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Figure 6.92 Complete hydatidiform mole. Top: Enlarged, hydropic villi correspond to the grape-like vesicles seen in curettage specimens. Bottom: Villous stromal cells and cytotrophoblastcellsdonotexpresspaternallyimprintednuclearp57incompletehydatidiform mole.
PlacentalSiteNoduleandPlaque
Placentalsitenodulesareessentiallyhyalinizedimplantationsites.Theyoccurduringthe
reproductiveyearsandmaybeacauseofuterinebleedingoranincidentalfinding.Theyare discretelesions,formingnodulesorplaques,butoccasionallytheymaypresentasmultiple fragmentsorlesionsinauterinesampling(Fig.6.96).Ahistoryofpregnancymayberemote orevenabsent.Placentalsitenoduleorplaqueisabenignprocess,nottobeconfusedwith placentalsitetrophoblastictumor.
Figure 6.93 Invasive mole. Complete hydatidiform mole with exuberant trophoblastic proliferationinvadesthemyometriuminthishysterectomyspecimen.
Figure 6.94 Choriocarcinoma. Bilaminar pattern of syncytiotrophoblastic and cytotrophoblasticcellsisdiagnosticofthistumor.
Figure 6.95 Placental site trophoblastic tumor. Top: Large, atypical eosinophilic and polygonalcellsdiffuselyinfiltrate the deepmyometrium.Bottom:Humanplacentallactogenis expressedbytheneoplasticintermediatetrophoblasticcells.
Figure 6.96 Placental site nodule. Discrete nodules or plaques of hyalinized intermediate trophoblastictissuemaybeseenincurettagespecimens.
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7
EpidemiologyandBiostatistics
DanielW.Cramer KathrynL.Terry
Thedisciplinesofepidemiologyandbiostatisticsapplytogynecologiconcologyindefining cancer occurrence and survival, identifying risk factors, and implementing strategies for treatment or prevention, including the proper design of clinical trials. Epidemiology and biostatisticsareessentialtothepracticeofevidence-basedmedicine.Somekeyprinciplesof epidemiology and biostatistics are considered under the headings of descriptive statistics, etiologicstudies,statisticalinferenceand validity,andcancerriskandprevention.Standard statistical and epidemiologic texts present more detailed discussions and computational formulas(1,2).
DescriptiveStatistics
Cancer is described in populations by statistics related to its occurrence and patient survival. How cancer varies by age, ethnicity, and geography is of particular interest.
Descriptive statistics about cancer in the United States can be obtained from the National CancerInstitutethroughitswebsite:http://www.seer.cancer.gov/.Descriptivestatisticsabout cancer worldwide can be obtained from the International Agency for Research on Cancer
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