Placenta - Revision history

Mikael Häggström: /* Microscopy report */ +Twin

2023-11-27T21:50:19Z

Microscopy report: +Twin

← Older revision		Revision as of 17:50, 27 November 2023
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	Mild to moderate inflammation in the decidua alone can be ignored (as it is most commonly a physiological response and doesn't have a clinical significance for the fetus).		Mild to moderate inflammation in the decidua alone can be ignored (as it is most commonly a physiological response and doesn't have a clinical significance for the fetus).

			Example in a '''twin''' placenta:
			{\|class=wikitable
			\| Twin placenta, Caesarean section:
			*Third trimester dichorionic, diamniotic twin placenta.
			*Villous morphology histologically appropriate for gestational age.
			*Placental weight approximately 25th percentile for gestational age.
			*Two three-vessel umbilical cords.
			*Negative for chorioamnionitis and funisitis.
			\|}
	<noinclude>{{Bottom}}</noinclude>		<noinclude>{{Bottom}}</noinclude>

Mikael Häggström: /* Microscopic examination */ +Knots

2023-11-25T20:06:36Z

Microscopic examination: +Knots

← Older revision		Revision as of 16:06, 25 November 2023
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	File:Histopathology of fibrinoid necrosis of the placenta.jpg\|Villous '''[[Fibrinoid necrosis of the placenta\|fibrinoid necrosis]]'''. Only needs mention when severe {{Comprehensive-begin}}or moderate{{Comprehensive-end}}.		File:Histopathology of fibrinoid necrosis of the placenta.jpg\|Villous '''[[Fibrinoid necrosis of the placenta\|fibrinoid necrosis]]'''. Only needs mention when severe {{Comprehensive-begin}}or moderate{{Comprehensive-end}}.
	File:Histopathology of chorangiosis.jpg\|'''Chorangiosis''', an abundance of blood vessels within the chorionic villi.		File:Histopathology of chorangiosis.jpg\|'''Chorangiosis''', an abundance of blood vessels within the chorionic villi.
			File:Histopathology of placenta with increased syncytial knotting of chorionic villi, annotated.jpg\|Increased syncytial knotting of chorionic villi, with two knots pointed out. Causes include both hypoxia and hyperoxia.<ref name="pmid17140657">{{cite journal\| author=Heazell AE, Moll SJ, Jones CJ, Baker PN, Crocker IP\| title=Formation of syncytial knots is increased by hyperoxia, hypoxia and reactive oxygen species. \| journal=Placenta \| year= 2007 \| volume= 28 Suppl A \| issue= \| pages= S33-40 \| pmid=17140657 \| doi=10.1016/j.placenta.2006.10.007 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17140657 }} </ref>
	</gallery>		</gallery>

Mikael Häggström: /* Tissue selection */ +Bags

2022-12-13T22:55:05Z

Tissue selection: +Bags

← Older revision		Revision as of 18:55, 13 December 2022
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	*Placental section including '''maternal surface''' (full thickness if possible)		*Placental section including '''maternal surface''' (full thickness if possible)
	*Any '''lesions''' or '''abnormalities'''		*Any '''lesions''' or '''abnormalities'''
	Avoid taking placental sections near the margin		Avoid taking placental sections near the margin. {{Moderate-begin}}If transported or processed together with other cases, put the placental in thin-mesh cassettes or tissue bags to limit contamination{{Moderate-end}}.<ref group=note>Chorionic villi are promiscuous contaminants of other tissues, and may cause a false positive finding for a cassette containing products of conception.<br>- {{cite journal\| author=Carll T, Fuja C, Antic T, Lastra R, Pytel P\| title=Tissue Contamination During Transportation of Formalin-Fixed, Paraffin-Embedded Blocks. \| journal=Am J Clin Pathol \| year= 2022 \| volume= 158 \| issue= 1 \| pages= 96-104 \| pmid=35195717 \| doi=10.1093/ajcp/aqac014 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35195717 }} </ref>

