VULVA

B/M Epidemiology Gross Histology Genetics Pathology/Misc

Bartholin Cyst B - cysts lined by the ductal squamous - Infection of the
metaplastic and/or epithelium Bartholin gland
- Treated by
resection
Lichen scleosus B - MC in post- - Smooth, white - epithelial cells disorder
menopausal plaques or papules - thinning of epidermis
- Disappearance of rete pegs
- hydropic degeneration of basal cells
- superficial hyperkeratosis
- Dermal fibrosis with scant perivascular
- Mononuclear inflammation
Squamous cell B - epithelial cells disorder - May be due to
hyperplasia or lichen - epithelial thickening rubbing/scratching of
simplex chonicus - expansion of stratum granulosum the skin to relieve
- significant surface hyperkeratosis pruitis
- No atypia - Does not risk of
cancer
Condyloma acuminatum B - STD - verrucous (covered - exophylic lesions
- HPV 6, 11 with wart or wart-like - branching, tree-like cores of stroma
- Not precancerous projection) covered by squamous epithelium
- Koilocytic atypia: enlarge, atypical
nuclei, perinuclear halo and cytoplasmic
vacuolation
- virus in squamous cells
Vulvar intraepithelial M - Rare - Squamous cell
neoplasia/ Vulvar - 3% all genital - Basaloid and warty - HPV 16, 18, 31
carcinoma cancer in female carcinoma - Precursor: classic VIN
- >60 yrs old + Nuclear atypia
- SCC most + Reproductive age
common + analogous to cervical squamous intraepithelial lesion (SIL)
+ Risk: young afe at first intercourse, multiple sex partners, male
partner with multiple sexual partners
+ Invasion risk: > 45 yrs old, immunosuppressives
+ Gross: white, flesh-colored or pigmented, slightly raised lesions.
Exophytic, papillary architecture, koilocytic atypia.
+ Histo: infiltrating tumors, nest/ cords of small, tightly packed
malignant indifferentiated squamous cells. Tumor may have central
necrosis

- Keratinizing SCC - NOT related to HPV

- Mean age: 76 yrs old
- Precursor: differentiated VIN or VIN simplex
+ atypia of the basal layer with normal epithelial maturation and
 differentiation in the superficial layers
+ Histo: infiltrating tumor with nests of malignant cells and keratinized
pearls
+ Risk of cancer depends on age, invasion, immune status
+ lesion < 2cm: 60 80% 5ys
+larger size + lymph involvement: < 10% 5ys

- Verrucous - resemble conduloma acuminatum

carcinoma - NOT HPV induced
- RARE metastasis
- Cured by excision

- Basal cell - Similar to counterpart in the skin

carcinomas - NOT HPV induced
- RARE metastasis
- Cured by excision

B/M Epidemiology Gross Histology Genetics Paths/ Misc

Papillary Hidradenoma M - Sharply - Grandular cells, counterpart of breast glands
circumscribed nodule - identical to intraductal papiloma of the breast
- MC site on labia - Papillary projections covered w/ 2 layers of cells
majora or interlabial + top columnar secretory cells
folds + underlying layer of flattened myoepithelial
cells: characteristic of sweat glands and weat gland
tumor

Extramamary Paget dz M - Similar to Paget dz - Grandular cells, counterpart of breast glands - Likely to be recurrent,
of the breast - Paget dz: a distinctive intraepithelial proliferation of difficult to get clean margin
- Pruritic, red, malignant cells - If there is invasion -> poor
crusted, sharply - Large tumor cell lying singly or in small cluster prog based on the stage.
demarcated, maplike within epidermis and its appendages
area - Halo surrounding tumor cells
- MC on the labia - Finely granular cytoplasm
majora - PAS +. Alcin blue +, mucicarmine +
- Apocrine, eccrine, keratinocyte differentiation
- Usually contained
- If metastasize -> poor prognosis

Malignant melanoma M - Rare - Similar to - Distinguish from Paget dz:

