Products of conception

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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.
  • 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

Arias-Stella reaction

General

Note:

  • To the novice... the nuclei look really scary, i.e. they look like cancer.

Microscopic

Features:[3]

  • Large nuclei - key feature.
  • NC ratio is preserved.
  • Usually a focal change.
  • +/-Mitoses - uncommon.

Notes:

  • No decidual reaction in the stroma.

DDx:

Images:

Subtypes

There are five subtypes:[3]

  1. Minimal atypia.
    • Usually early gestation.
  2. Early secretory pattern.
    • Mimics secretory endometrium: cytoplasmic vacuoles, central nucleus, palisading architecture.
  3. Secretory or hypersecretory pattern.
  4. Regenerative, proliferative or nonsecretory pattern.
  5. 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

  1. 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.
  2. 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. 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.
  4. Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 236 (bottom). ISBN 978-0470519035. .