=============

Common Disc Abnormalities:    

-- Third trimester placenta with adequate villous maturation and disc weight in the 25th percentile for the gestational age.   

-- No diagnostic abnormality.   

-- No disc infarction, villitis or vasculitis.   

-- Prominent intervillous fibrin clot (1.2 cm measured on slides), < 5% of the disc volume.    

-- Multifocal prominent syncytial knots and villous crowding, consistent with early infarcts.    

-- Recent disc infarction (1.2 cm), less than 5% of the disc volume.    

-- Focal moderate lymphoplasmacytic villitis and venulitis (see Note).     

-- Moderately accelerated villous maturation for gestational age.    

-- Nucleated red blood  cells within fetal vascular spaces (fetal erythroblastosis).    

-- Focal  chorioangiosis, less than 5% of disc volume.    

-- Focal moderate thrombotic acute vasculitis of chorionic plate.    

-- Diffuse acute subchorionitis and focal chorioamnionitis, predominantly on membranes of the chorionic  plates.    

-- Focal fibrotic and avascular villi, consistent with fetal thrombotic vasculopathy.    

-- Geographic acute villitis with intervillous microabscesses.    

-- Blood clot and degenerated fibrin clot of maternal floor suggestive of retroplacental hematoma.    

Common Membrane Abnormalities:

-- No chorioamnionitis or meconium histiocytosis.     

-- Diffuse moderate acute chorioamnionitis, with focal chorionic vasculitis.    

-- Pigment-laden histiocytes, consistent with microscopic meconium histiocytosis.    

-- Focal mild to moderate subchorionic acute decidualitis.     

-- Prominent decidual laminar necrosis (>33%).     

-- Acute necrotizing chorioamnionitis with chorionic vasculitis.     

Common Cord Abnormalities:

-- Focal moderate acute vasculitis in one of three cord vessels.    

-- Focal moderate funisitis associated with severe acute vasculitis in two of three cord vessels.    

-- Hypercoiled (0.8 coil/cm vs. normal 0.2 coil/cm) trivascular umbilical cord.     

-- Two-vessel umbilical cord with segmental supercoiling and associated focal perivascular hemorrhage.    

-- Trivascular umbilical cord, 68 cm, with furcate insertion.    

=============

Clinical scenario:  .       

Placenta and cord, cesarean section with manual removal:      

Placental disc:

-- Third trimester placenta with adequate villous maturation and a disc weight in the 50th percentile for the gestational age. 

Membranes:

-- No excessive intervillous fibrin deposition, disc infarction, villitis or vasculitis. 

-- No diagnostic abnormality. 

Umbilical cord: 

-- No diagnostic abnormality in trivascular umbilical cord. 

=============

Clinical scenario:          

Placenta and cord, spontaneous vaginal delivery:    

Placental disc  

-- Third trimester placenta with adequate villous maturation with a disc weight in the 50th percentile for the gestational age. 

-- No diagnostic abnormality. 

Membranes  

-- No diagnostic abnormality.  

Umbilical cord  

-- No diagnostic abnormality in trivascular umbilical cord.         

Slides exam:         H&E X  4 

CPT code:        88309 X  3

Editor's comment:

This format is preferred by most clinicians, esp. when reporting complex abnormalities present in different parts of the specimen. However, for a normal placenta, a short compact format may be better (see next example)

=============

Clinical scenario:          

Placenta and cords, vaginal delivery:     

-- Mature third trimester placenta with adequate villous maturation and a disc weight in 25th percentile for the gestational age.

-- No disc infarction, villitis, chorioamnionitis or vasculitis

-- No diagnostic abnormality in fetal membranes and trivascular umbilical cord.

Slides exam:         H&E x  4

CPT code:        88309 x 1

Editor's comment:

This format is best suitable for reporting a normal specimen. To report complex lesions, organizing by disc, membranes and umbilical cord makes the report easier to read.

=============

Clinical scenario:          

Placenta and cords, Cesarean section with manual removal:     

-- Third trimester, dichorionic-diamniotic twin placenta with a combined disc weight in the 10 percentile for the gestational age.

