Introductory teaching tool utilizing immunohistochemistry to explain the placenta

Introduction: The placenta occupies an important place in science, medicine, and law; yet, it remains a difficult organ to explain and understand because of its unique characteristics. Methods and Materials: A descriptive observational study was carried out on placentas. Placental components were illustrated with diagrams and corresponding microphotographs were highlighted by immunohistochemical staining to identify cell-types and structures. Results: The placenta was diagrammatically demonstrated by dividing it into chorionic plate with umbilical cord, basal plate and placental disc. In highlighting the histological components, approximately 80 immunohistochemical preparations were taken into account Conclusion: Placental complexity continues to be the critical interface for maternal-fetal dialogue. Better educational methods are needed to explain the complex pathophysiology of this essential organ. Improving placental education is the key to attracting young researchers dedicated to this field.https://orcid.org/0000-0002-7147-425Xhttps://orcid.org/0000-0002-0446-0042N/

The mysterious extravillous trophoblast

Extravilluos Trophoblast (EVT) is a truly special cell. It has a temporary character and tumor-like behavior and tumor-like appearance, all of which seem to belong to the malignancy fi eld [1,2]. It is also known as intermediate trophoblast, derived from cytotrophoblast [3-5], having formed between the latter and the syncytiotrophoblast. EVT is capable of reaching the decidua through trophoblast cell columns that connect the anchoring villi to the basal plate in early gestation.https://orcid.org/0000-0002-7147-425Xhttps://orcid.org/0000-0002-0446-0042Revista Internacional - No indexadaN

Umbilical cord abnormalities in fetal and neonatal pathology in Bogota

Introducción: Se realizó un análisis de casos de mortalidad fetal y perinatal entre 2007 y 2011, en fetos y recién nacidos en el Departamento de Patología del Hospital Universitario San Ignacio (HUSI), en Bogotá. Se estudiaron las características típicas del cordón umbilical, sus anormalidades y resultados clínicos. Métodos: se realizó un estudio prospectivo para autopsias neonatales y fetales; También se estudiaron las placentas y se revisaron los casos clínicos de HUSI. Resultados: Un total de 914 casos, incluidos fetos, embriones, placentas y recién nacidos, conformaron el estudio. 323 casos (35.33%) tenían anormalidades del cordón umbilical: anormalidades de longitud (7.87%): cortas (3.39%), largas (4.48%); inserción anormal (23.63%): velato (4.04%), furcate (0.43%), marginal-paramarginal (19.14%); cordones en espiral (6.01%): poco enrollado (0.65%), hiperenrollado (5.36%); número de vasos (arteria umbilical única) (0,43%); enredos en partes fetales (0.54%); nudos verdaderos (0.21%). En 4,81% se encontró más de una alteración: la hiperbobina, la más frecuente, apareció en seis casos con inserción marginal, en cinco casos con cordones largos, en cuatro casos con cordones cortos. La causa de muerte atribuible al cordón umbilical (colisión del cordón umbilical) ocurrió en 3.82%; hubo trombosis de la circulación fetal en 6,6%. Las anomalías del cordón umbilical se asociaron significativamente con anomalías cromosómicas (p <0.003, OR - 2.53), gestaciones múltiples (OR - 5.78, 59.3%) e hipertensión materna (principalmente preeclampsia) (p <0.018, OR - 1.85). Conclusiones: cada característica anatómica del cordón umbilical tiene un significado. Las anormalidades del cordón umbilical asociadas con resultados indeseables son variadas y deben reconocerse y describirse. Entre los factores reconocidos como predisponentes están las anormalidades cromosómicas, las gestaciones múltiples y, como un elemento nuevo, encontramos preeclampsia.Q4Artículo original22-27Introduction: Analysis was carried out on cases of fetal and perinatal mortality from 2007-2011, on fetuses and newborns in the Pathology Department at San Ignacio University Hospital (HUSI), in Bogota. Typical characteristics of the umbilical cord, their abnormalities and clinical outcomes were studied. Methods: A prospective study was performed for neonatal and fetal autopsies; placentas were also studied, and HUSI clinical cases were reviewed. Results: A total of 914 cases including fetuses, embryos, placentas and newborns made up the study. 323 cases (35.33%) had umbilical cord abnormalities: length abnormalities (7.87%): short (3.39%), long (4.48%); abnormal insertion (23.63%): velamentous (4.04%), furcate (0.43%), marginal- paramarginal (19.14%); coiled cords (6.01%): hypocoiled (0.65%), hypercoiled (5.36%); number of vessels (single umbilical artery) (0.43%); entanglements in fetal parts (0.54%); true knots (0.21%). In 4.81% more than one alteration was found: hypercoiled, the most frequent, appeared in six cases with marginal insertion, in five cases with long cords, in four cases with short cords. Cause of death attributable to umbilical cord (umbilical cord collision) occurred in 3.82%; there were thrombosis of the fetal circulation in 6,6%. Umbilical cord abnormalities were significantly associated with chromosomal abnormalities (p < 0.003, OR – 2.53), multiple gestations (OR – 5.78, 59.3%) and maternal hypertension (mainly preeclampsia) (p < 0.018, OR – 1.85). Conclussions: Every anatomical feature of the umbilical cord has a meaning. The abnormalities of the umbilical cord associated with undesirable outcomes are varied and should be recognized and described. Among the factors recognized as predisposing are chromosomal abnormalities, multiple gestations and as a like a new item, we found preeclampsia

