8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 1/30
Module in OBSTETRIC PATHOLOGY
for LU 4Sept. 5, 2005, 1PM- 5 PM
Agustina D. Abelardo, MD
Professor of Pathology
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 2/30
Case 1: Endometrial curettings from a 23 year
old with vaginal bleeding and a missed period of
one month
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 3/30
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 4/30
Decidua and immature placental tissue in early
abortion
• Describe the products of conception.
• What is Arias- Stella reaction?
• Enumerate the causes of abortion.
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 5/30
Case 2: Salpingectomy specimen of a 22 year old
with sudden left lower quadrant pains.LMP was 7
weeks ago
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 6/30
Microscopic section (low power magnification)
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 7/30
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?
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 8/30
Case 3: Cut section of a placenta from a 32 year
old preeclamptic woman who delivered
prematurely.
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 9/30
Microscopic section of the placenta along the tan
white area
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 10/30
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?
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 11/30
Case 4: Placenta of a 28 year old who figured in a
vehicular accident had cesarian section for fetal
distress
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 12/30
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?
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 13/30
Case 5: Placenta from a 25 year old who had
premature rupture of membranes
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 14/30
High power magnification of the section from
the chorioamniotic membranes
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 15/30
Villitis ( high power magnification )
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 16/30
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.
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 17/30
Case 6: Cesarian hysterectomy specimen of a 32
year old G4P4
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 18/30
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.
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 19/30
Case 7: Vaginal bleeding with sudden passage of
molar vesicles in a 26 year old hypertensive.
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 20/30
Tissue section of the molar vesicles
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 21/30
Subsequent hysterectomy was performed; section taken
from the myometrium
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 22/30
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?
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 23/30
Case 8: Hysterectomy specimen in a 38 year old with a
previous history of abortion
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 24/30
Tissue section of the uterine tumor
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 25/30
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?
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 26/30
Case 9: Uterus of a 30 year old with vaginal bleeding and
clinical presentation of missed abortion. Serum hCG is
low.
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 27/30
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
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 28/30
Case 10: Fetus and placenta delivered by a 24 year
old G3P1 with a history of maternofetal ABO
incompatibility.
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 29/30
Microscopic picture of the section of the placenta
8/14/2019 09 18 06 Module on Obstetric Pathology
http://slidepdf.com/reader/full/09-18-06-module-on-obstetric-pathology 30/30
Fetoplacental hydrops
• Enumerate the causative factors of hydrops fetalis
and megaplacenta.
• Discuss the gross and microscopic features of the placenta.