       Placenta "A" (1 cord clamp, ___ g):

   -- Adequate villous maturation for the gestational age.

   -- No infarction, villitis, chorioamnionitis or vasculitis.

   -- No diagnostic abnormality in membranes.

   -- No diagnostic abnormality in trivascular umbilical cord (18 cm).

       Placenta "B" (2 cord clamps, ___ g):

       -- Adequate villous maturation for the gestational age

       -- No infarction, villitis, chorioamnionitis or vasculitis

       -- No diagnostic abnormality in membranes

   -- No diagnostic abnormality in trivascular umbilical cord (21 cm).

Right and left fallopian tubes, bilateral segmental salpingectomy:     

-- No diagnostic abnormality.

-- Complete cross-sections identified.

Slides exam:         H&E x  8 

CPT code:        88309 x 1, 88302 x 2

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

=============

Clinical scenario:          

Placenta and cords, Cesarean section with manual removal:     

-- Third trimester, dichorionic-diamniotic twin placenta with a combined disc weight in the 10 percentile for the gestational age.

       Placenta "A" (1 cord clamp, ___ g):

       -- Focal laminar necrosis of decidua and focal moderate acute chorioamnionitis.

       -- Multifocal increase in syncytial knots and villous crowding, consistent with early infarction.

       -- Multifocal villous edema.

       -- No diagnostic abnormality in trivascular umbilical cord (38 cm).

       Placenta "B" (2 cord clamps, ___ g):

       -- Adequate villous maturation for the gestational age

       -- No infarction, villitis, chorioamnionitis or vasculitis

       -- No diagnostic abnormality in membranes

       -- No diagnostic abnormality in trivascular umbilical cord (31.5 cm).

Slides exam:         H&E x  6 

CPT code:        88309 x  ___

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

=============

Clinical scenario:         

Twin placenta, cesarean section:    

-- Diamnionic dichorionic twin placenta with fused placental discs

-- Villous maturation  appropriate with combined disc weight in the 50th percentile for gestational age  

-- Mild, focal chronic lymphocytic villitis, disc A only.  

-- Small organizing  intervillous thrombi ranging from 0.8 to 3.0 cm, less than 5% of the placental disc  

-- Focal area of infarct, 0.8 cm in greatest dimension, disc B only.  

-- No diagnostic abnormality in placental membranes 

-- Both umbilical cords are trivascular with no diagnostic abnormality      

Slides exam:         H&E x  6 

CPT code:        88309 X  ___

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

=============

Clinical scenario:          

Placenta and cord, cesarean section with manual removal:    

Placental disc  

-- Third trimester placenta with adequate villous maturation and disc weight in the 25th percentile for the gestational age.

-- Focal peripheral disc infarction (___ cm), less than 5% of the  disc volume.

-- No excessive intervillous fibrin deposition, villitis or vasculitis. 

Membranes  

-- Mild meconium histiocytosis.

-- No choroiamnionitis.

Umbilical cord  

-- No diagnostic abnormality in trivascular umbilical cord.

Slides exam:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

=============

Clinical scenario:  34-year old woman. GA 38 4/7 weeks; SVD..        

Placenta and cords, spontaneous vaginal delivery:       

-- Third trimester placenta with adequate villous maturation and a disc weight in the 25th percentile for the gestational age.

-- Prominent intervillous fibrin deposition (1.2 cm), less than 5% of the disc volume.

-- No disc infarction, villitis or vasculitis.

-- No diagnostic abnormality in fetal membranes and trivascular umbilical cord.

Slides exam:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

The mast majority of encountered cases  can be reported with this example with minor modifications .

=============

Clinical scenario:         

Placenta and cords, spontaneous vaginal delivery:       

Placental disc  

-- Mature, preterm placenta with a disc weight below 3rd percentile for gestational age. 

-- Moderately accelerated villous maturation for gestational age.

-- Extensive lymphohistiocytic villitis with marked villous destruction and patchy areas of associated intervillositis (see Note).    