Comprendiendo el cordón umbilical

Diferentes aspectos que determinan un resultado exitoso al final de la gestación han merecido ser analizados desde el punto de vista evolutivo y a la luz de la obstetricia y la perinatología. En este artículo analizamos la principal característica del cordón umbilical: la longitud, las fuerzas, que se cree, la determinan y sus repercusiones en la salud fetal y del recién nacido.Artículo de revisión200-205A number of factors which play essential roles in bringing gestation to a successful outcome merit analysis from evolutionary, obstetric and perinatology perspectives. We analyze the most important feature of the umbilical cord, its length, its repercussions in fetal health and in the newborn, as well as elements that are believed to determine umbilical cord length

Limb-body wall complex in the San Ignacio Teaching Hospital at Bogota, Colombia : a case report and literature review

Introducción: las alteraciones del cordón umbilical están asociadas con diversas complicaciones de la gestación a corto y a largo plazo, algunas con pocas probabilidades de sobrevida y relacionadas con lesiones fetales múltiples. El complejo Limb-Body Wall (LBWC), compuesto por defectos de la pared corporal lateral y anomalías por acortamiento de miembros, es una de tales complicaciones, cuyas aún discutidas etiologías, pobre pronóstico y posibilidad de recurrencia hacen que cobre importancia en el diagnóstico ecográfico, la atención neonatal y el abordaje de la autopsia. Objetivos: reportar un caso de LBWC y revisar la literatura publicada sobre su etiología, características clínicas y diagnóstico, en el contexto de las complicaciones asociadas con las alteraciones del cordón umbilical. Materiales y métodos: se presenta el caso clínico de una recién nacida de primer embarazo de madre adolescente quien consultó a una entidad de nivel referencia y alta complejidad, recién nacida que falleció a los pocos minutos de nacer; presentaba defecto de la pared abdominal, escoliosis y esbozo de miembro superior izquierdo, asociado con cordón umbilical de 6 cm. Se realizó una revisión de la literatura publicada en las bases de datos Medline vía PubMed, Ovid e Hinari. Conclusión: el LBWC se asocia con un índice importante de morbimortalidad y con la expresión de un cordón excesivamente corto; por tanto, cobra gran relevancia hacer un diagnóstico oportuno y brindar asesoría genética adecuada a las familias.Q4Reporte de caso331-337Hospital Universitario San IgnacioIntroduction: umbilical cord alterations are associated with several short and long-term complications during pregnancy, some involving little chance of survival related to multiple foetal lesions. One of those anomalies is the Limb-Body Wall Complex (LBWC) which consists of lateral body wall defects and anomalies due to shortening of the limbs. Its still discussed aetiology, poor prognosis and possible recurrence make it important in ecographic diagnosis, neonatal attention and the approach during autopsy. Objectives: reporting a case of LBWC and reviewing the literature published about its aetiology, clinical characteristics and diagnosis within the context of the complications associated with umbilical cord alterations. Materials and methods: a clinical case of a female newborn resulting from an adolescent mother’s first pregnancy who consulted a reference and high complexity entity is presented. The newborn died a few minutes after being born, presenting a defect of the abdominal wall, scoliosis and upper left limb stump associated with a 6 cm umbilical cord. The literature published in Medline data bases was reviewed using PubMed, Ovid and Hinari. Conclusion: LBWC is an expression of an excessively short cord and is associated with important morbidity-mortality. Thus an early diagnosis must be made and suitable genetic advice given to families

