Gestational trophoblastic neoplasia pathophysiology

Template:Choriocarcinoma Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Shivali Marketkar, M.B.B.S. [2]

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Pathophysiology

Microscopic Pathology

On light microscopy, there is malignant trophoblastic proliferation without hydropic villi.Characteristic feature is the identification of intimately related syncytiotrophoblasts and cytotrophoblasts without formation of definite placental type villi.Syncytiotrophoblasts are large multi-nucleated cells with eosinophilic cytoplasm. They often surround the cytotrophoblasts, reminiscent of their normal anatomical relationship in chorionic villi. Cytotrophoblasts are polyhedral, mononuclear cells with hyperchromatic nuclei and a clear or pale cytoplasm. Extensive hemorrhage is a common finding.Shown below is an image of choriocarcinoma.(High mag|H&E stain)

The Image shows:

Choriocarcinomas consist of two cell populations:

1. Cytotrophoblasts.
   • Pale/clear cytoplasm.
2. Syncytiotrophoblasts.
   • Hyperchromatic cytoplasm.
   • Typically multinucleated.

Traditionally, the syncytiotrophoblasts are said to produce the beta-hCG;however, it has been determined that cytotrophoblast also produce some.The syncytiotrophoblasts are often arranged around the outside of cytotrophoblast cell clusters, reminicent of the arrangement in the placenta. On placental villi, the syncytiotrophoblasts are superficial to and, early in pregnancy, cover the cytotrophoblast.Choriocarcinoma is classified as a germ cell tumour. It can arise in the testis or ovary and from a hydatidiform mole. It may be part of a mixed germ cell tumour.

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