EXAM #1: TROPHOBLASTIC & CERVICAL CANCER

Question 1

What is a hydatid?

Answer 1

A cyst containing watery fluid

Question 2

What is a mole?

Answer 2

Abnormal mass of tissue in the uterus

Question 3

What is a Hyaditidiform Mole?

Answer 3

Abnormality of the placenta resulting from faulty fertilization

Question 4

What are the clinical manifestations of a Hyaditidiform Mole?

Answer 4

• 4th to 5th month gestation
• Size of the uterus MUCH LARGER than corresponding months
• Vaginal bleeding

Question 5

What is the different between a complete and partial Hyaditidiform Mole?

Answer 5

Complete= fertilization of an EMPTY OVUM with one or two sperm

• Results in 46 chromosomes
• NO EMBRYO

Partial= OVUM is 23X, results in 69 chromosomes
- Will have FETAL DEVELOPMENT

Question 6

How will a complete hyaditiform mole present?

Answer 6

Large, distended, bizarre, gelatinous mass

Question 7

How does the HCG level compare between complete and partial Hyaditidiform Mole?

Answer 7

Complete= very very high 
Partial= high

Question 8

What US finding is pathognomonic for a complete Hyaditidiform Mole?

Answer 8

Snowstorm

Question 9

Grossly, how is a Complete Hyaditidiform Mole described?

Answer 9

“Bunch of grapes”

Question 10

How do the chorionic villi appear in a Complete Hyaditidiform Mole?

Answer 10

Large avascular villi

Question 11

How do the chorionic villi for partial and complete Hyaditidiform Mole compare?

Answer 11

Partial= slight hyperplasia 
Complete= extensive hyperplasia

Question 12

What is an Invasive Mole?

Answer 12

Complete Hyaditidiform Mole with penetration of villi and trophoblast into the myometrium

Question 13

What are the complications of Invasive Moles?

Answer 13

1) Uterine rupture

2) Embolization of villi to lungs

Question 14

After D/C for complete Hyaditidiform Mole, what should you be concerned about if B-HCG remains elevated?

Answer 14

Invasive Mole

Question 15

What is a Chroiocarcinoma?

Answer 15

• Highly malignant neoplasm of trophoblastic cells

- Fleshy, hemorrhagic tumor with cytotrophoplast and syncytiotrophoblasts

Question 16

How does Choriocarcinoma present?

Answer 16

• Irregular spotting of brown, bloody, foul-smelling fluid

- Elevated B-HCG

Question 17

What is unique about Choriocarcinoma?

Answer 17

Very sensitive to chemotherapy

Question 18

What are Choriocarcinomas lacking?

Answer 18

Villi

Question 19

Where do Choriocarcinomas come from?

Answer 19

1) Normal pregnancy
2) Spontaneous abortion
3) Complete Mole*

*Most common

Question 20

What is a placental site tumor?

Answer 20

Tumor of the implantation site with intermediate trophoblasts

Question 21

What will the B-HCG levels be in a placenta site tumor?

Answer 21

Low

Question 22

What is the transformation zone?

Answer 22

Transition from columnar epithelial cells to squamous epithelial cells in the cervix (protective)

Question 23

Why is the transformation zone important?

Answer 23

Cervical intraepithelial neoplasia and carcinoma originate from the transformation zone

Question 24

What serotypes of HPV are the most oncogenic?

Answer 24

16 and 18

Question 25

How do HPV 16/18 cause cervical cancer?

Answer 25

``` E6= inhibits p53 E7= inhibits p53, p21, and Rb ```

Question 26

How does the outcome of HPV exposure to columar vs. sqamous epithelium differ?

Answer 26

``` Columnar= adenocarcinoma Squamous= squamous carcinoma ```

Question 27

What morphologic feature is characteristic of CIN?

Answer 27

Nuclear atypia

Question 28

What is LSIL?

Answer 28

Low-grade Squamous Intraepithelial Lesion

Question 29

How does LSIL appear on microscopy?

Answer 29

1) Koilocytes ("empty cytoplasm")--indicative of HPV infected cells 2) Ki-67 staining showing extension of proliferating cells from basal layer to superficial layer

Question 30

What is CIN-I?

Answer 30

Dysplasia in the lower 1/3

Question 31

What is CIN-2?

Answer 31

Dysplasia in the lower 2/3 i.e. extending into the parabasal layer

Question 32

What is CIN-3?

Answer 32

Dysplasia extending into all layers

Question 33

What is the difference between CIN-3 and CIS?

Answer 33

In CIN-3, the upper most layer is not involved, though the upper 1/3 is

Question 34

What is invasive cervical cancer?

Answer 34

Penetration of malignant cells through the basement membrane

Question 35

What is the most common type of cervical cancer?

Answer 35

Squamous cell

Question 36

What is the prognosis for Stage 1-2 cervical cancer?

Answer 36

Good