Chorion laeve accreta - Another manifestation of morbid adherence.

INTRODUCTION: Smooth muscle in the decidua of fetal membranes (membrane myofibers, MMF) is not mentioned in standard textbooks. METHODS: The current report presents collected observations on 52 patients with MMF at 2 institutions between 2004 and 2017 - including placentas, postpartum curettages, and hysterectomies. RESULTS: Clinical presentations include observation of adherent membranes during delivery, disrupted and incomplete membranes in placentas submitted for examination, postpartum bleeding associated with retained fetal membranes, association with membrane hematomas and membrane hemosiderin, morbidly adherent fetal membranes in hysterectomies; and association with grossly adherent pieces of tissue or nodules in fetal membranes. DISCUSSION: Although MMF can be an incidental microscopic observation in a routine placenta, the suggested diagnostic terminology when there are clinical and/or gross presentations is Chorion Laeve Accreta (ChLA). Further study is needed but MMF appears to be the fetal membrane counterpart of BPMF(basal plate myofibers), possibly due to damage of subjacent myometrium by trophoblastic proteases, so that shear stress during delivery causes myofibers to come out attached to the decidua of fetal membranes. Neither the prevalence of MMF, nor its reliability as a marker for placenta accreta is addressed in this collection. Association of MMF with BPMF, and recurrence of MMF, are documented; but the true frequency of these phenomena remains to be established.

Glucose transporter 3 (GLUT3) protein expression in human placenta across gestation.

Conflicting information regarding expression of GLUT3 protein in the human placenta has been reported and the localization and pattern of expression of GLUT3 protein across gestation has not been clearly defined. The objective of this study was characterization of syncytial GLUT3 protein expression across gestation. We hypothesized that GLUT3 protein is present in the syncytial microvillous membrane and that its expression decreases over gestation. GLUT3 protein was measured in samples from a range of gestational ages (first to third trimester), with human brain and human bowel used as a positive and negative control respectively. As an additional measure of specificity, we transfected BeWo choriocarcinoma cells, a trophoblast cell line expressing GLUT3, with siRNA directed against GLUT3 and analyzed expression by Western blotting. GLUT3 was detected in the syncytiotrophoblast at all gestational ages by immunohistochemistry. Using Western blotting GLUT3 was detected as an integral membrane protein at a molecular weight of ∼50 kDa in microvillous membranes from all trimesters but not in syncytial basal membranes. The identity of the primary antibody target was confirmed by demonstrating that expression of the immunoblotting signal in GLUT3 siRNA-treated BeWo was decreased to 18 ± 6% (mean ± SEM) of that seen in cells transfected with a non-targeting siRNA. GLUT3 expression in microvillous membranes detected by Western blot decreased through the trimesters such that expression in the second trimester (wks 14-26) was 48 ± 7% of that in the first trimester and by the third trimester (wks 31-40) only 34 ± 10% of first trimester expression. In addition, glucose uptake into BeWo cells treated with GLUT3 siRNA was reduced to 60% of that measured in cells treated with the non-targeting siRNA. This suggests that GLUT3-mediated uptake comprises approximately 50% of glucose uptake into BeWo cells. These results confirm the hypothesis that GLUT3 is present in the syncytial microvillous membrane early in gestation and decreases thereafter, supporting the idea that GLUT3 is of greater importance for glucose uptake early in gestation.

Adnexal torsion leading to death of an infant.

BACKGROUND: Torsion of the uterine adnexa is an uncommon occurrence in infants, but when it does occur, the consequences may be catastrophic. CASE: A 4-month-old female presented with sudden cardiac and respiratory arrest. There were no prior signs of illness. The infant was resuscitated and survived for one day after the event. Autopsy revealed a left ovarian cyst with torsion. Necrosis of the transverse colon was also seen. Other organs revealed signs of shock. The cause of death was felt to be related to the torsion. SUMMARY AND CONCLUSION: Torsion of the uterine adnexa is rare in infants. In the few reported cases, antecedent symptoms were present. Clinicians should be aware of this possibility and include it in the differential diagnosis of death in infancy.

