1 / 49

Chapter 12

Diseases of female genital system and the breast Xuemei jiang Department of Pathology Basic Medical School. Chapter 12. §4 Gestational trophoblastic diseases (GTD). Anatomy of female genital system. Ideograph of normal villi. blood cell. cytotrophoblast

alyssa
Download Presentation

Chapter 12

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diseases of female genital system and the breast Xuemei jiangDepartment of PathologyBasic Medical School Chapter 12

  2. §4 Gestational trophoblastic diseases (GTD)

  3. Anatomy of female genital system

  4. Ideograph of normal villi blood cell cytotrophoblast cube、polygon or orbicular-ovate ; transparent or light colour cytoplasm;cell with well-defined，big and round nuclear、pale colour， placenta syncytiotrophoblast big cell，irregular shape，red cytoplasm， cell with ill-defined， irregular nuclear，dark-staining

  5. villi cytotrophoblast Stroma cell syncytiotrophoblast blood vessel in villi stroma

  6. placental villus of full term （足月胎盘绒毛）

  7. GTD Hydatidiform mole (noninvasive mole) Invasive mole choriocarcinoma Complete mole partialmole Gestational trophoblastic diseases (GTD)

  8. 一. Hydatidiform mole • Two types of benign, noninvasive moles—complete and partial 1. Etiology and pathogenesis unclear related to heredity related to pregnancy

  9. No Maternal DNA No Maternal DNA completemole Two sperm ( 23XX or 23 XY ) or Egg Paternal chromosomes only 23X sperm Duplication of sperm DNA Egg

  10. partialmole 23X 23x 23Y 23x 46X 23x Egg Maternal and paternal Chromosomes (Triploid) Egg

  11. 2. Pathological change (1) Gross • thin-walled, translucent, cystic, • grape-like structure • develop within the uterus and not invade myometrium • complete mole: All villi edema • partial mole: villous edema involves a • part of villi

  12. complete Hydatidiform mole----vesicular mole thin-walled, translucent, cystic, grape-like structure

  13. completeHydatidiform mole thin-walled, translucent, cystic, grape-like structure

  14. completehydatidiform mole develop within the uterus and not invade myometrium thin-walled, translucent, cystic, grape-like structure

  15. (2) LM ① High edematous stroma of villi ② Absence or obvious decreasing of stroma blood vessel ③ Trophoblastic proliferation syncytiotrophoblast cytotrophoblast important

  16. Normal villi

  17. 葡萄胎

  18. completeHydatidiform mole ① High edematous stroma of villi ② Absence or obvious decreasing of stroma blood vessel ③ Trophoblastic proliferation syncytiotrophoblast cytotrophoblast 4,Without embryonic development

  19. completeHydatidiform mole

  20. cytotrophoblast cube、polygon or orbicular-ovate ; transparent or light colour cytoplasm;cell with well-defined，big and round nuclear、pale colour， syncytiotrophoblast big cell，irregular shape，red cytoplasm， cell with ill-defined ， irregular nuclear，dark-staining Two type of trophoblastic cell

  21. completehydatidiform mole partial hydatidiform mole With foetus or appendant organ

  22. 3. CPC • abnormal uterus bleeding begins early in the course of menolipsis (2) uterus enlargement is more rapid than anticipated----abdominal pain (3) HCG↑↑ (Human Chorionic Gonadotropin) (4) prognosis majority→recover 10%→invasive mole 2.5%→choriocarcinoma

  23.  Features of Complete Versus Partial Hydatidiform Mole Table 22-5--Features of Complete Versus Partial Hydatidiform Mole

  24. 二. Invasive mole 1.Distinguish between benign and invasive mole benign invasive myometrium invasion myometrium bleeding metastasis (-) (-) (-) (+) (+) (+)

  25. 2. Gross Hydropic villi invaded to myometrium Hemorrhage, necrosis

  26. Invasive mole Hemorrhage, necrosis Invasive mole presenting as a hemorrhagic mass adherent to the uterine wall. On cross-section, the tumor invades into the myometrium.  

  27. 3. LM Trophoblastic cell proliferation atypia Hydropic villi structure present

  28. Invasive mole myometrium Hydropic villi

  29. Invasive mole Hydropic villi myometrium Trophoblastic cell proliferation with atypia

  30. Invasive mole Hydropic villi Trophoblastic cell proliferation with atypia

  31. Invasive mole On cross-section, the tumor invades into the myometrium. Hydropic villi structure present in the myometrium

  32. 4. Clinical course ① Uterus irregular enlargement HCG↑↑ Vaginal bleeding ② Metastasis common lung

  33. 三. choriocarcinoma • Gestational choriocarcinoma is an epithelial malignant neoplasm of trophoblastic cells derived from any form of previously normal or abnormal pregnancy. • Choriocarcinoma is a rapidly invasive, widely metastasizing malignant neoplasm, but once it is identified, it responds well to chemotherapy

  34. 1. Pathological changes (1) Gross • Carcinoma nodules • →invaded myometrium • Extensive hemorrhage, necrosis

  35. choriocarcinoma a bulky hemorrhagic mass invading the uterine wall.

  36. purple nodule ，with Hemorrhage， necrosis，d=2-10cm choriocarcinoma

  37. hemorrhagic focus in the ovary hemorrhagic focus through the Uterine wall

  38. (2) LM ① have no chorionic villi ② abnormal proliferation of trophoblast cytotrophoblast syncytiotrophoblast ③ have no stroma and no blood vessel →obvious hemorrhage

  39. choriocarcinoma LM： no chorionic villi no stroma no blood vessel abnormal proliferation of trophoblast

  40. choriocarcinoma obvious hemorrhage

  41. (3) Distinguish between invasive mole and choriocarcinoma invasive molechoriocarcinoma villi (+) villi (-)

  42. 2. Clinical course (1) related to normal or abnormal pregnancy 50%→hydatidiform mole 25%→miscarriage 20%→after normal childbirth

  43. (2) Bleeding, uterus↑↑, HCG↑ (3) Feature widespread metastasis lung: 50% vagina: 30-40% brain, liver, kidney

  44. lung

  45. obvious hemorrhage In liver

  46. brain metastasis of choriocarcinoma

  47. Spread -Direct The first spread is directly into neighbouring structures – peritoneum, uterus, bladder, bowel and omentum.

  48. Spread -Blood Stream Blood spread is usually to the lungs 、vagina and liver

More Related