J. Shim

Distinct patterns of C4d immunoreactivity in placentas with villitis of unknown etiology, cytomegaloviral placentitis, and infarct

C4d deposition is considered to be evidence of antibody-mediated rejection. This study was conducted to compare C4d immunoreactivity between villitis of unknown etiology (VUE) and cytomegaloviral placentitis. C4d immunohistochemistry was performed in cases with VUE (nxa0=xa016) and cytomegaloviral placentitis (nxa0=xa05). Distinct, linear C4d immunoreactivity along the syncytiotrophoblast was found in all VUE cases. In cytomegaloviral placentitis, the intensity of C4d immunoreactivity along the syncytiotrophoblast was not prominent, but cytoplasmic C4d immunoreactivity of villous cytotrophoblasts was frequently observed. Further screening of the cases with placental infarcts (nxa0=xa05) demonstrated prominent C4d immunoreactivity in the chorionic villi adjacent to the infarct. We report the characteristic co-localization of VUE and C4d immunoreactivity. The overall findings in this study strongly suggest that the complement activation is a common mechanism of diverse placental injuries associated with rejection, infection, and ischemia.

Molecular genetic, cardiac and neurodevelopmental findings in cases of prenatally diagnosed rhabdomyoma associated with tuberous sclerosis complex

Rhabdomyoma is the most common type of cardiac tumor in fetuses and is often associated with tuberous sclerosis complex (TSC) with neurologic sequelae. The purpose of this study was to investigate the cardiac and neurodevelopmental outcomes of fetal rhabdomyoma.

Clinical Utility of Des-γ-Carboxy Prothrombin Kinetics as a Complement to Radiologic Response in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

PURPOSEnSerial α-fetoprotein (AFP) measurements are useful for assessing tumor responses to numerous therapies for hepatocellular carcinoma (HCC). This study tested the predictive value of changes in des-γ-carboxy prothrombin (DCP), in parallel with AFP, as an indicator of HCC response after transarterial chemoembolization.nnnMATERIALS AND METHODSnThe study group consisted of 327 patients with HCC initially seropositive for DCP (≥ 40 mAU/mL) and/or AFP (≥ 100 ng/mL) who underwent repeated chemoembolization as first-line therapy. Radiologic responses were measured based on modified Response Evaluation Criteria In Solid Tumors guidelines. Serologic response was defined as a decrease of at least 50% in DCP or AFP level from baseline. Radiologic-serologic correlation and disease progression and survival according to serologic responses were analyzed.nnnRESULTSnBefore treatment, 129 patients (39%) had high DCP alone, 66 (20%) had high AFP alone, and 58 (18%) had high levels of both. Radiologic and serologic responses were achieved in 88.2% and 91.4% of patients with high DCP levels and in 89.5% and 91.1% of those with high AFP levels, respectively. Serologic response based on AFP or DCP was significantly correlated with radiologic response, and this was confirmed by landmark analysis (P < .001). DCP and AFP responders had better times to progression and overall survival than nonresponders (P < .001). Cox models revealed that both serologic responses were independent estimates of survival (hazard ratios, 0.11 for DCP and 0.14 for AFP; P < .001).nnnCONCLUSIONSnAfter transarterial chemoembolization for HCC, DCP response may be a useful surrogate endpoint of immediate and prolonged clinical outcomes, along with AFP response.

Cholestyramine resin for erythropoietic protoporphyria with severe hepatic disease: a case report

Erythropoietic protoporphyria (EPP) is a rare disorder of heme biosynthesis caused by mutations in the gene encoding the enzyme ferrochelatase. In EPP, deficient ferrochelatase activity leads to the excessive production and biliary excretion of protoporphyrin (PP). The major clinical features of EPP are photosensitivity and hepatobiliary disease that may progress to severe liver disease, that are caused by the toxicity of PP. EPP-related liver disease has been treated medically or surgically including liver transplantation. We described a 20-year-old male with severe liver disease who was diagnosed with EPP based on clinical and laboratory findings. He was treated with cholestyramine resin. Six months after the treatment, he was doing well without any abdominal pain or photosensitivity.

Protective effect of fetal pulmonary sequestration in two cases of postnatal manifestation of congenital diaphragmatic hernia

We describe two cases of postnatally diagnosed congenital diaphragmatic hernia (CDH) combined with pulmonary sequestration, both of which were diagnosed as isolated pulmonary sequestration on prenatal ultrasound. In these cases, prenatal ultrasonography demonstrated only a hyperechoic mass on the left lower lung and the diaphragm seemed intact. In each case both lungs showed otherwise normal development throughout pregnancy. Pulmonary sequestration may serve as a ‘protector’, preventing herniation of abdominal contents into the thoracic cavity. The co‐occurrence of CDH may be obscured by a lung mass, especially on the left lower lung, and therefore it is necessary to deliver these infants at a tertiary center and parents should be counseled about the possibility of postnatal CDH. Copyright

Concurrent hepatic adenomatoid tumor and hepatic hemangioma: a case report

A 45-year-old male with alleged asymptomatic hepatic hemangioma of 4 years duration had right upper-quadrant pain and was referred to a tertiary hospital. Computed tomography and magnetic resonance imaging scans revealed a hypervascular mass of about 7 cm containing intratumoral multilobulated cysts. A preoperative liver biopsy was performed, but this failed to provide a definitive diagnosis. The patient underwent a partial hepatectomy of segments IV and VIII. The histologic findings revealed multifocal proliferation of flattened or cuboidal epithelioid cells and a highly vascular edematous stroma. Immunohistochemistry findings demonstrated that the epithelioid tumor cells were positive for cytokeratin (AE1/AE3), vimentin, calretinin, and cytokeratin 5/6, and were focally positive for CD10, and negative for WT1 and CD34, all of which support their mesothelial origin. Immunohistochemistry for a mesothelial marker should be performed for determining the presence of an adenomatoid tumor when benign epithelioid cells are seen.

