Twin Placenta
The specimen is received fresh labeled “placenta baby A with one cord clamp, baby B with 2 cord clamps” and consists of a 774 g (trimmed, fixed), 21.0 x 19.0 x 2.3 cm, diamniotic, fused, discoid, twin placenta that is designated by one clamp as baby A and 2 clamps as baby B. The fetal membranes are pink-tan, glistening, transparent and unremarkable. Side A comprises approximately 40% of the entire parenchyma and side B comprises approximately 60% of the parenchyma. The common dividing membrane is tan-pink, semi-translucent, slightly wrinkled, and glistening. No vascular anastomoses are evident.
The trivascular, eccentric inserted umbilical cord to baby A is 33 cm in length and 2.3 cm in greatest diameter. The fetal surface is grey-tan, congested, glistening and transparent. There is a 2.5 x 2.0 cm, tan-white, firm subchorionic fibrin deposition located 4.0 cm from the cord insertion site. The maternal surface is red-brown, and exhibits intact cotyledons which upon sectioning have a maroon -brown, spongy and unremarkable cut surface.
The trivascular, eccentric inserted umbilical cord to baby B is 40 cm in length and 2.2 cm in greatest diameter. The fetal surface is grey-tan, congested, glistening and transparent. The maternal surface is red-brown, and exhibits intact cotyledons which on sectioning have a maroon -brown, spongy and unremarkable cut surface.
- A1: Fetal membranes, including transition zone
- A2: Baby A umbilical cord
- A3: Peripheral Placenta A, full thickness
- A4-A5: Central Placenta A, full thickness
- A6: Subchorionic deposition from Placenta A
- A7: Baby B umbilical cord
- A8: Peripheral Placenta B, full thickness
- A9-A10: Central Placenta B, full thickness
Products of Conception: Missed Abortion
The specimen is received fresh labeled “products of conception” and consists of a markedly fragmented fetus, a detached segment of umbilical cord, a markedly fragmented portion of placenta, and a mesh bag filled with hemorrhagic and spongy soft tissue.
The fetus has a foot length of 1.5 cm but due to the disruption of the axial skeleton the Crown rump or crown heel length cannot be assessed with certainty. The fetus contains 3 intact limbs and 1 detached segment of left upper extremity. Intestinal tissue is identified but most of the visceral organs are too disrupted to assess their proper location with certainty.
The detached segment of umbilical cord measures 35.0 cm in length and 0.4 cm in maximum diameter and exhibits an average of 6 helical coils per 5 cm. The cord does not appear to contain 3 vessels but this cannot be assessed with certainty due to the small diameter.
The markedly fragmented placental tissue weighs 76 g in total and measures 9.0 x 7.0 x 2.0 cm in aggregate. The fetal membranes appear to be present and are pink-tan and glistening. The fetal surface is glistening , pink-tan, and is lightly vascularized. The maternal surface does not display intact or distinct cotyledons and has a light pink spongy cut surface.
The mesh bag contains a 4.5 x 4.0 x 2.5 cm aggregate of hemorrhagic and mucoid fibromembranous soft tissue.
Representative sections are submitted in cassettes A1-A4:
- A1: Fetal contents
- A2: Cross sections of umbilical cord and possible fetal membranes
- A3: Placental parenchyma
- A4: Mesh sac components
Hysterectomy: Fibroids & Polyp
The specimen is received in formalin labeled “uterus, cervix ” and consists of a 277 g uterus (11.0 x 10.0 x 6.0 cm), attached cervix (4.5 x 2.5 x 1.7 cm), left fallopian tube (3.6 cm in length x 0.4 cm in diameter), and right fallopian tube (2.5 cm in length x 0.3 in cm diameter). There are 2 metal, spiral medical devices extruding from the cornua of the uterus.
The uterus is globoid, red-tan, smooth, and covered in part by a roughened and fragmented parametrium along the left aspect. The superior fundus serosa displays areas of pink-tan, string-like fibrous adhesions.