			Example report:
			{\|class=wikitable
			\| Container A. Labeled "bladder tumor". The specimen is received in formalin and consists of multiple fragments of tan-gray, friable soft tissue measuring about __ x __ x __ cm in aggregate. The specimen is entirely submitted for microscopic examination in __ cassettes.
			\|}

	===Gross report===		===Gross report===

Mikael Häggström:

2022-12-04T15:41:40Z

← Older revision		Revision as of 11:41, 4 December 2022
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	{{Top		<noinclude>{{Top
	\|author1=[[User:Mikael Häggström\|Mikael Häggström]]		\|author1=[[User:Mikael Häggström\|Mikael Häggström]]
	\|author2=		\|author2=
	}}		}}
	{{Comprehensiveness}}		{{Comprehensiveness}}
			</noinclude>
	==Gross processing==		==Gross processing==
	*Determine the '''shape''' of the placenta		*Determine the '''shape''' of the placenta
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	Mild to moderate inflammation in the decidua alone can be ignored (as it is most commonly a physiological response and doesn't have a clinical significance for the fetus).		Mild to moderate inflammation in the decidua alone can be ignored (as it is most commonly a physiological response and doesn't have a clinical significance for the fetus).
	{{Bottom}}		<noinclude>{{Bottom}}</noinclude>

Mikael Häggström: /* Gross processing */ Linked

2022-12-02T14:12:14Z

Gross processing: Linked

← Older revision		Revision as of 10:12, 2 December 2022
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	*'''Weigh''' the trimmed disk, after having trimmed away the cord and membranes, and after having removed excess amounts of loose retroplacental blood clots over the maternal surface.		*'''Weigh''' the trimmed disk, after having trimmed away the cord and membranes, and after having removed excess amounts of loose retroplacental blood clots over the maternal surface.
	*Examine the '''fetal surface''' (chorionic plate):		*Examine the '''fetal surface''' (chorionic plate):
	:*Note its '''color''', in particular if it is green (often faint and tan-green, brown-green to yellow-green (which indicates meconium staining).		:*Note its '''color''', in particular if it is green (often faint and tan-green, brown-green to yellow-green (which indicates '''[[Meconium histocytosis\|meconium staining]]''').
	:*Look for any '''pathologies''' including granular excrescences, subchorionic fibrin or subamniotic hemorrhage		:*Look for any '''pathologies''' including granular excrescences, subchorionic fibrin or subamniotic hemorrhage
	:*Look at the integrity and extent of the '''vasculature''', including any traumatic damage. Also palpate the vasculature for any thrombosis. If a thrombus is grossly found for a live birth, the baby may have thrombosis, so the finding must immediately be reported to the clinician in care of the baby.		:*Look at the integrity and extent of the '''vasculature''', including any traumatic damage. Also palpate the vasculature for any thrombosis. If a thrombus is grossly found for a live birth, the baby may have thrombosis, so the finding must immediately be reported to the clinician in care of the baby.

Mikael Häggström: /* Gross processing */ +Green

2022-12-02T14:10:44Z

Gross processing: +Green

← Older revision		Revision as of 10:10, 2 December 2022
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	*'''Weigh''' the trimmed disk, after having trimmed away the cord and membranes, and after having removed excess amounts of loose retroplacental blood clots over the maternal surface.		*'''Weigh''' the trimmed disk, after having trimmed away the cord and membranes, and after having removed excess amounts of loose retroplacental blood clots over the maternal surface.
	*Examine the '''fetal surface''' (chorionic plate):		*Examine the '''fetal surface''' (chorionic plate):
	:*Note its '''color'''		:*Note its '''color''', in particular if it is green (often faint and tan-green, brown-green to yellow-green (which indicates meconium staining).
	:*Look for any '''pathologies''' including granular excrescences, subchorionic fibrin or subamniotic hemorrhage		:*Look for any '''pathologies''' including granular excrescences, subchorionic fibrin or subamniotic hemorrhage
	:*Look at the integrity and extent of the '''vasculature''', including any traumatic damage. Also palpate the vasculature for any thrombosis. If a thrombus is grossly found for a live birth, the baby may have thrombosis, so the finding must immediately be reported to the clinician in care of the baby.		:*Look at the integrity and extent of the '''vasculature''', including any traumatic damage. Also palpate the vasculature for any thrombosis. If a thrombus is grossly found for a live birth, the baby may have thrombosis, so the finding must immediately be reported to the clinician in care of the baby.

