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Plegmonous colitis: review of the literature; report of a case with submucosal cholesterol embolism as a possible pathogenetic mechanism
3
ANATOMICAL PATHOLOGY
CORRELATION BETWEEN PATI(OL0GY rINDINGS AND ULTRASONIC PREDICTION IN TWIN PREGNANCY
Dr. A . Cheung*, Dr. C.W. Wan, D r . R.J. Collins. Departments of Pathology and Obstetrics and Gynaecology, University of Hong Kong The macroscopic and microscopic pathology findings ilr 32 twin pregnancies w e r e compared wlth the antenatal sonographic classi fication into monochorionlc and dichorionic pregnancy. The latter was based on the thickness o f the intervening septum. The ultrasound diagnosis was confirmed in 2 4 of 30 cases giving an T h i r t e e n of t h e 2 4 c a s e s w e r e accuracy o f 8 0 % . dichorionic diamniotlc type while 10 showed monochorionic diamniotic placentation. Only one case o f monochorionic monoamniotic twin pregnaocy was found. In SIX of the remaining 8 cases there was discrepancy between the ultrasound prediction and pathology f indings. Definite conclusions about the chorion type could not be drawn from either ultrasound or pathology examination i n t h e No monoamniotic twin pregnancy was remainfng 2 cases. missed i n the latter 8 cases. This i s important because of the associated high mortality. The detection of monochorionic diamniotic placentation i s also crucial because of the unique Occurrence of vascular anastanoses between the two foetal clrculations and potential of developing twin-to-twin transfusion and discordancy o f foetal growth. Determination of chorion type also helps in the analysis of zygoslty o f the twin-pregnancy and bears implication in genetic amniocentesis.
CARCINOID TUMOR ARISING FROM A DEVELOPMENTAL HJNDGUT CYST - IMEfflNOIiTSlOCHEMICAL AND ULTRASTHIICTURAL FEATURES B . K . Y . C h i u , D. Murray and N. Colapinto Departments of Pathology and Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada M5B lW8. We report a case of a carcinoid tumor arising from rare retro-rectal hindgut cyst in a 25-year old female. The tumor shows the typical morphological features of a carcinoid tumor with numerous dense core granules ultrastructurally. An unusual feature is the presence of cytoplasmic "fibrous bodies" a s seen in pituitary adenomas. The tumor is immunoreactive with neuronspecific enolase, chromogranin, vasoactive intestinal peptide, glucagon, gastrin and serotonin. The epithelial lining o f the cyst also shows sparse dense-core granules ultrastructurally and similar immunoreactivity except f o r serotonin. The patient did not have carcinoid syndrome and urinary 5111AA was negative, however, the tumor was widely disseminated. The significance of serotonin in this tumor i s discussed. 3
Presenter: Dr B r i a n Chiu, Pathology Department, SMII.
PLEGMONOUS COLITIS: REVIEW OF THE LITEKATURE; REPORT OF A CASE WITH SUBMUCOSAL CHOLESTEROL EMBOLTSM A S A POSSIBLE PATHOGENETIC MECHANISM B.K.Y. Chiu, D. Murray Department of Pathology, St Michael's Hospital, University o f Toronto, Ontario, Canada, M5B 1W8. Ten cases of phlegmonous inflammation solely involving the colon have been reported in the English literature. The pathogenetic mechanism is unclear hut is reported to be associated most often with liver disease, alcoholism, renal disease and pneumonia. We report a case of phlegmonous colitis in a morbidly obese elderly lady. The patient was found to have liver cirrhosis during laparotony. Cholesterol emboli were seen in the submucosal vessels in the resected specimen. We postulate that focal mucosal ischemic injury may permit entry of Gram negative bacilli into the submucosa as a possible pathogenetic mechanism of phlegmonous colitis. Her Ante-mortem blood culture grew E. coli. The majority of these cases are fatal because of delay in diagnosis and overwlielrning septicemia.
RECOGNIZAULE PATTERNS OF FETAL DYSMORPllOLOGY
F.Y. Chan, C. Lam, L.M. Fung. K.H. Fu, Chan. S. Lam and H . K . Ma. Department of Obstetrics and Gynaecology, Department of Pathology, University of Hong Kong and Department of Genetic Services, Government of Hong Kong. A. Ghosh, M. T a w .
Y.F.
