Difference between revisions of "Products of conception"
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*Benign atypical endometrial changes associated with chorionic tissue.<ref name=pmid11756756>{{Cite journal | last1 = Arias-Stella | first1 = J. | title = The Arias-Stella reaction: facts and fancies four decades after. | journal = Adv Anat Pathol | volume = 9 | issue = 1 | pages = 12-23 | month = Jan | year = 2002 | doi = | PMID = 11756756 }}</ref> | *Benign atypical endometrial changes associated with chorionic tissue.<ref name=pmid11756756>{{Cite journal | last1 = Arias-Stella | first1 = J. | title = The Arias-Stella reaction: facts and fancies four decades after. | journal = Adv Anat Pathol | volume = 9 | issue = 1 | pages = 12-23 | month = Jan | year = 2002 | doi = | PMID = 11756756 }}</ref> | ||
**May be seen in a normal pregnancy, [[hydatidiform mole]]s, others. | **May be seen in a normal pregnancy, [[hydatidiform mole]]s, others. | ||
*Historically it was diagnosed as [[endometrial cancer]]. | |||
===Microscopic=== | ===Microscopic=== | ||
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Notes: | Notes: | ||
*To the novice... the nuclei look really scary, i.e. they look like cancer. | *To the novice... the nuclei look really scary, i.e. they look like cancer. | ||
DDx: | |||
*[[Choriocarcinoma]]. | |||
*[[Herpes simplex virus|Herpetic]] [[endometritis]]. | |||
Images: | Images: | ||
*[http://commons.wikimedia.org/wiki/File:Arias-Stella_reaction_-_low_mag.jpg Arias-Stella reaction - low mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Arias-Stella_reaction_-_low_mag.jpg Arias-Stella reaction - low mag. (WC)]. | ||
*[http://commons.wikimedia.org/wiki/File:Arias-Stella_reaction_-_high_mag.jpg Arias-Stella reaction - high mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Arias-Stella_reaction_-_high_mag.jpg Arias-Stella reaction - high mag. (WC)]. | ||
====Subtypes==== | |||
There are five subtypes:<ref name=pmid11756756/> | |||
#Minimal atypia. | |||
#Early secretory pattern. | |||
#Secretory or hypersecretory pattern. | |||
#Regenerative, proliferative or nonsecretory pattern. | |||
#Monstrous cell pattern. | |||
==Screening tests== | ==Screening tests== | ||
Revision as of 01:36, 14 August 2011
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.
History
- Therapeutic abortions - may be abbreviated "MVC" (manual vacuum aspiration).[1]
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.
- Should have decidual reaction of endometrium.
- Decidual changes -- mnemonic NEW:
- Nucleus central.
- Eosinophilic cytoplasm.
- Well-defined cell borders.
- Decidual changes -- mnemonic NEW:
- Embryo or fetus - a bonus.
- +/-Hyaline globules.[2]
Image:
Aside:
- Embryo = conceptus before 8 weeks.
- Fetus = conceptus 8th weeks 'til birth.
Beta-hCG
Calculator: http://www.countdowntopregnancy.com/tools/beta_doubling_calculator.php
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.
Arias-Stella reaction
General
- Benign atypical endometrial changes associated with chorionic tissue.[3]
- May be seen in a normal pregnancy, hydatidiform moles, others.
- Historically it was diagnosed as endometrial cancer.
Microscopic
Features:[3]
- Large nuclei - key feature.
- +/-Nuclear hyperchromasia, i.e. dark nuclei.
- +/-Irregular nuclear membrane.
- +/-Nuclear clearing.[4]
- +/-Nuclear pseudoinclusions.
- NC ratio is preserved.
- Usually a focal change.
- +/-Mitoses - uncommon.
Notes:
- To the novice... the nuclei look really scary, i.e. they look like cancer.
DDx:
Images:
Subtypes
There are five subtypes:[3]
- Minimal atypia.
- Early secretory pattern.
- Secretory or hypersecretory pattern.
- Regenerative, proliferative or nonsecretory pattern.
- Monstrous cell pattern.
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+).
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.
- ↑ 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.
- ↑ 3.0 3.1 3.2 Arias-Stella, J. (Jan 2002). "The Arias-Stella reaction: facts and fancies four decades after.". Adv Anat Pathol 9 (1): 12-23. PMID 11756756.
- ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 236 (bottom). ISBN 978-0470519035. .