-- No viral cytopathic changes, abscess, vasculitis, vascular thrombosis or disc infarction

-- No cytomegalovirus and herpes simplex virus identified on Immunostains  

-- No microorganisms identified on Steiner and gram stains. 

Fetal membranes        

-- Patchy, moderate, acute chorioamnionitis.        

-- Pigment-laden histiocytes, consistent with meconium histiocytosis       

Umbilical cord  

-- Trivascular  umbilical cord  

-- No vasculitis or funisitis  

Note: The presence of plasma cell-rich chronic villitis raises the possibility of an infectious etiology especially the so-called TORCH group.  Negative results of histological special stains do not necessarily exclude the infection by these pathogens. Correlation with serologic findings should also be considered.

Slides exam:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

It's a good practice to report the presence or absence of changes related to relevant differential diagnosis (e.g., villitis - CMV infection) and potential resultant changes (e.g., cord vasculitis --> ? thrombosis). This helps cultivate the habit to examine the specimen in an organized systematic approach.

=============

Clinical scenario:          

Placenta and cord, vaginal delivery:    

Placental disc

-- Immature, second trimester placenta (109 g) 

-- Villous maturation appropriate for gestational age 

-- Extensive cytomegalovirus-associated lymphoplasmacytic villitis with numerous viral inclusions, confirmed by immunohistochemical stain  

-- Increased fetal nucleated red blood cells 

Placental membranes 

-- No chorioamnionitis or meconium histiocytosis

Umbilical cord 

-- Trivascular umbilical cord with mild acute phlebitis  

-- No funisitis or vascular thrombosis  

Slides exam:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

It's a good practice to report the presence or absence of changes related to relevant differential diagnosis (e.g., villitis <-- CMV infection) and potential resultant changes (e.g., cord vasculitis --> thrombosis). This helps cultivate the habit to examine the specimen in an organized systematic approach.

=============

Clinical scenario:          

Placenta and cord, spontaneous vaginal delivery:    

Placental disc

-- Moderate to severe acute vasculitis of chorionic plate. 

-- A small solitary chorioagioma, 0.7 cm.

-- Third trimester placenta with adequate villous maturation and disc weight in the __th percentile for the gestational age.

-- No occlusive thrombosis is identified

-- No disc infarction or villitis.

Membranes 

-- Focal moderate acute chorioamnionitis.

-- A few Pigment-laden histiocytes, consistent with meconium histiocytosis. 

Umbilical cord   

-- No diagnostic abnormality in trivascular umbilical cord.

Slides exam:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

In the presence of significant vasculitis, presence of absence of (associated) vasculat thrombosis should be reported.

=============

Clinical scenario:  .       

Placenta and cord, spontaneous vaginal delivery:      

-- Third trimester placenta with adequate villous maturation and a disc weight in the 5th percentile for the gestational age. 

-- No disc infarction, excessive intervillous fibrin deposition, villitis or vasculitis. 

-- Diffuse mild acute chorioamnionitis and mild meconium histiocytosis. 

-- Lightly hypercoiled trivascular umbilical cord (0.3 coil/cm versus normal 0.2 coil/cm). 

-- No cord vasculitis, funisitis or vascular thrombosis.  

Slides examined:         H&E X  6 

CPT code:        88309 X  1

=============

Clinical scenario:  .       

Placenta and cord, cesarean section :       

-- Third trimester placenta with adequate villous maturation and a disc weight in the 95th percentile for the gestational age. 

-- No disc infarction, excessive intervillous fibrin deposition, villitis or vasculitis. 

-- Focal prominent acute chorioamnionitis. 

-- Diffuse mild meconium histiocytosis. 

-- No diagnostic abnormality in trivascular umbilical cord. 

Slides examined:         H&E X  6 

CPT code:        88309 X  1

=============

Clinical scenario:          

Placenta and cord, spontaneous vaginal delivery:    

Placental disc  

-- Adequate villous maturation with a disc weight in the 50th percentile for the gestational age of 39 weeks.

-- No disc infarction, villitis or vasculitis.

Membranes

-- Diffuse moderate to severe acute chorioamnionitis.

