|
|
 |
  |
 |
|
|
|
|
|
 |
21st European Congress of Pathology
Istanbul, Turkey, September 08-13, 2007
http://www.ecp2007istanbul.org/
Slide Seminar 13, September 10th
Unexpected histological findings that change the clinical diagnosis in foetoplacental pathology
Chairpersons: P.B.Nunes and E.Ozer |
|
|
|
Case 1
Presented by: Dr. Ronald de Krijger
Clinical History
33-year-old woman of Asian origin, G1P0. Termination of pregnancy at 23 weeks because of severe intra-uterine growth retardation. Mother has spent a holiday in endemic area for malaria without prophylaxis while pregnant, but has not been ill. Slide of placenta.
Gross features: placental weight 90 grams, no other striking features.
|
|
Diagnosis & discussion |
|
|
|
|
Case 2
Presented by: Dr. Marta Cohen
Clinical History
A 31 year old, gravida 3, para 2. Caucasian woman was referred to the tertiary fetal medicine unit at 18 weeks gestation because of a placental abnormality. Her previous pregnancies were unremarkable. An ultrasound scan showed generalized vesicular lesions affecting the whole placenta. There was a single fetus which demonstrated reduced growth parameters and oligohydramnios.
Macroscopic findings: The trimmed placental weight was 769 g (mean expected weight 451 g at 37 weeks gestation). The cord inserted eccentically and contained 3 vessels. The chorionic vessels were thickened and prominent. The cut surface was pale and friable with multiple cysts, measuring between 0.6 and 2 cm diameter, more frequently present on and beneath the material surface.
|
|
Diagnosis & discussion |
|
|
|
|
Case 3
Presented by: Dr. Paula Borralho Nunes
Clinical History
A 24 week gestation foetus with bilateral symetrical ventricular masses that were diagnosed as intraventricular bilateral haemorrhage on the ultrasound. A section of the left ventricular lesion is sent.
|
|
Diagnosis & discussion |
|
|
|
|
Case 4
Presented by: Dr. Miguel Reyes-Mugica
Clinical History
A female fetus was delivered through elective termination of pregnancy at 23 weeks, after an ultrasound revealed polycystic kidney disease. The mother was 34 years old, G2P1 and previously healthy.
Autopsy gross findings were unremarkable, except for kidneys, which displayed a granular appearance, both externally and on the section. Slides from liver and kidney are shown.
|
|
Diagnosis & discussion |
|
|
|
|
Case 5
Presented by: Dr. Miguel Reyes-Mugica
Clinical History
A male fetus was delivered through elective termination of pregnancy at 19 weeks, after an ultrasound revealed a Dandy-Walker malformation, bilateral enlarged kidneys and oligohydramnios. The mother was 30 years old, G1P0 and previously healthy.
On gross examination, no external malformations were found. Internal examination revealed marked enlargement of kidneys, with a multicystic appearance; examination of the brain showed a dilated fourth ventricle, and agenesis of corpus callosum. Pulmonary hypoplasia was also present. Slides from liver and kidney are shown.
|
|
Diagnosis & discussion |
|
|
|
|
Case 6
Presented by: Dr. Erdener Ozer
Clinical History
A female neonate weighing 2025g was born at 37-week-gestation to a 35-year-old gravida 2, para 1 mother by caesarean section. Apgar scores were 6 at 1 and 5 minutes. The patient was admitted to the NICU after delivery because of pallor and respiratory distress. The gestational history included IUGR, but no fetal anomaly or placental pathology. The mother’s medical history was unremarkable.
On physical examination, pale skin color, tachycardia and tachypnea were noted. Cardiac oscultation revealed a systolic murmur on the apex. Bilateral crackles were also noted on the basis of the lungs. Abdomen was distended and liver was palpated 4 cm below costal margin. Her hemoglobin level was 10.8 g/dl, hematocrit 38%, white blood cell 27500/mm3 and platelet count 31000/mm3. Peripheral blood smear revealed polychromasis, anisocytosis and poikilocytosis. There was 80% normoblast Bone marrow aspiration was planned.. Chest X-ray showed cardiomegaly. Echocardiography was normal. Patient was entubated and mechanical ventilation was performed because of respiratory failure. Antibiotic therapy was started because of the risk of sepsis. Thrombocyte suspension was administrated and packed red cell transfusion were performed. On pathogical examination, the placenta showed multiple nodules. Slide represents one of the nodules.
|
|
Diagnosis & discussion |
|
|
|
|
Case 7
Presented by: Dr. Phil Cox
Clinical History
N567/06: Neonatal death of a 4 day old male infant born at 34 weeks gestation. Mother is North African, G2 P0+1, having had one previous miscarriage. No significant medical or family history. Pregnancy was booked abroad. She was found to have symptoms of pre-eclampsia at 34 weeks gestation and was delivered the same day by Caesarean section. Birth weight 1490g, Apgars 8 at 1min and 10 at 5 mins. He was well until day 3 when he was found pale, grey and unsettled and tests showed a metabolic acidosis. He was found to have suffered pulmonary haemorrhage and was intubated and ventilated and received full resuscitation, transfusion, vitamin K, FFP and saline boluses. Initially he stabilised, but about 4 to 6 hours later he developed severe metabolic acidosis which was refractory to treatment. The cranial ultrasound scan showed echodensities in the frontal and occipital regions. He died on day 4 of life.
Macroscopic findings: A male infant whose birth weight is well below the 1st centile for 34/40 week gestation. Mild generalised oedema and jaundice. Small dark brown nodular liver. Gastric mucosal haemorrhage. Bilateral pulmonary haemorrhage. Section of liver.
|
|
Diagnosis & discussion |
|
|
|
|
Case 8
Presented by: Dr. Irene Scheimberg
Clinical History
Mother aged 19 years primigravida. No consanguinity and no congenital abnormalities in the family. LMP 14/06/05, EDD by dates and by USS 21/03/06. No maternal diseases, in particular no hypertension or diabetes. Down’s screen test was normal. USS at 18+3 weeks and at 24+0 weeks showed fetal abnormalities: moderate cystic hygroma; right hydronephrosis; cardiac defect (double outlet right ventricle, transposition of the great arteries, ventricular septal defect) and possible ureterocele; polyhydramnios was also noted. CVS showed normal male karyotype. A mildly macerated hydropic male baby was spontaneously delivered at 30+2 weeks, BW 2620g (well above 99th centile).
Examination: Facial dysmorphism; skin flap on the neck.11 pairs of ribs. Bilateral pleural effusions; ascites; subcutaneous oedema; mild pulmonary hypoplasia. Heart: ASD; potential interventricular communication between muscular outlet septum and remainder of ventricular septum. Partial intestinal malrotation. Duplication of the right renal pelvis and ureter; segmental dysplasia of the upper pole of the right kidney; bilateral hydronephrosis and hydroureters. Testes looked normal and were sited in the abdominal cavity
|
|
Diagnosis & discussion |
|
|
|
|
|
 |
 |
 |
|
