Products of conception
Products of conception, abbreviated POC, is stuff formed from the union of egg and sperm. This article covers POC superficially.
There are separate articles for chorionic villi and gestational trophoblastic disease.
General
Clinical
- Therapeutic abortions - may be abbreviated "MVC" (manual vacuum aspiration).[1]
- Diagnosis of pregnancy: beta-hCG > 10 mIU/mL.
- Beta-hCG calculator: http://www.countdowntopregnancy.com/tools/beta_doubling_calculator.php.
- If the beta-hCG is >1500 mIU/mL -- there is a good chance an ultrasound is diagnostic.[2]
Screening tests
First trimester screen
- PAPP-A.
- Nuchal translucency.
- Beta-hCG.
Maternal serum screen
- Alpha-fetoprotein.
- Beta-hCG.
- Estriol.
Diagnostic tests
- Chorionic villus sampling (10-12 weeks???).
- Amniocentesis (15-16 weeks+).
Ectopic pregnancy
- Chorionic villi have to be identified (in some location, e.g. Fallopian tube) to Dx a pregnancy.
- Endometrium: decidual reaction, as seen in any pregnancy.
Microscopic
Features:
- Chorionic villi are need to call POC - key feature.
- Cytotrophoblast.
- Centre of villi often have fetal red blood cells (which have nuclei) -- not required for diagnosis of POC.
- +/-Endometrium (intrauterine pregnancy):
- Should have decidual changes -- mnemonic NEW:
- Nucleus central.
- Eosinophilic cytoplasm.
- Well-defined cell borders.
- Should have decidual changes -- mnemonic NEW:
- +/-Uterine tube +/- decidualization (tubal pregnancy).
- +/-Hyaline globules.[3]
- +/-Embryo or fetus - a bonus.
- Cartilage.
- Primitive neuroepithelium.
- Gastrointestinal epithelium.
Images:
Aside:
- Embryo = conceptus before 8 weeks.
- Fetus = conceptus 8th weeks 'til birth.
Arias-Stella reaction
General
- Benign atypical endometrial changes associated with chorionic tissue.[4]
- May be seen in a normal pregnancy, hydatidiform moles, others.
- Historically it was diagnosed as endometrial cancer.
Note:
- To the novice... the nuclei look really scary, i.e. they look like cancer.
Microscopic
Features:[4]
- Epithelial component of endometrium with large nuclei - key feature.
- +/-Nuclear hyperchromasia, i.e. dark nuclei.
- +/-Irregular nuclear membrane.
- +/-Nuclear clearing.[5]
- +/-Nuclear pseudoinclusions.
- NC ratio is preserved.[5]
- Usually a focal change.
- +/-Mitoses - uncommon.
Notes:
- No decidual reaction in the stroma.
DDx:
- Choriocarcinoma.
- Herpetic endometritis.
- Clear cell carcinoma.
Images:
Subtypes
There are five subtypes:[4]
- Minimal atypia.
- Usually early gestation.
- Early secretory pattern.
- Mimics secretory endometrium: cytoplasmic vacuoles, central nucleus, palisading architecture.
- Secretory or hypersecretory pattern.
- Regenerative, proliferative or nonsecretory pattern.
- Monstrous cell pattern.
See also
References
- ↑ Edelman A, Nichols MD, Jensen J (June 2001). "Comparison of pain and time of procedures with two first-trimester abortion techniques performed by residents and faculty". Am. J. Obstet. Gynecol. 184 (7): 1564-7. PMID 11408881. http://linkinghub.elsevier.com/retrieve/pii/S0002937801372241.
- ↑ Barnhart, KT.; Simhan, H.; Kamelle, SA. (Oct 1999). "Diagnostic accuracy of ultrasound above and below the beta-hCG discriminatory zone.". Obstet Gynecol 94 (4): 583-7. PMID 10511363.
- ↑ Dharan M (September 2009). "Hyaline globules in ectopic decidua in a pregnant woman with cervical squamous cell carcinoma". Diagn. Cytopathol. 37 (9): 696–8. doi:10.1002/dc.21113. PMID 19526574.
- ↑ 4.0 4.1 4.2 Arias-Stella, J. (Jan 2002). "The Arias-Stella reaction: facts and fancies four decades after.". Adv Anat Pathol 9 (1): 12-23. PMID 11756756.
- ↑ 5.0 5.1 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 236-7. ISBN 978-0470519035.
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