Mikael Häggström: /* Gross processing */ If

2022-12-02T14:01:05Z

Gross processing: If

← Older revision		Revision as of 10:01, 2 December 2022
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	*Note the '''color''' of the parenchyma and describe any pale areas, cysts, thrombi, increased fibrin, calcifications and infarcts. For possible infarcts, estimate the total amount of infarcted tissue as a percentage of the placental volume. Infarction is clinically significant if it involves at least 5-10% of the placental volume.		*Note the '''color''' of the parenchyma and describe any pale areas, cysts, thrombi, increased fibrin, calcifications and infarcts. For possible infarcts, estimate the total amount of infarcted tissue as a percentage of the placental volume. Infarction is clinically significant if it involves at least 5-10% of the placental volume.
	[[File:Gross pathology of placental disorders.jpg\|thumb\|520px\|center\|Gross pathology of placental disorders.<ref name="ChenZhang2020">{{cite journal\|last1=Chen\|first1=Yukun\|last2=Zhang\|first2=Zhuomin\|last3=Wu\|first3=Chenyan\|last4=Davaasuren\|first4=Dolzodmaa\|last5=Goldstein\|first5=Jeffery A.\|last6=Gernand\|first6=Alison D.\|last7=Wang\|first7=James Z.\|title=AI-PLAX: AI-based placental assessment and examination using photos\|journal=Computerized Medical Imaging and Graphics\|volume=84\|year=2020\|pages=101744\|issn=08956111\|doi=10.1016/j.compmedimag.2020.101744}}<br>- Fig 5- available via license: Creative Commons Attribution 4.0 International.</ref>]]		[[File:Gross pathology of placental disorders.jpg\|thumb\|520px\|center\|Gross pathology of placental disorders.<ref name="ChenZhang2020">{{cite journal\|last1=Chen\|first1=Yukun\|last2=Zhang\|first2=Zhuomin\|last3=Wu\|first3=Chenyan\|last4=Davaasuren\|first4=Dolzodmaa\|last5=Goldstein\|first5=Jeffery A.\|last6=Gernand\|first6=Alison D.\|last7=Wang\|first7=James Z.\|title=AI-PLAX: AI-based placental assessment and examination using photos\|journal=Computerized Medical Imaging and Graphics\|volume=84\|year=2020\|pages=101744\|issn=08956111\|doi=10.1016/j.compmedimag.2020.101744}}<br>- Fig 5- available via license: Creative Commons Attribution 4.0 International.</ref>]]
			If you see a '''true knot''' (rather than "false knots" which are merely bulges or protuberances that may look like knots), report whether the diameter of the cord is significantly different before versus after the knot (which is a sign of constriction caused by the knot).

