Labs & Pathology: January 2007 (Jeremiah)

SURGICAL PATHOLOGY REPORT

DIAGNOSIS:

A) Placenta and cord:

1. Placenta with hypovascular villi consistent with prior fetal demise.

2. Decidual tissue and membranes with focal inflammation, non-specific.

3. No villitis.

B) Placenta and cord for chromosomal analysis:

Intrauterine fetal demise

Karyotype:

46,XY

Interpretation:

Apparently normal male karyotype.

There has been no evidence of growth of this specimen's fetal tissue (skin) after 10 days of culturing, but the placental tissue did grow and a 20 cell study of the placenta tissue shows an apparently normal male karyotype, Since the resulting specimen contained only placental tissue, this study does not rule out mosaicism confined to the fetus that would lead to a false negative interpretation of these results.

PLEASE NOTE: This male karyotype carries a pericentric inversion of the heterochromatic region of one chromosome 9. This inversion Ewritten inv(9)(p12q13)) is an apparently normal chromosomal variation (polymorphism) found in approximately 2% of the general population. A large study carried out by Hsu et al. (1987) did not find any deleterious phenotypic or clinical effect of this chromosomal polymorphism, nor of any apparent association with fetal loss.

C) Thigh tissue for chromosomal analysis:

There has been no evidence of growth of this specimen’s fetal tissue (skin) after 10 days of culturing.


ORGAN/TISSUE SITE:

Placenta and cord/placenta and cord/Thigh tissue skin

GROSS DESCRIPTION:

A) Received is placenta, umbilical cord, and fragments of blood clot and decidual tissue. The placenta itself measures 9.2 x 7.5 x 2 cm. It weighs 74 grams. The umbilical cord is located within the central approximately 4 cm from the nearest margin. There is an additional approximately 38 cm umbilical cord. Twisting of the cord appears abnormal, with more twists per centimeter than average. The placenta appears somewhat disrupted. The membranes appear smooth. The cord has three vessels evident. Sections of this are submitted. Representative sections are embedded.

B) The specimen is received in formalin labeled placenta and cord for chromosome analysis and consists of a small amount of placental tissue aggregating to 2.5 cm in greatest dimension. The specimen is entirely sent for chromosome analysis.

C) The specimen is received in saline labeled thigh tissue skin for chromosomal analysis and consists of a 1 .2 x 0.3 x 0.2 cm aggregate of lightly tan soft tissue. The specimen is entirely sent for chromosomal analysis.

MICROSCOPIC EXAMINATION

A) The microscopic examination substantiates the diagnosis cited.

B-C) Gross examination only, no microscopic examination done.



LAB RESULTS FROM FIRST LOSS

Cardiolipin AB, IgG - 7 (Negative - January 2007) and 6 (Negative - retest February 2007)

Interpretive Data for Cardiolipin IgG:

Less than 15 GPL …………………..Absent or None Detected
15 - 19 GPL ..........…………………. Inconclusive
20 - 79 GPL ……………………….. Moderate Positive
80 GPL or greater …………………..High Positive

Cardiolipin AB, IgM - 36 (Moderate positive - January 2007) and 18 (Inconclusive - retest February 2007)
Interpretive Data for Cardiolipin IgM:
Less than 12 MPL …………………….Absent or none detected
12 - 19 MPL …………………………..Inconclusive
20 - 79 MPL ..........…………………... Moderate positive
80 MPL or greater …………………….High positive

Results in the inconclusive range and positive results for IgM only, should be carefully interpreted. Most patients with ''antiphospholipid antibody syndrome'' (Br J Rheumatol 26:324-326 1987) have moderate or high levels of cardiologic antibodies and are positive for IgG only, or IgG and IgM.


OTHER LAB TESTS

Coagulation Studies (INR, PTT, D DIMER) - Normal Range Results
Factor V Leiden - Negative
Factor II, prothrombin 20210A mutation - Negative
HSV IgG & IgM - Negative
Lupus - Negative
Cytomegalovirus - Negative
Rubella - Negative
Parvovirus - Negative
HIV - Negative
Hepatitis B - Negative
Toxoplasmosis - Negative
Listeria - Negative
TSH (Thyroid) - Normal
Glucose - Normal