Lack of proliferative activity of surface epithelial inclusion cysts of the ovary.

Surface epithelial inclusion cysts (SEICs) of the ovary are epithelial inclusions in the ovarian cortex believed to form from invagination of the surface epithelium at the time of ovulation. It has long been theorized that SEICs are related to the development of epithelial ovarian cancer. Ki-67 antigen is a marker of cell proliferation and has been shown to be prognostic in epithelial ovarian cancer. The purpose of this study was to evaluate Ki-67 activity in SEICs to evaluate their possible connection to ovarian neoplastic proliferation. A retrospective review of benign ovaries removed at the time of pelvic surgery was performed. Slides were immunostained with Ki-67. Proliferation index, expressed as the percent of cells staining in SEICs, was calculated. Proliferative activity was scored as negligible, low, moderate, or high, at <5%, 5-10%, 11-40%, and >40%, respectively. Eighteen ovaries from 18 women were evaluated. The percentage of Ki-67 positive cells ranged from 0% to 7%. Ki-67 activity in SEICs of the ovary is negligible to low. Proliferative activity as assessed by Ki-67 staining does not explain any possible relationship of SEICs to epithelial ovarian cancer.

Remodelling of uteroplacental arteries is decreased in high altitude placentae.

Uterine blood flow and birth weight are reduced and the risk of pre-eclampsia is increased in high-altitude pregnancies. Since IUGR and pre-eclampsia are associated with reduced invasion and remodelling of maternal spiral arteries we asked whether the terminal ends of uteroplacental arteries located at the maternal-foetal decidual interface evidenced less remodelling in 19 high (3100 m) compared with 13 moderate (1600 m) altitude placentae from normal pregnancies. Previous work has demonstrated marked villous angiogenesis in high altitude placentae. We asked whether such changes are compensatory for reduced modelling and/or whether they contribute to increased birth weight. Placentae were randomly sampled and examined with immunohistochemistry to evaluate vessel remodelling and foetal capillary density. The decidual ends of uteroplacental arteries were 8-fold more likely to be remodelled at 1600 vs. 3100 m (OR=8.1; CI 2.4, 27.0,P< 0.001). There were more than twice as many uteroplacental arteries observed in the high vs. moderate altitude placentae (OR=2.1; CI: 1.3, 3.5, P=0.006). Foetal capillary density was greater at 3100 vs. 1600 m (P< 0.001), but did not relate to remodelling nor to birth weight. In this in vivo model for chronic hypoxia, remodelling is reduced, and villous angiogenesis is not fully compensatory for reduced PO(2).

Presence and quantification of macrophages in squamous cell carcinoma of the cervix.

Cervical cancer is a major cause of morbidity and mortality in women. The presence of macrophages as well as other inflammatory cells has been noted in many of these tumors. Intratumoral macrophages/monocytes induce anergy to cytokine therapy and cause apoptosis in natural killer(NK) and T cells. The aim of this study was to better evaluate and quantify the presence of macrophages in these tumors. Twenty-four cases of squamous cell carcinoma of the cervix seen at our institution were evaluated. Sections were stained with CD68, a marker for macrophages. Staining was graded microscopically by two reviewers together on a scale of 0-4+, with 4+ representing the greatest number of positive cells. Image analysis was conducted to quantify the percent area stained in a given lesion. For each lesion, 10 fields were evaluated, and a mean percentage area stained was calculated. 4+ staining was observed in five cases, 3+ in zero cases, 2+ in three cases, 1+ in six cases, 1-2+ in one case, and nine cases were negative. Image analysis results correlated well with the light microscopic scoring. Presence of a prominent infiltrate of macrophages did not correlate with tumor grade or with histologic lymph node status, but showed a strong negative correlation with tumor stage. Some squamous cell carcinomas of the cervix show a prominent macrophage component in the tumor-associated inflammatory infiltrate. The presence of this prominent infiltration of macrophages did not correlate with tumor grade or lymph node status, but showed a strong negative correlation with tumor stage. The results suggest that immunotherapy may have a potential role in the treatment of cervical carcinoma. Computerized image analysis appears to be a valid measure to assess macrophage counts in such lesions.

