Difference between revisions of "Trophoblast"

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m (moved Chorionic villi to Trophoblast: more inclusive... article changed)
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'''Chorionic villi''' are part of a normal [[pregnancy]].  They are derived from the conceptus, i.e. NOT maternal.  
'''Trophoblast''' is part of a normal [[pregnancy]].  Trophoblasts are derived from the conceptus, i.e. '''not''' maternal.
Part of the trophoblast forms '''chorionic villi'''.


Tumours arising from the trophoblast are dealt with in ''[[gestational trophoblastic disease]]''.
Tumours arising from the trophoblast are dealt with in ''[[gestational trophoblastic disease]]''.


==Chorionic villi 101==
=Trophoblast table=
*Maternal blood is around villi.
*Fetal blood (nucleated (fetal) [[RBC]]s) in the villi.
 
===Basic histology===
*Outer layer of villus / closer to mother : syncytiotrophoblasts.
*Inner layer of villus / closer to fetus : cytotrophoblasts.
 
==Chorionic villi 102==
*Syncytiotrophoblasts (eosinophilic cytoplasm with vacuoles (contain hCG), multiple hyperchromatic nuclei).
**Large + many irreg. or lobular hyperchromatic nuclei.
**Eosinophilic vacuolated cytoplasm (contains hCG).
**Closest to mom - covers cytotrophoblast.<ref>[http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]</ref>
*Cytotrophoblasts (polygonal shape, distinct borders, clear cytoplasm, in cords, single nucleus).
**Polygonal shaped cells in cords/masses.
**Distinct cell borders.
**Covered by syncytiobrophoblast<ref>[http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]</ref> - closer to fetus than syncytiotrophoblasts.
**Clear cytoplasm.
**Single uniform nucleus.
 
==Intermediate trophoblast==
===General===
*Abbreviated: ''IT''.
 
*Thought to be the cell of origin for:<ref name=pmid11192071>{{cite journal |author=Shih IM, Kurman RJ |title=The pathology of intermediate trophoblastic tumors and tumor-like lesions |journal=Int. J. Gynecol. Pathol. |volume=20 |issue=1 |pages=31–47 |year=2001 |month=January |pmid=11192071 |doi= |url=}}</ref>
**[[Exaggerated placental site]] (EPS).
**[[Placental site nodule]] (PSN).
**[[Placental site trophoblastic tumour]] (PSTT).
**[[Epithelioid trophoblastic tumour]] (ETT).
 
===Subtypes===
Three subtypes of IT are recognized:<ref name=pmid11192071>{{cite journal |author=Shih IM, Kurman RJ |title=The pathology of intermediate trophoblastic tumors and tumor-like lesions |journal=Int. J. Gynecol. Pathol. |volume=20 |issue=1 |pages=31–47 |year=2001 |month=January |pmid=11192071 |doi= |url=}}</ref>
#Implanation site IT.
#Villous IT.
#Chorionic-type IT.
 
===Microscopic===
Features:
*Large cells.
*Eosinophilic cytoplasm.
**May be multi-nucleated.
 
Images:
*[http://pathology2.jhu.edu/trophoblast/introduction.cfm IT - high mag. (jhu.edu)].
*[http://commons.wikimedia.org/wiki/File:Intermediate_trophoblast_-_high_mag.jpg IT - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Intermediate_trophoblast_-_lmwk_-_high_mag.jpg IT - LMWK - high mag. (WC)].
 
====IHC====
Features:<ref name=pmid1694585>{{cite journal |author=Yeh IT, O'Connor DM, Kurman RJ |title=Intermediate trophoblast: further immunocytochemical characterization |journal=Mod. Pathol. |volume=3 |issue=3 |pages=282–7 |year=1990 |month=May |pmid=1694585 |doi= |url=}}</ref>
*hPL (human placental lactogen) +ve.
*beta-hCG -ve.
*Keratin +ve.
*EMA +ve in 2nd & 3rd trimester.
*CD146 +ve.<ref>URL: [http://www.epitomics.com/diagnostics/product/5618 http://www.epitomics.com/diagnostics/product/5618]. Accessed on: 14 August 2011.</ref>
 
Notes:
*Cytotrophoblast and syncytiotrophoblast - keratin +ve.<ref name=pmid1694585/>
 
==Age of villi==
===Young villi===
*Do not have [[blood vessel]]s.
*No syncytial knots.
 
===Old villi===
*Blood vessels present and at the periphery of villus - contain nucleated (fetal) RBCs.
*Syncytial knots.
 
