Difference between revisions of "Products of conception"

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'''Products of conception''', abbreviated '''POC''', is stuff formed from the union of egg and sperm. This article covers POC superficially.
'''Products of conception''', abbreviated '''POC''', is stuff formed from the union of egg and sperm. This article covers POC superficially.


There are separate articles for ''[[chorionic villi]]'' and ''[[gestational trophoblastic disease]]''.
There are separate articles for ''[[chorionic villi]]'' and ''[[gestational trophoblastic disease]]''.
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*Chorionic villus sampling (10-12 weeks???).
*Chorionic villus sampling (10-12 weeks???).
*Amniocentesis (15-16 weeks+).
*Amniocentesis (15-16 weeks+).
==Gross==
Fetal parts absent:
*Minimum of five cassettes.<ref>URL: [https://voices.uchicago.edu/grosspathology/peds-perinatal/products-of-conception/ https://voices.uchicago.edu/grosspathology/peds-perinatal/products-of-conception/]. Accessed on: 2023 April 3.</ref>


==Microscopic==
==Microscopic==
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====Images====
====Images====
<gallery>
<gallery>
Image:Endometrium_ocp_use2.jpg | Decidualization due to OCP - high mag. (WC)
Image:Chorionic_villi_-_intermed_mag.jpg | Chorionic villi - intermed. mag. (WC)
Image:Chorionic_villi_-_intermed_mag.jpg | Chorionic villi - intermed. mag. (WC)
Image:Products_of_conception_-_low_mag.jpg | Chorionic villi and fetal parts - low mag. (WC)
Image:Products_of_conception_-_low_mag.jpg | Chorionic villi and fetal parts - low mag. (WC)
</gallery>
</gallery>
<gallery>
Image:Intermediate_trophoblast_3_-_low_mag.jpg | Intermediate trophoblast reaction - low mag. (WC)
Image:Intermediate_trophoblast_3_-_high_mag.jpg | Intermediate trophoblast - high mag. (WC)
</gallery>
www:
www:
*[http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=24&cat2=181&cat3=586&cat4=3&stype=n Tubal pregnancy - several images (gfmer.ch)].
*[http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=24&cat2=181&cat3=586&cat4=3&stype=n Tubal pregnancy - several images (gfmer.ch)].
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**+/-Nuclear hyperchromasia, i.e. dark nuclei.
**+/-Nuclear hyperchromasia, i.e. dark nuclei.
**+/-Irregular nuclear membrane.
**+/-Irregular nuclear membrane.
**+/-Nuclear clearing.<ref name=Ref_DCHH236-7>{{Ref DCHH|236-7}}.</ref>  
**+/-Nuclear clearing.<ref name=Ref_DCHH236-7>{{Ref DCHH|236-7}}</ref>  
**+/-[[Nuclear pseudoinclusions]].
**+/-[[Nuclear pseudoinclusions]].
*[[NC ratio]] is preserved.<ref name=Ref_DCHH236-7>{{Ref DCHH|236-7}}</ref>
*[[NC ratio]] is preserved.<ref name=Ref_DCHH236-7>{{Ref DCHH|236-7}}</ref>
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*[[Clear cell carcinoma]].
*[[Clear cell carcinoma]].


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:Intermediate_trophoblast_3_-_low_mag.jpg Intermediate trophoblast reaction - low mag. (WC)].
*[http://www2.odn.ne.jp/g_nexus_6/images/Arias-Stella.jpg Arias-Stella reaction (odn.ne.jp)]<ref>URL: [http://pathblog.wordpress.com/2009/01/23/what-is-arias-stella/ http://pathblog.wordpress.com/2009/01/23/what-is-arias-stella/]. Accessed on: September 8, 2014.</ref>
*[http://commons.wikimedia.org/wiki/File:Intermediate_trophoblast_3_-_high_mag.jpg Intermediate trophoblast - high mag. (WC)].


