Frederick T. Kraus

Thrombophilia: a mechanism of disease in women with adverse pregnancy outcome and thrombotic lesions in the placenta.

The purpose of this study was to examine the relationship among adverse pregnancy outcome, the presence of thrombotic lesions in the placenta, and the frequency and type of laboratory abnormalities consistent with the presence of a thrombophilic state. A retrospective cohort study was designed to determine the frequency of laboratory abnormalities consistent with thrombophilia among patients with thrombotic lesions of the placenta and adverse pregnancy outcome. The workup for a thrombophilic state included anticardiolipin antibodies, lupus anticoagulant, protein C and antithrombin III activities, protein S total and free, activated protein C resistance ratio, and Factor V Leiden mutation. Thrombotic lesions were identified by histopathologic examination of the placenta. Thirteen patients met the study criteria over an 11-month period. Seven patients were heterozygous for Factor V Leiden mutation (53.8%). Protein S deficiency was found in three cases (23.0%), and no hemostatic abnormality was detected in three cases (23.0%). Mothers with an adverse pregnancy outcome and thrombotic lesions of the placenta often have laboratory abnormalities indicative of a thrombophilic state. We propose that thrombophilia leading to thrombosis in the maternal and/or fetal circulations is a significant mechanism of disease during pregnancy.

Placental histology and clinical characteristics of patients with preterm premature rupture of membranes.

Objective To analyze the placental histology in cases of preterm premature rupture of membranes (PROM), classify the cases according to the results of the histologic examination, and determine if these histologic groups have different clinical characteristics and outcomes. Methods During a 3-year period, a cohort of 235 women with preterm PROM was studied prospectively. The women were classified according to placental histologic findings, and their prenatal and intrapartum courses and perinatal mortality and morbidity were analyzed and compared. Results One hundred two placentas (43.4%) exhibitied acute inflammatory lesions, 48(20.4%) had vascularlesions, 48(20.4%) had both inflammatory and vascular lesions, (13.2%) had no abnormal findings, four (1.7%) had villous edema, and two (0.8%) had chronic villitis. The four largest histologic groups had distinctive characteristics with respect to gestational age at the time of PROM and at delivary, duration of the latency period, and perinatal mortality and morbidity. Conclusion Cases of preterm PROM may be classified according to placental histologic findings, and these groups have different clinical manigestations, prognoses, and outcomes.

Cerebral palsy and thrombi in placental vessels of the fetus: insights from litigation.

Fetal vessels in the placentas of 11 of 15 infants with cerebral palsy contained thrombi. An alternate basis for the injury was identified in the four placentas without thrombi. Autopsy findings in one infant who died at age 1 month confirmed the presence of cerebral thrombi and infarcts. It is concluded that thrombotic events in utero may explain the pathogenesis of many instances of cerebral palsy and that identification of a coagulopathy in parents could potentially identify those at risk and provide a basis for preventive treatment during pregnancy.

Minimal deviation endocervical adenocarcinoma: Clinical and histologic features, immunohistochemical staining for carcinoembryonic antigen, and differentiation from confusing benign lesions

Thirteen patients with a diagnosis of very well-differentiated endocervical adenocarcinoma were studied in order to characterize the histological and immunohistochemical features of minimal deviation adenocarcinoma (MDA). Five of these patients had neoplasms composed of structures almost identical to normal endocervical glandular patterns. These five neoplasms, representing MDA, were characterized by a haphazard proliferation of both large, claw-shaped glands, and smaller, slit-shaped, pointed glands. Focal mild cytologic atypia was identified in each case. Immunohistochemical stains displayed focal cytoplasmic carcinoembryonic antigen (CEA) in each neoplasm. Two of the five patients with MDA died of their neoplasms; both presented with advanced disease. Three well-differentiated adenocarcinomas lacked the deceptively bland appearance of MDA. Two of these three well-differentiated endocervical adenocarcinomas also contained CEA. Atypical endocervical gland proliferations originally diagnosed as MDA in five patients were reclassified as benign lesions on the basis of histologic pattern, findings after subsequent surgical procedures, and benign subsequent clinical courses. Of these five benign lesions, only reserve cell hyperplasia was found to contain CEA. Minimal deviation adenocarcinoma should be distinguished from the more common well-differentiated endocervical adenocarcinoma and from atypical benign lesions. Criteria for these distinctions are presented. While the histological appearance of an endocervical gland proliferation is the paramount basis for identifying an MDA, immunohistochemical staining represents a useful diagnostic aid.

