prezentace aplikace powerpoint · •slovak republic 1: 20 311 pregnancies clinical features of...
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![Page 1: Prezentace aplikace PowerPoint · •Slovak Republic 1: 20 311 pregnancies Clinical Features of Choriocarcinoma • Choriocarcinoma can follow any form of gestation • Choriocarcinoma](https://reader034.vdocument.in/reader034/viewer/2022042802/5f3dae6701829642ae529ae6/html5/thumbnails/1.jpg)
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Gestačná trofoblastová choroba
2020
WHO histopathologic classification of GTD
2014
Molar pregnancies
1. Hydatidiform mole
• Complete
• Partial
• Invasive
Neoplasms
2. Choriocarcinoma
3. Placental site trophoblastic tumor
4. Epithelioid trophoblastic tumor
Non neoplastic lesions
5. Exaggerated placental site
6. Placental site nodule and plaque
cytotrofoblast syncytiotrofoblast
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Intermediárny trofoblast
Expresia cytokeratínov v trofoblaste
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Infiltrácia myometria trofoblastom -fyziologickáExpresia cytokeratínov v bb. trofoblastu(hnedá farba)
Infiltrácia myometria trofoblastom
Invázia trofoblastu do ciev – fyziologickáSekrečne endometrium s decidualizáciou strómy –diff. dg. tehotnosť
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Cytokeratin
s
Ki67
7th week
41st weekKi67 Alfa-inhibin v bb. intermediárneho trofoblastu
Alpha-InhibinExpresia HCG v bb. syncyciotrofoblastu na začiatku tehotnosti
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Expresia HCG na konci tehotnosti
Hydatidiform mole
• Complete - CHM
• Partial - PHM
• Invasive - IV
CHM
CHMCHM- cirkumferentná hyperplázia trofoblastu na povrchu klkov
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CHM- hydropická degenerácia strómy klkov – centrálne cisterny p57 – negativita v cytotrofoblaste – dôkaz CHM
CHM výrazná expresia HCG CHM v SEM
CHM v SEM –hyperplázia trofoblastu Fyziologické klky v SEM-trubicovitý tvar
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CHM –pohľad do vnútra klku
PHM –časť klkov je hydropicky degenerovanáPHM - fokálna hyperplázia trofoblastu, na časti klkov
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PHM – expresia p57 v cytotrofoblaste
PHM – expresia PLAP v povrchovom trofoblaste
Invazívna hydatidózna mola – infiltrácia myometria
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Včasná forma hydat. moly – laločnatý povrch,
hyperplázia trofoblastu
Fyziologická - polárna hyperplázia trofoblastu
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Hydropicky potrat
Gestational Trophoblastic
Neoplasms
Choriocarcinoma
The Origin of Gestational Choriocarcinoma
CHM
50,0%
Ect. Grav
2,5%
Birth
22,5%
Abortus
25,0%
The incidence of choriocarcinoma
• USA and Europe 1: 20 000 – 40 000 pregnancies
• Asia, Africa,
Latin America 1: 500 – 1000 pregnancies
• Slovak Republic 1: 20 311 pregnancies
Clinical Features of Choriocarcinoma
• Choriocarcinoma can follow any form of gestation
• Choriocarcinoma may have a long latent period
• Abnormal uterine bleeding
• About 5% of choriocarcinomas arise in salpinx after
ectopic pregnancy
• Elevation of HCG levels in serum
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Choriokarcinóm
Choriokarcinóm – zmiešaná populácia
buniek trofoblastu
HE HCG
Choriokarcinóm
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Ki 67
Choriokarcinóm
HPL
Metastáza choriokarcinómu do pľuc
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HCGMetastáza v obličke Metastáza v obličke
Po chemoterapii – iba jazva Metastáza v slezine
St. po chemoterapii –iba jazva
;
27 year old
ST mozgu – meta choriokarcinómu
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Metastázy do pečene
Salpinx, HE –prim. choriokarcinóm
Salpinx – primárny choriokarcinómOvary, HE – prim. choriokarcinóm
Ovárium, primárny choriokarcinóm
Gestational Trophoblastic Neoplasms
Placental Site Trophoblastic Tumor - PSTT
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HE- bunky IT v myometriu HE
HE, PSTT – intermediárny trofoblast HPL
Ki 67 HCG
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HPL HPL
AktínPrítomnosť fibrinoidu v PSTT
Mallory
PSTT
Pregnancy
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Non neoplastic lesions
Exaggerated placental site
Placental site nodules
„Exagg. plac. site“
HE
Ki 67
„Exagg. plac. site“
HPL
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AE1/3 AE1/3
HPL
Placental site nodules
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HE
Imunohistochemická analýza
trofoblastových lézií - trofogram
1. Odlíšenie buniek trofoblastu od buniek inej
histogenézy
2. Determinácia buniek trofoblastu:
- pochádza lézia z IT v mieste implantácie ?
- pochádza lézia z IT chorionového typu ?
- ide o choriokarcinóm ?
3. Odlíšenie nezhubných lézií od pravých nádorov
trofoblastuMing Shih, I., Mazur, M.T., Kurman, R., I. 2010
Ming Shih I, Mazur MT, Kurman RI, 2010
Odporúčaný panel protilátok
• HSD 3B1 odlišuje trofoblastové lézie od non trofoblastových
• Cytokeratíny 8,18 odlíšia GTCH od mezenchýmových lézií
• Vimentín odlíši epitelové a mezenchýmové bunky od seba
• HCG odlíši choriokarcinóm od PSTT a iných lézií
• HPL odlíši PSTT od iných lézií
• Cyclin E odlíši ETT od PSN a iných lézií
• Ki 67 kvantifikovaná expresia odlíši jednotlivé lézie
GTCH od seba
• p 63 odlíši jednotlivé typy IT od seba