Eoghan Mooney

Sampling and Definitions of Placental Lesions: Amsterdam Placental Workshop Group Consensus Statement

CONTEXTn-The value of placental examination in investigations of adverse pregnancy outcomes may be compromised by sampling and definition differences between laboratories.nnnOBJECTIVEn-To establish an agreed-upon protocol for sampling the placenta, and for diagnostic criteria for placental lesions. Recommendations would cover reporting placentas in tertiary centers as well as in community hospitals and district general hospitals, and are also relevant to the scientific research community.nnnDATA SOURCESn-Areas of controversy or uncertainty were explored prior to a 1-day meeting where placental and perinatal pathologists, and maternal-fetal medicine specialists discussed available evidence and subsequently reached consensus where possible.nnnCONCLUSIONSn-The group agreed on sets of uniform sampling criteria, placental gross descriptors, pathologic terminologies, and diagnostic criteria. The terminology and microscopic descriptions for maternal vascular malperfusion, fetal vascular malperfusion, delayed villous maturation, patterns of ascending intrauterine infection, and villitis of unknown etiology were agreed upon. Topics requiring further discussion were highlighted. Ongoing developments in our understanding of the pathology of the placenta, scientific bases of the maternofetoplacental triad, and evolution of the clinical significance of defined lesions may necessitate further refinements of these consensus guidelines. The proposed structure will assist in international comparability of clinicopathologic and scientific studies and assist in refining the significance of lesions associated with adverse pregnancy and later health outcomes.

Lymphovascular space involvement in early stage well-differentiated endometrial cancer is associated with increased mortality

Objectiveu2002 To study the relationship between lymphovascular space involvement (LVSI) in stage 1a or 1b well‐differentiated endometrial cancer and survival.

Parvovirus infects cardiac myocytes in hydrops fetalis.

Parvovirus infection during pregnancy is an important cause of hydrops fetalis. It is attributed to anemia caused by viral-induced destruction of red blood cells. Infection of other organs has been reported including the heart, liver, and lungs. Few of these reports, however, convincingly demonstrate virions within the functional parenchyma of the tissue. This is of particular concern regarding myocardium in the context of hydrops fetalis which is, in part, due to cardiac failure. The problem in routine pathology practice is that most fetuses with the infection are macerated. This, in part, probably explains the paucity of published information on cardiac involvement. This study examined five cases of fatal hydrops fetalis with variable maceration with serologically proven parvovirus B19 infection. Transmission electron microscopy of cardiac tissue demonstrated intranuclear virions in both erythroid precursor cells and in cardiac myocytes in three of these cases. In each of these, immunogold electron microscopy provided confirmatory evidence of parvovirus infection. Virions were not identifiable where maceration had caused disintegration of nuclei in the myocytes. In addition, virions were absent in the three negative control cases where retroplacental hemorrhage was confirmed as the cause of death.This study suggests that parvovirus infection of cardiac myocytes may play a more important role in causing hydrops fetalis than previously realized. It also demonstrates that maceration should not discourage the use of electron microscopy.

Spherulosis of the Breast A Spectrum of Mucinous and Collagenous Lesions

OBJECTIVEnCollagenous spherulosis of the breast is an uncommon localized pattern of basement membrane material deposition that may be mistaken for atypical proliferations or carcinoma. This report describes 9 cases in which the predominant or exclusive appearance of the spherules was basophilic instead of eosinophilic.nnnDESIGNnThe files of all cases of collagenous spherulosis diagnosed at the Armed Forces Institute of Pathology were reviewed to ascertain the frequency of diagnosis.nnnRESULTSnSpherulosis with a predominantly basophilic pattern had a histochemical and immunohistochemical profile similar to collagenous spherulosis and was associated with more collagenous-appearing forms in 7 of 9 cases. Review of 81 cases showed that collagenous spherulosis was correctly diagnosed in 15% of referrals and was mistaken for intraductal or invasive carcinoma in 11% of cases.nnnCONCLUSIONSnMucinous and collagenous patterns appear to be related forms of spherulosis. They are underrecognized by pathologists and maybe mistaken for atypia or malignancy.

Spherulosis of the Breast

Abstract Objective.—Collagenous spherulosis of the breast is an uncommon localized pattern of basement membrane material deposition that may be mistaken for atypical proliferations or carcinoma. This report describes 9 cases in which the predominant or exclusive appearance of the spherules was basophilic instead of eosinophilic. Design.—The files of all cases of collagenous spherulosis diagnosed at the Armed Forces Institute of Pathology were reviewed to ascertain the frequency of diagnosis. Results.—Spherulosis with a predominantly basophilic pattern had a histochemical and immunohistochemical profile similar to collagenous spherulosis and was associated with more collagenous-appearing forms in 7 of 9 cases. Review of 81 cases showed that collagenous spherulosis was correctly diagnosed in 15% of referrals and was mistaken for intraductal or invasive carcinoma in 11% of cases. Conclusions.—Mucinous and collagenous patterns appear to be related forms of spherulosis. They are underrecognized by pathologists...

Umbilical artery thrombosis is a rare but clinically important finding: a series of 7 cases with clinical outcomes.