Brenner tumor of the ovary with extensive stromal luteinization presenting in pregnancy: report of a case and review of the literature.

Brenner tumor in pregnancy is rare, with only two reported cases in association with intrauterine pregnancy. A 30-year-old woman, G1P0, was found to have an adnexal mass at 15 weeks of gestation. The mass was resected at Cesarean section and found to be a Brenner tumor with areas of stromal luteinization. Brenner tumor should be considered in the differential diagnosis of adnexal masses presenting during pregnancy. The stromal luteinization was probably related to the hormonal environment of the pregnancy.

Incidental finding of malignant mixed mesodermal tumor at hysterectomy for uterine prolapse. A case report.

BACKGROUND: The finding of unanticipated pathology in a uterus after vaginal hysterectomy for prolapse is uncommon. CASE: An incidental small malignant mixed mesodermal tumor was found at vaginal hysterectomy in a 68-year-old woman. CONCLUSION: A MED-LINE search found no other reported cases of malignant mixed mesodermal tumor in a patient undergoing vaginal hysterectomy for uterine prolapse. Unexpected endometrial and cervical lesions will be discovered occasionally after hysterectomy for benign disease.

Cutaneous ciliated cyst with interspersed apocrine features presenting as a pilonidal cyst in a child.

We present a case of a cutaneous ciliated cyst that presented in a 13-year-old female. The lesion was felt to be a pilonidal cyst, based on its location and clinical appearance. This case is unusual because it is the youngest reported example of this very rare lesion. In addition, the admixture of apocrine and ciliated cells is extremely unusual. The histogenesis of cutaneous ciliated cysts is considered.

Serous tumor of low malignant potential of the fallopian tube.

Although serous tumors of low malignant potential (STLMP) of the ovary are relatively common, similar tumors of the fallopian tube are exceedingly rare. We report the case of an STLMP of the fallopian tube in a 31-year-old woman and review the literature.

Basaloid squamous cell carcinoma of the vagina metastasizing to the lung. A case report.

BACKGROUND: While observed on the vulva, basaloid squamous cell carcinoma (BC) of the vagina is extremely rare, with no reported cases. CASE: A 54-year-old, African American woman presented with carcinoma metastatic to both lungs, morphologically similar to her BC of the vagina four years previously. She was treated initially in 1995 with local excision. Reexcision and radiation therapy were given for a recurrence in 1996. CONCLUSION: BC of the vagina is an extremely rare and aggressive tumor, which can recur and metastasize.

Reliability of frozen section of uterine curettings in evaluation of possible ectopic pregnancy.

STUDY OBJECTIVE: To assess the accuracy of frozen section evaluation of uterine curettings to look for chorionic villi and rule out ectopic pregnancy before laparoscopy. DESIGN: Retrospective review (Canadian Task Force classification III). SETTING: Northeastern medical school-affiliated teaching hospital. PATIENTS: Thirty-six women. Intervention. Dilatation and curettage, laparoscopy, and laparotomy. MEASUREMENTS AND MAIN RESULTS: Of 36 cases, 13 showed evidence of intrauterine pregnancy, either chorionic villi or implantation site, on final permanent sections. Five false negatives were identified in which no villi were identified on frozen section, although villi or evidence of an implantation site was noted on permanent sections (sensitivity 62%, 95% CI 0.32, 0.86). CONCLUSION: Frozen section evaluation of uterine curettings can produce false negative diagnoses, and this should be considered in the operative planning of women with suspected ectopic pregnancy.