C-cell hyperplasia developing in residual thyroid following resection for sporadic medullary carcinoma

Four years following resection of a medullary carcinoma of the thyroid, a 49‐year‐old man experienced elevated serum calcitonin levels. There was no evidence of metastasis. A re‐exploration of the patients neck demonstrated a histologically normal thyroid remnant that demonstrated C‐cell hyperplasia by immunoperoxidase staining. The lack of a familial history, a normal parathyroid, and the absence of C‐cell hyperplasia in non‐tumorous thyroid of the original resection support the concept that the patient had a sporadic tumor. Patients who have undergone incomplete thyroidectomies for non‐familial disease are at risk for developing C‐cell proliferation and possibly medullary carcinoma. We conclude that the C‐cell hyperplasia in this thyroid remnant is the source of the elevated calcitonin level; this mechanism may also explain postoperatively elevated calcitonin levels in some patients with medullary carcinoma treated by partial thyroidectomy and high calcitonin levels for a variable period after complete thy‐roidectomy.

Histiocytic lymphoma in chronic ulcerative colitis

Colonic lymphoma and adenocarcinoma occurred together in a man with long‐standing ulcerative colitis. The association between lymphoma and ulcerative colitis may be significant since primary colonic lymphomas are very rare. It is suggested that the factors which increase the risk of developing lymphoma of the colon in patients with ulcerative colitis may be the same as those which influence the development of adenocarcinoma, since most of the patients with either neoplasm were in their twenties at the time of onset of ulcerative colitis, the average duration of ulcerative colitis before developing lymphoma or carcinoma was long (12 years), and in most cases, the ulcerative colitis was severe and extensive. In both types of neoplastic disease, an abrupt change in symptoms is the most consistent indication that cancer has developed.

Subchorionic Fibrin Cultures for Bacteriologic Study of the Placenta

Previous bacteriologic studies of the placenta have been hampered by a high rate of contamination of vaginal flora. In the present study, cultures of the subchorionic fibrin layer of the placenta were compared to conventional swab-cultures of the surface of the fetal membranes for recovery of aerobic and anaerobic bacteria. Parallel cultures of membrane surface and subchorionic fibrin (SCF) were done in the placentas of 33 deliveries suspected clinically of being complicated by infection (CD). Placentas from 46 uncomplicated deliveries were similarly cultured to serve as controls. SCF cultures were positive in 11 of 33 CD placentas and in only 1 of 46 controls (P less than 0.001). SCF cultures showed contaminating vaginal flora in 2 of 79 while surface cultures showed vaginal contamination in 16 of 79 (P less than 0.01). Recovery of pathogens was similar by the two methods: 10 of 33 and 14 of 33 respectively. One hundred ninety-one additional CD placentas were cultured by the SCF technique. Forty-nine of the 224 SCF cultures yielded pathogens with a predominance of group B hemolytic streptococci, anaerobic gram positive cocci and anaerobic gram negative rods (81 total isolates). Escherichia coli was isolated in 5 cases. Cultures showing exclusively contaminating vaginal flora were obtained from only 3 of the 224 placentas. Subchorionic fibrin cultures combine technical simplicity, low rate of contamination and excellent recovery of pathogens. The bacterial types found by this method are the predominant species that cause endometritis, pelvic infections, and neonatal septicemia. Subchorionic fibrin culture is a useful technique for the bacteriologic diagnosis of infection in the placenta.