	===Tissue selection===		===Tissue selection===

Mikael Häggström: /* Microscopic examination */ Villous

2022-11-29T19:07:27Z

Microscopic examination: Villous

← Older revision		Revision as of 15:07, 29 November 2022
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	<gallery mode=packed heights=200>		<gallery mode=packed heights=200>
	File:Histology of calcification of a term placenta.jpg\|'''Calcifications''', are normal in term placentas. Report if seen in a placenta younger than 36 weeks of gestational age.<ref>[https://www.researchgate.net/publication/287299495_Placental_calcification_Its_processes_and_impact_on_pregnancy Chapter 3. Placental Calcification: Its Processes and Impact on Pregnancy], {{cite book \| last=Kachewar \| first=Sushil \| title=Calcification : processes, determinants and health impact \| publisher=Nova Science Publishers, Inc \| publication-place=New York \| year=2013 \| isbn=978-1-62618-155-7 \| oclc=840507829}}</ref>		File:Histology of calcification of a term placenta.jpg\|'''Calcifications''', are normal in term placentas. Report if seen in a placenta younger than 36 weeks of gestational age.<ref>[https://www.researchgate.net/publication/287299495_Placental_calcification_Its_processes_and_impact_on_pregnancy Chapter 3. Placental Calcification: Its Processes and Impact on Pregnancy], {{cite book \| last=Kachewar \| first=Sushil \| title=Calcification : processes, determinants and health impact \| publisher=Nova Science Publishers, Inc \| publication-place=New York \| year=2013 \| isbn=978-1-62618-155-7 \| oclc=840507829}}</ref>
	File:Histopathology of fibrinoid necrosis of the placenta.jpg\|'''[[Fibrinoid necrosis of the placenta\|~~Fibrinoid~~ necrosis]]'''. Only needs mention when severe {{Comprehensive-begin}}or moderate{{Comprehensive-end}}.		File:Histopathology of fibrinoid necrosis of the placenta.jpg\|Villous '''[[Fibrinoid necrosis of the placenta\|fibrinoid necrosis]]'''. Only needs mention when severe {{Comprehensive-begin}}or moderate{{Comprehensive-end}}.
	File:Histopathology of chorangiosis.jpg\|'''Chorangiosis''', an abundance of blood vessels within the chorionic villi.		File:Histopathology of chorangiosis.jpg\|'''Chorangiosis''', an abundance of blood vessels within the chorionic villi.
	</gallery>		</gallery>

Mikael Häggström: Ignore

2022-07-15T23:56:18Z

Ignore

← Older revision		Revision as of 19:56, 15 July 2022
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	==Microscopic examination==		==Microscopic examination==

	*Look for '''inflammation''', especially by the fetal surface in the intervillous spaces and around the fetal blood vessels.~~<ref group=note>Minor inflammation in the decidua can be ignored as it doesn't have a clinical significance for the fetus.</ref>~~		*Look for '''inflammation''', especially by the fetal surface in the intervillous spaces and around the fetal blood vessels.
	<gallery mode=packed heights=200>		<gallery mode=packed heights=200>
	File:Histopathology of subchorionic intervillositis, annotated.jpg\|Acute '''subchorionic intervillositis''', with neutrophils (annotated) in Langhan’s layer of fibrinoid (by the fetal surface, at the base of a chorionic villus, seen at top right).		File:Histopathology of subchorionic intervillositis, annotated.jpg\|Acute '''subchorionic intervillositis''', with neutrophils (annotated) in Langhan’s layer of fibrinoid (by the fetal surface, at the base of a chorionic villus, seen at top right).
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	\| {{Moderate-begin}}Placenta, <<vaginal/Caesarean>> delivery:{{Moderate-end}}<br>Third trimester placenta with term villous histology. Placental weight (__ gm), at __th percentile for gestational age. Membranes without significant histopathologic changes{{Comprehensive-begin}}, negative for chorioamnionitis{{Comprehensive-end}}. Trivascular umbilical cord, with no significant histopathologic changes{{Comprehensive-begin}}, negative for funisitis{{Comprehensive-end}}.		\| {{Moderate-begin}}Placenta, <<vaginal/Caesarean>> delivery:{{Moderate-end}}<br>Third trimester placenta with term villous histology. Placental weight (__ gm), at __th percentile for gestational age. Membranes without significant histopathologic changes{{Comprehensive-begin}}, negative for chorioamnionitis{{Comprehensive-end}}. Trivascular umbilical cord, with no significant histopathologic changes{{Comprehensive-begin}}, negative for funisitis{{Comprehensive-end}}.
	\|}		\|}

			Mild to moderate inflammation in the decidua alone can be ignored (as it is most commonly a physiological response and doesn't have a clinical significance for the fetus).
	{{Bottom}}		{{Bottom}}

