% present at stage 1, surgery is sufficient for treatment. 5-year 96% survival with no metastases vs 66% with metastatic spread
Endometrial lining connects to vagina- presents early. ANY post-menopausal bleeding needs to be worked up (~10% associated with endometrial cancer)
Screening: transvaginal sonography; unable to complete meaningful endometrial stripe measurement. Not used for evaluating asymptomatic patients.
Diagnosis: dilation and curettage, endometrial biopsy, hysteroscopy (small camera inside uterus)
Treatment: surgery, radiation (whole pelvic or brachytheraphy= vaginal area), oral progesterone (high failure rate), chemotherapy (only in high-grade serous tumors like ovarian cancer)
Prognosis: 85% five-year survival
* Re-screen patients who have repeated bleeding within 3 months of first evaluation
A 60 year old woman presents to your office with bloating, pelvic pain, and a sense of fullness for the past three weeks. A vaginal ultrasound reveals irregular masses in her ovaries. Biopsies are taken from her abdominal cavity and ovaries and the following sample is examined from her omentum. What is her diagnosis and prognosis?
Ovarian carcinoma: 5-year survival 40% due to late diagnosis. Only becomes symptomatic once disease has advanced and metastasized to abdominal/pelvic spaces. This sample is from the omentum, where many malignant ovarian cancers seed.
Types of ovarian tumors:
- Surface epithelial: benign (serous, mucinous or brenner), borderline (serous and mucinous), malignant (serous, mucinous, endometrioid, transitional cell)
- Germ cell: benign (dermoid cyst teratoma), malignant (dysgerminoma, yolk sac tumor, choriocarcinoma, embryonal carcinoma)
- Sex cord stromal: Benign (thecoma, fibroma), Malignant (granulosa cell, sertoli-leydig cell)
- Metastatic
1 week after delivery, a woman presents to her gynecologist with lower abdominal pain and complaints of a smelly greenish discharge from her vagina. What is her possible diagnosis (based on the histology slide) and what are the complications of this condition?
Pyosalpinx= Acute salpingitis due to ascending infection following delivery. Could be from sexually transmitted disease (Gonorrhea, chlamydia) or from delivery (streptococcus, staphylococcus, actinomyces, mycoplasma)
Chronic salpingitis–> tubular distortion, plasma cell infiltrate, lymphocytes–> PID/ impaired tubal function
A woman comes to the emergency room reporting some vaginal bleeding and lower abdominal pain. She states she is 11 weeks pregnant (confirmed by beta-hCG testing) and is concerned that she could be having a miscarriage. Upon ultrasound examination, the attending is unable to locate the fetus in utero but her beta-hCG is elevated at 12,000. What is her possible diagnosis and what steps should be taken?
Possibilities= ectopic pregnancy or hydatidiform mole. Assuming no molar pregnancy is visible on ultrasound and her beta-hCG is not extremely elevated, this is most likely an ectopic pregnancy.
On histological exam, can see traces of placental villus tissue within fallopian tube.
Treatment: surgical or methotrexate. Evaluate tubal wall in tact (trophoblasts will penetrate by 12th week.
An obese 28 year-old woman goes to a fertility clinic complaining of problems of conceiving after trying for 16 months. She states she has never had regular periods. She has acne and her fasting blood sugar is elevated. An ultrasound of her uterus and ultrasound is performed and the following image is taken. What is her diagnosis and treatment?
PCOS: polycystic ovarian syndrome. The patient has cytic ovaries, hirsutism (acne), is overweight, and shows some level of insulin resistance.
7% women affected by PCOS (leading cause of infertility): see cystic follicles, atresia, and persistant anovulation; hirsutism, acne, male-pattern alopecia, obesity
Treatment: She needs to be treated with hormonal therapy as she has higher estrogen stimulation of her uterus which puts her at risk for endometrial cancer. For pregnancy she may have to undergo hormonal or IVF treatment.
Ovarian cyst: arises from surface epithelium (cortical inclusion) or from ovarian follicles (follicular/corpus luteum cysts). Asymptomatic, may see precocious puberty, menstrual dysfunction, rupture
Corpus luteum cyst: delayed resolution of corpus luteum–> increased progesterone production–> menstrual irregularities
Theca lutein cysts (hyperreactio luteinalis): high gonadotropin levels–> multiple/bilateral cysts–> can rupture, leading to intraabdominal hemorrhage
* Can see virilization in 15% of affected women (elevated progesterone–> hirsutism)
Below is a sample from the ovary of a 60 year old woman with no children and a family history of breast cancer (sister at age 45, mother at 53). What is the abnormality below and what is the prognosis?
Malignant serous epithelial ovarian carcinoma
- # 5 cause of cancer death, highest mortality of any cancer diagnosis (Majority detected at stage 3/4)
- Risk factors= no pregnancies, family history, older age
Below is a histologic specimen from the ovary of an older woman. What type of tissue is this and what is the prognosis?
Borderline serous epithelial ovarian tumor
Borderline tumors usually mucionous or serous, do NOT invade underlying tissue, but have the potential to spread (see cells proliferating/nuclear atypia)
Below is a specimen recovered from an ovary. What type of tumor is this and what is the prognosis?
