PMC3862214_01
A. Gross appearance of sectioned vaginal vault mass. B&C. Histological features of PSTT. Pleomorphic population of trophoblastic tumors cells focally intermixed in interstitial fibrinoid material. Note mitotic figures (C) (HE, 200 x).
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The mass is pearly white color with areas of hemorrhage (Fig. 1, A). These cells have often a single irregular highly atypical nucleus with focally prominent nucleoli, but some are multinucleate, resembling to syncytiotrophoblastic giant cells (Fig. 1, B&C).
Immunophenotype of tumor cells (HIS, 100 x). A, B & C. The staining of hCG (A) and hPL (B) is focally positive. The staining of PLAP (C) is more diffuse. In PSTT, the staining of hPL is usually strong and diffuse while expression of PLAP is negative or focal.
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Mitotic figures (2/10 high power field), extensive necrosis, hemorrhage and vascular invasion are observed. The immunohistochemical pattern is ambiguous (Fig. 2).