Clinicopathological study of perinatal mortality of fetuses of second and third trimester

Introduction: Perinatal mortality reflects the level of health system in every country and constitutes one of the basic indicators of obstetric care. This study aims to present the perinatal mortality causes and rates of the last 20 years in a tertiary Greek hospital. Materials and methods: This retrospective study is based on the pathology department-autopsies of stillbirths of perinatal period (22 weeks of gestation to 7 days postpartum) regarding clinical information. We excluded pharmaceutical abortions and those containing vague variables. The macro/microscopic examination was performed by a pathologist specialized in perinatal medicine. Between over than 32 recorded classification systems, we selected the ReCoDe 2005(relevant condition of death) which best-corresponded on the findings of our laboratory. Results: The sample comprised 278 deaths of fetuses and newborns between 23.520 births from 1993 until 2012. The registration data were divided by time and gestational age. 52.1% of deaths were related to boys. Also, 90.3% of cases were premature. The average weight was 1029, 3 gr and percentile average was 29.8. In 78.4% of cases the placenta was not normal and 27.7% the umbilical cord was not normal. Still, 33.0% of cases concerned twin / multiple pregnancies. The type of death was mainly automatic before birth-stillbirths (94.6% of cases). 30.9% of abortions were recorded from 1993 to 1997, and the majority of abortions took place between 22nd and 27th week of pregnancy with the rate reaching 61.2%. Also, 33.2% of cases involved mothers who were 25-30 years old and 31.8% for mothers who were 31-35 years old. Overall, 11.8 abortions per 1000 live births were recorded, while the most frequent cause of death concerned in embryo problem with the rate reaching 44.6%, while 19.4% had a problem with the placenta.Conclusions: The important reduction of perinatal mortality in a representative sample of the Greek area is an indicator of improvement in perinatal medicine. However, the target rates highlight the need for careful observation and recording of perinatal mortality etiology.Εισαγωγή: Η περιγεννητική θνησιμότητα είναι ένας από τους πρωιμότερους δείκτες Μαιευτικής Περίθαλψης. Έχουν καταγραφεί τουλάχιστον 32 συστήματα ταξινόμησης των αιτιών θανάτου με βάση διαφορετικούς ορισμούς, τη χρονική περίοδο, τα διαφορετικά δεδομένα και τους στόχους των εκάστοτε μελετών. Παρουσιάζουμε τα αίτα θανάτου των θνησιγενών εμβρύων και νεογνών κατά τα έτη 1993-2012 σε τριτοβάθμιο Νοσοκομείο των Αθηνών. Υλικά και Μέθοδος: Πρόκειται για μια αναδρομική μελέτη βασισμένη στο αρχείο των νεκροτομών εμβρύων και νεογνών της τελευταίας 20ετίας από την 22η εβδομάδα κύησης έως και 7 ημέρες μετά τον τοκετό. Για την ταξινόμηση των αποτελεσμάτων εξαιρέθηκαν οι φαρμακευτικές αποβολές και όσες περιείχαν ασαφείς μεταβλητές. Η μακρο/μικροσκοπική εξέταση του θνησιγενούς εμβρύου-υμένων πραγματοποιήθηκαν από παθολογοανατόμο εξειδικευμένο στην περιγεννητική ιατρική. Επιλέχθηκε το σύστημα ReCoDe2005 (relevant condition of death) το οποίο ανταποκρινόταν με απλό και ανά εξεταζόμενη μονάδα -έμβρυο, μητέρα, υμένες, τραύμα κτλ- στα ευρήματα του Εργαστηρίου μας.Αποτελέσματα: Από το 1993 μέχρι το 2012 καταγράφηκαν 23.520 γεννήσεις. Σε αυτές, σημειώθηκαν 278 περιγεννητικοί θάνατοι. Το 52,1% των θανάτων αφορούσε σε αγόρια. Επίσης, το 90,3% των περιπτώσεων ήταν πρόωρα. Το μέσο βάρος ήταν 1029,3 gr και το μέσο εκατοστημόριο ήταν το 29,8. Στο 78,4% των περιπτώσεων ο πλακούντας δεν ήταν φυσιολογικός και στο 27,7% ο ομφάλιος λώρος δεν ήταν φυσιολογικός. Ακόμα, το 33,0% των περιπτώσεων αφορούσε σε δίδυμη/πολύδυμη κύηση. Το είδος της αποβολής ήταν κατά κύριο λόγο αυτόματη (94,6% των περιπτώσεων). Το 30,9% των αποβολών που καταγράφηκαν έγιναν από το 1993 έως το 1997, και η πλειοψηφία των αποβολών έγινε μεταξύ 22ης και 27ης εβδομάδας κύησης με το ποσοστό να φτάνει το 61,2%. Επίσης, το 33,2% των περιπτώσεων αφορούσε σε μητέρες που ήταν 25-30 ετών και το 31,8% σε μητέρες που ήταν 31-35 ετών. Συνολικά, στο χρόνο καταγραφής σημειώθηκαν 11,8 αποβολές ανά 1000 γεννήσεις, ενώ η συχνότερη αιτία αφορούσε σε πρόβλημα το εμβρύου με το ποσοστό να φτάνει το 44,6% ενώ στο 19,4% υπήρξε πρόβλημα στον πλακούντα.Συμπεράσματα: Η χρήση μιας ενιαίας μεθόδου κατηγοριοποίησης των αιτιών της περιγεννητικής θνησιμότητας σε ευρεία βάση δεδομένων – πχ ICD10 – θα μπορούσε να συνεισφέρει στην καλύτερη κατανόηση και αντιμετώπισή τους

