Difference between revisions of "Products of conception"

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==Comprehensiveness==
 
 
{{Comprehensiveness}}
 
{{Comprehensiveness}}
  
 
==Gross processing==
 
==Gross processing==
[[File:Gross pathology of fetal membranes versus decidua.jpg|thumb|Fetal membranes versus decidua.]]
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*Look for '''fetal tissue''' (fetus, fetal membranes or chorionic villi). If chorionic villi are found, no lengthy search is needed for other kinds of fetal tissue, just a quick look for obvious ones. Membranous material is less reliable, and may still indicate further sampling. Inspect any found fetal tissue for gross anomalies. If found, submit one piece of the fetus and one piece of the placenta.<ref name=Chicago>{{cite web|url=https://voices.uchicago.edu/grosspathology/peds-perinatal/products-of-conception/|title=Gross Pathology Manual, By The University of Chicago Department of Pathology - Products of Conception|accessdate=2020-08-13}}</ref>
*Look for '''fetal tissue''' (fetus, fetal membranes or chorionic villi). If any fetal tissue is found, no lengthy search is needed for other kinds of fetal tissue. Inspect them for gross anomalies. If found, submit one piece of the fetus and one piece of the placenta.<ref name=Chicago>{{cite web|url=https://voices.uchicago.edu/grosspathology/peds-perinatal/products-of-conception/|title=Gross Pathology Manual, By The University of Chicago Department of Pathology - Products of Conception|accessdate=2020-08-13}}</ref>
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<gallery mode=packed heights=180>
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File:Gross pathology of fixed chorionic villi.jpg|'''Chorionic villi''' (here fixed) are more apparent in fluid.
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File:Gross pathology of fresh chorionic villi.jpg|Fresh '''chorionic villi'''
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File:Gross pathology of partially fixed placental parenchyma.jpg|Fresh '''chorionic villi''' in a placenta for comparison.
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File:Gross pathology of fetal membranes versus decidua.jpg|'''Fetal membranes''' versus decidua.
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</gallery>
 
*If fetal parts are not visually found, search for diagnostic '''placental tissue''', which is soft and shaggy or spongy (as opposed to membranous, which is likely to be decidua or blood clots).<ref name=Chicago/>
 
*If fetal parts are not visually found, search for diagnostic '''placental tissue''', which is soft and shaggy or spongy (as opposed to membranous, which is likely to be decidua or blood clots).<ref name=Chicago/>
*If '''no fetal or placental tissue''' is found, all presented tissue needs to be submitted.
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*If '''no fetal or placental tissue''' is found, all presented tissue generally needs to be submitted.
  
 
===Gross report===
 
===Gross report===
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==Microscopy==
 
==Microscopy==
Most important is to detect the presence of chorionic villi.
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The most important is to detect the presence of '''chorionic villi'''.
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<gallery mode=packed heights=170>
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File:Histopathology of products of conception, with chorionic villi among decidualized endometrium.jpg|Products of conception, with '''chorionic villi''' (arrow) among decidualized endometrium
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File:Histopathology of chorionic villi at gestational age of 9 weeks.jpg|'''Immature chorionic villi''', having loose stroma and few capillaries.
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File:Histopathology of necrotic chorionic villi.jpg|thumb|'''Necrotic chorionic villi''' in a tubal pregnancy.
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File:Histology of scantly cellular decidua.jpg|Scantly cellular '''decidua''' may look like chorionic villi, but lack the thick trophoblastic lining.
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</gallery>
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In the absence of chorionic villi, look for '''implantation site intermediate trophoblasts (ISITs)''':
 
<gallery mode=packed heights=170>
 
<gallery mode=packed heights=170>
File:Histopathology of products of conception, with chorionic villi among decidualized endometrium.jpg|Histopathology of products of conception, with chorionic villi (arrow) among decidualized endometrium
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File:Histology of implantation site intermediate trophoblasts.jpg|'''ISITs''', having relatively large and dark nuclei.
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File:Histology of decidua.jpg|Histology of '''decidua''' for comparison, having smaller and brighter nuclei.
 
</gallery>
 
</gallery>
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===Microscopy report===
 
===Microscopy report===
[[File:Histopathology of chorionic villi at gestational age of 9 weeks.jpg|thumb|Immature chorionic villi, having loose stroma and few capillaries.]]
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Examples:
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{|class=wikitable
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|
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[[File:Histopathology of chorionic villi at gestational age of 9 weeks.jpg|130px|right]]
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{{Comprehensive-begin}}Products of conception/fetal tissue:{{Comprehensive-end}} Products of conception, including immature chorionic villi, and fetal tissue corresponding to first trimester pregnancy. {{Comprehensive-begin}}Spontaneous abortion, clinically.{{Comprehensive-end}}
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|}
  
Example:
 
 
{|class=wikitable
 
{|class=wikitable
|{{Comprehensive-begin}}Products of conception/fetal tissue:{{Comprehensive-end}} Products of conception, including immature chorionic villi, and fetal tissue corresponding to first trimester pregnancy. {{Comprehensive-begin}}Spontaneous abortion, clinically.{{Comprehensive-end}}
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|
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[[File:Histology of implantation site intermediate trophoblasts.jpg|130px|right]]
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{{Comprehensive-begin}}Products of conception/fetal tissue:{{Comprehensive-end}} Fragments of focally necrotic decidua and implantation site, consistent with intrauterine products of conception. Negative for chorionic villi.
 
|}
 
|}
 
{{Bottom}}
 
{{Bottom}}

Revision as of 18:12, 12 November 2020

Author: Mikael Häggström [note 1]

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Gross processing

  • Look for fetal tissue (fetus, fetal membranes or chorionic villi). If chorionic villi are found, no lengthy search is needed for other kinds of fetal tissue, just a quick look for obvious ones. Membranous material is less reliable, and may still indicate further sampling. Inspect any found fetal tissue for gross anomalies. If found, submit one piece of the fetus and one piece of the placenta.[1]
  • If fetal parts are not visually found, search for diagnostic placental tissue, which is soft and shaggy or spongy (as opposed to membranous, which is likely to be decidua or blood clots).[1]
  • If no fetal or placental tissue is found, all presented tissue generally needs to be submitted.

Gross report

(Labeled - products of conception.) The specimen (is received <<fresh / in formalin>>) and consists of multiple fragments of soft tan-pink decidua, blood clots and amniotic sac measuring about 5 cc in aggregate. The intact amniotic sac measures 2.3 cm in greatest dimension. Fetal tissue is identified within the amniotic sac, measuring 1.0 cm in crown-rump length. Representative sections are submitted for microscopic examination (in 1 cassette).

Microscopy

The most important is to detect the presence of chorionic villi.

In the absence of chorionic villi, look for implantation site intermediate trophoblasts (ISITs):

Microscopy report

Examples:

Histopathology of chorionic villi at gestational age of 9 weeks.jpg

((Products of conception/fetal tissue:)) Products of conception, including immature chorionic villi, and fetal tissue corresponding to first trimester pregnancy. ((Spontaneous abortion, clinically.))

Histology of implantation site intermediate trophoblasts.jpg

((Products of conception/fetal tissue:)) Fragments of focally necrotic decidua and implantation site, consistent with intrauterine products of conception. Negative for chorionic villi.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

Image sources