Difference between revisions of "Pediatric pathology"
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==Gastrointestinal pathology== | ==Gastrointestinal pathology== | ||
===Aganglionosis=== | |||
*[[AKA]] Hirschsprung disease. | |||
====General==== | |||
*Congenital. | |||
*Fixed by surgery. | |||
Pathology: | |||
*Parasympathetic ganglion cells in intramural and submucosal plexuses - not present.<ref name=pathcon_hirschsprung>URL: [[http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970813-0] [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970813-0]]. Accessed on: 11 January 2011.</ref> | |||
====Microscopic==== | |||
Features:<ref name=pathcon_hirschsprung/> | |||
*Ganglion cells missing in submucosal plexus and myenteric plexus. | |||
*+/-Submucosal fibrosis. | |||
====Stains==== | |||
*Acetylcholinesterase: abundant, disorganized, nerve fibers. | |||
*CD117. (???) | |||
Images: | |||
*[http://66.244.141.33/colorectal-Hirschsprung-disease Hirschsprung disease - collection (66.244.141.33)]. | |||
*[http://pathology.mc.duke.edu/research/Histo_course/myent_plexus.jpg Normal myenteric plexus (duke.edu)].<ref>URL: [http://pathology.mc.duke.edu/research/PTH225.html http://pathology.mc.duke.edu/research/PTH225.html]. Accessed on: 11 January 2011.</ref> | |||
===Meconium peritonitis=== | |||
====General==== | |||
*May be due to a number of causes: | |||
**Aganglionosis (Hirschsprung disease). | |||
**Meconium ileus. | |||
====Microscopic==== | |||
Features: | |||
*Brown granular material - '''key feature'''. | |||
*+/-Multinucleated giant cells. | |||
*Inflammatory infiltrate (PMNs, lymphocytes, plasma cells). | |||
Image: | |||
*[http://www.pathologyoutlines.com/caseofweek/case2008106image2.jpg Meconium peritonitis - gross (pathologyoutlines.com)]. | |||
===Necrotizing enterocolitis=== | ===Necrotizing enterocolitis=== | ||
====General==== | ====General==== | ||
Revision as of 19:50, 11 January 2011
The article deals with paediatric pathology, which is quite different than adult pathology. Many diseases that afflict children are uncommon or unheard of in adults.
Gastrointestinal pathology
Aganglionosis
- AKA Hirschsprung disease.
General
- Congenital.
- Fixed by surgery.
Pathology:
- Parasympathetic ganglion cells in intramural and submucosal plexuses - not present.[1]
Microscopic
Features:[1]
- Ganglion cells missing in submucosal plexus and myenteric plexus.
- +/-Submucosal fibrosis.
Stains
- Acetylcholinesterase: abundant, disorganized, nerve fibers.
- CD117. (???)
Images:
Meconium peritonitis
General
- May be due to a number of causes:
- Aganglionosis (Hirschsprung disease).
- Meconium ileus.
Microscopic
Features:
- Brown granular material - key feature.
- +/-Multinucleated giant cells.
- Inflammatory infiltrate (PMNs, lymphocytes, plasma cells).
Image:
Necrotizing enterocolitis
General
- Disease of the newborn.
- Diagnosed by imaging.
Microscopic
Features:
- Large spaces.
Images:
Pancreatic islet cell hyperplasia
General
- Assoc. with maternal diabetes.
Microscopic
Features:
- Marked size variation of pancreatic islets.
- Normal islets ~ 150 micrometers (diameter). Hyperplastic islets - up to ~500 micrometers (diameter).
Image:
Persistent pulmonary hypertension of the newborn
- Abbreviated PPHN.
- Related to patent ductus arteriosus and persistent fetal circulation.[4]
Associations:[5]
- Meconium aspiration.
- Anemia.
- Infection.
- Pneumonia (severe).
- Hypoglycemia.
- Birth asphyxia.
Hypoxic-ischemic encephalopathy
Main article: Neuropathology
- Abbreviated HIE.
General
- Autopsy adds some information.
- Two-tone liver - suggests prior injury.[6]
- HIE in perinatal period may be unique to the specific time of the injury, i.e. the type of hypoxic insults vary by developmental stage.[7]
- Some hypoxic injuries that are prenatal do not occur after birth.
- Pontosubicular necrosis is prenatal; the subiculum postnatal (like in adults) is resistant to hypoxic-ischemic insults.
- Hypoxic-ischemic insults are predominantly in the white matter. (???)
- Some hypoxic injuries that are prenatal do not occur after birth.
- HIE is the most common cause of neonatal seizures and often difficult to control with anticonvulsants.[8]
Possible findings in HIE
Hemorrhagic lesions:[9]
- Germinal matrix & intraventricular hemorrhage.
- Choroid plexus hemorrhage.
- Cerebellar hemorrhage.
- Subpial hemorrhage.
White matter lesions:[9]
- Periventricular leukomalacia.
- Subcortical leukomalacia.
- Telencephalic (cerebral) leukomalacia.
Grey matter lesions:[9]
- Pontosubicular necrosis.
- Infarcts of the cerebral cortex, basal ganglia, thalamus, brain stem.
Germinal matrix hemorrhage
- Arises from the germinal matrix, the tissue from which neurons and glial arise from.[10]
- Location: periventricular; may cause an intraventricular hemorrhage.
- The germinal matrix is thought to be intrinsically fragile and is especially so in premature infants.
References
- ↑ 1.0 1.1 URL: [[1] [2]]. Accessed on: 11 January 2011.
- ↑ URL: http://pathology.mc.duke.edu/research/PTH225.html. Accessed on: 11 January 2011.
- ↑ URL: http://cueflash.com/decks/Pathology_Pediatrics. Accessed on: 11 January 2011.
- ↑ URL: http://www.thechildrenshospital.org/wellness/info/parents/20830.aspx. Accessed on: 4 January 2011.
- ↑ URL: http://www.thechildrenshospital.org/wellness/info/parents/20830.aspx. Accessed on: 4 January 2011.
- ↑ Elder DE, Zuccollo JM, Stanley TV (July 2005). "Neonatal death after hypoxic ischaemic encephalopathy: does a postmortem add to the final diagnoses?". BJOG 112 (7): 935–40. doi:10.1111/j.1471-0528.2005.00608.x. PMID 15957995.
- ↑ Grafe MR, Kinney HC (February 2002). "Neuropathology associated with stillbirth". Semin. Perinatol. 26 (1): 83–8. PMID 11876572.
- ↑ URL: http://emedicine.medscape.com/article/973501-overview. Accessed on: 7 January 2011.
- ↑ 9.0 9.1 9.2 Riezzo I, Neri M, De Stefano F, et al. (2010). "The timing of perinatal hypoxia/ischemia events in term neonates: a retrospective autopsy study. HSPs, ORP-150 and COX2 are reliable markers to classify acute, perinatal events". Diagn Pathol 5: 49. doi:10.1186/1746-1596-5-49. PMC 2914029. PMID 20626887. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2914029/.
- ↑ 10.0 10.1 Ballabh P (January 2010). "Intraventricular hemorrhage in premature infants: mechanism of disease". Pediatr. Res. 67 (1): 1–8. doi:10.1203/PDR.0b013e3181c1b176. PMC 2799187. PMID 19816235. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799187/.