Gestational trophoblastic neoplasia pathophysiology: Difference between revisions
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{{CMG}}{{AE}}{{MD}} | {{CMG}}{{AE}}{{MD}} | ||
==Overview== | ==Overview== | ||
Gestational trophoblastic | Gestational trophoblastic neoplasia arises from the [[trophoblast]]ic tissue, which provide nutrients to the embryo and develop into a large part of the [[placenta]]. On gross pathology, dark, shaggy, focally hemorrhagic & friable/necrotic-appearing, and invasive border are characteristic findings of gestational trophoblastic neoplasia. The pathophysiology of gestational trophoblastic neoplasia depends on the [[histological]] subtype.<ref name= abc> Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
A [[hydatidiform mole]] is characterized by a [[conceptus]] of [[hyperplasia|hyperplastic]] [[trophoblast]]ic tissue attached to the [[placenta]]. The conceptus does not contain the [[inner cell mass]]. | A [[hydatidiform mole]] is characterized by a [[conceptus]] of [[hyperplasia|hyperplastic]] [[trophoblast]]ic tissue attached to the [[placenta]]. The conceptus does not contain the [[inner cell mass]]. | ||
The hydatidiform mole can be of two types: a ''complete mole'', in which the abnormal embryonic tissue is derived from the father only, and a ''partial mole'', in which the abnormal tissue is derived from both parents. | The hydatidiform mole can be of two types: a ''complete mole'', in which the abnormal [[embryonic]] tissue is derived from the father only, and a ''partial mole'', in which the abnormal tissue is derived from both parents. | ||
* '''Complete moles''' usually occur when an empty ovum is fertilized by a sperm that then duplicates its own DNA. A 46, XY genotype may occur when 2 sperm (one 23, X and the other 23, Y) fertilize an empty egg.<ref name= aaa>{{cite journal |author=Woo J, Hsu C, Fung L, Ma H |title=Partial hydatidiform mole: ultrasonographic features |journal=Aust N Z J Obstet Gynaecol |volume=23 |issue=2 |pages=103-7 |year=1983 |pmid=6578773}}</ref> Their DNA is purely paternal in origin, and is diploid. Ninety percent are 46,XX, and 10% are 46,XY. In a complete mole, the fetus fails to develop. | * '''Complete moles''' usually occur when an empty ovum is fertilized by a sperm that then duplicates its own DNA. A 46, XY [[genotype]] may occur when 2 sperm (one 23, X and the other 23, Y) fertilize an empty egg.<ref name= aaa>{{cite journal |author=Woo J, Hsu C, Fung L, Ma H |title=Partial hydatidiform mole: ultrasonographic features |journal=Aust N Z J Obstet Gynaecol |volume=23 |issue=2 |pages=103-7 |year=1983 |pmid=6578773}}</ref> Their DNA is purely paternal in origin, and is diploid. Ninety percent are 46,XX, and 10% are 46,XY. In a complete mole, the [[fetus]] fails to develop. | ||
* '''Partial moles''' can occur if a normal [[haploid]] ovum is fertilized by two sperm, or if | * '''Partial moles''' can occur if a normal [[haploid]] ovum is fertilized by two [[sperm]], or if [[fertilize]]d by one sperm, if the paternal [[chromosomes]] become duplicated. Thus their DNA is both maternal and paternal in origin. They can be triploid (e.g. 69 XXX, 69 XXY) or even tetraploid. | ||
Choriocarcinoma of the [[placenta]] during pregnancy is preceded by: | Choriocarcinoma of the [[placenta]] during [[pregnancy]] is preceded by: | ||
* [[Hydatidiform mole]] (50% of cases) | * [[Hydatidiform mole]] (50% of cases) | ||
* [[Spontaneous abortion]] (20% of cases) | * [[Spontaneous abortion]] (20% of cases) | ||
| Line 16: | Line 16: | ||
* Normal term pregnancy (20-30% of cases) | * Normal term pregnancy (20-30% of cases) | ||
==Genetics== | ==Genetics== | ||
* Invasive mole- diploid or aneuploid karyotype | * Invasive mole- diploid or aneuploid [[karyotype]] | ||
* Choriocarcinomas- aneuploid karyotype | * Choriocarcinomas- aneuploid karyotype | ||
==Gross Pathology== | ==Gross Pathology== | ||
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* Invasive border | * Invasive border | ||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
Gestational trophoblastic | Gestational trophoblastic neoplasia classification<ref name= abc> Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015</ref> | ||
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Revision as of 19:06, 15 October 2015
Template:Choriocarcinoma Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]
Overview
Gestational trophoblastic neoplasia arises from the trophoblastic tissue, which provide nutrients to the embryo and develop into a large part of the placenta. On gross pathology, dark, shaggy, focally hemorrhagic & friable/necrotic-appearing, and invasive border are characteristic findings of gestational trophoblastic neoplasia. The pathophysiology of gestational trophoblastic neoplasia depends on the histological subtype.[1]
Pathophysiology
A hydatidiform mole is characterized by a conceptus of hyperplastic trophoblastic tissue attached to the placenta. The conceptus does not contain the inner cell mass. The hydatidiform mole can be of two types: a complete mole, in which the abnormal embryonic tissue is derived from the father only, and a partial mole, in which the abnormal tissue is derived from both parents.
- Complete moles usually occur when an empty ovum is fertilized by a sperm that then duplicates its own DNA. A 46, XY genotype may occur when 2 sperm (one 23, X and the other 23, Y) fertilize an empty egg.[2] Their DNA is purely paternal in origin, and is diploid. Ninety percent are 46,XX, and 10% are 46,XY. In a complete mole, the fetus fails to develop.
- Partial moles can occur if a normal haploid ovum is fertilized by two sperm, or if fertilized by one sperm, if the paternal chromosomes become duplicated. Thus their DNA is both maternal and paternal in origin. They can be triploid (e.g. 69 XXX, 69 XXY) or even tetraploid.
Choriocarcinoma of the placenta during pregnancy is preceded by:
- Hydatidiform mole (50% of cases)
- Spontaneous abortion (20% of cases)
- Ectopic pregnancy (2% of cases)
- Normal term pregnancy (20-30% of cases)
Genetics
- Invasive mole- diploid or aneuploid karyotype
- Choriocarcinomas- aneuploid karyotype
Gross Pathology
- Dark, shaggy, focally hemorrhagic & friable/necrotic-appearing
- Invasive border
Microscopic Pathology
Gestational trophoblastic neoplasia classification[1]
| Types of Gestational Trophoblastic Neoplasia | Histopathological features |
|---|---|
|
Invasive mole |
|
|
Choriocarcinoma |
|
|
Placental-site trophoblastic tumor |
|
|
Epithelioid trophoblastic tumor |
|
References
- ↑ 1.0 1.1 Cellular Classification of Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_5 Accessed on October 8, 2015
- ↑ Woo J, Hsu C, Fung L, Ma H (1983). "Partial hydatidiform mole: ultrasonographic features". Aust N Z J Obstet Gynaecol. 23 (2): 103–7. PMID 6578773.