To estimate the percentage of deliveries eligible for pathologic examination of the placenta and ... more To estimate the percentage of deliveries eligible for pathologic examination of the placenta and compare with observed practice using the College of American Pathologists' (CAP) 1997 guidelines for examination of the placenta. Records were reviewed from all live-birth deliveries 20 weeks or more of gestation in 2001 at Strong Memorial Hospital. The expected number of deliveries with CAP recommended indications was determined and compared with the observed number of deliveries in which the placenta was actually examined. Descriptive statistics, independent t tests, chi(2) tests, difference between two population proportions test, odds ratios, 95% confidence intervals, and multiple logistic regression were used to analyze the data. The observed number and percentage of deliveries with CAP recommended indications that had pathologic placental examination, 575 and 18.2% (95% confidence interval 16.9-19.6), was significantly lower (P<.001) than expected, 1,185 and 37.5% (95% confidence interval 35.8-39.2). The placenta was examined less frequently than expected in 9 of 14 categories. Independent predictors of examination of the placenta were gross placental abnormalities, multiple gestation, prematurity, peripartum fever, neonatal intensive care unit care of infant, cesarean delivery, and delivery by a maternal-fetal medicine specialist. Using the CAP guidelines for submission of the placenta would result in pathologic examination in 37.5% of all deliveries. Less than one half of all deliveries in which the placenta was eligible for submission were actually examined. Current advances in our understanding of pathologic conditions of the placenta and their relation to infant outcomes may warrant re-evaluating policy on placental examination at institutional and national levels. II.
Pediatric and Developmental Pathology, May 1, 2003
The pediatric pathology residency rotations described herein represent an innovative multidiscipl... more The pediatric pathology residency rotations described herein represent an innovative multidisciplinary approach to residency education that combines concepts from anatomic pathology and laboratory medicine, and utilizes faculty members from pathology, pediatrics, and obstetrics/gynecology to teach pathology residents the clinicopathological highlights of antenatal, perinatal, and postnatal pathology. Training is provided through a combination of didactic interactions, laboratory experiences, and current clinical cases. As such, it can be a model for other multidisciplinary residency rotations that could span graduate medical education in pathology to permit a more thorough, informative, and stimulating residency experience.
Pediatric and Developmental Pathology, Apr 6, 2022
Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We id... more Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We identified that chorionic, stem villus, and umbilical vessels in these fixed placentas are ectatic with greater frequency than in our in-house fresh placentas. Methods We searched our LIS for third trimester placentas using keywords “ectasia” or “ectatic” over a 12-month period. We fixed incoming in-house placentas over a 2-week period for 24–72 hours and tabulated the presence or absence of vascular ectasia as defined by Parast et al, 2008. Results The LIS search identified 61% of placental cases from outlying hospitals that had ectatic vessels vs 3% of in-house placentas ( P < .001). Of 38 placentas fixed in a 2-week period, 45% had ectatic chorionic or stem villus vessels and 21% had umbilical vessel ectasia. In comparison, in the 2 subsequent weeks, 3.8% ( P < .001) of fresh placentas had vascular ectasia. Conclusion These data suggest that large fetal vessels in the placenta become engorged with blood at delivery and, if fixed soon after delivery, remain ectatic and congested when processed for pathology. The identification of artifactual ectasia is important because fetal vessel ectasia can suggest the presence of fetal vascular malperfusion (FVM) if diagnostic signs of FVM are present.
License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Collagenous mucosal inflammatory disease is a rare gastrointestinal disorder that involves the columnar lining of gastric and intestinal mucosa and is characterized by a distinct subepithelial collagen deposition. Recent clinical and pathological evidence have indicated that collagenous mucosal inflammatory disease can be extensive disease that may concomitantly involve several gastrointestinal sites at the same time. This entity, however, occurs infrequently in children. It is even less common to find concomitant depositions of collagen in the mucosa of gastrointestinal sites other than the colon. Only two cases in pediatric literature reported concomitant involvement, one with gastric and colonic involvement and the other one with gastroduodenocolitis. We are reporting a 15-month-old boy who presented with severe diarrhea and diffuse edema secondary ...
