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Diseases
Previllous trophoblast
Cytotrophoblast Syncytiotrophoblast
Nucleus Single Multiple
Shape Round Irregular,highly
variable
Cytoplasm Scant,clear to Abundant,dense
granular, multiple
prominent cell vacuoles,lacunae
borders
Cytokerati ++++ ++++
n
hCG - ++/++++
Mel-CAM - -
PLA P - ++++
Intermediate trophoblast
Features intermediate
Uni/Bi/Multinucleate
Cytoplasm like ST
Trophoblast
Villous CT, ST, IT
Extravillous- Used to make
nonvillous parts of placenta e.g.
chorion
Extravillous ST
Extravillous CT
Gestational Trophoblastic
Diseases
Spectrum of pregnancy related
trophoblast proliferation
abnormalities.
GTD
Originate from placental tissues and can be
cured even in the presence of widespread
metastasis
Persistent gestational trophoblastic tumors
develop most commonly after a molar
pregnancy
HCG correlates well with the amount of viable
trophoblast and serves as an ideal tumour
marker.
History
Hertig & Edmonds 1940-Hydropic
swelling type I,II,III
Marchand - choriocarcinoma
Modified WHO Classification
Hydatidiform mole-complete,partial
Invasive mole
Choriocarcinoma
Placental site trophoblastic tumor
Epithelioid trophoblastic tumor
Exaggerated placental site
Placental site nodule
Unclassified trophoblastic lesions
Clinical Classification
Gestational Trophoblastic Disease
Gestational Trophoblastic Tumours
Invasive Mole
Choriocarcinoma
PSTT
Metastatic Trophoblastic Disease
Metastatic-Low vs High risk
hCG in urine hCG in urine
<100,000IU/24 hrs >100,000IU/24 hrs
and serum and serum
<40,000mIU/ml >40,000mIU/ml
Symptoms <4 mths Symptoms >4 mths
No brain or liver Brain or liver mets
mets
No prior Prior chemotherapy
chemotherapy failure
Pregnancy event Term Pregnancy
Aetiology
Epidemiology-1:160 India
Ethnicity-More in Blacks and
Orientals
Oncogenic viruses?
Cytogenetics esp in H. mole
ABO Blood groups
Differential Diagnosis Of
Trophoblastic Lesions
Specimen
Villous Nonvillous
Products of conception
Hydropic abortus
Hydropic Hydatidiform
Abortion Mole
Gross findings +/- on gross Diffuse
of villous involvement
swelling on gross
Hydropic Focal Diffuse
degeneration
Cistern Not seen Marked
formation
Foetal vessels Seen +/-
Hyperplasia of Attenuated/pol Hyperplasia
trophoblast ar Min/No and atypia
NonVillous TrophoblasticTissue
Curetting mostly represents
retained products of conception
Hydatid
No fetal parts
Marked generalised villous hydrops
Villous swelling with circumferential
hyperplasia of trophoblastic cells
Cytological atypia with
trophoblastic proliferation
Complete mole in a twin gestation
D/d from partial mole-
Much more exuberant CT, ST hyperplasia
Extensive pronounced cisterns
No scalloping,trophoblastic inclusions
One population of villi
Diagnosis of a partial mole is usually made
after a histologic review of curettage
specimens
Partial Mole
Clinical presentation less severe
Mostly triploid
Extrahaploid component is
paternal
Gross
Variable no of vesicles
Clinical diagnosis
hCG titers plateau or rise following
evacuation of a mole.
Differential diagnosis
Intracavitary noninvasive
hydatidiform mole-Marked
trophoblastic proliferation
Choriocarcinoma-Absence of true
chorionic villi
Differential diagnosis
Placenta acreta Molar villi superficially
attached on myometrium,without
intervening decidua
Placenta increta-Extend deep,without
serosa
Placenta percreta-Full thickness involved
Exaggerated Placental Site
Benign nonneoplastic lesion
CK 18,hPL,Mel- CK 18,hPL,Mel-
CAM ++++ CAM,Ki-67 ++++
Placental Site Nodule
Well circumscribed hyalinized
lesion composed of chorionic type
intermediate trophoblastic cells
Pathologic features
Gross-Yellow ,tan or haemorrhagic
nodule in endometrium or
superficial myometrium
Placental Site Nodule
Cluster of hyperchromatic and vacuolated
chorionic type intermediate trophoblastic
cells in a hyaline matrix
Choriocarcinoma
Gods first cancer and mans first cure
Highly aggressive malignant tumor from
previllous trophoblast of early
implantation or villous surface of placenta
50% develop from a complete H.mole
Metastasis may be the first sign of
tumour
Pathogenesis
Influence of maternal environment
Genetic abnormalities
Chorionic villi
Metastasis to lungs >75%,brain,
liver gastrointestinal tract
Poor prognostic factors
Non gestational choriocarcinoma
Placental site trophoblastic tumor
Neoplastic transformation of
implantation site intermediate
trophoblast
Sheets of implantation site intermediate trophoblastic cells
separating smooth muscle cells of myometrium
Replacement of vascular wall by implantation site
intermediate trophoblastic cells,fibrinoid material in
vessel wall.
Implantation site intermediate trophoblastic
cells,pale to clear cytoplasm.
Choriocarcinoma PSTT
Clinical Hge ,preceding Amenorrhoea
features history of H.mole
Gross Hgic areas prominent -