OP11.02: Intrauterine transfusion in severe fetal anemia: does peak systolic velocity of middle cerebral artery correlate with fetal hemoglobin?: Short oral presentation abstracts

gestational age at cordocclusion (CO) are still debated. The goal of this study was to review umbilical cord occlusion procedures in TRAP sequence in relation with outcome. Methods: Review of all cases of elective CO between 2001-2016. CO was performed by bipolar forceps and/or endoscopic laser coagulation. Outcome included survival, intrauterine fetal death (IUFD), termination of pregnancy (TOP), gestational age (GA) at delivery, and premature rupture of membrane (PPROM). Results: Of 107 cases diagnosed at 13,5 (8-23,7) weeks, 13 (12%) CO was not performed due to spontaneous cessation of flow in the mass (n=8, 7%), IUFD (n=4, 4%) or TOP (n=1, 1%). 94 cases, 87 MC twins and 7 triplets underwent CO by laser (n=44, 55%), bipolar forceps (n=17, 21%) coagulation or a combination of both (n=19, 24%) at a median 19.5 weeks. Overall 67 (77%) pump-twins were born alive at 34 (24-38) weeks including 31 (67%) and 36 (88%) when CO was before and after 19 weeks (p=0.02). However, GA at birth was inversely correlated to GA at CO (r = 0,39, p = 0,001). Conclusions: Elective extra fetal cord coagulation allows survival of over 80% of pump-twins. Better outcomes could be achieved by performing surgery after 19 weeks, although earlier procedures, if successful, are associated with fewer preterm deliveries. IUFD occurred in 4% of cases between diagnosis and CO.

OC11.05: Comparison of clinical manifestation in fetuses with Ebstein's anomaly and pulmonary atresia with intact ventricular septum

cases. With no previously affected child, about half use echo and fetal heart rate monitoring and about one quarter use echo alone. Most respondents (∼ 2/3) would start monitoring at 16-20weeks. Frequency of monitoring varied, being every 2 weeks in ∼40%, and weekly in about one quarter of responses. From replies, there was no consensus on how long to monitor the pregnancy for. If 1st degree atrioventricular (AV) block or myocardial abnormalities were found, most (50-60%) would increase frequency of scans and ∼40% would start steroids. Most use left ventricular inflow-outflow Doppler to measure the AV interval, but there is no consensus on how to define 1st degree AV block. With a previously affected child, most would monitor the pregnancy differently but ∼20% would not. Conclusions: Although there were some trends, there was no clear consensus on how to monitor these pregnancies. Evidence-based guidelines are likely to optimise fetal surveillance.

OC10.08: *The risk of preterm birth in vanishing twin: a multicentre prospective cohort study

S. Jisu1, S. Lee1, Y. Han2, M. Kim2, J. Shim3, M. Lee3, S. Oh4, J. Lee5, S. Kim6, D. Cha6, G. Cho7, H. Kwon8, B. Kim9, M. Park10, H. Cho11, H. Ko12, C. Park1, J. Park1, J. Jun1, H. Ryu2, S. Lee1 1Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; 2Obstetrics and Gynecology, Cheil General Hospital and Women’s Healthcare Centre, Dankook University College of Medicine, Seoul, Republic of Korea; 3Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea; 4Obstetrics and Gynecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 5Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea; 6Obstetrics and Gynecology, CHA Gangnam Medical Centre, CHA University, Seoul, Republic of Korea; 7Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea; 8Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea; 9Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Centre, Seoul, Republic of Korea; 10Obstetrics and Gynecology, Ewha Woman’s University, Seoul, Republic of Korea; 11Obstetrics and Gynecology, CHA Bundang Medical Centre, CHA University, Sung Nam, Republic of Korea; 12Obstetrics and Gynecology, Catholic University of Korea College of Medicine, Seoul, Republic of Korea

P18.07: Prenatal diagnosis of aortopulmonary window and its perinatal outcomes: a single-centre experience: Poster discussion hub abstracts

Objectives: The aim of this study is to constructing fetal CHD database system, to improve training effectiveness of prenatal diagnosis of CHD. Methods: From Jan 2011 to Dec 2017, we established the ultrasonic database of fetal CHD by continuous transverse scanning or STIC technology which included the transverse section of the abdominal cavity, four chamber, left ventricular outflow tract, right ventricular outflow tract and three vessels trachea section. For the fetuses with conus arteriosus or great vascular malformations, the STIC flow imaging is stored. The anatomical database was established when the fetus was terminated pregnancy. Every anatomical database contains 500 to 800 cross-section images. The above ultrasonic and anatomy database constructed the CHD database system. Results: Total 90 cases database system were established which involve more than 95% different types CHD. The anatomical databases could be displayed continuously and rotated arbitrarily which can be used to displaying the sectional and spatial anatomical structures of different types CHDs. Combining ultrasonic databases and STIC blood flow imaging (figure), students can easily understand and grasp the ultrasonic characteristics of different types of CHDs. Conclusions: The fetal CHD database system includes anatomy and ultrasonic databases of different types of fetal CHD. We can improve the quality and efficiency of training by contrastive learning.