Syspath400 -- reproductive pathologies (4-3) Flashcards
class 4 – reproductive pathologies
Prenatal Pathologies
Gestational Tumors
Breast Pathologies
placenta previa
“Previa” is a combination of two words: “pre” (or “prae”) meaning before, and “via” meaning way. “Previa” in medicine, usually refers to anything obstructing the passage in childbirth. Literally therefore, vasa previa means “vessels in the way, before the baby”.
placenta previa is
Implantation of the placenta over or near cervix, in lower part of the uterus.
Placenta may completely or partially cover the opening of the cervix.
placenta previa – how common?
who is more affected?
Occurs in 1 of 200 deliveries,
usually in women who have had more than one pregnancy
or who have structural abnormalities of the uterus, such as fibroids.
common risk factor – placenta previa
Scars in the uterus are a common risk factor
placenta previa — incidence increasing or lowering?
Incidence increasing
possibly increased smoking/alcohol
and increased proportion of women giving birth at later age
placenta previa — bleeding
Placenta previa can cause painless bleeding from the vagina that suddenly begins late in pregnancy.
The blood may be bright red.
can placenta previa be life-threatening?
Bleeding may become profuse, endangering the life of the woman and the fetus
how is placenta previa identified?
Ultrasonography helps doctors identify placenta previa and distinguish it from a placenta that has detached prematurely.
what happens if profuse bleeding during placenta previa?
When bleeding is profuse, women may be hospitalized until delivery, especially if the placenta is located over the cervix.
Women who bleed profusely may need repeated blood transfusions.
what happens if there is not significant bleeding during placenta previa
When bleeding is slight and delivery is not imminent, doctors typically advise bed rest in the hospital.
If the bleeding stops and does not recur, women are usually sent home, provided that they can return to the hospital easily.
is vaginal birth common for placenta previa?
A caesarean section is almost always performed before labour begins.
what can happen when women with placenta previa go into labour?
If women with placenta previa go into labour, the placenta tends to become detached very early, depriving the baby of its oxygen supply.
—> The lack of oxygen may result in brain damage or other problems.
ABRUPTIO PLACENTAE
Aka placental abruption
placental abruption is
Placental abruption is the premature detachment of a normally positioned placenta from the wall of the uterus. The placenta may detach incompletely (sometimes just 10 to 20%) or completely.
placental abruption, cause
The cause is usually unknown.
see risk factors
placental abruption, risk factors
Tobacco use
Mother is younger than 20 or older than 35
Fibroids
Previous c-section
high BP
(including preeclampsia)
cocaine-use
how commonly does placental detachment occur
Detachment of the placenta occurs in up to 1% of all deliveries.
preeclampsia
Etymology. The word “eclampsia” is from the Greek term for lightning.
“perhaps alluding to how suddenly and unexpectedly convulsions may arise.”
____
a condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria.
ABRUPTIO PLACENTAE – bleeding/hemorrhage
The uterus bleeds from the site where the placenta was attached.
The blood may pass through the cervix and out the vagina as an external hemorrhage,
or it may be trapped behind the placenta as a concealed hemorrhage.
placental abruption, SSx
Symptoms depend on the degree of detachment and the amount of blood lost (which may be massive).
Symptoms may include sudden continuous or crampy abdominal pain, tenderness when the abdomen is pressed, and shock.
complications of premature detachment (placental abruption)
can lead to widespread clotting inside the blood vessels (DIC),
kidney failure,
and bleeding into the walls of the uterus, esp. in women who also have preeclampsia.
kidney failure vs blood loss
“Heavy blood loss, an injury, or a bad infection called sepsis can reduce blood flow to the kidneys. Not enough fluid in the body (dehydration) also can harm the kidneys.”
what happens to fetus during placental abruption
When the placenta detaches, the supply of oxygen and nutrients to the fetus may be reduced.
how is placental abruption diagnosed
Doctors suspect premature detachment of the placenta on the basis of symptoms.
Ultrasonography can confirm the diagnosis.
how are women with placental abruption treated?
Women with premature detachment of placenta are hospitalized.
Treatment is bed rest.
If symptoms lessen, women may be discharged from the hospital.
what happens if bleeding worsens during placental disruption?
If bleeding continues or worsens or if the pregnancy is near term, an early delivery is often best for the woman and the baby.
placental abruption – vaginal birth?
If vaginal delivery is not possible, a c-section is performed.
