09 18 06 module on obstetric pathology

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Module in OBSTETRIC PATHOLOGY

for LU 4Sept. 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



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 organinvolved?

• 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 retroplacentalhematoma?

• 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 sizeand shape, growth pattern, margins, mitoticcount,hemorrhage and necrosis, associatedchorionic villi.

• Differentiate the tumor from an exaggerated placental site (EPS).What immunostain is helpfulin distinguishing this from PSTT?

• Tabulate the immunohistochemical marker profileof EPS, PSTT, and choriocarcinoma.

C 10 d l d li d b 24



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.

09 18 06 module on obstetric pathology

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