- 60 70 yrs old melanoma of the skin + uniform reactivity to S100 protein
- Prognosis depends + absence of reactivity with antibodies to
of depth of invasion cytokeratin
+ lack mucopolysaccharides
VAGINA: rare
Gartner duct cysts B - Relatively - Lesion on lateral - Fluid-filled cysts in submucosa - Derived from woffian duct

Vaginal adenosis B - Women exposed
Vaginal intraepithelial
neoplasia and squamous
cell carcinoma
Embryonal
rhabdomyosarcoma
CERVIX
Endocervical polyps B - Rare
Cervical intraepithelial
neoplasia (CIN) or
squamous intraepithelial
lesion (SIL)
common walls of the vagina rest
- Red, grandular - Columnar endocervical-type epithelium - Remnant of columnar
to DES in utero areas contrasting endocervical-type
with normal pale-pink epithelium
vaginal mucosa
- MC tumor of - Vaginal intraepithelial neoplasia = cervical - HPV
vagina: carcinoma squamous intraepithelial lesions - Risk:
metastatic from the previous
cervix carcinoma
of the
cervix or
vulva
- aka sarcoma - Polypoid, rounded, - Small tumor cells with oval nuclei, with small - Good prognosis with early
botryoides bulky masses that fill protrusions of cytoplasm from one end, resembling dx, bad if the tumors invade
- < 5yrs old or project out of the the tennis racquet or older age
vagina - Loose fibromyxomatous stroma that is edematous
- Grape-like structure and contain inflammatory cells
- Irregular vaginal - Soft, mucoid, lesions composed of a loose
spotting or bleeding fibromyxomatous stroma harboring mucus
that arouses endocervix gland, often with inflammation
suspicion of more
ominous lesions
-Most important - Koilocytic atypia : - HPV infects immature
Risk: high - Nuclear atypia basal cells of the squamous
oncogenic HPV - Expression of Ki-67 and p16 confirms HPV epithelium in areas of
- HPV 16, 18 infection epithelial breaks, or
- Risk: multiple - CIN I: mild dysplasia immature metaplastic
sexual partners, + Koilocytic atypia squamous cells present at
male partner w/ + Expansion of immature basal cells limited to the squamocolumnar
multiple ex/current 1/3 of the epithelial thickness junction
sexual partners, + Low grade: productive HPV infection, no - HPV cannot infect the
young age at first cellular changes, most regress spontaneously, NOT mature superficial
intercourse, high treated like premalignant lesion squamous cells that cover
parity, persistent - CIN II: Moderate dysplasia the ectocervix, vagina, or
infection with HPV + Progressive atypia vulva unless there is break.
16 and 18, + Expansion beyond lower 1/3 of the thickness - Replication can be in
immunosuppressiv + High grade: progressive deregulation of cell mature cells
- Viral E6 and E7 proteins
es, cartain HLA cycle, less common than low-grade.
are crucial
subtypes, use of - CIN III: severe dysplasia
OCD, nicotine. + Diffuse atypia
- Peak: 20 yrs old + Loss of maturation
+ Expansion of the immature basal cells to the
epithelial thickness
 + High grade
Cervical carcinoma M - MC cervical - Either exophytic or - Nest or tongue of malignant squamous epithelium - All is HPV- induced
cancer infiltrative invading underlying cervical stroma
- Precursor: HSIL - Either keratinized or non-keratinized
- Peak: 45 yrs old - Hyperchromic large nuclei due to mucin-depleted
- >50% cases are cytoplasm
those who did not - Adenosquamous: both grandular and squamous
have regular intermixed
screening - Neuroendocrine: similar to small cell carcinoma of
the lung
- Staging:
+ 0: CIS
+ 1: carcinoma confined to the cervix (95% 5ys)
+ 2: carcinoma extends beyond the cervix but not
the the pelvic wall (75% 5ys)
+ 3: carcinoma extended to the pelvic wall. On
rectal exam there is no space b/w tumor and pelvic
wall. < 50% 5ys
+ 4: carcinoma involve the mucosa of bladder
and rectum
BODY OF UTERUS AND ENDOMETRIUM
Endometriosis B - Women of - Presence of - Usually contain both endometrial glands and - Complication: infertility,
productive age, endometrial tissue stroma dysmenorhhea (painful
30s, 40s. outside of the uterus - Descending order of frequency: ovary, uterine menstruation), pelvic pain,
Clinical: ligaments, rectovaginal septum, sul de sac, pelvic etc.
- Severe peritoneum, large and small bowel and appendix,
dysmenorrheal mucosa of the cervix, vagina and fallopian tubes, - Rare progression to
- Dyspareunia (Pain and laparotomy scars. malignancy
with intercourse) - Presence of endometrial glands and stoma (very - High activation of
- Pelvic pain due to rare that it contains either or) inflammatory cascade
intrapelvic bleeding such as prostaglandin,
and periuterine interferon, TNF.
adhesion - Estrogen production is
- Infertility upregulated
- Rare Malignancy

