Retained Trophoblastic Tissue: A Clinicopathological Study

Abstract

Introduction: Remnants of Conception (ROC) are routinely submitted for Histopathological Examination (HPE) to confirm the presence of trophoblastic tissue, to rule out gestational trophoblastic diseases, for ascertaining the aetiology of recurrent abortions as well as diagnosing foetal pathologies apart from medicolegal purposes. However, there is a lot of debate about the usefulness of routine HPE of all ROC. Aim: To assess the usefulness of routine histopathological examination for remnants of conception. Materials and Methods: This retrospective study was conducted between January 2021 to May 2021at Department of Pathology, Guntur Medical College (Government General Hospital) Guntur, Andhra Pradesh, India. The data of cases were collected between June 2017 to July 2019. There were a total of 104 cases during the study period. The cases were retrieved by retrospective search of pathology records and patient details and other relevant clinical information was obtained from patient requisition form and clinical case sheet. The Haematoxylin and Eosin (H&E) slides were reviewed. Statistical analysis was performed using percentages and frequencies. Results: Gestational age was known in 54 cases out of which cases presenting in first trimester were 41 (75.93%) cases, second trimester were 11 (20.37%) cases, and third trimester or postdelivery were 2 (3.70%) cases. Out of 41 first trimester cases, 22 (40.7%) cases were below eight weeks of gestation. The indication of surgical uterine evacuation was incomplete miscarriage in 50 cases, missed miscarriage in 19 cases, suspected molar pregnancy in 17 cases and anembryonic miscarriage in two cases, and suspected ectopic in five cases. On HPE, ROC was confirmed in 77 (74.04%) cases, 12 (11.5%) cases showed only decidual tissue with arias stella reaction and no villi. There was choriocarcinoma in 1 (0.9%) case and molar pregnancy in 13 (12.5%) cases. On HPE, there was no evidence of trophoblastic tissue in 1 (0.9%) case. Conclusion: Remnants of conception was most common in first pregnancy, and during the first trimester in the study. Histopathological examination is required for confirmation of trophoblastic tissue and in diagnosis of molar pregnancy and other trophoblastic diseases.

Keywords

• arias stella reaction
• chorionic villi
• miscarriage
• molar pregnancy