Ovarian germ cell teratoma: see somatic differentiation within germ cell. This is a mature teratoma (recovered from ovaries- therefore germ cells) and is much more likely to be benign. An immature teratoma is found in other tissues, is composed of embryonic tissue and is malignant (totipotent cells with 3 germ layers)
Though benign, these tumors grow other cell types within them that can transform into malignancy (ex. skin can lead to squamous cell carcinoma, or thyroid tissue can lead to papillary thyroid carcinoma)
Below: teratoma with adipose and thyroid papilary tissue
Below is a benign ovarian tumor removed from a 60 year old woman. She was diagnosed with this tumor due to increasing ascites/pleural effusion before it was removed but since removal her symptoms have resolved. What type of tumor is this and what was her diagnosis?
Benign fibroma= 75% of stromal tumors, associated with Meig’s syndrome (tumor causing ascites). Solid white tissue.
Benign thecoma (below)= similar to fibroma, may produce estrogens/androgens, causing systemic effects. Fatty yellow tissue.
Below is a sample from an ovarian tumor removed from a post-menopausal woman. Before diagnosis, the woman presented with endometrial bleeding. What type of tumor is in the histologic sample below?
Granulosa cell tumor (post-menopausal adult form): presents with Call-Exner body, an estrogen-producing cluster of cells with grooved nuclei (causing endometrial thickening/hyperplasia).
Cystic, hemorrhagic tumor (see below)
Juvenile form seen in children and young women causing precocious puberty and hyperestrinism
After a premature rupture of membranes before delivery, this placenta was recovered from the mother. Both mother and baby were treated with antibiotics after delivery for an infection. What is the diagnosis and etiology?
Chorioamnionitis= seen in 10% of placentas, hallmark of ascending infection, (acute inflammation following premature rupture of membranes).
*Can lead to fetal demise, postpartum endometritis, pelvic sepsis
A woman presented to the emergency room stating she was 8 weeks pregnant and was concerned because she had a fever accompanying a long bout of “morning sickness”. A beta-hCG test showed elevated levels and her uterus measurement demonstrated a pregnancy closer to 16 weeks. The following specimen was recovered from the uterus:
What is the chromosome type of the sample and what is the risk of this type of pregnancy?
Hydatidiform mole (gestational trophoblastic disease). Based on the histologic sample showing completely abnormal chorionic villi (trohpoblastic proliferation around villi) and no fetal parts, this was diagnosed as a complete mole.
The sample was diploid (2 sperm and one egg or NALP egg defect= 1 defective egg + 1 sperm) and there is a risk for invasiveness (into uterine wall/blood vessels) leading to choriocarcinoma
Clinical: snowstorm ultrasound, enlarged uterus (larger than normal gestational age), v. elevated beta-hCG, 15-20% persistant tissue–> 2% choriocarcinoma
* test for p57- maternally transcribed, paternally imprinted gene (CDK inhibitor) expressed in maternal tissue
After a D+C of a hydatidiform mole, the following histologic sample was recovered. What type of mole was it and what are the risks associated with this type of mole? What are the clinical symptoms associated with this type of molar pregnancy?
Partial hydatidiform mole= triploid (2 sperm + 1 egg or 1 diploid sperm + 1 egg)
(gestational trophoblastic disease)
May have fetal parts
Mixed population of normal and abnormal chorionic villi
Symptoms: normal beta-hCG elevations (vs elevated in complete mole), small uterus for gestation dating), fetal parts possible, rare to see cisterns on gross specimen.
A 65 year old woman presented with vaginal bleeding and lower abdominal pain. In her ob/gyn history, it was noted that she had a molar pregnancy 30 years previously. She had a complete historectomy and the following was noted in her uterus. What is her diagnosis and what is the etiology of the disease?
Choriocarcinoma: rare malignancy of trophoblasts with no chorionic villi; presents 30 years after pregnancy.
Associated factors: 50% complete molar pregnancy, 25% spontaneous abortion, 20% normal pregnancy, 5% ectopic pregnancy
Histology: solid sheets of cytotrophoblasts, rim of syncytium infiltrating surroundings, NO villi
* can metastasize to lungs
The following specimen was recovered from placental tissue of a baby delivered prematurely due to intrauterine growth restriction. What is notable in the tissue and what other conditions is this associated with?
Chronic Villitis: most have unknown etiology (some infectious, due to CMV, syphillis, toxoplasmosis, listeria, treponema pallidum, tuberculosis) but are associated with intrauterine growth restriction (IUGR) or intrauterine fetal death (IUFD); high recurrance rate. May be associated with maternal floor infarction; immune mediated
Histology: see chronic inflammatory infiltrate in villous tissue, multifocal, involving basal plate.
At 39 weeks a woman presented to her obstetrician with persistant hypertension and proteinuria. Her blood pressure readings were normally around 140/90 but at the time of her visit has spiked to 160/110, and her protein levels had increased to almost 5mg/dL over a 24 hour collection. Her physician took her to Labor and delivery for an emergency c-section. Upon histologic exam of her placental tissue, the following was found. What is abnormal about the tissue and what was her condition?
Preeclampsia: diseased uteroplacental vessel that have muscular walls (abnormal in fetal arterioles). Can see thickened walls in arterioles with inflammatory cells, which could lead to reduced blood flow to the fetus. In normal pregnancies, there is no muscular wall so the fetus will have unlimited blood supply regardless of the hemodynamic state of the mother.