==Trophoblast table==
Based on Shih ''et al.'':<ref name=pmid11192071/>
Based on Shih ''et al.'':<ref name=pmid11192071/>
{| class="wikitable"
{| class="wikitable"
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Notes:
Notes:
*Keratin is positive in all trophoblastic tissue and negative in decidual tissue.<ref name=pmid1694585/>
*Keratin is positive in all trophoblastic tissue and negative in decidual tissue.<ref name=pmid1694585/>
=Chorionic villi=
==Chorionic villi 101==
*Maternal blood is around villi.
*Fetal blood (nucleated (fetal) [[RBC]]s) in the villi.
===Basic histology===
*Outer layer of villus / closer to mother : syncytiotrophoblasts.
*Inner layer of villus / closer to fetus : cytotrophoblasts.
==Chorionic villi 102==
*Syncytiotrophoblasts (eosinophilic cytoplasm with vacuoles (contain hCG), multiple hyperchromatic nuclei).
**Large + many irreg. or lobular hyperchromatic nuclei.
**Eosinophilic vacuolated cytoplasm (contains hCG).
**Closest to mom - covers cytotrophoblast.<ref>[http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]</ref>
*Cytotrophoblasts (polygonal shape, distinct borders, clear cytoplasm, in cords, single nucleus).
**Polygonal shaped cells in cords/masses.
**Distinct cell borders.
**Covered by syncytiobrophoblast<ref>[http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]</ref> - closer to fetus than syncytiotrophoblasts.
**Clear cytoplasm.
**Single uniform nucleus.
==Age of villi==
===Young villi===
*Do not have [[blood vessel]]s.
*No syncytial knots.
===Old villi===
*Blood vessels present and at the periphery of villus - contain nucleated (fetal) RBCs.
*Syncytial knots.


==Villi and age - table==
==Villi and age - table==
Line 165: Line 129:
|}
|}


==See also==
=Intermediate trophoblast=
===General===
*Abbreviated: ''IT''.
 
*Thought to be the cell of origin for:<ref name=pmid11192071>{{cite journal |author=Shih IM, Kurman RJ |title=The pathology of intermediate trophoblastic tumors and tumor-like lesions |journal=Int. J. Gynecol. Pathol. |volume=20 |issue=1 |pages=31–47 |year=2001 |month=January |pmid=11192071 |doi= |url=}}</ref>
**[[Exaggerated placental site]] (EPS).
**[[Placental site nodule]] (PSN).
**[[Placental site trophoblastic tumour]] (PSTT).
**[[Epithelioid trophoblastic tumour]] (ETT).
 
===Subtypes===
Three subtypes of IT are recognized:<ref name=pmid11192071>{{cite journal |author=Shih IM, Kurman RJ |title=The pathology of intermediate trophoblastic tumors and tumor-like lesions |journal=Int. J. Gynecol. Pathol. |volume=20 |issue=1 |pages=31–47 |year=2001 |month=January |pmid=11192071 |doi= |url=}}</ref>
#Implanation site IT.
#Villous IT.
#Chorionic-type IT.
 
===Microscopic===
Features:
*Large cells.
*Eosinophilic cytoplasm.
**May be multi-nucleated.
 
Images:
*[http://pathology2.jhu.edu/trophoblast/introduction.cfm IT - high mag. (jhu.edu)].
*[http://commons.wikimedia.org/wiki/File:Intermediate_trophoblast_-_high_mag.jpg IT - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Intermediate_trophoblast_-_lmwk_-_high_mag.jpg IT - LMWK - high mag. (WC)].
 
====IHC====
Features:<ref name=pmid1694585>{{cite journal |author=Yeh IT, O'Connor DM, Kurman RJ |title=Intermediate trophoblast: further immunocytochemical characterization |journal=Mod. Pathol. |volume=3 |issue=3 |pages=282–7 |year=1990 |month=May |pmid=1694585 |doi= |url=}}</ref>
*hPL (human placental lactogen) +ve.
*beta-hCG -ve.
*Keratin +ve.
*EMA +ve in 2nd & 3rd trimester.
*CD146 +ve.<ref>URL: [http://www.epitomics.com/diagnostics/product/5618 http://www.epitomics.com/diagnostics/product/5618]. Accessed on: 14 August 2011.</ref>
 
Notes:
*Cytotrophoblast and syncytiotrophoblast - keratin +ve.<ref name=pmid1694585/>
 
=See also=
*[[Endometrium]].
*[[Endometrium]].
*[[Products of conception]].
*[[Products of conception]].
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*[[Arias-Stella reaction]] - benign atypical changes associated with chorionic tissue.
*[[Arias-Stella reaction]] - benign atypical changes associated with chorionic tissue.


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]


==External links==
=External links=
*[http://www.med.yale.edu/obgyn/kliman/placenta/articles/AJP%20Commentary.html Uteroplacental Blood Flow: The Story of Decidualization, Menstruation and Trophoblast Invasion (yale.edu)].
*[http://www.med.yale.edu/obgyn/kliman/placenta/articles/AJP%20Commentary.html Uteroplacental Blood Flow: The Story of Decidualization, Menstruation and Trophoblast Invasion (yale.edu)].

