Module in OBSTETRIC PATHOLOGY

for LU 4
Sept. 5, 2005, 1PM- 5 PM

Agustina D. Abelardo, MD
Professor of Pathology
 Case 1: Endometrial curettings from a 23 year
old with vaginal bleeding and a missed period of
one month
Other areas in the curettings
 Decidua and immature placental tissue in early
abortion

• Describe the products of conception.

• What is Arias- Stella reaction?
• Enumerate the causes of abortion.
Case 2: Salpingectomy specimen of a 22 year old
with sudden left lower quadrant pains.LMP was 7
weeks ago
Microscopic section (low power magnification)
 Tubal pregnancy

• Define ectopic pregnancy.

• Enumerate the various sites where this lesion can
be found.What is the most common organ
involved?
• Discuss the pathogenesis of this lesion.
• What are the possible sequelae/ complications of
ectopic pregnancy?
Case 3: Cut section of a placenta from a 32 year
old preeclamptic woman who delivered
prematurely.
Microscopic section of the placenta along the tan
white area
 Placental infarcts

• What are placental infarcts?

• Distinguish between a fresh ( recent ) and an old
infarct.
• What is the significance of a placental infarct?
• What conditions can arise from extensive
placental infarcts?
Case 4: Placenta of a 28 year old who figured in a
vehicular accident had cesarian section for fetal
distress
 Retroplacental hematoma

• Define retroplacental hematoma.

• What conditions are associated with retroplacental
hematoma?
• Discuss its relation to abruptio placenta.
• How would you assess the clinical significance of
a retroplacental hematoma?
• What is the pathology of the overlying placenta
where the hematoma is located?
Case 5: Placenta from a 25 year old who had
premature rupture of membranes
High power magnification of the section from
the chorioamniotic membranes
Villitis ( high power magnification )
 Acute and chronic chorioamnionitis

• Discuss the pathogenesis of the disease.

• Enumerate the bacteria mostly commonly
associated with this condition.
• Describe the gross and histologic features of
chorioamnionitis.
• What is the main clinical impact of
chorioamnionitis?
• When does villitis occur? Discuss its
etiopathogenesis.
Case 6: Cesarian hysterectomy specimen of a 32
year old G4P4
 Placenta accreta

• What is the pathologic basis for this condition?

• Define placenta accreta, placenta increta, placenta
percreta.
• What are the predisposing factors linked to this
condition?
• Discuss the gross and microscopic morphology of
the lesion.
Case 7: Vaginal bleeding with sudden passage of
molar vesicles in a 26 year old hypertensive.
Tissue section of the molar vesicles
Subsequent hysterectomy was performed; section taken
from the myometrium
 Invasive mole

• Define gestational trophoblastic diseases.Discuss its

pathogenesis.
• Differentiate the pathologic features of a complete and
a partial hydatidiform mole in terms of karyotype,
embryo, villous outline, hydropic swelling,
trophoblastic proliferation.
• What laboratory test is most useful in monitoring
recurrent gestational trophoblastic disease?
Case 8: Hysterectomy specimen in a 38 year old with a
previous history of abortion
Tissue section of the uterine tumor
 Choriocarcinoma

• Describe the gross and microscopic morphology of the

tumor.
• Compare the beta hCG titer from that of PSTT.
• What are the common sites of metastasis?
Case 9: Uterus of a 30 year old with vaginal bleeding and
clinical presentation of missed abortion. Serum hCG is
low.
 Placental site trophoblastic tumor (PSTT)

• Discuss the gross and microscopic morphology of

this tumor in terms of cellular population, cell size
and shape, growth pattern, margins, mitotic
count,hemorrhage and necrosis, associated
chorionic villi.
• Differentiate the tumor from an exaggerated
placental site (EPS).What immunostain is helpful
in distinguishing this from PSTT?
• Tabulate the immunohistochemical marker profile
of EPS, PSTT, and choriocarcinoma.
Case 10: Fetus and placenta delivered by a 24 year
old G3P1 with a history of maternofetal ABO
incompatibility.
Microscopic picture of the section of the placenta
 Fetoplacental hydrops

• Enumerate the causative factors of hydrops fetalis

and megaplacenta.
• Discuss the gross and microscopic features of the
placenta.