There is scant information about the expression of CD44 and E-cadherin, two cell adhesion molecul... more There is scant information about the expression of CD44 and E-cadherin, two cell adhesion molecules, and the antimetastatic protein nm23-H1, in complete hydatidiform moles. We measured the expression of these markers to determine their usefulness in predicting the development of invasive disease. We performed a retrospective study of 27 patients with complete hydatidiform moles, collecting clinical information including the patient's age, pre-evacuation hCG level, pathology, hCG monitoring, and the development of gestational trophoblastic neoplasia. Immunohistochemical staining for CD44, E-cadherin, and nm23-H1 was performed. CD44 expression was classified as positive or negative. For E-cadherin and nm23-H1, the intensity of expression was graded on a 0 to 3 scale. Chi-square or Fisher's exact testing was used to evaluate the relationship between these markers and the development of invasive disease. CD44 was expressed in 26% of cases. E-cadherin expression was 1+, 2+, and 3+in 8%, 33%, and 59% of cases, respectively. Nm23-H1 expression was 1+, 2+, and 3+in 4%, 11%, and 85% of cases. The risk of developing invasive disease did not correlate with the expression of CD44, E-cadherin, or nm23-H1. In this preliminary study, there is no relationship between CD44, E-cadherin, and nm23-H1 expression in complete hydatidiform moles and the risk of invasive disease. Other molecular markers predictive of invasive disease should be sought to limit hCG surveillance to those at risk.
Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We id... more Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We identified that chorionic, stem villus, and umbilical vessels in these fixed placentas are ectatic with greater frequency than in our in-house fresh placentas. Methods We searched our LIS for third trimester placentas using keywords “ectasia” or “ectatic” over a 12-month period. We fixed incoming in-house placentas over a 2-week period for 24–72 hours and tabulated the presence or absence of vascular ectasia as defined by Parast et al, 2008. Results The LIS search identified 61% of placental cases from outlying hospitals that had ectatic vessels vs 3% of in-house placentas ( P < .001). Of 38 placentas fixed in a 2-week period, 45% had ectatic chorionic or stem villus vessels and 21% had umbilical vessel ectasia. In comparison, in the 2 subsequent weeks, 3.8% ( P < .001) of fresh placentas had vascular ectasia. Conclusion These data suggest that large fetal vessels in the placenta bec...
A successful pregnancy largely relies on proper immune regulation in the gravid uterus. This revi... more A successful pregnancy largely relies on proper immune regulation in the gravid uterus. This review describes immune mechanisms that permit the fetal allograft to continue to grow to term. Chronic inflammatory lesions may be manifestations of altered immune status in the placenta and are often present in preterm placentas. These lesions are compared with the more common acute inflammatory lesions of pregnancy, and described with respect to their pathology and clinical significance.
To estimate the percentage of deliveries eligible for pathologic examination of the placenta and ... more To estimate the percentage of deliveries eligible for pathologic examination of the placenta and compare with observed practice using the College of American Pathologists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (CAP) 1997 guidelines for examination of the placenta. Records were reviewed from all live-birth deliveries 20 weeks or more of gestation in 2001 at Strong Memorial Hospital. The expected number of deliveries with CAP recommended indications was determined and compared with the observed number of deliveries in which the placenta was actually examined. Descriptive statistics, independent t tests, chi(2) tests, difference between two population proportions test, odds ratios, 95% confidence intervals, and multiple logistic regression were used to analyze the data. The observed number and percentage of deliveries with CAP recommended indications that had pathologic placental examination, 575 and 18.2% (95% confidence interval 16.9-19.6), was significantly lower (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) than expected, 1,185 and 37.5% (95% confidence interval 35.8-39.2). The placenta was examined less frequently than expected in 9 of 14 categories. Independent predictors of examination of the placenta were gross placental abnormalities, multiple gestation, prematurity, peripartum fever, neonatal intensive care unit care of infant, cesarean delivery, and delivery by a maternal-fetal medicine specialist. Using the CAP guidelines for submission of the placenta would result in pathologic examination in 37.5% of all deliveries. Less than one half of all deliveries in which the placenta was eligible for submission were actually examined. Current advances in our understanding of pathologic conditions of the placenta and their relation to infant outcomes may warrant re-evaluating policy on placental examination at institutional and national levels. II.
Pediatric and Developmental Pathology, May 1, 2003
The pediatric pathology residency rotations described herein represent an innovative multidiscipl... more The pediatric pathology residency rotations described herein represent an innovative multidisciplinary approach to residency education that combines concepts from anatomic pathology and laboratory medicine, and utilizes faculty members from pathology, pediatrics, and obstetrics/gynecology to teach pathology residents the clinicopathological highlights of antenatal, perinatal, and postnatal pathology. Training is provided through a combination of didactic interactions, laboratory experiences, and current clinical cases. As such, it can be a model for other multidisciplinary residency rotations that could span graduate medical education in pathology to permit a more thorough, informative, and stimulating residency experience.