Umbilical artery thrombosis is a rare occurrence and is associated with poor neonatal outcomes. We present a series of 7 cases occurring over a 13-year period. The National Maternity Hospital is a tertiary referral center with approximately 10 000 births per annum. Cases were identified by a keyword search on the laboratory computer system. Seven cases were retrieved over a 13-year period (from an estimated 116 000 births): 5 cases from 7306 placentas and 2 cases from 1174 autopsies performed. Only cases with isolated umbilical artery thrombosis were included in the study. Placental histology from all cases was examined, placental gross findings were recorded, and clinical information and Doppler findings were obtained. Two infants were stillborn, and an additional 3 of the 7 cases were small for dates. All liveborn infants had a complicated neonatal course: 1 infant had a caudate infarction, 1 was born with partial acrania and schizencephaly, and 1 had a prolonged intensive care unit admission for low birth weight and jaundice. One case had absent end diastolic flow on Doppler ultrasound. Three cases had a cord diameter narrower than that expected for gestational age. All cases showed evidence of placental hypoperfusion. Umbilical artery thrombosis is a rare occurrence and carries a poor prognosis.

The role of placental cytogenetic cultures in intrauterine and neonatal deaths

Knowledge of chromosomal status is useful in helping to explain fetal and neonatal deaths, but maceration has been felt to compromise the success rate. As well as skin fibroblast culture, the placenta can be sampled and this may be useful where permission for autopsy is refused. We examined placental cytogenetic results from 250 cases over a 5-year period. There was a success rate of 84.4%, with neither weight (<u200aoru200a> 500 g) nor maceration status showing a significant impact. Placentas sampled within 1 day were significantly more likely to give a positive culture. The results suggested that placental cytogenetic cultures should be attempted in all perinatal deaths where such information is desired.

Histological grading of epithelial ovarian carcinomas

Summary The grade of an ovarian epithelial neoplasm provides useful information. However, different approaches to grading exist and many ovarian cancers are not graded. We examined primary ovarian cancers from patients treated at our hospital and applied the ‘universal’ grading system. We found a significant association between grade and clinical stage, with a survival difference between grades for low-stage tumours. The application of grade is discussed in the light of developments in the grading of other gynaecological cancers.

An audit of healthcare professionals’ knowledge regarding perinatal autopsy

BackgroundPerinatal autopsy is one the most valuable investigations to ascertain the cause of death (Nijkamp et al., Seminars in Fetal & Neonatal Medicine. 22:167-175, 2017; Korteweg et al., AJOG 53, e1-12, 2012; Late Interuterine Death and Stillbirth’ RCOG Green-top Guideline No.55, 2015). Discussions about perinatal autopsy can be difficult for parents and healthcare professionals. Perinatal staff need a good level of knowledge and understanding regarding perinatal autopsy in order to discuss the procedure with parents. This study aims to investigate healthcare professionals’ knowledge regarding perinatal autopsy.MethodsAn audit conducted in a large teaching hospital using a questionnaire was developed and distributed to healthcare professionals in the hospital.ResultsSeventy healthcare professionals participated in the audit. Of those surveyed, 64% (nu2009=u200945) have discussed perinatal autopsy with a mother and the majority of healthcare professionals (67%) found this difficult. Self-reported levels of understanding were found to be low with just 10% reporting ‘excellent understanding’.ConclusionsThe results of this audit highlight the need for further education among all healthcare professionals working with bereaved families.

Low rates of fimbrial excision at tubal ligation: room for improvement?

An intratubal placenta and a 14 cm umbilical cord protruding m the fimbrial end of the tube connected to a 12 cm macerated tus were found (Fig. 1). The patient was discharged well on post-operative day 2. Nine ys later a repeat bHCG was 29.8 IU/L suggesting no retained ophoblast. Histological examination showed chorionic villi ithin tube and a separate fetus. Abdominal pregnancy is a rare and potentially dangerous agnosis, with mortality rates between 5.1 and 30 per 1000 [5]. sed on Studdiford’s criteria [3], this is a secondary abdominal egnancy and we were able to demonstrate tubal implantation llowed by abortion of fetus into the POD and retention of acenta within tube. We hypothesize that fetal demise might have curred after the amnion ruptured at around 15 weeks resulting ensuing symptoms or that placenta within the tube could no nger expand to support the growing pregnancy. Clinicians and sonographers should be aware of the possibility abdominal pregnancies which may be mistaken as intrauterine later gestation. Ultrasound should allow accurate diagnosis d timely diagnosis and treatment are pertinent in reducing orbidity and mortality. A laparoscopic approach may be nsidered depending on the size of the fetus and the risk of eeding/complexity of the placental implantation site. rate is less than 40% and 278 women die yearly from the disease [2]. Ovarian serous carcinoma (OSC) is the most common type of ovarian cancer. Serous tubal intraepithelial carcinoma (STIC) is a fallopian tube lesion increasingly implicated as the important precursor of OSC [1], and can be seen in 60% of cases of OSC [3]. Tubal ligation (TL) can lower the risk subsequent OSC and is an effective, reliable form of contraception that can be performed at caesarian section. Nearly 70% of Irish Obstetricians/Gynaecologists list partial excision/ligation as their preferred method of tubal ligation at caesarian section; most do not perform routine salpingectomy when performing hysterectomies for benign indications [4]. As STIC, the precursor lesion of OSC, develops almost exclusively in the fimbria of the fallopian tube, we looked to establish how often the fimbriated end of the fallopian tube was excised when TL was performed at the time of caesaerian section. Between 1st January 2012 and 31st of December 2013, 4069 women had caesarean deliveries in our institution; 177 women had synchronous tubal sterilisation. In nine cases, the fimbrial end of the tube was included in the excision and was available for microscopic examination (5.1% of cases). Over the same period, 161 hysterectomies were performed for benign indications where no ovarian pathology was suspected. Fa pr