Mikael Häggström: Note

2022-06-19T20:46:54Z

Note

← Older revision		Revision as of 16:46, 19 June 2022
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	*Examine the '''umbilical cord'''		*Examine the '''umbilical cord'''
	:*Measure the '''distance''' between the insertion point and the nearest placental margin		:*Measure the '''distance''' between the insertion point and the nearest placental margin
	:*Measure the cord '''length''' and give proximal and distal diameter. In placental pathology, the ''proximal'' umbilical cord refers to the segment closest to the placenta, and ''distal'' is the segment closest to the fetus.<ref group=~~notes~~>In contrast, in embryology and fetal medicine, the ''proximal'' umbilical cord refers to the segment closest to the fetus:<br>- {{cite journal\| author=Wyburn GM\| title=The formation of the umbilical cord and the umbilical region of the anterior abdominal wall. \| journal=J Anat \| year= 1939 \| volume= 73 \| issue= Pt 2 \| pages= 289-310.9 \| pmid=17104757 \| doi= \| pmc=1252509 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17104757 }}<br>{{cite web\|url=https://medicine.yale.edu/obgyn/kliman/placenta/research/Umbilical%20Cord%20EOR_163162_284_18220_v1.pdf\|title=The Umbilical Cord (from The Encyclopedia of Reproduction)\|author=Harvey J. Kliman, M.D., Ph.D.\|website=Yale School of Medicine\|date=2006-10-29}}</ref>		:*Measure the cord '''length''' and give proximal and distal diameter. In placental pathology, the ''proximal'' umbilical cord refers to the segment closest to the placenta, and ''distal'' is the segment closest to the fetus.<ref group=note>In contrast, in embryology and fetal medicine, the ''proximal'' umbilical cord refers to the segment closest to the fetus:<br>- {{cite journal\| author=Wyburn GM\| title=The formation of the umbilical cord and the umbilical region of the anterior abdominal wall. \| journal=J Anat \| year= 1939 \| volume= 73 \| issue= Pt 2 \| pages= 289-310.9 \| pmid=17104757 \| doi= \| pmc=1252509 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17104757 }}<br>{{cite web\|url=https://medicine.yale.edu/obgyn/kliman/placenta/research/Umbilical%20Cord%20EOR_163162_284_18220_v1.pdf\|title=The Umbilical Cord (from The Encyclopedia of Reproduction)\|author=Harvey J. Kliman, M.D., Ph.D.\|website=Yale School of Medicine\|date=2006-10-29}}</ref>
	:*Count the number of '''vessels''' away from the insertion		:*Count the number of '''vessels''' away from the insertion
	*'''Weigh''' the trimmed disk, after having trimmed away the cord and membranes, and after having removed excess amounts of loose retroplacental blood clots over the maternal surface.		*'''Weigh''' the trimmed disk, after having trimmed away the cord and membranes, and after having removed excess amounts of loose retroplacental blood clots over the maternal surface.
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	==Microscopic examination==		==Microscopic examination==

	*Look for '''inflammation''', especially by the fetal surface in the intervillous spaces and around the fetal blood vessels.<ref group=~~notes~~>Minor inflammation in the decidua can be ignored as it doesn't have a clinical significance for the fetus.</ref>		*Look for '''inflammation''', especially by the fetal surface in the intervillous spaces and around the fetal blood vessels.<ref group=note>Minor inflammation in the decidua can be ignored as it doesn't have a clinical significance for the fetus.</ref>
	<gallery mode=packed heights=200>		<gallery mode=packed heights=200>
	File:Histopathology of subchorionic intervillositis, annotated.jpg\|Acute '''subchorionic intervillositis''', with neutrophils (annotated) in Langhan’s layer of fibrinoid (by the fetal surface, at the base of a chorionic villus, seen at top right).		File:Histopathology of subchorionic intervillositis, annotated.jpg\|Acute '''subchorionic intervillositis''', with neutrophils (annotated) in Langhan’s layer of fibrinoid (by the fetal surface, at the base of a chorionic villus, seen at top right).