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Difference between revisions of "Products of conception"
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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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**+/-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}} | **+/-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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*[[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> | <pre> | ||
Submitted as "Products of Conception": | Submitted as "Products of Conception": | ||
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</pre> | </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: | ||
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- NO VIABLE CHORIONIC VILLI IDENTIFIED. | - NO VIABLE CHORIONIC VILLI IDENTIFIED. | ||
- NO EVIDENCE OF MALIGNANCY. | - NO EVIDENCE OF MALIGNANCY. | ||
</pre> | </pre> | ||