Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (284 page)

   Endometrial curettings demonstrate a fleshy mass in the endomyometrium.

   Histology reveals sheets of mononuclear atypical trophoblasts that dissected between the muscle fibers.

   Immunostaining is positive for human placental lactogen, keratin, and p63, and MIB-1 fraction is usually >15%.

   Choriocarcinoma

May occur following molar pregnancy, abortion, ectopic pregnancy, or normal pregnancy. The diagnosis is usually made several months following the pregnancy. Patients present with abnormal uterine bleeding or may have symptoms of metastatic disease. Prognosis is better if diagnosed following a molar pregnancy most likely due to closer patient surveillance and earlier diagnosis.
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   Laboratory Findings

   HCG rises 2 weeks after delivery.

   Endometrial curettage demonstrates hemorrhagic tumor nodules, no villi are present.

   Histologic evaluation reveals atypical syncytial trophoblasts and cytotrophoblasts.

   Immunostaining reveals strongly positive β-hCG.

References

1.  Hemming JD, Quirke P, Womack C, et al. Diagnosis of molar pregnancy and persistent trophoblastic disease by flow cytometry.
J Clin Pathol.
1987;40(60):615–620.

2.  Feltmate CM, Genest DR, Goldstein DP, et al. Advance as in the understanding of placental site trophoblastic tumor.
J Reprod Med.
2002;47:337–341.

3.  Papadopolous AJ, Foskett M, Seckl MJ, et al. Twenty-five years’ clinical experience with placental site trophoblastic tumors.
J Reprod Med.
2002;47(6):460–464.

4.  Soper JT. Gestational trophoblastic neoplasia.
Curr Opin Obstet Gynecol.
1990;2(1):92–97.

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This section contributed by Michael J. Mitchell, MD.

*
This section contributed by Michael J. Mitchell, MD.

*
Contributed by Mary Williamson.

*
This section contributed by Michael J. Mitchell, MD.

Chapter 9

Hematologic Disorders

Liberto Pechet

Red Blood Cell Disorders

Anemias

Macrocytic Anemias

Microcytic Anemias

Normocytic Anemias

Aplastic Anemia (AA)

Pancytopenia

Pure Red Cell Aplasia (PRCA)

Fanconi Anemia (FA)

Diamond-Blackfan Anemia (DBA)

Hemoglobinopathies

Sickle Cell Anemia

Hemoglobin S−Hemoglobin C Disease

Sickle Cell−α-Thalassemia Disease

Sickle Cell−β-Thalassemia Disease

Sickle Cell−Persistent High Fetal Hemoglobin

Sickle Cell−Hemoglobin D Disease

Hemoglobin C Disease

Hemoglobin C−β-Thalassemia

Hemoglobin D Disease

Hemoglobin E Disease

Hemoglobin E−β-Thalassemia

Hemoglobin E−Alpha-Thalassemia

The Thalassemias

β-Thalassemia Major

β-Thalassemia Minor (TRAIT)

Alpha-Thalassemia Syndromes

Hemolytic Intrinsic Red Blood Cell Defects

Enzymopathies

Glucose-6-Phosphaste Dehydrogenase (G6PD) Deficiency

Pyruvate Kinase (PK) Deficiency

Hereditary Spherocytosis (HS)

Hereditary Elliptocytosis (HE)

Hereditary Pyropoikilocytosis (HP)

Hereditary Ovalocytosis (HO)