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NBME 23 Answers

nbme23/Block 1/Question#20

A 22-year-old woman at 12 weeks' gestation comes to ...

Hydropic villi with central cisterns

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this patient's uterus was increased in size compared to a 12 week uterus. she had grape like structures and no fetus. this would indicate a hydatidiform mole. this patient also had no fetal parts so it would be a complete mole.

according to pathoma, a hydatidiform mole is an "abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts"

also in a complete mole, most villi are hydropic and trophoblasts will proliferate diffusely around these hydronic villi.

the sheetlike masses of syncytiotrophoblasts would indicate a choriocarcinoma.

nwinkelmann  Also, ball like masses of proliferating decidua, I think, means ectopic decidua, which can be seen in endometriosis, deciduocervicitis, and in the lymph nodes. Markedly dilated fetal blood vessels can be seen in rare complication of placentomegaly which could potentially lead to IUGR but could also result in a normal neonate. +2  
yb_26  @nwinkelmann no, ball-like masses of proliferating decidua are seen in endometrial papillary syncytial change +