Adenomyosis B - Presence of - Irregular nests of endometrial stroma, with or

endometrial tissue without glands, arranged within the myometrium
within the uterine wall
(myometrium)
- Similar clinical
symptoms as
endometriosis

Endometrial polyps B - Rare - Exophylic masses - MC the glands are hypertrophic or atrophic, are
 transformation to of variable size that functional
adenocarcinoma project into the
endometrial cavity
- Asymptomatic or
abnormal bleeding
Endometrial Hyperplasia B - Prolong or high - Increase proliferation of the gland in relation to the inactivation
estrogen stroma of the endometrium of PTEN
stimulation - Simple hyperplasia without atypia tumor
- Can progress to + Aka cystic or mild hyperplasia suppressor
endometrial + Glands of various sizes and irregular shapes gene
carcinoma with cystic dilation
+ Mild increase in gland/stroma ratio
+ Rare progression to adenocarcinoma
- Simple hyperplasia with atypia
+ Uncommon
+ Similar architecture as the one above but with
cellular atypia such as loss of polarity, vesicular
nuclei, prominent nucleoli
+ 8% grogresses to carcinoma
- Complex hyperplasia without atypia\
+ Grand crowding, branching of glands -> back-
to-back crowding with little intervening stroma and
abundant mitotic figures
+ Glands remains distinctive and nonconfluent
+ Epithelial cells remains cytologically normal
+ 3% progresses to adenocarcinoma
- Complex hyperplasia with atypia
+ Morphologic overlap with well-differentiated
endometrioid adenocarcinoma
+ 23% - 48% of dx already progesses to
adenocarcinoma
+ Treatment:
* Hysterectomy
* Progestin: 50% has persistent dz, 25%
recuured, 25% progresses to carcinoma

Carcinoma of the M - MC invasive - Type I: most common

endometrium cancer of the + If differentiated -> endometrioid carcinoma
female genital tract + Precurosr: endometrial hyperplasia (obesity, diabetes, HTN, infertility, unopposed estrogen
- Post-menopausal, stimulation)
50 yrs, 60 yrs + PTEN, p53
- presenting + Localized or diffuse polypoid tumors
symptoms: + Spread by direct invasion into the surrounding structure
postmenopausal + Most are endometrioid carcinoma
+ Grading: based on grandular patterns
bleeding ->
* G1: well-differentiated adenocarcinoma, less than 5% solid growth
alarming -> these * G2: moderately differentiated adenocarcinoma with partly (< 50%) solid growth
symptom presents
 early * G3: Poorly differentiated adenocarcinoma with predominantly solid growth (> 50%)