Update on Chorioamnionitis: A Look from the Microscope

La corioamnionitis se ha relacionado con desenlaces desfavorables en el periodo prenatal y neonatal (abortos, parto pretérmino, sepsis neonatal, entre otros), además de implicaciones a largo plazo en la infancia, como alteraciones en el coeficiente intelectual. Por esta razón, es de vital importancia el diagnóstico histopatológico oportuno. En este artículo se revisa el abordaje histopatológico de la corioamnionitis, su estadificación e implicaciones clínicas.Q4Chorioamnionitis has been related to unfavorable outcomes in the prenatal and neonatal period (abortions, preterm delivery, neonatal sepsis, among others), as well as long-term implications in childhood, such as changes in IQ. For this reason, timely histopathological diagnosis is of vital importance. In this article, the histopathological approach to chorioamnionitis, its staging and clinical implications will be reviewed.https://orcid.org/0000-0002-7147-425Xhttps://orcid.org/0000-0002-7441-7832Revista Nacional - IndexadaS

Type IA achondrogenesis : case report

La condrogénesis tipo IA (#MiM 200600) es una rara y letal displasia esquelética, caracterizada por un grave retardo de la osificación, con modo de herencia autosómico recesivo. hasta el momento se desconocen sus bases moleculares. en este artículo se reporta el caso de un feto de sexo femenino, de 23 semanas de edad de gestación, de padres no consanguíneos, con diagnóstico ecográfico de hipoplasia torácica, hipoplasia pulmonar, costillas cortas con múltiples fracturas, micromelia grave, hipocalcificación y fractura de huesos largos, pies en varo y manos en garra. En el estudio microscópico se evidencia un trastorno de osificación endocondral. La acondrogénesis pertenece a la forma más crónica de condrodisplasias humanas invariablemente letales. Las bases bioquímicas y moleculares no son claras en la acondrogénesis tipo IA, ya que el diagnóstico se basa en la integración de estudios radiológicos e histológicos en cada caso específico, por lo cual se considera que el caso presentado corresponde a acondrogénesis tipo IA.Reporte de caso3189-3192Type IA Achondrogenesis (#MIM 200600) is a rare lethal autosomal recessive form of skeletal dysplasia characterized by severe delay of ossification. In this article we discuss the case of a 23-week female fetus of non-consanguineous parents, with an ultrasonographic diagnosis of thoracic and pulmonary hypoplasia, fractured ribs at multiple sites, severe micromelia, hypocalcification and fracture of all tubular bones, clubbing of the feet and clawing of the digits. The histological study revealed an endochondral ossification disorder. Achondrogenesis represents the most severe form of an invariably lethal human chondrodysplasia. The biochemical and molecular bases of type IA Achondrogenesis are unclear. Diagnosis is based on the integrated radiological and histological findings in specific cases

Diagnostic difficulties in congenital tumor with positive antibodies for skeletal muscle. Lipofibromatosis case report

