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Bizarre Chorionic-type Trophoblast in Second-trimester and Third-trimester Placentas: Clinicopathologic Characterization of a Placental Pseudoneoplastic Lesion.
- Source :
-
The American journal of surgical pathology [Am J Surg Pathol] 2022 Feb 01; Vol. 46 (2), pp. 258-267. - Publication Year :
- 2022
-
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.<br />Competing Interests: Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.<br /> (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Biopsy
Diagnosis, Differential
Female
Fumarate Hydratase analysis
Humans
Immunohistochemistry
Ki-67 Antigen analysis
Middle Aged
Multienzyme Complexes analysis
Placenta Diseases metabolism
Predictive Value of Tests
Pregnancy
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Progesterone Reductase analysis
Steroid Isomerases analysis
Trophoblastic Neoplasms chemistry
Trophoblasts chemistry
United States
Uterine Neoplasms chemistry
Young Adult
Placenta Diseases pathology
Trophoblastic Neoplasms pathology
Trophoblasts pathology
Uterine Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-0979
- Volume :
- 46
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The American journal of surgical pathology
- Publication Type :
- Academic Journal
- Accession number :
- 34799484
- Full Text :
- https://doi.org/10.1097/PAS.0000000000001838