Pediatric and Developmental Pathology, Apr 6, 2022
Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We id... more Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We identified that chorionic, stem villus, and umbilical vessels in these fixed placentas are ectatic with greater frequency than in our in-house fresh placentas. Methods We searched our LIS for third trimester placentas using keywords “ectasia” or “ectatic” over a 12-month period. We fixed incoming in-house placentas over a 2-week period for 24–72 hours and tabulated the presence or absence of vascular ectasia as defined by Parast et al, 2008. Results The LIS search identified 61% of placental cases from outlying hospitals that had ectatic vessels vs 3% of in-house placentas ( P &lt; .001). Of 38 placentas fixed in a 2-week period, 45% had ectatic chorionic or stem villus vessels and 21% had umbilical vessel ectasia. In comparison, in the 2 subsequent weeks, 3.8% ( P &lt; .001) of fresh placentas had vascular ectasia. Conclusion These data suggest that large fetal vessels in the placenta become engorged with blood at delivery and, if fixed soon after delivery, remain ectatic and congested when processed for pathology. The identification of artifactual ectasia is important because fetal vessel ectasia can suggest the presence of fetal vascular malperfusion (FVM) if diagnostic signs of FVM are present.
License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Collagenous mucosal inflammatory disease is a rare gastrointestinal disorder that involves the columnar lining of gastric and intestinal mucosa and is characterized by a distinct subepithelial collagen deposition. Recent clinical and pathological evidence have indicated that collagenous mucosal inflammatory disease can be extensive disease that may concomitantly involve several gastrointestinal sites at the same time. This entity, however, occurs infrequently in children. It is even less common to find concomitant depositions of collagen in the mucosa of gastrointestinal sites other than the colon. Only two cases in pediatric literature reported concomitant involvement, one with gastric and colonic involvement and the other one with gastroduodenocolitis. We are reporting a 15-month-old boy who presented with severe diarrhea and diffuse edema secondary ...
There is scant information about the expression of CD44 and E-cadherin, two cell adhesion molecul... more There is scant information about the expression of CD44 and E-cadherin, two cell adhesion molecules, and the antimetastatic protein nm23-H1, in complete hydatidiform moles. We measured the expression of these markers to determine their usefulness in predicting the development of invasive disease. We performed a retrospective study of 27 patients with complete hydatidiform moles, collecting clinical information including the patient&#39;s age, pre-evacuation hCG level, pathology, hCG monitoring, and the development of gestational trophoblastic neoplasia. Immunohistochemical staining for CD44, E-cadherin, and nm23-H1 was performed. CD44 expression was classified as positive or negative. For E-cadherin and nm23-H1, the intensity of expression was graded on a 0 to 3 scale. Chi-square or Fisher&#39;s exact testing was used to evaluate the relationship between these markers and the development of invasive disease. CD44 was expressed in 26% of cases. E-cadherin expression was 1+, 2+, and 3+in 8%, 33%, and 59% of cases, respectively. Nm23-H1 expression was 1+, 2+, and 3+in 4%, 11%, and 85% of cases. The risk of developing invasive disease did not correlate with the expression of CD44, E-cadherin, or nm23-H1. In this preliminary study, there is no relationship between CD44, E-cadherin, and nm23-H1 expression in complete hydatidiform moles and the risk of invasive disease. Other molecular markers predictive of invasive disease should be sought to limit hCG surveillance to those at risk.
Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We id... more Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We identified that chorionic, stem villus, and umbilical vessels in these fixed placentas are ectatic with greater frequency than in our in-house fresh placentas. Methods We searched our LIS for third trimester placentas using keywords “ectasia” or “ectatic” over a 12-month period. We fixed incoming in-house placentas over a 2-week period for 24–72 hours and tabulated the presence or absence of vascular ectasia as defined by Parast et al, 2008. Results The LIS search identified 61% of placental cases from outlying hospitals that had ectatic vessels vs 3% of in-house placentas ( P < .001). Of 38 placentas fixed in a 2-week period, 45% had ectatic chorionic or stem villus vessels and 21% had umbilical vessel ectasia. In comparison, in the 2 subsequent weeks, 3.8% ( P < .001) of fresh placentas had vascular ectasia. Conclusion These data suggest that large fetal vessels in the placenta bec...
A successful pregnancy largely relies on proper immune regulation in the gravid uterus. This revi... more A successful pregnancy largely relies on proper immune regulation in the gravid uterus. This review describes immune mechanisms that permit the fetal allograft to continue to grow to term. Chronic inflammatory lesions may be manifestations of altered immune status in the placenta and are often present in preterm placentas. These lesions are compared with the more common acute inflammatory lesions of pregnancy, and described with respect to their pathology and clinical significance.
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