====Subtypes====
====Subtypes====
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*[[Chorionic villi]] have to be identified (in some location, e.g. [[Fallopian tube]]) to Dx a pregnancy.
*[[Chorionic villi]] have to be identified (in some location, e.g. [[Fallopian tube]]) to Dx a pregnancy.
*[[Endometrium]]: decidual reaction, as seen in any pregnancy.
*[[Endometrium]]: decidual reaction, as seen in any pregnancy.
Clinical:
*Abdominal pain in woman of childbearing age.
**''Every woman of childbearing age should be assumed pregnant until proven otherwise!''<ref name=pmid23210111>{{Cite journal  | last1 = Doust | first1 = J. | title = A is for aphorism - a woman is pregnant until proven otherwise. | journal = Aust Fam Physician | volume = 41 | issue = 10 | pages = 827 | month = Oct | year = 2012 | doi =  | PMID = 23210111 |url = http://www.racgp.org.au/afp/2012/october/a-is-for-aphorism/ }}</ref>
*Typical gestational age (GA) for a tubal pregnancy ~ 5-9 weeks.<ref name=pmid9207811/>
**Beta-hCG elevated but may be relatively low (<100 IU/L) even in the context of (uterine tube) rupture.<ref name=pmid9207811>{{Cite journal  | last1 = Saxon | first1 = D. | last2 = Falcone | first2 = T. | last3 = Mascha | first3 = EJ. | last4 = Marino | first4 = T. | last5 = Yao | first5 = M. | last6 = Tulandi | first6 = T. | title = A study of ruptured tubal ectopic pregnancy. | journal = Obstet Gynecol | volume = 90 | issue = 1 | pages = 46-9 | month = Jul | year = 1997 | doi = 10.1016/S0029-7844(97)00180-4 | PMID = 9207811 }}</ref>


===Microscopic===
===Microscopic===
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*[[Complete hydatidiform mole]].
*[[Complete hydatidiform mole]].
*[[Partial hydatidiform mole]].
*[[Partial hydatidiform mole]].
====Images====
<gallery>
Image:Ectopic pregnancy -- low mag.jpg | EP - low mag. (WC)
Image:Ectopic pregnancy -- intermed mag.jpg | EP - intermed. mag. (WC)
Image:Ectopic pregnancy -- high mag.jpg | EP - high mag. (WC)
Image:Ectopic pregnancy - decidua -- intermed mag.jpg | EP - intermed. mag. (WC)
</gallery>


===Sign out===
===Sign out===
<pre>
Fallopian Tube, Right Salpingectomy:
    - Fallopian tube with chorionic villi (tubal pregnancy).
</pre>
<pre>
Submitted as "Left Fallopian Tube and Ectopic Pregnancy", Excision:
    - Tubal pregnancy; Fallopian tube with chorionic villi and fetal parts.
</pre>
====Block letters====
<pre>
<pre>
FALLOPIAN TUBE, RIGHT, SALPINGECTOMY:
FALLOPIAN TUBE, RIGHT, SALPINGECTOMY:
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===Sign out===
===Sign out===
<pre>
Submitted as "Products of Conception":
- Chorionic villi present with degenerative changes, NEGATIVE for
  proliferation or significant atypia.
- Benign decidual tissue present.
- Necro-inflammatory debris and fibrin.
</pre>
====Variants====
<pre>
Submitted as "Products of Conception":
- Fetal tissue present.
- Benign decidual tissue present.
- Chorionic villi present, NEGATIVE for proliferation or significant atypia.
</pre>
<pre>
Submitted as "Products of Conception":
- Chorionic villi present with degenerative changes, negative for proliferation
  or significant atypia.
- Benign decidual tissue present.
- Negative for fetal tissue.
</pre>
<pre>
Products of Conception, Curettage:
- Chorionic villi present without proliferation or significant atypia.
- Decidua present.
- Negative for malignancy.
</pre>
====No chorionic villi====
<pre>
Submitted as "Products of Conception", Curettage:
- Blood and fibrin.
- Scant benign squamous epithelium and scant benign endocervical epithelium.
- NEGATIVE for decidua.
- NEGATIVE for chorionic villi, see comment.
Comment:
The tissue was submitted in total. Clinical correlation is suggested.
The above was communicated to the on call gynecologist.
</pre>
Notes:
*The above is considered a [[critical diagnosis]].
*It should be communicated to the on call gynecologist and this communication should be documented.
<pre>
Submitted as "Products of Conception":
    - Decidualized endometrium with necro-inflammatory changes/degeneration,
      blood and fibrin.
    - NEGATIVE for chorionic villi, see comment.
Comment:
The tissue was submitted in total.
The ultrasound impression (intrauterine gestational sac present) is noted. The decrease in serum beta-hCG is noted.
The lack of chorionic villi on pathology is a discordance with the clinical findings.
A non-exhaustive list of possible explanations includes: non-removal/retention and prior spontaneous passing. Clinical correlation is required.
</pre>
====Block letters====
<pre>
<pre>
ENDOMETRIUM, CURETTAGE:
ENDOMETRIUM, CURETTAGE:
Michael
48,475

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