Trophoblastic diseases and cervical cancer Flashcards
what is a hydatid?
cyst containing watery fluid
what is a mole?
abnormal mass of tissue in the uterus
what is GTD?
gestational trophoblastic diseases - series of disease associated with proliferation of placental trophoblast or villi
what is the key clinical finding in GTD?
size of uterus is much larger than corresponding gestational age
what is a hydatidiform mole? when does it manifest, and how?
- developmental abnormality of the placenta resulting from faulty fertilization
- manifests 4-5th month gestation with discordance between uterine size and dates, vaginal bleeding, possible expulsion of vesicles
what are the two types of hydatidiform mole? how are they diagnosed?
- complete and partial
- karyotype, histology
what constitutes a complete mole?
fertilization of an empty ovum by one or two sperms - no embryo develops
- empty egg + 1 (duplicate later) sperm
- empty egg + 2 sperms
what constitutes a partial mole?
fertilization of an ovum by one diploid or two haploid sperm
1 egg + 2 sperms
what is the appearance of the chorionic villi in a complete mole?
edematous with variable degrees of trophoblastic proliferation
what are the levels of serum HCG in a complete mole?
very high
“snowstorm image” on US indicates what condition?
complete mole
“bunch of grapes” appearance indicates what condition?
complete mole
are there fetal parts in a complete mole? partial?
complete - no
partial - yes
what are the HCG levels in partial moles?
high, but not as high as complete moles
what is the karyotype for partial moles?
69 XXX
69 XXY
69 XYY (rare)
what is the karyotype for complete moles?
46 XX or 46 XY
what is the appearance of the villi in a partial mole?
- swollen villi
- slight hyperplasia surface trophoblast
what is an invasive mole? what are two adverse results?
- usually complete hydatidiform mole with penetration of villi and trophoblast into the myometrium, possibly extending to the serosal surface
- may cause uterine rupture
- vascular invasion may lead to embolization of villi to lungs
what are the HCG levels in an invasive mole?
elevated levels persist after evacuation of uterine cavity
what is a choriocarcinoma?
uncommon highly malignant neoplasm of trophoblastic cells derived from:
- normal gestations
- spontaneous abortions
- ectopic pregnancies
- complete moles
how does choriocarcinoma manifest?
irregular spottin gof brown, bloody, foul smelling fluid, elevated HCG levels
what is the appearance of villi in choriocarcinoma?
NO VILLI
what is the gross appearance of choriocarcinoma? what cell types?
fleshy, hemorrhagic tumor consisting of cytotrophoblast and syncytiotrophoblast
how does choriocarcinoma respond to chemotherapy?**
VERY WELL**
what is a placental site tumor?
uncommon, locally invasive tumor of implantation site
what are the HCG levels in a placental site tumor?
low
what is the transformation zone?
transition from columnar (endocervix) epithelium to squamous (ectocervix) epithelium results from squamous metaplasia and occurs over a varying region of the cervix
what factors affect the transformation zone of the cervix?
- hormone levels
- pH
- vaginal flora
- trauma
why is the transformation zone important diagnostically?
cervical intraepithelium neoplasia (CIN) and carcinoma originate in the transformation zone?
what are the risk factors for cervical cancer?
- HPV 16 and 18
- infection of columnar or squamous epithelium in transitional zone
- early age at sexual debut
- multiple sex partners
- HSV-2, HIV, cigarette smoking, immune compromise
which HPV strains are highly oncogenic for cervical cancer?
HPV 16 and 18
which viral proteins are associated with HPV 16 and 18? what are their roles?
E6, E7
interfere with function of p53, p21, Rb and thus promote proliferation and inhibit apoptosis of virally altered cells
E6 inhibits p53
E7 inhibits p53 + p21 + Rb
what are the morphologic features of cervical intraepithelial neoplasia (CIN)?
- nuclear atypia
- altered nuclear-cytoplasmic ratio
- loss of basal polarity
- pleomorphism
- increased mitotic features
- lack of differentiation and maturation
HPV infected cells will show what structures on histology?
koilocytes
CIN-1 is associated with what type of cellular change?
mild dysplasia
CIN-2 is associated with what type of cellular change?
moderate dysplasia
CIN-3 is associated with what type of cellular change? what is the main occurrence?
severe dysplasia and carcinoma in situ
invasion of basement membrane
the most common type of invsasive cervical carcinoma is what type?
squamous
which stages of cervical cancer have a good prognosis?
stage I
stage II
