Chorangiomas : histopthological, clinical and genetic studies

Chorangioma (CA), although, is the most common non-trophoblastic, vascular, tumor-likelesion of the placenta with incidence approximately 0.5-1% of all examined placentas, the specific etiology and genetic background of these lesions is still poorly understood. However, an increased incidence of CAs has been reported in pregnancies occurring at high altitudes and in relation to the in utero hypoxic status (preeclampsia, multiple gestation). Thus, CAs are suggested to be hypoxia-induced reactive vascular hyperplasias rather than true tumors, although this theory has not been supported by systemic genetic studies, so far. In contrast, the occasional reports of recurrence of CA suggest that genetic factors may play also role in the pathogenesis of these lesions. Further, infantile hemangioma (IH) shares various histochemical and genetic characteristics with placental endothelial cells; notably, a predictable life cycle of initial proliferation followed by apoptotic involution similarly to that of the placenta. These findings suggest the possibility that the placenta could be the origin site of IH. Our first and second studies characterized 170 CA cases morphologically and clinically providing evidence that CAs are associated with an increased rate of hypoxia related placental morphological changes and more adverse clinical outcome in singleton pregnancies compared with multiple pregnancies. Our cohort of CAs demonstrated a high incidence of preeclampsia, which could be an invaluable information for clinical placental diagnostics and might lead to a possible recognition of CAs as potential morphologic indicator for placental hypoxia. The third study of genetic background of CA analyzed eight large CAs using the array comparative genomic hybridization method and revealed no pathogenic copy number variants in the CA samples compared with either standard control DNA or unaffected placenta DNA from the same individual. This lack of association in our pilot study could support a non-tumorous, non-genetic origin of the CAs; however, additional genetic studies of larger sample sets are required to fully exclude a possible genetic contribution. In our fourth study, we investigated the co-existence of CA and IH using a questionnaire answered by the parents and failed to demonstrate any correlations between CAs and IH. Furthermore, the occurrence of multiple pregnancies or preeclampsia was not associated with an increased incidence of IH. The latter could be explained by the fact that pathogenesis of IH is more complex and several risk factors contributing to its etiology

Whipple’i tõbi: ülevaade haigusest ja haigusjuht

Whipple’i tõbi on harva esinev multisüsteemne bakteriaalne infektsioon, mille tekitajaks on grampositiivne bakter Tropheryma whippelii. Artiklis on antud ülevaade Whipple’i tõvest ning kirjeldatud haigusjuhtu TÜ Kliinikumi sisekliiniku endokrinoloogia-gastroenteroloogia osakonnas. Eesti Arst 2004; 83 (11): 750–75

Angiotensiini konverteeriva ensüümi inhibiitori ja angiotensiin II retseptori blokaatori kasutamise ohud raseduse ajal: haigusjuhu kirjeldus ja kirjanduse ülevaade

Artiklis on kirjeldatud raseduse kulgu ja vastsündinu seisundit kogu raseduse vältel angiotensiini konverteeriva ensüümi inhibiitorit (AKEI) ja angiotensiin II retseptori blokaatorit (ARB) kasutanud naisel. Reniin-angiotensiinsüsteemi (RAS) mõjutavad ravimid määrati 2. tüüpi diabeeti põdevale kõrgvererõhktõvega naisele 3 aastat enne rasedust. Raseduse ajal jäi raviskeem muutmata. Raseduse 37. nädalal diagnoositi oligohüdramnion, loote düstress ning loote kasvu mahajäämus ja rasedus lõpetati erakorralise keisrilõikega. Vastsündinu suri kopsude hüpoplaasia ning neerupuudulikkuse tõttu 38 tunni vanusena. Kirjanduse andmetel seostatakse selliseid vastsündinu kahjustusi AKEI ja ARB rasedusaegse kasutamisega, mistõttu neid ravimeid raseduse ajal tarvitada ei tohi. Haigusjuhtu on arutatud TÜ Kliinikumi patoanatoomilisel konverentsil 12. mail 2010. Eesti Arst 2010; 89(7−8):502−50

Clinical Outcome in Singleton and Multiple Pregnancies with Placental Chorangioma.