The 3.2 x 2.4 cm ectocervix is tan-white, smooth, glistening and contains a slit like 0.7 x 0.2 cm cervical os which is determined to be probe-patent. Upon sectioning, the endocervical canal is tan-pink, finely trabeculated and is 4.5 cm in length and 1.1 cm in greatest diameter. Sectioning through the cervix reveals a homogenously tan-white and mucoid cut surface associated with multiple thin-walled cysts.
The triangular endometrial cavity is 5.0 cm in length and 3.5 cm from cornu to cornu. The endometrium is pink-tan, smooth, glistening, hyperemic, and ranges from 0.1-0.2 cm in thickness. There is a pedunculated, pink-tan, ovoid, 1.1 x 0.5 x 0.3 cm polyp located on the posterior wall of the fundus. The myometrium is vaguely nodular, coarsely trabeculated, markedly thickened, and exhibits numerous blood-filled cysts. It measures 4.0 cm in greatest thickness.
On sectioning the fallopian tubes both lumina are identified and are partially occluded by the previously described medical devices. No fimbriae are identified.
Representative sections are submitted in cassettes A1-A10:
- A1: Anterior cervix, including transition zone
- A2: Posterior cervix, including transition zone
- A3: Posterior fundic polyp
- A4-A5: Anterior endomyometrium
- A6-A7: Posterior endomyometrium
- A8: Serosal adhesions
- A9: Right fallopian tube
- A10: Left fallopian tube
Hysterectomy: Inflammation from Residual Placental Bed
A. Uterus, cervix, tubes and ovaries-bilateral:
The specimen is received fresh labeled “uterus, cervix, tubes and ovaries-bilateral” and consists of a 2415 g hysterectomy specimen which includes a uterus (25.0 x 23.0 x 15.0 cm), cervix (5.5 x 3.5 x 2.5 cm), right fallopian tube (10.0 cm in length x 1.2 cm in diameter), left fallopian tube (11.0 cm x 1.0 cm in diameter), right ovary (5.5 x 3.5 x 2.0 cm), and left ovary (6.0 x 3.5 x 2.0 cm).
The uterus is markedly and asymmetrically enlarged and covered by a red tan congested serosa with multifocal fibrous adhesions, at least 2 subserosal nodules both measuring 2.5 cm in greatest dimension, and a sutured surgical scar located along the anterior body of the uterus consistent with a previous cesarean section. Bivalving the uterus reveals a poorly delineated endometrial cavity that is diffusely mottled, discolored, and bears a 10.0 cm in greatest dimension segment of placental bed. No endometrial mucosa can be grossly identified. Situated in the myometrium is a 10.5 cm in greatest dimension well-circumscribed tan-white to tan-pink firm nodule which when sectioned reveals a whorled, slightly calcified but otherwise unremarkable cut surface. The remainder of the myometrium is markedly engorged, firm, and coarsely trabeculated with no other grossly discrete lesions.
The 5.5 x 2.5 cm ectocervix is green brown, wrinkled, fragmented and bears a 2.5 x 2.5 cm irregular cervical os which when probed exhibits a moderate amount of resistance. The red-brown shaggy endocervical canal measures 4.0 cm in length and is markedly dilated to a diameter of 3.2 cm.
The left fallopian tube is fimbriated and covered by a purple-tan congested serosa that exhibits a thin-walled unilocular cyst measuring 1.0 cm in greatest dimension. The right fallopian tube is also fimbriated and covered by a similar purple tan congested serosa that bears a similar cyst measuring 5.0 cm in greatest dimension.
The left ovary is markedly enlarged, mottled and has a markedly hemorrhagic cut surface with a tan white nodule measuring 0.8 cm in greatest dimension. The right ovary is also similarly enlarged, mottled, and has a hemorrhagic cut surface. No grossly discrete lesions are identified.
ALINA MAYSTERCHUK 