HYDATIDIFORM mole
The first part of the name ‘hydatidiform’ comes from the Greek word ‘hydatid’ meaning droplet
These droplets appear to burrow into the wall of the uterus, hence the name mole.
In a complete molar pregnancy, the growth stops a fetus from developing.
HYDATIDIFORM MOLE aka
Aka molar pregnancy
hydatidiform mole is
growth of an abnormal fertilized egg
These growths are not viable
complete vs incomplete mole
Complete mole (46 XX or 46 XY)
Incomplete mole (69 XXY or 92 XXXY)
hydatidiform mole pathogenesis – vs normal
Normally, the fetus has 46 chromosomes, half of which have been inherited from the mother and the other half from the father
The cells of the complete mole (molar pregnancy) have a 46 XX or 46 XY KARYOTYPE;
—>
all of which have been inherited from the father.
—> 46 YY is not seen
karyotype define
“the number and visual appearance of the chromosomes in the cell nuclei of an organism or species.”
who passes on genetics for hydatidiform moles (COMPLETE MOLE)?
“all of which have been inherited from the father.”
(for complete moles)
what happens to maternal chromosomes during fertilization?
(in hydatidiform mole pathogenesis)
During fertilization the maternal chromosomes are lost and the paternal chromosomes (23X or 23Y) duplicate, bringing the number of chromosomes to 46
—> Thus, the hydatidiform mole has the correct number of chromosomes but the incorrect genetic makeup
pathogenesis of INCOMPLETE moles
involves mother and father
The incomplete moles (partial molar pregnancy) evolve from the oocytes fertilized with 1 or 2 spermatozoa;
—> the sperm duplicate; therefore, the cells have 69 or 92 chromosomes – one set from the mother and TWO sets from the father
hydatidiform moles – risk factors
The risk of hydatidiform moles is highest for women who become pregnant before age 17 or in their late 30s or later.
hydatidiform moles – rate
Hydatidiform moles occur in about 1 of 2,000 pregnancies in the United States and,
for unknown reasons, are nearly 10 times more common among Asian women
hydatidiform moles — clinical manifestations
what happens to abdomen?
Women who have a hydatidiform mole feel as if they are pregnant.
But because hydatidiform moles grow much faster than a fetus, the abdomen becomes larger much faster than it does in a normal pregnancy.
hydatidiform moles – SSx
Severe nausea and vomiting are common,
vaginal bleeding may occur.
—>
These symptoms indicate the need for prompt evaluation by a doctor.
hydatidiform moles – complications
infections,
bleeding,
and preeclampsia
or eclampsia
eclampsia
a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure, often followed by coma and posing a threat to the health of mother and baby.
hydatidiform mole, Dx
Often, hydatidiform mole is diagnosed shortly after conception.
No fetal movement and heartbeat are detected.
what can happen as a result of mole decay?
where does the decayed tissue go?
what does it resemble?
As parts of the mole decay, small amounts of tissue that resemble a bunch of grapes may pass through the vagina.
—>
After examining this tissue under a microscope, a pathologist can confirm the diagnosis.
hydatidiform mole — other Dx techniques
blood test type?
Ultrasonography may be performed.
hCG blood test
—>
hCG level is higher if a hydatidiform mole is present
—>
(mole produces a large amount of this hormone.)
hydatidiform mole, Tx
surgery / D&C
D&C
dilation and curettage
hydatidiform moles vs INVASIVE moles
how commonly do hydatidiform moles become invasive?
About 15 to 20% of hydatidiform moles invade the surrounding tissue and tend to persist.
what is a complication of invasive moles?
Of these invasive moles, 2 to 3% become cancerous and spread throughout the body;
they are then called
choriocarcinomas.
choriocarcinoma
Choriocarcinoma is a fast-growing cancer that occurs in a woman’s uterus (womb).
The abnormal cells start in the tissue that would normally become the placenta.
choriocarcinoma – metastasis
Can spread quickly through
the lymphatic vessels or
bloodstream
choriocarcinoma
A malignant tumour composed of cytotrophoblastic and syncytiotrophoblastic cells
cytotrophoblast
“‘Cytotrophoblast’ is the name given to both the inner layer of the trophoblast (also called layer of Langhans) or the cells that live there. It is interior to the syncytiotrophoblast and external to the wall of the blastocyst in a developing embryo.”
“The syncytiotrophoblast (from the Greek ‘syn’- “together”; ‘cytio’- “of cells”; ‘tropho’- “nutrition”; ‘blast’- “bud”) is the epithelial covering of the highly vascular embryonic placental villi, which invades the wall of the uterus to establish nutrient circulation between the embryo and the mother. It is a multinucleate, terminally differentiated syncytium, extending to 13 cm.”
where does choriocarcinoma originate?