- Type II carcinoma:
+ Occur in women 10 yrs later than type I
+ MC arise in the setting of endometrial atrophy
+ Poorly differentiated tumors
+ 3 types:
* Serous carcinoma (overlap with ovarian serous carcinoma)
* Clear cell carcinoma
* Malignant mixed mullerian tumor
+ p53 tumor suppressor gene
+ Serous carcinoma (endometrial intraepithelial carcinoma):
* Precursor: surface epithelial neoplasm, endometrial intraepithelial carcinoma (EIC)
* Morphology: Arise in small atrophic uteri; EIC: similar to serous carcinoma without
stromal invasion; Cytologic atypia
* Clinical course: May go asymptomatic for a long time; Irregular or postmenopausal
vaginal bleeding with excessive leucorrhea; Serous: tendency for extrauterine spread even when
confined to the endometrium or its surface epithelium
+ Malignant mixed mullerian tumors (MMMTs)
* Endometrial adenocarcinoma with malignant changes in the stroma
* Morphology: MMMTs are fleshier than adenocarcinomas; Histology: Adenocarcinoma
mixed with malignant mesenchymal elements, sarcomatous components may mimic extrauterine
tissues

Malignant Mixed Mullerian M - 50 60 yrs - MMMTs are fleshier - Endometrial adenocarcinoma with malignant - Relatively poor prognosis
Tumors (carcinosarcoma) - Hx of radiation than changes in the stroma
adenocarcinomas - Adenocarcinoma mixed with malignant
mesenchymal elements, sarcomatous components
may mimic extrauterine tissues
- adenocarcinoma with expanded stroma (large
cells, mitoses)

Adenosarcoma - 40 50 yrs old - usually presents as - tumors of the endometrium with stromal
large broad-based differentiation
endometrial polypoid - Usually benign gland and malignant stromal lesion
growths that may
prolapsed through
the cervical os
Stromal tumor - tumors of the endometrium with stromal
differentiation
- Benign stromal nodules
+ Well-circumscribed aggregate of endometrial
stromal cells in the myometrium that does nor
penetrate the myometrium
 - Endometrial stromal sarcomas
+ Endometrial stromal lying between muscle
bundles of the myometrium
+ Diffuse infiltration of myometrial tissue/
invasion of lymphatic channels
+ t(7;17)

Leiomyomas B - aka fibroid - tumors of the myometrium

- benign smooth - Sharply circumscribed, discret, round, firm, gray-
muscle neoplasm, white tumors
singly or multiple - Usually found in myometrium of the corpus
- Whorled pattern of smooth muscle
- Individual smooth muscle cells are uniform in size
and shape and have the characteristic oval nucleus
and long, slender bipolar cytoplasmic processes
- Rare mitotic figures
- Benign metastasizing leiomyoma: uterine tumor
extending into vessels and migrates to other sizes,
most commonly the lung. Benign!!
- Disseminated peritoneal leiomyomatosis: presents
as multiple small nodules on the peritoneum.
Benign!!

Leiomyosarcomas M - Rare
FALLOPIAN TUBES
Paratubal cysts
Hydrids of Morgagni
Adenomatoid tumors
OVARIES: most ovarian (80%) tumors are benign
Follicle and Luteal Cysts B
- Bulky, fleshy - tumors of the myometrium - Relatively poor prognosis
- Arise de novo masses that invade - wide range of atypia -> indifferentiated
- 40 60 yrs old the uterine wall, or - High mitotic index
- before or after polypoid masses that - zonal necrosis
menopause project into the
uterine lumen
- MC - small, translucent - arise from remnant of mullerian duct
cysts filled with clear
serous fluid
- paratubal cysts
found in fimbrae end
or in broad ligament
- aka mesothelioma
- Cystic follicles:
+ So common -> normal
+ Due to unruptured Graffian follicles or the
ruptured ones that were sealed right away
+ Morphology: Serous filled cyst; Glistening gray
membranes
- Granulosa luteal cysts:
+ Normally in the ovary
+ Lined by rim of bright yellow tissue containing
 luteinized (increased amount of pale cytoplasm)
granulosa cells
+ Occasionally rupture and cause peritoneal rx

