PATOLOGI

SISTEM
REPRODUKSI
WANITA
PENYAKIT GESTASIONAL

Dr. H. Soekimin, Sp. PA; dr. Jessy Chrestella, Sp. PA

Dept. Patologi Anatomi Fakultas Kedokteran
Universitas Sumatera Utara
Medan 2012

PREGNANCY DISEASES
PLACENTA
ABORTION
INFECTION
PUERPERAL INFECTION
HYDATID MOLE
CHORIO CARCINOMA
TOXEMIA GRAVIDARUM
ECTOPIC PREGNANCY
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PLACENTAL DISEASES
Succenturiate placenta
Circumvallate placenta
Battledore placenta
Vilamentous insertio of cord
Placenta previa
Marginal
Partial
Total

Abruptio placentae
External and internal bleeding
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Succenturiate (accessory) placenta

Large succenturiate lobe from which the
cord arises. No complications are evident

Succenturiate lobes in an immature

placenta. Some of these lobes are infarcted
(pallor & atrophy

Courtesy of Drs. Farsad and Gore, Birmingham, Alabama.)

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Circumvallate placenta
the small surface area of
chorion frondosum & large white
fibrin ring at the periphery.

(A)

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there is a lesser degree of

circumvallation than in Figure (A)

(B)
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CIRCUMVALLATE

Vilamentous insertion of cord

Velamentous insertion of umbilical cord
on the dividing membranes (M) of dichorionic twin placenta

(Courtesy of Dr. M. Rockwell.)

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Abortion

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Spontaneous abortus with the presence

of a fragmented and macerated embryo
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(arrow).

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Abortion
(Spontaneous abortus at 9 weeks )

Showing major growth

disorganization with a
cylindrical embryo
It was also small for the
gestational age (expected
crown-rump length, 2.5
cm).
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Fragment of decidual tissue

Note: the membranous character with one

smooth (right) and one granular (left)
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surface.
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Fetus after pregnancy termination

procedure with typical disruption

The fetal parts have been

arranged such that the
normal anatomical position
has been approximated.
The skull became collapsed
during the procedure.

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ECTOPIC PREGNANCY
Cervical

Interstitial

Isthmic

Ampulla

Infundibular

Ovarial

Abdominal
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Gestational Trophoblastic Disease

Is a spectrum of disorders with
abnormal trophoblast
proliferation & maturation
As well as neoplasms derived
from trophoblast
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Table 23.1. WHO classification of

gestational trophoblastic disease
Hydatidiform
mole

Trophoblastic
neoplasms

Complete
mole
Partial mole
Invasive mole
Metastatic
mole

Choriocarcino
ma
Placental site
trophoblastic
tumor
Epithelioid
trophoblastic
tumor

Nonneoplastic,
nonmolar
trophoblastic
lesions
Placental site
nodule and
plaque
Exaggerated
placental site

Source: From Tavassoli FA, Devilee P. World Health Organization classification of tumours: pathology and genetics. Tumours of
the breast and female genital organs. Lyon, France: IARC Press, 2003.

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Origin of complete and

partial hydatidiform moles

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(A) Most commonly, Complete moles

Arise from fertilization of an empty

ovum by a single sperm that then
undergoes duplication of its
chromosomes.
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(B) Less commonly, complete moles

Less commonly, complete moles arise from

dispermy in which two sperm fertilize an
empty ovum.
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(C) Partial moles

Arise from two sperm fertilizing a

single ovum.
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Mole/Molar
pregnancy
Incomplete mole
Fetal parts present, no
carcinoma.

Complete mole
No fetal parts
2% chance of carcinoma.

Invasive /
Aggressive mole.

Choriocarcinoma.
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Girls < 15 years of age

Increases progressively > 40 years of
age
Women > 50 years of age have 200
times the risk
Asian women > white women.
Prior hydatidiform mole

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Risk
Factor
s:

HYDATIDIFORM
MOLE

Complete mole:

Hydatidiform Mole (Image: ACT Pathology description)

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Complete - Hydatidiform Mole

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Partial Mole:

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Complete Mole

Entire uterine cavity is filled

with swollen villi.
Diameter villi 1 - 3 mm
Appear grape-like

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Complete Mole ...

Cavitated central cisterns
Trophoblastic
hyperplasia &
atypia

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Cavitated central cisterns

Trophoblastic hyperplasia &
atypia
Blood vessels of the villi
atrophied & disappeared.

Molar villi
have:

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Complete Mole vs. Partial

Mole
Complete mole
All villi cystic
Fetal parts (-)
Diffuse
trophoblastic
hyperplasia
46xx of sperm

Choriocarcinoma
common.
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Partial mole
Partially cystic
Fetal parts (+)
Focal trophoblastic
hyperplasia
69 xxy or 92
xxxy (ovum &
sperm)
Rare carcinoma

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Complete Mole
u
vill
e
g
Lar

s
illu
V
al
rm
o
N

Trophoblast Hyperplasia

No Blood Vessel in villi

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Complete Mole
Tr

ia
as
l
rp
pe
y
H
st
a
l
ob
h
op

u
vill
e
g
Lar

No Blood Viessel in villi

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Complete Mole

Tr

ia
as
l
rp
pe
y
H
st
a
l
ob
h
op

Atypia

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Invasive Mole

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Uterus Invasive mole

Myometrium
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Choriocarcinoma
Gestational choriocarcinoma is a
malignant tumor derived from
trophoblast.
Incidence, related to abnormalities
of pregnancy :

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1
1
1
1

of
of
of
of

160.000 normal gestations

15.000 spontaneous abortions
5.000
ectopic pregnancies
40
complete molar pregnancies
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Metastasizes
by
hematogenou
s route to

Lungs (> 90%)

Brain
Gastrointestinal tract
Liver
Vagina.

The tumor contains a dimorphic population

of cytotrophoblast & syncytiotrophoblast
Varying degrees of intermediate
trophoblast.

Abnormal uterine bleeding.

Histological
Clinical

Choriocarcinoma

Choriocarcinoma

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Choriocarcinoma:

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Eclampsia & pre-eclampsia

Hypertension of pregnancy
Pathogenesis
Unknown
Genetic / Immune

Common with First / molar

pregnancy ? Trophoblasts
Seizures & Cerebral edema.
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Eclampsia & pre-eclampsia ...

Reduced placental blood flow

Spiral arteries of the uteroplacental bed do not
respond or dilate.
Extensive placental infarction or retroplacental
hemorrhage in 1/3 patients with severe preeclampsia.
Chorionic villi show
Underperfusion
Cytotrophoblast hyperplasia
Thickening of basement membrane

Kidneys always show glomerular changes

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ECLAMPSIA
&
PREECLAMPSIA

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Placental anatomy. (Reproduced, with permission, from Copenhaver WM, Kelly DE, Wood
RL: Bailey's Textbook of Histology, 17th ed. Williams & Wilkins, 1978.)
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