The histopathology of trophoblastic tumours

Elston, C. W.

doi:10.1136/jcp.29.suppl_10.111

Cited by 38 publications

(6 citation statements)

References 58 publications

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“…Firstly, the low impedance reflects the presence of arterio-venous shunts within the uterus. This may have the effect of decreasing the perfusion of the tumour which has been shown to be relatively avascular within itself (Elston, 1976). Thus, penetration of the cytotoxic drugs would be reduced and their effectiveness diminished leading to the development of clinical drug resistance.…”

Section: Discussionmentioning

confidence: 99%

Doppler assessment of the uterine circulation and the clinical behaviour of gestational trophoblastic tumours requiring chemotherapy

Long

Boultbee²,

Langley³

et al. 1992

Br J Cancer

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SummaryThe haemodynamics of the uterine arteries and myometrium were assessed using Doppler ultrasound in forty consecutive patients requiring treatment for invasive mole and choriocarcinoma. The investigations were performed prior to the commencement of chemotherapy and the subjects followed prospectively. The Doppler waveforms from the uterine arteries were analysed using the pulsatility index. It was found that patients with a pulsatility index of 1.1 or less were significantly more likely to develop drug resistance than those with a higher value (P <0.04). There was no significant association between the pulsatility index and metastatic disease or uterine bleeding. Five out of eight patients who developed drug resistance could have avoided initial inadequate treatment if the Doppler findings were included in the scoring system for selecting chemotherapy for these tumours. It can be concluded that assessment of the uterine arteries using the pulsatility index prior to the treatment of patients with invasive mole and choriocarcinoma is of help in predicting those who will develop drug resistance.

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Section: Discussionmentioning

confidence: 99%

Doppler assessment of the uterine circulation and the clinical behaviour of gestational trophoblastic tumours requiring chemotherapy

Long

Boultbee²,

Langley³

et al. 1992

Br J Cancer

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“…These have been discussed by Elston and Bagshawe. 15 28 In a series of 54 patients, they examined curettings from 38 being followed up after delivering a hydatidiform mole, 12 after normal pregnancies and 4 after spontaneous abortions. They identified three histological groups:…”

Section: Placenta Cord and Membranesmentioning

confidence: 99%

Examination of products of conception from previable human pregnancies.

Rushton¹

1981

J Clin Pathol

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The incidence, aetiology, and mechanisms of spontaneous abortion are outlined. A simplified classification of products of conception specifically orientated for routine histopathological laboratories rather than research centres is presented. Its introduction should not in itself greatly increase the work load of a service laboratory already examining such material. Specific practical problems are discussed and these are related to the clinical situation. The importance is emphasised of proper examination of tissues from pregnancies aborting after diagnostic amniocentesis, as well as those from therapeutic terminations performed for fetal abnormality or disease. Special techniques are suggested for processing suspected procured abortions. Finally the value is stressed of routine examination of spontaneously aborted material in the current and future management of the patient, in the furtherance of our knowledge of fetal diseases and of some of the major contributory factors to perinatal morbidity and mortality.

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“…2 Squamous cell carcinoma may also be positive for hCG, therefore immunostaining for cytokeratin and hCG is of no value in differentiating between squamous cell carcinoma and choriocarcinoma. 4 Choriocarcinoma, relatively uncommon in the Western world, is exceedingly frequent in Asia and Africa. The presence of placental villi, the ultrasound findings and hormonal evaluation could be helpful in this regard.…”

mentioning

confidence: 99%

“…The presence of placental villi, the ultrasound findings and hormonal evaluation could be helpful in this regard. 4 Choriocarcinoma, relatively uncommon in the Western world, is exceedingly frequent in Asia and Africa. 5,6 Cytopathologists in these regions should be aware of this fact and able to rule out the possibility of choriocarcinoma in their evaluations of cervical smears with features similar to the above-mentioned case by recommending follow-up of b-hCG serum titres.…”

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confidence: 99%

Cytological findings of intrauterine and cervical choriocarcinoma

Kadivar

Hosseini

2007

Cytopathology

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Dear Editor, Gestational intrauterine choriocarcinoma, a malignant tumour of placental trophoblasts, can present symptomatically as uterine enlargement or abnormal bleeding. Cytology is limited in making the initial diagnosis of cervical/uterine choriocarcinoma. 1 Instead, the diagnosis is frequently made by evaluating b human chorionic gonadotropin (b-hCG) serum levels. In our case report, clinical findings along with the cytological and histomorphological features of cervical/uterine choriocarcinoma are described.A 45-year-old woman presented with an 8-month history of abnormal uterine bleeding. Gynaecological examination revealed an enlarged uterus. Computed tomography scan displayed an enlarged uterus with multiple various sized masses in the corpus and a large heterogeneous mass in the uterine cervix. Laboratory investigations showed low haemoglobin and high serum titre of b-hCG (244,000 mIU/ml).Preoperative cervical smears revealed malignant cells intermingled with benign intermediate and superficial squamous epithelium and many neutrophils. The malignant cells, which formed either clusters of cells or were isolated in an inflammatory background, had moderate to abundant cytoplasm. There were a few mononucleated and binucleated cells, and many cells displaying syncytium-like features ( Figure 1a). The nuclei of the malignant cells varied considerably in size; the largest were 5 to 10 times larger than the smallest ones ( Figure 1b). There were a few cells with abundant, irregularly shaped cytoplasm and bizarre nuclei. Some cells showed prominent eosinophilic nucleoli (Figure 2a). The distribution of nuclear chromatin was coarsely granular. Based on the clinical and cytological findings, the diagnosis of choriocarcinoma was entertained.An abdominal hysterectomy was performed. Sectioning of the enlarged uterus revealed one leiomyoma, two ill-defined 3 cm masses with a necrotic and haemorrhagic area in the corpus, and an infiltrative 5 cm mass with foci of haemorrhage and necrosis in the cervix. Microscopically, the uterine and cervical lesions were composed of clusters of cytotrophoblast separated by streaming masses of syncytiotrophoblasts, resulting in dimorphic plexiform patterns in a haemorrhagic and necrotic background (Figure 2b). The tumour cells were positive for both keratin and hCG. The diagnosis of choriocarcinoma was established. The patient underwent chemotherapy and was followed by monitoring serum b-hCG levels that demonstrated a gradual decline in titres.A major challenge in the cytology diagnosis of cervical choriocarcinoma is the exclusion of a primary cervical neoplasm, particularly squamous cell carcinoma. To differentiate choriocarcinoma from squamous cell carcinoma in cervical smears, one should pay attention to the presence of highly atypical cells with abundant cytoplasm, and bizarre nuclei with prominent nucleoli. The cells of choriocarcinoma are usually larger than carcinoma cells, form syncytiumlike structures, and do not produce keratin. The Figure 1. (a) Cervical cytology. Syncyti...

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The histopathology of trophoblastic tumours

Cited by 38 publications

References 58 publications

Doppler assessment of the uterine circulation and the clinical behaviour of gestational trophoblastic tumours requiring chemotherapy

Doppler assessment of the uterine circulation and the clinical behaviour of gestational trophoblastic tumours requiring chemotherapy

Examination of products of conception from previable human pregnancies.

Cytological findings of intrauterine and cervical choriocarcinoma

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