Neonatos con Tumores congénitos de partes blandasIntroduction: Congenital soft tissue tumors are uncommon; proper diagnosis calls for histopathological experience and ancillary techniques based upon immunohistochemial, cytogenetic, and molecular biology. Following excision, intermediately aggressive soft tumors tend to local recurrence, which significantly impacts prognosis; some cases occur close to malignity; subsequently, diagnostic implications are enormous for the patient. Case report: A 26-day old neonate with a posterior left thigh mass entered hospital. Initial biopsy analysis could not rule out either striated muscle origin or malignancy; resection and classification of surgical piece followed. Pursuant to resection, using immunohistochemistry panel, tumor analysis and classification took place. Conclusion: Soft tumor diagnosis is a complex process, even more so for newborns. Infrequent occurrence requires that examiners have ample histopathological experience in the handling of ancillary techniques. Furthermore, as in lipofibromatosis, determining the presence of trapped vs. malignant tissue hinders proper classification, which, in turn, has profound implications for the patient. We include a standard diagnostic algorithm based on clinical and histological characteristics for this type of congenital lesions.https://orcid.org/0000-0003-3507-7596https://orcid.org/0000-0001-8932-4877https://orcid.org/0000-0002-7147-425Xhttps://orcid.org/0000-0001-7982-4552Revista Internacional - No indexadaN

A physics approach to the consequences of excess umbilical cord length

Introducción: el cordón umbilical es una estructura incomprendida a pesar de transportar todo lo que un feto necesita para crecer y subsistir. Cada una de sus características es relevante, y la principal es la longitud, la cual, cuando está alterada, se relaciona con pobre pronóstico neurológico y muerte fetal. Materiales y métodos: con base en la revisión de principios físicos, se proponen fórmulas que podrían explicar la importancia de la longitud del cordón por sus repercusiones hemodinámicas. Resultados: se analizó la circulación fetal desde el corazón hasta la red capilar vellositaria en el plato placentario y, por medio de fórmulas físicas, se plantea la importancia de la longitud del cordón en la perfusión fetal. Conclusiones: las complicaciones clínicas conocidas para la excesiva longitud del cordón umbilical fueron analizadas desde el punto de vista de la física, dejando listas las fórmulas para ser alimentadas con datos reales provenientes de doppler fetales y mediciones del cordón umbilical.Q3Artículo original53-60Introduction: Despite its role of transporting all the things that a foetus needs to grow and survive, the umbilical cord is still poorly understood. All of its characteristics are relevant, and paramount among them is its length. When abnormal, length is associated with poor neurological prognosis and foetal demise. Materials and methods: Based on a review of physics principles, formulae were proposed in an attempt to explain the importance of umbilical cord length on the basis of its haemodynamic repercussions. Results: Foetal circulation was analysed from the heart to the placental villous capillaries and physics formulae were used to describe the importance of umbilical cord length in foetal perfusion. Conclusions: Clinical complications known to be associated with excess umbilical cord length were analysed from the physics perspective, and formulae were established for use with real data derived from foetal Doppler scans and umbilical cord measurements

Cystic kidney disease : a review

La enfermedad renal quística (ERQ) comprende un amplio espectro de patologías generadas por dis- tintas variables que alteran el proceso de la nefrogénesis y maduración renal. La ERQ puede ser dividida en enfermedades hereditarias y no hereditarias. Los avances en genética han generado cambios en la manera de clasificar y definir cada una de estas enfermedades. Los quistes resultan de alteraciones mal inductivas entre el epitelio y el estroma como consecuencia de efectos obstructivos por largos periodos de tiempo, que se dan por procesos degenerativos o diferentes mecanismos neoplásicos y mutagénicos. El objetivo de esta revisión es definir de manera amplia y clara la ERQ. Se realizó una revisión sistemática de la literatura en mEdlinE de publicaciones que incluyeran los términos dysplastic kidneys, multicystic dysplasia y kidney dysplasia. Se revisaron importantes y diversas publicaciones las cuales fueron seleccionadas, analizadas y referenciadas en esta publicaciónQ4Artículo de revisión29-36Cystic kidney disease (CKD) encompasses a wide spectrum of pathologies caused by different varia- bles that disturb the nephrogenesis and renal maturation process. CKD can be divided into hereditary and non-hereditary disease. Advances in genetics have led to changes in the way we classify and define each of these diseases. Cysts are a result of disturbances between the epithelium and the stroma as a consequence of having obstructive effects for long periods of time due to degenerative disorders or neoplastic and mu- tagenic mechanisms. The objective of this review is to define CKD in a broad and comprehensive way. We performed a systematic review of the literature in mEdlinE for publications that included the terms dysplas- tic kidneys, multicystic dysplasia and kidney dysplasia. We reviewed various important publications which we selected, analyzed and referenced in this article