Are Short Umbilical Cords Seen in Pathology Really Short?

PURPOSE: Short umbilical cords are associated with adverse perinatal outcomes. Clinicians may rely on measurements made by pathologists, which do not include portions of the cord remaining n the child or sent for blood gasses. METHODS: This was a retrospective chart review of term placentas. Sequential cases from January through August 2017 were reviewed from the Pathology archive. RESULTS: 198 placentas were recorded as either third trimester of mature, of which 146 were 37 or greater weeks of gestation. Of these 146, 142 had cords measuring less than 35 cm, the definition of short. Mean cord length was 19.6 cm. Of the 146 placentas, 50(34%) had had blood gases submitted. CONCLUSIONS: 34% of short cords by Pathology measurement had had blood gases sent. The fact that 142 out of 146 sequential placentas were recorded as "short" suggests an additional unmeasured loss of length due to cord attached to the infant. Pathology laboratory measurements should not be interpreted as truly short without clinical correlation.

Targeting the adnexal epithelium: an unusual case of syringometaplasia in a patient on vemurafenib.

Cutaneous adverse events (cAEs) are reported in 90% of all patients on selective BRAF inhibitors and contribute significantly to patient morbidity. Two weeks after initiating vemurafenib for metastatic melanoma, our patient developed a pruritic eruption with numerous, 1-2 mm pink hyperkeratotic follicular papules over his trunk and upper extremities. A biopsy demonstrated squamous metaplasia of the eccrine ducts with irregular hyperplasia of hair follicles sparing the interfollicular epidermis. Diffuse adnexal metaplasia is a novel and unusual cutaneous response to vemurafenib. The patient was started on acitretin 10 mg daily with improvement of the eruption after 4 weeks. We report an unusual cAE of vemurafenib selectively targeting the adnexal epithelium with relative sparing of the interfollicular epidermis. Interval improvement was noted after 4 weeks of acitretin, which is an effective therapeutic option for patients with cAEs involving squamous hyperplasia secondary to vemurafenib. Our case illustrates the particular sensitivity of the adnexal epithelium for vemurafenib-induced dysfunction in proliferation and differentiation, providing the basis for common cAEs observed on this medication.