In 50% of cases, choriocarcinoma arises from preexisting complete moles
in 25% it arises from placental cells retained after miscarriage
25% arises from normal placenta after completion of a normal pregnancy
which mole type can give rise to choriocarcinoma (via invasive moles?)
COMPLETE MOLES
choriocarcinoma cells are highly ____ and secrete ____
Cells are highly invasive, secrete hCG
choriocarcinoma – what blood test is used to detect amount of tumour tissue?
hCG levels are used for estimating the amount of tumour tissue and for monitoring tumour tissue recurrence after chemotherapy
what can choriocarcinoma form in placental bed?
Choriocarcinoma forms bulky HEMORRHAGIC NODULES in the placental bed
where can choriocarcinoma implant?
It invades through the walls of the uterus and often implants in the vagina
where can choriocarcinoma metastasize?
invading the veins, it metastasizes to…
lung(s),
liver,
brain
where does choriocarcinoma most COMMONLY metastasize to?
brain
despite high rate of metastasis, does choriocarcinoma respond well to Treatment if detected early?
Yes.
Fortunately, this tumour responds well to combination of chemotherapy and medications
—> Cure rates of 80% to 100% have been achieved but only in those patients who do not have brain metastases
Mastitis
typically caused by ___
mastos = breast
Typically is caused by purulent bacteria, such as staphylococcus or streptococcus
how do microbes invade breasts?
The microbes invade the breast
through the dilated milk ducts
or through skin lacerations or
minor injuries acquired during suckling
mastitis usually affects women who are ____
Usually affects woman who are lactating (acute)
how common is mastitis
The most common inflammatory disease of the breast
under what circumstance can mastitis occur more commonly?
Stagnant milk in breast that has not been fully emptied by suckling provides a good growth medium for the bacteria
(plugged ducts)
can mastitis spread throughout a larger area of breasts?
Yes
Acute inflammation may spread through the entire breast
what can form as a complication of mastitis?
can cause a localized abscess to form
lesion develops quickly and causes localized or diffuse swelling of the breast
mastitis – how does the affected area feel?
The inflamed area appears red, is painful, and is sensitive to palpation
(point tenderness)
mastitis – what happens to fluid?
which cells invade area?
The entire area is edematous
is infiltrated with numerous acute inflammatory cells, mostly polymorphonuclear leukocytes (PMNs)
under what circumstances can abscesses form during mastitis?
The excretory ducts may contain pus, and if massive suppuration occurs in conjunction with destruction of tissue, an abscess will develop.
how can abscess formation be prevented
However, this does not usually happen if acute mastitis is recognized early and the lesion is properly treated
mastitis – Tx
Treatment - antibiotics and emptying the breast
Benign breast disease / Fibroadenoma
..
Common, benign breast irregularities
other names for benign breast disease
aka mammary dysplasia
(formerly fibrocystic breast disease)
benign breast disease / fibroadenoma
can be described as “____”
“Tissue nodularity”
clinical manifestations
Bilateral and cyclical swelling, discomfort, tenderness, pain
Mastalgia
Nodularity – regular, firm, mobile, rubbery
Nipple discharge
Infections and inflammation
Fluctuations in size
etiology
Idiopathic
Related to estrogen levels (pregnancy, lactation, menopause)
Dx
Examination
Palpation
Mammogram
Biopsy
Tx
Analgesics
Local heat/cold
Adequate support
fat necrosis
Sometimes the normal fat cells in the breast become round, firm lumps made up of damaged fatty tissue. This is called fat necrosis of the breast.
is fat necrosis in the breast painful?
The lumps may or may not be painful.
fat necrosis of breast — most common in which individuals?
This problem is most often seen in obese women who have very large breasts or after an injury to a breast.
fat necrosis can be caused by
Can be caused by an injury or blow to the breast.
skin around lump can look ____
Sometimes the skin around this lump looks red or bruised.
after what type of injury can fat necrosis of breasts occur?
Sometimes seen following a MVA in
which the seat belt has forcefully
squeezed the breast
fat necrosis of breasts – pathogenesis
The inadequate blood supply causes some cells to die and release particles of fat.
—> These drain to the surface. The remaining tissue may become hard or calcified.
is fat necrosis of breasts common?
Fat necrosis of the breast is uncommon.