Chorangiomas (CAs) are the most common non-trophoblastic tumor-like-lesions of the placenta. Although the clinical significance of small CAs is unknown, the large lesions are often associated with maternal and fetal complications. The aim of our study was to assess the maternal clinical characteristics and neonatal outcome in singleton and multiple pregnancies with placental CA.Among 15742 selected placentas 170 CAs were diagnosed. Pregnancy and neonatal outcomes were analyzed in singleton (n = 121) and multiple (n = 49) pregnancy groups including 121 and 100 neonates, respectively.The frequency of APGAR score <7 at 5 minutes (p = 0,012), abnormal pulsatility index (p = 0,034), and abnormal blood flow class (p = 0,011) were significantly higher in neonates from singleton compared to multiple pregnancies. Significantly smaller CAs in singleton pregnancies were related to small for gestational age neonates (p = 0,00040) and neonates admitted to the neonatal care unit (p = 0,028). In singleton pregnancies, significantly smaller CAs were associated to maternal preeclampsia (p = 0,039) and larger CAs to multiparity (p = 0,005) and smoking (p = 0,001) groups. The frequency of preeclampsia was high in both singleton and multiple pregnancy groups (41,32% vs 26,53%, respectively), however, the difference did not reach the level of statistical significance.A high incidence of preeclampsia in cohort of placental CA might lead to a possible recognition of CAs as potential morphologic indicator of placental hypoxia.A more favorable pregnancy outcome in multiple gestations compared to the singleton gestations with CAs might reflect an adaptive mechanism for increased demand of oxygen and associated placental tissue hypoxia in this group

Neonatal outcome characteristics in singleton and multiple pregnancies.

<p>Neonatal outcome characteristics in singleton and multiple pregnancies.</p

Association of maternal outcomes with diameter of CA in singleton and multiple pregnancies.

<p>Association of maternal outcomes with diameter of CA in singleton and multiple pregnancies.</p

Fetal Calcifications Are Associated with Chromosomal Abnormalities

<div><p>Objective</p><p>The biological importance of calcifications occasionally noted in fetal tissues (mainly liver) at autopsy or ultrasound is largely unexplored. Previous reports hint at an association to infection, circulatory compromise, malformations or chromosomal abnormalities. To identify factors associated with calcifications, we have performed a case-control study on the largest cohort of fetuses with calcifications described thus far.</p><p>Methods</p><p>One-hundred and fifty-one fetuses with calcifications and 302 matched controls were selected from the archives of the Department of Pathology, Karolinska University Hospital. Chromosome analysis by karyotyping or quantitative fluorescence-polymerase chain reaction was performed. Autopsy and placenta reports were scrutinized for presence of malformations and signs of infection.</p><p>Results</p><p>Calcifications were mainly located in the liver, but also in heart, bowel, and other tissues. Fetuses with calcifications showed a significantly higher proportion of chromosomal abnormalities than controls; 50% vs. 20% (p<0.001). The most frequent aberrations among cases included trisomy 21 (33%), trisomy 18 (22%), and monosomy X (18%). A similar distribution was seen among controls. When comparing cases and controls with chromosomal abnormalities, the cases had a significantly higher prevalence of malformations (95% vs. 77%, p=0.004). Analyzed the other way around, cases with malformations had a significantly higher proportion of chromosomal abnormalities compared with controls, (66% vs. 31%, p<0.001).</p><p>Conclusion</p><p>The presence of fetal calcifications is associated with high risk of chromosomal abnormality in combination with malformations. Identification of a calcification together with a malformation at autopsy more than doubles the probability of detecting a chromosomal abnormality, compared with identification of a malformation only. We propose that identification of a fetal tissue calcification at autopsy, and potentially also at ultrasound examination, should infer special attention towards co-existence of malformations, as this would be a strong indicator for a chromosomal abnormality.</p></div

Maternal baseline characteristics and pregnancy outcomes in singleton and multiple pregnancies.

<p>Maternal baseline characteristics and pregnancy outcomes in singleton and multiple pregnancies.</p

Association of neonatal outcomes with diameter of CA in singleton and multiple pregnancies.

<p>Association of neonatal outcomes with diameter of CA in singleton and multiple pregnancies.</p

Proportion of chromosomal abnormalities and malformations in fetal cases with tissue calcifications, and matched controls.

<p>TOP = termination of pregnancy. The p-values are derived from McNemar’s test for matched case-control studies, and indicate if there are significant differences in the proportions of chromosomal aberrations or malformations between cases and controls. P-values below 0.025 are considered statistically significant.</p><p>Proportion of chromosomal abnormalities and malformations in fetal cases with tissue calcifications, and matched controls.</p