PA29.{5,10} | Gestational Trophoblastic Disease & Female Genital Morphology — Summary & Reflection

REFLECT

You have now reviewed the gross and microscopic signatures of 17 female genital tract entities — enough to cover any practical scenario at the Year-2 level.

Reflect on these three questions before you close the SDL:

1. If a slide shows a uterine tumor that looks 'like a fibroid but with haemorrhage inside', what is the single most important microscopic feature you would count or grade to confirm or exclude leiomyosarcoma?

1. If an examiner hands you two ovarian cysts — one with thin watery fluid and smooth inner lining, one with thick gelatinous multilocular contents — what is the most likely diagnosis for each, and what single microscopic feature would clinch each diagnosis?

1. In GTD, you have learned that choriocarcinoma is curable even with metastases. What is the single biological feature that drives that curability, and how does PSTT differ in this respect?

Write a two-sentence answer to each before checking your notes. This pattern-matching self-test is what the practical examiner will conduct — own your answers now.

KEY TAKEAWAYS

Gestational Trophoblastic Disease — core facts:

• Complete mole: 46,XX diploid androgenetic; all hydropic villi, circumferential trophoblastic hyperplasia, no fetus; very high hCG; ~15–20% risk of persistent GTD.
• Partial mole: 69,XXY triploid; mixed villi, scalloped contour, trophoblastic inclusions, fetal parts; lower hCG; negligible choriocarcinoma risk.
• Choriocarcinoma: Biphasic cyto + syncytiotrophoblast, no villi, hemorrhagic-necrotic, hematogenous spread (lung first), markedly elevated hCG, exquisitely sensitive to MTX.
• PSTT: Intermediate trophoblast, hPL >> hCG, less chemosensitive, treated surgically.

Morphology practical — recognition anchors:

• Endometriosis triad: glands + stroma + hemosiderin macrophages (all three required).
• Leiomyosarcoma vs fibroid: Stanford triad (atypia + ≥10 mit/10HPF + coagulative necrosis) vs firm/white/whorled.
• Granulosa cell tumor: Call-Exner bodies + coffee-bean nuclei + inhibin + estrogen secretion.
• Dysgerminoma: clear cells, fibrous lymphocyte-infiltrated septa, LDH marker.
• Krukenberg: bilateral, signet-ring cells in fibromatous stroma — gastric primary.
• HGSC: papillary, psammoma bodies, marked atypia, TP53, bilateral, lethal.
• Atypical hyperplasia: crowded glands + nuclear atypia → 25–30% → carcinoma.

Master the recognition table (17 entities) — at the practical bench, gross appearance decides which 2–3 entities to consider; microscopy decides which one it is.