RESUMEN
The malignant transformation of trophoblast is interesting to contemplate, as trophoblast normally behaves in a manner that is interpreted as indicative of malignancy. First of all, trophoblasts show "controlled invasion" at the placental site as part of the normal process of implantation. Secondly, it is estimated that 100,000 syncytiotrophoblastic cells are deported to the maternal circulation daily and these are commonly identified in the pulmonary circulation of pregnant women (38). These trophoblastic cells do not ordinarily produce disease and presumably are rejected by the mother, unlike true metastases. When trophoblastic malignancy does develop, however, the trophoblast continues to invade and grow without limit, eventually metastasizing and ultimately leading to death. Choriocarcinoma is, therefore, unique in that it represents a malignant transformation of a tissue that inherently has "invasive" and "metastatic" properties. It is also the only tumor which contains DNA foreign to the host, as it is derived from a conception which contains paternal genetic material. Thus, choriocarcinoma is a complex neoplasm, and to study it, one must study and understand graft rejection, immunologic mechanisms and a multitude of genetic concepts in addition to the mechanisms of invasion and metastasis.
Asunto(s)
Coriocarcinoma/patología , Carcinoma in Situ/patología , Coriocarcinoma/epidemiología , Coriocarcinoma/genética , Coriocarcinoma/historia , Femenino , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Historia Medieval , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Embarazo , Pronóstico , Neoplasias Trofoblásticas/historia , Neoplasias Trofoblásticas/patología , Neoplasias Uterinas/historia , Neoplasias Uterinas/patologíaRESUMEN
The trophoblast of the chorionic villi as well as the hydatidiform mole and choriocarcinoma have been recognized and studied for many years. However, the trophoblast comprising the implantation site, chorionic plate, chorion laeve, cell islands and septa have only in recent years received attention in the literature. These "extravillous" trophoblastic cells were originally referred to as "X" cells due to doubt regarding their derivation from either maternal or fetal tissue (70). Subsequent studies determined that they were trophoblastic in origin (42), but the term X-cell is still in use today by some researchers (30, 4). Due to continued uncertainty regarding their nature and origin, many other terms have been used including syncytial wandering cells (21), placental site trophoblast, placental site giant cells (42), extravillous trophoblast (25), extravillous cytotrophoblast, nonvillous trophoblast, and intermediate trophoblast (49). Light microscopic and immunohistochemical studies have led to elucidation of specific morphologic and biochemical features of the extravillous trophoblast (48-50) which is commonly designated as the "intermediate trophoblast". Lesions of the "intermediate" or extravillous trophoblast of the placental site include the exaggerated placental site, the placental site trophoblast tumor and the recently described placental site nodule. This article will review the clinical and pathologic features of these lesions, their differential diagnosis, treatment, and prognostic factors after discussion of the origin, nature and definition of the "intermediate" trophoblast.
Asunto(s)
Neoplasias Trofoblásticas/patología , Adolescente , Adulto , Diagnóstico Diferencial , Femenino , Historia del Siglo XIX , Humanos , Persona de Mediana Edad , Enfermedades Placentarias/historia , Enfermedades Placentarias/patología , Embarazo , Pronóstico , Neoplasias Trofoblásticas/historia , Tumor Trofoblástico Localizado en la Placenta/genética , Tumor Trofoblástico Localizado en la Placenta/patología , Tumor Trofoblástico Localizado en la Placenta/ultraestructuraAsunto(s)
Neoplasias Trofoblásticas/historia , Neoplasias Uterinas/historia , Femenino , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Historia Medieval , Humanos , Embarazo , Neoplasias Trofoblásticas/diagnóstico , Neoplasias Trofoblásticas/terapia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapiaRESUMEN
Gestational trophoblastic neoplasms have been recognized since 1600 AD. This article briefly reviews the history of this distinctive disease and highlights some interesting features.