PCOD and stromal B - 3 -6% - numerous cystic - thickened, fibrotic superficial cortex beneath which - Often associated with
hyperthecosis reproductive age follicles or follicle are innumerable follicle cysts associated with amenorrhea
cysts hyperplasia of the theca interna (follicular - Anovulation, obesity,
- ovaries 2x normal, hyperthecosis) hirsutism, virilism
smooth, gray-white - Stromal hyperthecosis: cortical stromal
outer cortex studded hyperplasia, usually in post menopausal women
w/ subcortical cysts - Theca lutein hyperplasia of pregnancy: physiologic
mimicking the PCOD
Serous Tumor - MC malignant - cystic neoplasm in - Tumor of surface (Mullerian) epithelium - Low - Low grade tend to
tumor which the papillary - lined by tall, columnar, both ciliated and non- grade: spread but the pt tend to
- Risk: nulliparity, epithelium is ciliated, epithelial cells KRAS or survive a long period of
family hx, heritable contained within a - Benign: cystadenoma BRAF time before dying of dz
mutation such as few fibrous walled - Serous borderline: increased complexity of stromal - High: p53
BRCA1 and cysts or projecting papillae, stratification of epithelium and mild nuclear
BRCA2 (20 60%) from the ovarian atypia but destructive infiltrative into the stroma is
- of those with surface not seen.
serous tumor, only - Benign: smooth - Malignancy (serous cystadenocarcinoma): larger #
5% carries BRCA glistening cyst wall of solid or papillary tumor mass, irregularity, fixstion
mutations. with no epithelial or nodularity of the capsule
thickening or w/ small + Marked nuclear atypia: pleomorphism, atypical
papillary projections mitotic figures, multinucleation
- BILATERAL!! + Psammoma bodies: concentric calcification:
- usually on surface characteristic of serous tumor
of the ovary, rare 1o + Low grade (more diffrentiation) vs. high grade
tumor of peritoneum (non differentiated)

Mucinous Tumor - 30% of all ovarian - RARE surface - Tumor of surface (Mullerian) epithelium - KRAS - pseudomyxoma
neoplasm involvement - Benign: lining of tall, columnar epithelial cells with proto- peritonei: extensive
- mostly benign - UNILATERAL!! apical mucin and absence of cilia oncogen mucinous ascites, cystic
- Risk: SMOKING!!! - larger cystic mass - Precursor to cystadenocarcinoma: epithelial implants on the
- Multiloculated + Mullerian mucinous cystadenoma: mucinous peritoneal surfaces,
tumors filled with tumors arising in endometriosis adhesions, and frequently
sticky, gelatinous fluid + tumors with abundant gland-like or papillary mucinous tumor involving
rich in glycoproteins groth with nuclear atypia and stratification, similar to the ovaries. May result in
tubular adenomas or vilous adenomas of the intestinal obstruction and
intestine death
- Cystadenocarcinoma: contains area of solid
growth and epithelial cell atypia and stratification,
loss of gland architecture, necrosis.
- Spread above ovary -> fatal
Endometrioid Tumor - Benign: - Tumor of surface (Mullerian) epithelium - PTEN, - If bilaterally -> may
 endometrioid - Presence of tubular glands bearing close KRAS, - implies the extension of
adenofibroma resemblance to benign or malignant endometrium catenin, the neoplasm beyond the
- combination of solid microsatelli genital tract
and cystic areas te instability
- p53
common in
poorly
differentiate
d
Clear Cell - Uncommon - Tumor of surface (Mullerian) epithelium
Adenocarcinoma - Exposed to DES - gland-like structure
in utero - Large epithelial cells with abundant clear
cytoplasm similar to hypersecretory gestational
endometrium
- Tend to be aggressive

Cystadenofibroma B - small and - Tumor of surface (Mullerian) epithelium

multilocular and have - More pronounced proliferation of the fibrous
simple papillary stroma that underlies the columnar lining epithelium
processes that do not - may be composed of mucinous, serous,
become as endometrioid, and transitional (Brenner)
complicated and
branching as in
ordinary
cystadenoma