All abortuses with dysmorphic features o r wlth prenatally diagnosed abnormalities delivered during second trimester from January 1986 to June 1989 were reviewed. Following categories of dysmorphology were recognized; malformation - 86, deformation - 6 and disruptions - 3 . Of these 4 6 were due to chromosomal abnormality (Trisomies - 28, unbalanced - 8, sex chromosomal - 6 , triploidy - 2, moaaiciem - 2 ) . Abnormalities due to deformation, disruption and s i n g l e localised defect malformation were most easily recognized. In fetuses with known malformation syndrome particularly due to chromosomal abnormality the recognition of known dysmorphic features uepended on the nature of abnormality and fetal age. Recognizable patterns of dysmorphology in second trimester fetuses due to malformation. deformation and disruption will be illustrated and the clinical significance discussed. Presenter: Or. A . Ghosh, Department of Obstetrics and Gynaecology. Tsan Yuk Ilospital, Hong Kong
ANATOMICAL PATHOLOGY
CORRELATION BETWEEN PATI(OL0GY rINDINGS AND ULTRASONIC PREDICTION IN TWIN PREGNANCY
Dr. A . Cheung*, Dr. C.W. Wan, D r . R.J. Collins. Departments of Pathology and Obstetrics and Gynaecology, University of Hong Kong The macroscopic and microscopic pathology findings ilr 32 twin pregnancies w e r e compared wlth the antenatal sonographic classi fication into monochorionlc and dichorionic pregnancy. The latter was based on the thickness o f the intervening septum. The ultrasound diagnosis was confirmed in 2 4 of 30 cases giving an T h i r t e e n of t h e 2 4 c a s e s w e r e accuracy o f 8 0 % . dichorionic diamniotlc type while 10 showed monochorionic diamniotic placentation. Only one case o f monochorionic monoamniotic twin pregnaocy was found. In SIX of the remaining 8 cases there was discrepancy between the ultrasound prediction and pathology f indings. Definite conclusions about the chorion type could not be drawn from either ultrasound or pathology examination i n t h e No monoamniotic twin pregnancy was remainfng 2 cases. missed i n the latter 8 cases. This i s important because of the associated high mortality. The detection of monochorionic diamniotic placentation i s also crucial because of the unique Occurrence of vascular anastanoses between the two foetal clrculations and potential of developing twin-to-twin transfusion and discordancy o f foetal growth. Determination of chorion type also helps in the analysis of zygoslty o f the twin-pregnancy and bears implication in genetic amniocentesis.
CARCINOID TUMOR ARISING FROM A DEVELOPMENTAL HJNDGUT CYST - IMEfflNOIiTSlOCHEMICAL AND ULTRASTHIICTURAL FEATURES B . K . Y . C h i u , D. Murray and N. Colapinto Departments of Pathology and Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada M5B lW8. We report a case of a carcinoid tumor arising from rare retro-rectal hindgut cyst in a 25-year old female. The tumor shows the typical morphological features of a carcinoid tumor with numerous dense core granules ultrastructurally. An unusual feature is the presence of cytoplasmic "fibrous bodies" a s seen in pituitary adenomas. The tumor is immunoreactive with neuronspecific enolase, chromogranin, vasoactive intestinal peptide, glucagon, gastrin and serotonin. The epithelial lining o f the cyst also shows sparse dense-core granules ultrastructurally and similar immunoreactivity except f o r serotonin. The patient did not have carcinoid syndrome and urinary 5111AA was negative, however, the tumor was widely disseminated. The significance of serotonin in this tumor i s discussed. 3
Presenter: Dr B r i a n Chiu, Pathology Department, SMII.
PLEGMONOUS COLITIS: REVIEW OF THE LITEKATURE; REPORT OF A CASE WITH SUBMUCOSAL CHOLESTEROL EMBOLTSM A S A POSSIBLE PATHOGENETIC MECHANISM B.K.Y. Chiu, D. Murray Department of Pathology, St Michael's Hospital, University o f Toronto, Ontario, Canada, M5B 1W8. Ten cases of phlegmonous inflammation solely involving the colon have been reported in the English literature. The pathogenetic mechanism is unclear hut is reported to be associated most often with liver disease, alcoholism, renal disease and pneumonia. We report a case of phlegmonous colitis in a morbidly obese elderly lady. The patient was found to have liver cirrhosis during laparotony. Cholesterol emboli were seen in the submucosal vessels in the resected specimen. We postulate that focal mucosal ischemic injury may permit entry of Gram negative bacilli into the submucosa as a possible pathogenetic mechanism of phlegmonous colitis. Her Ante-mortem blood culture grew E. coli. The majority of these cases are fatal because of delay in diagnosis and overwlielrning septicemia.
RECOGNIZAULE PATTERNS OF FETAL DYSMORPllOLOGY
F.Y. Chan, C. Lam, L.M. Fung. K.H. Fu, Chan. S. Lam and H . K . Ma. Department of Obstetrics and Gynaecology, Department of Pathology, University of Hong Kong and Department of Genetic Services, Government of Hong Kong. A. Ghosh, M. T a w .
Y.F.
All abortuses with dysmorphic features o r wlth prenatally diagnosed abnormalities delivered during second trimester from January 1986 to June 1989 were reviewed. Following categories of dysmorphology were recognized; malformation - 86, deformation - 6 and disruptions - 3 . Of these 4 6 were due to chromosomal abnormality (Trisomies - 28, unbalanced - 8, sex chromosomal - 6 , triploidy - 2, moaaiciem - 2 ) . Abnormalities due to deformation, disruption and s i n g l e localised defect malformation were most easily recognized. In fetuses with known malformation syndrome particularly due to chromosomal abnormality the recognition of known dysmorphic features uepended on the nature of abnormality and fetal age. Recognizable patterns of dysmorphology in second trimester fetuses due to malformation. deformation and disruption will be illustrated and the clinical significance discussed. Presenter: Or. A . Ghosh, Department of Obstetrics and Gynaecology. Tsan Yuk Ilospital, Hong Kong