PATOLOGI SISTEM

REPRODUKSI WANITA
Penyakit gestasional

Dr. Soekimin, SpPA ; dr. Jessy Chrestella, SpPA

Dept. Patologi Anatomi Fakultas Kedokteran
Universitas Sumatera Utara
Medan 2010

PLACENTA

INFECTION
HYDATID MOLE

TOXEMIA
GRAVIDARUM

ABORTION
PUERPERAL
INFECTION
CHORIO CARCINOMA

ECTOPIC PREGNANCY

Succenturiate placenta
Circumvallate placenta
Battledore placenta
Vilamentous insert. of cord
Placenta previa (marginal, partial, total)
Abruptio placentae (external and internal
bleeding).

Cervical
Interstitial
Isthmic
Ampulla
Infundibular
Ovarial
Abdominal

is a spectrum of disorders with abnormal

trophoblast proliferation and maturation,
as well as neoplasms derived from
trophoblast.

Spectrum of disorders with abnormal

trophoblast proliferation and maturation, as
well as neoplasms derived from trophoblast.
Incomplete mole fetal parts present,
no carcinoma.
Complete mole no fetal parts, 2%
chance of carcinoma.
Invasive / Aggressive mole.
Choriocarcinoma.

HYDATIDIFORM MOLE

Risk Factors :
Girls younger than 15 years of age
Increases progressively for women over 40 years of age.
Women older than 50 years of age have 200 times the risk
Higher in Asian women than among white women.
Women who had a prior hydatidiform mole

Hydatidiform Mole (Image: ACT Pathology description)

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A.
B.

C.

Entire uterine cavity is filled with swollen

villi.
The villi are each 1 to 3 mm in diameter and
appear grape-like.
Individual molar villi, many of which have
cavitated central cisterns, exhibit
considerable trophoblastic hyperplasia and
atypia. The blood vessels of the villi have
atrophied and disappeared.
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All villi cystic

No fetal parts
Diffuse trophoblastic
hyperplasia
46xx of sperm
Choriocarcinoma
common.

Partially cystic
Fetal parts may be
Focal hyperplasia of
trophoblasts
69xxy or 92xxxy
(ovum & sperm)
Rare carcinoma

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Trophoblast Hyperplasia

No BV in villi

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No BV in villi

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Atypia

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Invading chorionic villi

Myometrium

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Gestational choriocarcinoma is a malignant tumor derived from

trophoblast.
Incidence related to abnormalities of pregnancy :
occurs in 1 of 160,000 normal gestations,
1 of 15,000 spontaneous abortions,
1 of 5,000 ectopic pregnancies, and
1 of 40 complete molar pregnancies.
Clinical : abnormal uterine bleeding.
Histological:the tumor contains a dimorphic population of
cytotrophoblast and syncytiotrophoblast, with varying degrees of
intermediate trophoblast.
It metastasizes widely by the hematogenous route, especially to lungs
(more than 90%), brain, gastrointestinal tract, liver, and vagina.

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Hypertension of pregnancy.
Path: unknown/genetic/immune
Common with First / molar pregnancy ?
Trophoblasts
Seizures & Cerebral edema.
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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Terima kasih

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