Brenner Tumor - Most is benign - Solid or cystic - Tumor of surface (Mullerian) epithelium
- UNILATERAL - Adenofibromas in which the epithelial component
consists of nests of transitional-type epithelial cells
resembling those lining urinary bladder
- Sharply demarcated nests of epithelial ceolls
resembling the epithelium of the urinary tract, often
with mucinous glands in their center

Teratomas - Germ cell tumor

B - Young woman in - Unilocular cysts - Mature teratoma (dermoid cysts) - 46, XX - 1% dermoid cysts
active productive containing hair and - Stratified squamous epithelium with underlying undergo malignant
years cheesy sebaceoua sebaceous glands, hair shafts, and other skin transformation
material adnexal structure
- on section, thin wall
lined by an opaque,
gray-white, wrinkled
epidermis
- Hair shafts
frequently protrude
 - Tooth and area of
calcification

- Monodermal or Specialized terotoma:

+ Struma ovarii: UNILATERAL, mature thyroid
tissue
+ Ovarian acrcinoid (UNILATERAL!): can be
distinguished from metastatic carcinoid, which is
BILATERAL!!

M - pre-pubertal - Bulky, smooth - resembles fetal tissue - Immature one grows

adolescents and external surface - The more neuroepithelium -> the higher grade -> rapidly, frequently
young women, - areas of necrosis worse prognosis penetrate the capsule
mean age 18 yrs and hemorrhage
- resemble
embryonal and
immature fetal tissue
- Hair, sebaceous
materials, etc. may
be present

Dysgerminoma M - Ovarian - Most have no - Germ cell tumor - Oct3, - All is MALIGNANT!!
counterpart of endocrine function - Large vesicular cells having a clear cytoplasm, Oct4, - Respond to chemo
seminoma of the - UNILATERAL!! well-defined cell boundaries, centrally placed Nanog, - Event after spread -> 8-
testis - Yellow-white to regular nuclei receptor % cure
- 50% of all gray-pink - Dysgerminoma cells dispersed in sheets or cords tyrosine
malignant germ cell appearance and separated by scant fibrous stroma kinase c-
tumor often soft and fleshy - Mature benign lymphocytes are in the fibrous KIT
- 20 30 yrs old stroma

Endodermal Sinus (Yolk - Rare - Germ cell tumor - rich in - - Derived from
Sac) Tumor - Children or young - Glomerulus-like structure composed of a central fetoprotein differentiation of malignant
women presenting blood vessel enveloped by germ cells within a space and 1- germ cells along the extra-
with abdominal pain lined by germ cells: Schiller-Duval body antitrypsin embryonic yolk sac
and rapidly - Hyalin globule that may stained with alpha- - aggressive chemo is
developing pelvic fetoprotein. needed.
mass

Choriocarcinoma - Agressive - Germ cell tumor - High - More commonly of

chorionic placental origin
gonadotrop - Extra-embryonic
ins differentiation of malignant
germ cells
- Most exists with other
 germ cell tumors
- Those arise in ovary is
unresponsive to chemo
Granulosa-Theca cell - Post-menopausal - UNILATERAL!! - Sex-cord tumor - elevated - potential to elaborate
tumors - Solid, firm - Cuboidal to polygonal cells in cords, sheets, or inhibin, great # of estrogen
- may be yellow if strands product of - lead to malignant
active hormone - Gland-like structure filled with an acidophilic granulose granulose cell tumor
secretors material recall immature follicles: Call-Exner bodies cells - All granulose cell tumors
are potentially
MALIGNANT!!
Fibroma, Thecomas, and - UNILATERAL!! - Sex-cord tumor - Most are pure fibromas
Fibrothecomas - solid, spherical, or - Fibromas: fibroblasts arise in the ovarian stroma or hormonal inactive
slightly lobulated, - Thecomas: plump spindle cells with lipid droplets - Meigs syndrome:
encapsulated, hard, - Fibromathecomas: Both ovarian tumor,
gray-white masses hydrothorax, and ascites
covered by
glistening, intact
ovarian serosa