Revision as of 15:44, 15 August 2011

Trophoblast is part of a normal pregnancy. Trophoblasts are derived from the conceptus, i.e. not maternal. Part of the trophoblast forms chorionic villi.

Tumours arising from the trophoblast are dealt with in gestational trophoblastic disease.

Trophoblast table

Based on Shih et al.:[1]

Cytotrophoblast Syncytiotrophoblast Villous intermediate
trophoblast 		Implanation site
intermediate trophoblast 		Chorionic-type
intermediate trophoblast
Nuclear features round, small multinucleated polyhedral pleomorphic +/-multinucleation
(occasional), +/-nucleoli 		round / polyhedral
Cell borders well-defined poorly defined (?) well-defined moderately-defined poorly defined (?)
Cytoplasm minimal, clear to granular abundant, vacuolated abundant & eosinophilic to clear abundant & eosinophilic abundant & eosinophilic
Location villi - deep to
syncytiotrophoblast 		villi - superficial to
cytotrophoblast -
nearest to maternal blood 		villi implanatation site chorion
Function stem cell produces hormones ??? anchor placenta ???
IHC beta-hCG ??? beta-hCG ??? inhibin+, hPL+, beta-hCG-[2] ???
Image ST (jhu.edu)[3] CT (jhu.edu)[3] (WC)

hPL = human placental lactogen.

Notes:

  • Keratin is positive in all trophoblastic tissue and negative in decidual tissue.[2]

Chorionic villi

Chorionic villi 101

  • Maternal blood is around villi.
  • Fetal blood (nucleated (fetal) RBCs) in the villi.

Basic histology

  • Outer layer of villus / closer to mother : syncytiotrophoblasts.
  • Inner layer of villus / closer to fetus : cytotrophoblasts.

Chorionic villi 102

  • Syncytiotrophoblasts (eosinophilic cytoplasm with vacuoles (contain hCG), multiple hyperchromatic nuclei).
    • Large + many irreg. or lobular hyperchromatic nuclei.
    • Eosinophilic vacuolated cytoplasm (contains hCG).
    • Closest to mom - covers cytotrophoblast.[4]
  • Cytotrophoblasts (polygonal shape, distinct borders, clear cytoplasm, in cords, single nucleus).
    • Polygonal shaped cells in cords/masses.
    • Distinct cell borders.
    • Covered by syncytiobrophoblast[5] - closer to fetus than syncytiotrophoblasts.
    • Clear cytoplasm.
    • Single uniform nucleus.

Age of villi

Young villi

Old villi

  • Blood vessels present and at the periphery of villus - contain nucleated (fetal) RBCs.
  • Syncytial knots.

Villi and age - table

Gestational age Nucleated RBCs Cytotrophoblast /
syncytiotrophoblast 		Villi size Vessels Other
First trimester present both can be identified large few; location central
Second trimester rare cytotrophoblast difficult to identify; syncytial knots uncommon intermediate intermediate; location: central/periphery
Third trimester absent cytotrophoblast indistinct; syncytial knots common small abundant; location: periphery of villi focal calcifications

Intermediate trophoblast

General

  • Abbreviated: IT.

Subtypes

Three subtypes of IT are recognized:[1]

  1. Implanation site IT.
  2. Villous IT.
  3. Chorionic-type IT.

Microscopic

Features:

  • Large cells.
  • Eosinophilic cytoplasm.
    • May be multi-nucleated.

Images:

IHC

Features:[2]

  • hPL (human placental lactogen) +ve.
  • beta-hCG -ve.
  • Keratin +ve.
  • EMA +ve in 2nd & 3rd trimester.
  • CD146 +ve.[6]

Notes:

  • Cytotrophoblast and syncytiotrophoblast - keratin +ve.[2]

See also

References

  1. ↑ 1.0 1.1 1.2 Shih IM, Kurman RJ (January 2001). "The pathology of intermediate trophoblastic tumors and tumor-like lesions". Int. J. Gynecol. Pathol. 20 (1): 31–47. PMID 11192071.
  2. ↑ 2.0 2.1 2.2 2.3 Yeh IT, O'Connor DM, Kurman RJ (May 1990). "Intermediate trophoblast: further immunocytochemical characterization". Mod. Pathol. 3 (3): 282–7. PMID 1694585.
  3. ↑ 3.0 3.1 URL: http://pathology2.jhu.edu/trophoblast/introduction.cfm. Accessed on: 13 August 2011.
  4. ↑ http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png
  5. ↑ http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png
  6. ↑ URL: http://www.epitomics.com/diagnostics/product/5618. Accessed on: 14 August 2011.

External links

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