Virginia Billson

Umbilical Cord Stricture and Intrauterine Fetal Death

Umbilical cord stricture is an uncommon but distinctive condition associated with intrauterine fetal death. Although cases have been reported periodically since the last century, there has been considerable speculation as to whether the condition is real or a postmortem artifact. In the present study, 25 cases reported since 1925 are reviewed and 8 new cases are described. Clinically, a decrease in fetal movements is usually the only symptom during the second or third trimester of pregnancy and fetal death occurs soon after. The womens age, health, and previous history have shown no link with this condition, but a higher incidence is noted in twin pregnancies. Morphologically, most infants are macerated and an extremely narrow segment of umbilical cord is usually seen at the fetal end and rarely at the placental end or in multiple sites along the cord. Absence of Whartons jelly, stenosis, or obliteration of cord vessels at the narrow segment and intravascular cord thrombosis are the major pathological features. The findings of this study support the view that the condition can cause fetal death and alerts both pathologists and clinicians to the important features identifying this cause of perinatal wastage.

Bacillary angiomatosis of the spleen

&NA; Bacillary angiomatosis is a recently described vasoproliferative lesion associated with infection by a newly characterized rickettsial organism, Rochalimaea henselae. Most previous reports have described skin lesions in immunocompromized patients infected with human immunodeficiency virus. This is the first case report detailing the features of bacillary angiomatosis of the spleen occurring in a patient undergoing cytotoxic chemotherapy for disseminated ovarian carcinoma.

The accuracy and interobserver reproducibility of endometrial dating

Summary Although controversial, diagnosis of luteal phase defect (LPD) includes the morphological assessment of endometrial development. This study was conducted to determine if refresher training in the histological criteria could improve the accuracy and interobserver reproducibility of endometrial dating. Seventy‐eight endometrial biopsies were dated by a reference panel of two pathologists and then reviewed twice by a study panel of four pathologists. In the first review, usual practice was applied. Prior to the second review, they studied a standard document of histological criteria. Samples were dated as proliferative, secretory (post‐ovulatory day, POD), menstrual, and undatable. Accuracy levels based on the reference dating and agreement levels using s values were calculated per review and compared. The s for overall dating was 0.683 in the first review and 0.696 in the second. The respective first and second review s values were 0.736 and 0.771 for proliferative, and 0.794 and 0.764 for secretory. Amongst those dated as secretory in the first and second reviews, respectively, 31 and 28% were assigned the same POD by any two panellists, 68 and 63% were dated to within 1 day, and 77 and 71% were dated to within 2 days. Accuracy levels per panellist for overall dating were very high in both reviews but were low for individual PODs. Accuracy and interobserver reproducibility were unaffected by refresher training, suggesting the limits of histological dating have been reached.

Autopsy standards for fetal lengths and organ weights of an Australian perinatal population

Aims: This study aims to establish a complete and accurate set of Australian reference ranges to be used during the routine perinatal post‐mortem examination. Eighteen routinely measured parameters will be analysed for each gestational age from 12 weeks to 42 weeks inclusive. Methods: A retrospective review was performed of all perinatal and neonatal autopsies conducted at the Royal Womens Hospital (RWH), Melbourne, between 1 January 2001 and 31 December 2006. A total of 1116 post‐mortem examination reports were analysed for this study. Established study design, technical and statistical methodologies were followed. Results: Reference ranges comprising mean and standard deviation have been produced, together with the 5th, 50th and 95th percentiles for all parameters at each gestational age. Graphs demonstrating these data have been developed for each parameter. Conclusion: This study has established a complete set of reference ranges for parameters measured at perinatal post‐mortem examinations. As the sample population used is truly representative of the mixed immigrant population present in Australian society, the reference ranges and percentiles produced in this study will be valuable for all perinatal pathologists.

Umbilical-Cord Hemangioma Associated with Polyhydramnios, Congenital-Abnormalities and Perinatal Death in a Twin Pregnancy

&NA; A twin pregnancy is described in which an umbilical cord hemangioma, polyhydramnios, developmental abnormalities and perinatal death were restricted to one twin, while the other twin was unaffected. Cord hemangiomas are rare and their association with fetal abnormalities is controversial. This case study supports a direct association between the cord hemangioma and the adverse pregnancy outcome, since congenital abnormalities and a cord hemangioma were present in only one of the twins.

Solitary Luteinized Follicle Cyst of Pregnancy

BACKGROUNDnGiant luteinized follicle cyst is a recently recognized cause of ovarian enlargement during pregnancy and the puerperium. Only rare cases of this clinical condition have been reported in the literature, and the cytologic features have not been previously described.nnnCASEnA 34-year-old, pregnant woman presented at 10 weeks gestation with a large, right ovarian cyst. Clinical management was initially conservative, but four weeks later the patient presented with acute abdominal pain. At laparotomy, the ovarian cyst was aspirated and a cystectomy performed. On cytologic examination, the presence of a luteinized follicle cyst of pregnancy was suggested. Subsequent histologic examination confirmed the diagnosis.nnnCONCLUSIONnThis case illustrates the clinicopathologic features of a luteinized follicle cyst of pregnancy with special emphasis on the cytologic characteristics. The cytologic features are sufficient to establish the diagnosis in conjunction with the ultrasonographic appearance.

Umbilical cord stricture and fetal intrauterine death

Umbilical cord stricture is an uncommon but distinctive condition associated with intrauterine fetal death. There has been considerable speculation as to whether the condition is real or a post mortem artefact during the last five decades. In this study 25 cases reported since 1925 in the literature are reviewed and 6 new cases are described. Clinically, a decrease of fetal movements is usually the only symptom during the second or third trimester of pregnancy and fetal death occurs soon after. The womens age, health and previous history have shown no link with this c6ndition but a higher incidence is noted in twin pregnancy. Successive pregnancies complicated by cord stricture also reported in this study. Morphologically, most infants are macerated and an extremely narrow segment of umbilical cord is usually seen at the fetal end of the cord and rarely at the placental end or in multiple sites. Absence of Whartons jelly, stenosis or obliteration of cord vessels at the narrow segment and cord thrombosis are the major pathological features. The findings of this study support the view that the condition can cause fetal death and alerts both pathologists and clinicians to the important features identifying this cause of perinatal wastage. ATYPICAL AND MALIGNANT MENINGIOMAS; THE IMPORTANCE OF MICRONECROSIS AS A PROGNOSTIC INDICATOR.