-- A few pigment-laden histiocytes, consistent with microscopic meconium histiocytosis.

Umbilical cord  

-- No diagnostic abnormality in trivascular umbilical cord.        

Slides examined:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

The mast majority of encountered cases  can be reported with this example with minor modifications .

=============

Clinical scenario:          

Placenta and cord, spontaneous vaginal delivery:    

Placental disc  

-- Adequate villous maturation with a disc weight in the 50th percentile for the gestational age of 39 weeks.

-- No disc infarction, villitis or vasculitis.

Membranes

-- Decidual laminar necrosis (>33%).

-- Mild meconium histiocytosis.

-- No chorioamnionitis.

Umbilical cord  

-- No diagnostic abnormality in trivascular umbilical cord.        

Slides exam:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

Laminar necrosis of placental membranes, a band of coagulative necrosis at the choriodecidual interphase, is a histologic lesion of unclear pathogenesis that has been reported in placentas from preeclampsia, preterm premature rupture of membranes, and preterm abruption. It should be recognized and reported as a hypoxic placental lesion.

=============

Clinical scenario:          

Placenta and cord, spontaneous vaginal delivery:    

Placental disc  

-- Adequate villous maturation with a disc weight in the 50th percentile for the gestational age. 

-- No disc infarction, villitis or vasculitis. 

Membranes  

-- No diagnostic abnormality.  

Umbilical cord

-- Mild to moderate acute phlebitis and arteritis  involving all 3 vessels.

-- Focal mild acute funisitis.

-- No intravascular thrombosis identified.

Slides exam:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

The mast majority of encountered cases  can be reported with this example with minor modifications .

=============

Clinical scenario:          

Placenta and cord, spontaneous vaginal delivery:    

Placental disc  

       -- Adequate villous maturation with a disc weight in the 50th percentile for the gestational age. 

       -- No disc infarction, villitis or vasculitis. 

Membranes  

       -- No diagnostic abnormality.  

Umbilical cord

       -- Two-vessel umbilical cord with supercoiling (0.9 coils/cm v.s. normal 0.2/cm) (see Note).

       -- Associated focal perivascular hemorrhage 

       --  No intravascular thrombosis or vasculitis.

Note: In 30-44% of infants, bivascular umbilical cord has been found to be associated with a congenital anomalies.  Renal anomalies are found in approximately 16% of these infants.

Slides exam:         H&E X  6 

CPT code:        88309 X  1

Editor's comment:

Concurrent two-vessel umbilical cord and supercoiling is very rare.

=============

Clinical scenario:  .       

Placenta, cesarean section with manual :     

Placental disc:

-- Third trimester placenta with adequate villous maturation and a disc weight in the 75th percentile for the gestational age. 

-- No excessive intervillous fibrin deposition, disc infarction, villitis or vasculitis. 

Membranes:

-- Moderate coagulative laminar necrosis, approximately 60%

-- No inflammation or significant meconium histiocytosis. 

Umbilical cord:

-- Hypercoiled (0.4 coil/cm versus normal 0.2 coil/cm) trivascular umbilical cord. 

-- No vascular thrombosis or vasculitis is identified. 

B. And c. Right and left fallopian tubes, segmental salpingectomy:   

-- Full cross-sections of both fallopian tubes are identified. 

-- No diagnostic abnormality. 

Slides examined:  H&E x  __ 

CPT code:        88304 x __, 88305 x __, 88307 x __ 

=============

Clinical scenario:          

Uterine contents, curettage:      

--  Immature chorionic villi and membranes (products of conception), decidua and gestational endometrium.

--  No hydatidiform mole or fetal parts identified.

Slides exam:         H&E X  4 

CPT code:        88305 X  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

=============

Clinical scenario:   26-year old; POC, missed abortion.        

Uterine contents, curettage:       

-- Retained products of conception (degenerated chorionic villi, implantation site, sub-involuted vessels).

-- Weakly proliferative endometrium with breakdown.

-- No fetal tissue or placental trophoblast neoplasm identified.  

Slides examined:   H&E X 12

CPT code:        88305 X  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.    

