1. Bizarre Chorionic-type Trophoblast in Second-trimester and Third-trimester Placentas
- Author
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Tricia Murdock, Wissam Dahoud, Russell Vang, Aaron Varghese, Rebecca N. Baergen, Mark R Hopkins, Caitlin Alexander, Frederic B. Askin, Deyin Xing, and J. Kenneth Schoolmeester
- Subjects
Adult ,Pathology ,medicine.medical_specialty ,Placenta Diseases ,Adolescent ,Biopsy ,Pregnancy Trimester, Third ,Steroid Isomerases ,Trophoblastic Neoplasms ,Fumarate Hydratase ,Pathology and Forensic Medicine ,Diagnosis, Differential ,Lesion ,Young Adult ,Stroma ,Multienzyme Complexes ,Predictive Value of Tests ,Pregnancy ,Atypia ,medicine ,Trophoblastic neoplasm ,Humans ,reproductive and urinary physiology ,Hyaline ,Fetus ,Progesterone Reductase ,business.industry ,Trophoblast ,Middle Aged ,medicine.disease ,Immunohistochemistry ,United States ,Trophoblasts ,Ki-67 Antigen ,medicine.anatomical_structure ,Pregnancy Trimester, Second ,Uterine Neoplasms ,embryonic structures ,Female ,Surgery ,Anatomy ,medicine.symptom ,business - Abstract
Bizarre (atypical/symplastic) cells have been described in various gynecologic normal tissues and benign neoplasms. This type of bizarre cytologic change is usually an incidental finding and is regarded as a benign process. We describe 17 cases of bizarre chorionic-type trophoblast in second-trimester and third-trimester placentas that created concern for an underlying/undersampled or incipient intraplacental trophoblastic neoplasm, predominantly found in intervillous trophoblastic islands (11/17), placental septae (6/17), chorionic plate (1/17), and/or the chorion layer of fetal membranes (2/17). The bizarre trophoblastic cells exhibited sheet-like or nested architecture, had a multifocal/patchy distribution, and/or were present as individual cells within hyaline stroma; they were characterized by large nuclei with smudgy chromatin and occasional intranuclear pseudoinclusions. The degree of atypia was classified as mild (0/17), moderate (3/17), or severe (14/17). Mitotic figures and necrosis were not identified. A dual immunohistochemical stain for trophoblast (hydroxyl-delta-5-steroid dehydrogenase) and a proliferation marker (Ki-67), performed in 15 cases, demonstrated 0% to very low proliferative activity within the bizarre trophoblast (0% to 2% [10/15], 3% to 8% [5/15]). Immunohistochemical stains for fumarate hydratase showed intact/retained expression in the bizarre cells in 7 of 7 cases. Clinical follow-up ranged from 1 to 45 months, and all patients were alive and well without subsequent evidence of a gestational trophoblastic or other neoplasms. We conclude that bizarre chorionic-type trophoblast in second-trimester or third-trimester placentas have the potential to mimic an intraplacental trophoblastic neoplasm but are likely a benign degenerative change. This study expands the spectrum of bizarre cells that occur in the gynecologic tract.
- Published
- 2021
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