Trophoblastic diseases and cervical cancer

Question 1

what is a hydatid?

Answer 1

cyst containing watery fluid

Question 2

what is a mole?

Answer 2

abnormal mass of tissue in the uterus

Question 3

what is GTD?

Answer 3

gestational trophoblastic diseases - series of disease associated with proliferation of placental trophoblast or villi

Question 4

what is the key clinical finding in GTD?

Answer 4

size of uterus is much larger than corresponding gestational age

Question 5

what is a hydatidiform mole? when does it manifest, and how?

Answer 5

• 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

Question 6

what are the two types of hydatidiform mole? how are they diagnosed?

Answer 6

• complete and partial

- karyotype, histology

Question 7

what constitutes a complete mole?

Answer 7

fertilization of an empty ovum by one or two sperms - no embryo develops

• empty egg + 1 (duplicate later) sperm
• empty egg + 2 sperms

Question 8

what constitutes a partial mole?

Answer 8

fertilization of an ovum by one diploid or two haploid sperm

1 egg + 2 sperms

Question 9

what is the appearance of the chorionic villi in a complete mole?

Answer 9

edematous with variable degrees of trophoblastic proliferation

Question 10

what are the levels of serum HCG in a complete mole?

Answer 10

very high

Question 11

“snowstorm image” on US indicates what condition?

Answer 11

complete mole

Question 12

“bunch of grapes” appearance indicates what condition?

Answer 12

complete mole

Question 13

are there fetal parts in a complete mole? partial?

Answer 13

complete - no

partial - yes

Question 14

what are the HCG levels in partial moles?

Answer 14

high, but not as high as complete moles

Question 15

what is the karyotype for partial moles?

Answer 15

69 XXX
69 XXY
69 XYY (rare)

Question 16

what is the karyotype for complete moles?

Answer 16

46 XX or 46 XY

Question 17

what is the appearance of the villi in a partial mole?

Answer 17

• swollen villi

- slight hyperplasia surface trophoblast

Question 18

what is an invasive mole? what are two adverse results?

Answer 18

• 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

Question 19

what are the HCG levels in an invasive mole?

Answer 19

elevated levels persist after evacuation of uterine cavity

Question 20

what is a choriocarcinoma?

Answer 20

uncommon highly malignant neoplasm of trophoblastic cells derived from:

• normal gestations
• spontaneous abortions
• ectopic pregnancies
• complete moles

Question 21

how does choriocarcinoma manifest?

Answer 21

irregular spottin gof brown, bloody, foul smelling fluid, elevated HCG levels

Question 22

what is the appearance of villi in choriocarcinoma?

Answer 22

NO VILLI

Question 23

what is the gross appearance of choriocarcinoma? what cell types?

Answer 23

fleshy, hemorrhagic tumor consisting of cytotrophoblast and syncytiotrophoblast

Question 24

how does choriocarcinoma respond to chemotherapy?**

Answer 24

VERY WELL**

Question 25

what is a placental site tumor?

Answer 25

uncommon, locally invasive tumor of implantation site

Question 26

what are the HCG levels in a placental site tumor?

Answer 26

low

Question 27

what is the transformation zone?

Answer 27

transition from columnar (endocervix) epithelium to squamous (ectocervix) epithelium results from squamous metaplasia and occurs over a varying region of the cervix

Question 28

what factors affect the transformation zone of the cervix?

Answer 28

• hormone levels
• pH
• vaginal flora
• trauma

Question 29

why is the transformation zone important diagnostically?

Answer 29

cervical intraepithelium neoplasia (CIN) and carcinoma originate in the transformation zone?

Question 30

what are the risk factors for cervical cancer?

Answer 30

• 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

Question 31

which HPV strains are highly oncogenic for cervical cancer?

Answer 31

HPV 16 and 18

Question 32

which viral proteins are associated with HPV 16 and 18? what are their roles?

Answer 32

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

Question 33

what are the morphologic features of cervical intraepithelial neoplasia (CIN)?

Answer 33

• nuclear atypia
• altered nuclear-cytoplasmic ratio
• loss of basal polarity
• pleomorphism
• increased mitotic features
• lack of differentiation and maturation

Question 34

HPV infected cells will show what structures on histology?

Answer 34

koilocytes

Question 35

CIN-1 is associated with what type of cellular change?

Answer 35

mild dysplasia

Question 36

CIN-2 is associated with what type of cellular change?

Answer 36

moderate dysplasia

Question 37

CIN-3 is associated with what type of cellular change? what is the main occurrence?

Answer 37

severe dysplasia and carcinoma in situ

invasion of basement membrane

Question 38

the most common type of invsasive cervical carcinoma is what type?

Answer 38

squamous

Question 39

which stages of cervical cancer have a good prognosis?

Answer 39

stage I

stage II