Products of conception
Author:
Mikael Häggström [note 1]
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Gross processing
Look up the gestational age of the pregnancy.
- 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]
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Fresh chorionic villi (arrows), surrounded by decidua, at 10 weeks of gestational age.
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Chorionic villi (arrow) become more distinguished when held in fluid, having a fibrillary shape
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Fresh chorionic villi in a petri dish.
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Chorionic villi become more pale when fixed.
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Macropathology of umbilical cord, amnion and chorionic villi at 7-13 weeks of gestational age
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Fresh chorionic villi in a term placenta for comparison.
- 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.
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Products of conception, with chorionic villi (arrow) among decidualized endometrium -
Immature chorionic villi, having loose stroma and few capillaries.
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Necrotic chorionic villi in a tubal pregnancy.
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Scantly cellular decidua may look like chorionic villi, but lack the thick trophoblastic lining.
In the absence of chorionic villi, look for implantation site intermediate trophoblasts (ISITs):
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ISITs, having relatively large and dark nuclei.
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Histology of decidua for comparison, having smaller and brighter nuclei.
Microscopy report
Examples:
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((Products of conception/fetal tissue:)) Products of conception, including immature chorionic villi, and fetal tissue corresponding to first trimester pregnancy. ((Spontaneous abortion, clinically.)) |
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((Products of conception/fetal tissue:)) Fragments of focally necrotic decidua and implantation site, consistent with intrauterine products of conception. Negative for chorionic villi. |
Notes
- ↑ 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
- ↑ 1.0 1.1 . Gross Pathology Manual, By The University of Chicago Department of Pathology - Products of Conception. Retrieved on 2020-08-13.
Image sources