Mucinous cystadenocarcinoma of the breast: the challenge of diagnosing a rare entity

Mucinous cystadenocarcinoma is an extremely rare variant of primary breast tumor which is histologically similar to mucinous cystadenocarcinoma of the ovary and pancreas. Herein we report a case of a 63 years old woman diagnosed with diverse histological types of non-synchronous rare primary breast tumors, a medullary carcinoma of the right breast and a mucinous cystadenocarcinoma of the left breast. Macroscopically the neoplasm appeared multilocular filled with mucoid material. Under light microscopy the cystic areas were lined by columnar cells with abundant intracellular and extracellular mucin. Solid areas were composed of tall columnar cells with intracellular mucin. Moderate to marked atypia was noticed and tumor cells stained positive for cytokeratin 7 and negative for cytokeratin 20. Moreover tumor cells displayed a basal like immunophenotype expressed as followed: ER negative, PR negative, HER-2 negative, cytokeratin (CK5/6) positive and EGFR positive

Multicystic Hepatocarcinoma Mimicking Liver Abscess

The diagnosis of hepatocellular carcinoma (HCC) became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Multicystic HCC mimicking a liver abscess associated with septic-type fever and leukocytosis is rare, has a poor prognosis, and poses diagnostic and therapeutic dilemmas. We present the case of an 80-year-old patient, who presented with fever, leukocytosis, and large cystic masses involving right and left lobes of the liver initially considered abscesses and finally diagnosed as HCC after open drainage and liver biopsy. Although the patient died on the tenth postoperative day due to pulmonary oedema, the authors emphasize the high index of suspicion needed in the diagnosis of this unusual presentation of HCC

Rectus Abdominis Muscle Malignant Fibrous Histiocytoma Causing a Large Abdominal Wall Defect: Reconstruction with Biological Mesh

Malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma usually involving limbs and retroperitoneum. MFH of the rectus abdominis muscle is extremely rare. Surgery in similar cases leads to large abdominal wall defects needing reconstruction. Biological and synthetic laminar absorbable prostheses are available for the repair of hernia defects in the abdominal wall. They share the important feature of being gradually degraded in the host, resulting the formation of a neotissue. We herein report the case of an 84-year-old man with MFH of the rectus abdominis muscle which was resected and the large abdominal wall defect was successfully repaired with a biological mesh

Placenta and Umbilical Cord Cause in Antepartum Deaths

Stillbirth is a sudden and painful event for parents and obstetrical specialists as well. It is, therefore, of greatest importance to be able to give answers for the cause in order to plan a subsequent pregnancy. The aim of this retrospective study is to estimate the placental and umbilical cord cause of intrauterine death in relation to different gestational ages. The study took place on the Medical Birth Registry of Aretaieio Hospital, National and Kapodistrian University, Athens, Greece. We include a total of 19,283 pregnancies from 1998 to 2012. In this study period, 431 embryonic deaths occurred. The clinical history was documented on admission at delivery. Conditions thought to be associated with the intrauterine fetal death were recorded. Gestational age was calculated from the last menstrual period as well as with the three-trimester system. The autopsy, placenta and umbilical cord examination were performed by the same laboratory of pathology in Aretaieio University Hospital. We found that the majority of stillbirths occurred in the second trimester. We examined placenta and umbilical cord in all cases. The most frequent histologic abnormalities were those indicated placental vascular insufficiency. As far as the umbilical cord is concerned we found that the inflammatory disorder was the most common in antepartum deaths. A single umbilical artery was significantly related to gestational diabetes and congenital embryonic anomalies. Finally, our results showed steady declines in antepartum deaths during 1998-2012. As a result, we reached the conclusion that in order to reduce the fetal death rate, we have to insist on the autopsy of the placenta and umbilical cord in order to gain the appropriate information in counseling the parents