Endometriosis presenting as bloody pleural effusion and ascites-report of a case and review of the literature.

A 34 year-old female presented with blood-stained pleural effusion and ascites. Investigation revealed a pelvic mass. She underwent exploratory laparotomy, and was found to have endometriosis. Total abdominal hysterectomy and right salpingo-oophorectomy was performed.

Troglitazone-induced fulminant hepatitis: report of a case with autopsy findings.

Troglitazone is an insulin-sensitizing agent used to treat type 2 diabetes mellitus. Several cases have been reported of troglitazone-induced hepatic injury; some requiring transplantation, others resulting in death. We here present a case of troglitazone-induced fulminant hepatic necrosis that led to the death of the patient.

Pregnancy-associated invasive squamous cell carcinoma of the vulva in a 28-year-old, HIV-negative woman. A case report.

BACKGROUND: The incidence of invasive squamous cell carcinoma of the vulva in women under 40 years of age has been increasing, particularly in association with human papillomavirus. Invasive vulvar carcinoma is rare in women under 30, as is an association with pregnancy. We report on a 28-year-old woman who was diagnosed with invasive squamous cell carcinoma of the vulva during pregnancy. CASE: The patient, gravida 5, para 4105, HIV negative, presented to the emergency room with vulvar pain. She had delivered a term infant three months earlier at another institution and was diagnosed with squamous cell carcinoma of the vulva at that time. At this admission, a 4.0-cm, ulcerated lesion involving the left labium minus was noted. The patient underwent examination under anesthesia with bilateral inguinal lymph node dissection, cone biopsy, radical vulvectomy and excision of perianal lesions. CONCLUSION: This case demonstrates the need to biopsy all suspicious vulvar lesions, even in young and pregnant women.

Periurethral vaginal adenocarcinoma of the intestinal type: report of two cases and review of the literature.

INTRODUCTION: Vaginal adenocarcinomas in the absence of diethylstilbestrol (DES) exposure are rare neoplasms. Only a few cases with enteric type histology have been reported. Also rare are urethral adenocarcinomas in women. CASE REPORTS: Two cases of vaginal adenocarcinoma of the intestinal type in the absence of DES exposure are presented. Both cases arose in the periurethral area, raising the issue of urethral as well as vaginal origin. DISCUSSION: The possible histogenesis of these neoplasms is considered.

Extensive gastric heterotopia of the small intestine resulting in massive gastrointestinal bleeding, bowel perforation, and death: report of a case and review of the literature.

Gastric heterotopia of the small intestine is a rare occurrence outside of Meckel's diverticulum and intestinal duplication. The vast majority of cases of gastric heterotopia occur as polypoid or tumorous lesions in the duodenum. These lesions have been associated with clinical symptoms including diarrhea, obstruction, dyspepsia, ulceration, and gastrointestinal bleeding. We present a case of gastric heterotopia that is unique because the lesions occurred as multiple, carpet-like, nonpolypoid areas throughout a large portion of the small intestine. A review of the literature is included.

Malignant adenomyoepithelioma of the breast with malignant proliferation of epithelial and myoepithelial elements: a case report and review of the literature.

Malignant adenomyoepithelioma of the breast is a rare lesion characterized by malignant proliferation of epithelial and myoepithelial cells that show characteristic histologic and immunohistochemical features. Eleven cases have been reported, 4 of which showed evidence of distant metastasis. The authors report a case of malignant adenomyoepithelioma in the axillary tail of a 71-year-old woman, one of the oldest patients described so far, and review the literature. Malignancy in the current case was evidenced by the presence of local invasion, high mitotic rate, and severe cytologic atypia. The tumor was associated with adenosis and lobular adenomyoepithelial hyperplasia. Malignant adenomyoepithelioma is a rare neoplasm, diagnosable by light microscopy and immunohistochemistry. To date, it has only been reported in women, who ranged in age from 26 to 76 years. Metastases have only been documented in tumors 2.0 cm in diameter or larger.