=============

Clinical scenario:   26-year old; POC, missed abortion.        

Uterine contents, curettage:       

--  Predominantly (>80%) blood clot, decidua and hypersecretory endometrium.

--  No chorionic villus, fetal tissue or implantation site changes (see Note).

Note: The specimen is entirely submitted for histological examination. Multiple levels of selected blocks are examined. Dr. Sieverding is notified about the above findings via phone on March 12, 2015.

Slides exam:         H&E X  12 

CPT code:        88305 X  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

=============

Clinical scenario:   26-year old; POC, missed abortion.        

Uterine contents, dilation and curettage with suction:     

-- Partial hydatidiform mole (see Note).

Note:  DNA ploidy studies (MolCase-14-7543) show triploid DNA content of chorionic villous cell nuclei, supporting the diagnosis.  Additional cytogenetic studies will be performed as requested and reported separately.

Slides examined:   H&E X 12

CPT code:        88305 X  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.    

=============

Clinical scenario:   41-year old woman; POC.        

Uterine contents, dilation and curettage with suction:      

-- Immature hydropic chorionic villi with triploidy confirmed on cytogenetic studies, suspicious for partial hydatidiform mole (see Note).

Note: The patient's cytogenetic results of triploidy is noted. Histologic changes in this specimen are insufficient for a histologic diagnosis of partial hydatidiform mole.  However, it can be difficult to distinguish an early hydropic abortus from an early partial hydatidiform mole as their histologic features overlap.  The presence of triploidy in this case is concerning as approximately 85% of triploid pregnancies are partial hydatidiform moles.  Therefore, villous hydropic change as seen in this specimen in the presence of triploidy is suspicious for a partial hydatidiform mole. Follow-up of serial beta-HCG levels to zero in this patient is recommended.   

Slides examined:   H&E X 12

CPT code:        88305 X  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.    

=============

Clinical scenario:   26-year old; POC, missed abortion.        

Uterine contents, curettage:       

-- Hydropic chorionic villi with diploidy and abnormal immunohistochemical staining for P57, consistent with complete hydatidiform mole (see Note)

Note: 5925002.

Slides examined:   H&E X 12

CPT code:        88305 X  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.    

=============

Clinical scenario:   26-year old; POC, missed abortion.        

Uterine contents, curettage:       

-- Retained products of conception (degenerated chorionic villi, implantation site, sub-involuted vessels).

-- Weakly proliferative endometrium with breakdown.

-- No fetal tissue or placental trophoblast neoplasm identified.  

Slides examined:   H&E X 12

CPT code:        88305 X  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.    

=============

Clinical scenario:   26-year old; POC, missed abortion.        

Fetus, delivery:     

-- Stillborn macerated fetus with weight and measurements consistent with a gestational age of  16-17 weeks 

-- Weight  133 g (most consistent with 17 weeks) 

-- Crown to rump  13.5 cm (consistent with 17 weeks) 

-- Crown to heel  19.5  cm (consistent with 17 weeks) 

-- Foot length  2.0 cm (most consistent  with 16 weeks)  

-- Heart  0.7 g (consistent with 16 weeks) 

-- Combined lungs  2.8 g (consistent with 15 weeks) 

-- Combined kidneys  0.9 g (consistent with 16 weeks)  

-- Liver  4.94 g (most consistent with 16 weeks)        

-- Adrenals  0.37 g (most consistent with 15-16 weeks)        

-- Spleen  0.05 g (most consistent with 15 weeks)        

-- Thymus  0.07 g (most  consistent with 15 weeks)        

-- Brain  15 g (most consistent with 15-16 weeks)  

-- No external or internal congenital anomaly/malformation 

-- Disseminated  cytomegalovirus infection with viral inclusions identified within the lungs, liver, kidney, intestine, brain and adrenal glands  

-- Positive immunohistochemical staining for cytomegalovirus in lung parenchyma 

-- Marked stricture and narrowing of the umbilical cord caused by an amniotic band

Note: 02958203.

Slides examined:   H&E x 0X

CPT code:        8830X x  1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.