Sertoli-Leydig cell tumors - 20 30 yrs old - UNILATERAL!!!! - Sex-cord tumor - Masculinization or

(androblastomas) - Cut surface: gray to - Well-differentiated tumors with tubules compoased defeminization
golden borwn of Sertoli cells or Leydig cells interspersed with - few has estrogenic effect
appearance stroma - may block normal sexual
development in children
Hilus cell tumor Rare - UNILATERAL! - Sex-cord tumor
- Pure Leydig cell tumors
- large lipid laden cells with distinct borders
Pregnancy luteoma - Sex-cord tumor
Gonadoblastoma - Sex-cord tumor
GESTATIONAL TROPHOBLASTIC DZ
Complete Hydratidiform - teens and 40-50 - all or most villi are enlarged and edematous, with - 46, XX - Sperm fertilizing an
mole yrs central cavitation (cisterns) and lack adequately due to empty ovum
developed vessels chrom - spontaneous pregnancy
- Usually no fetal parts duplication loss
- Diffuse trophoblast hyperplasia (MC)
- No p57 protein expression in cytotrophoblast or - 46, XY or
stromal cells in the villi (p57 is paternally imprinted XX, an
but maternally expressed) empty egg
and 2
sperms
- hCG level

Partial Hydratidiform mole - teens and 40-50 - Delicate, friable - some of the villi are edematous, some shows only - 69, XXY - Spontaneous pregnancy
yrs mass of thin-walled, minor changes or XXX loss
translucent, cystic, - Fetal parts common - 92, XXXY,
 grapelike structures - p57 expressed XXXX
consisting of swollen
edematous
(hydropic) villi

Invasive Mole - teens and 40-50 - Mole that - hCG

yrs penetrates or even
perforates the uterine
wall
Choriocarcinoma - Rare in US but - soft, fleshy, yellow- - Does not produce chorionic villi - hCG - Derived from a
more frequent in white tumor with a - consists entirely of a mixed proliferation of than previously normal or
Africa marked tendency to syncytiotrophoblasts and cytotrophoblasts hydratidifor abnormal pregnancy,
- 50% arise in form large pale areas - Abundant mitoses m which can even include
hydratidiform moles of ischemic necrosis, - Tend to invade underlying myometrium and extrauterine ectopic
- 25% in previous foci of cystic underlying structures pregnancy
abortion softening, and - Rapid growth -> hemorrhage, ischemic necrosis, - Invasive and metastasize
- 22% in normal extensive and secondary inflammation wildly but respond well to
pregnancy hemorrhage - Bizzard cytology, hemorrhage, mitoses, and chemo
- 3% ectopic tons of mitoses. - Irregular vaginal spotting
- Pure ovarian choriocarcinoma is uncommon. of a bloody, brown fluid
Choriocarcinoma in the ovary has poor prognosis. - Usually, by the time
tumor is discovered,
radiographs of the chest
and bones already
disclose the presence of
metastatic lesions
- frequent site of
involvement: lung, vagina
Placental-site - 2% gestational - Normal extravillous trophoblasts are polygonal - Moderate - proliferation of
trophoblastic tumor trophoplastic mononuclear cells that have abundant cytoplasm hCG extravillous trophoblast,
(PSTT) neoplasm and produce human placental lactogen. aka intermediate
- May preceded by - Malignant -> PSTT -> uterine mass trophoblast
normal pregnancy - PSTT composed of malignant trophoblastic cells - abnormal bleeding,
(50%), diffusely infiltrating the endomyometrium amenorrhea
spontaneous - Proliferation of cytotrophoblasts. - Majority behaves non-
abortion, aggressively. Only 10%
hydratidiform metastasize and causes
moles. death