Visual identification of three kinds of human decidual tissues from elective termination of pregnancy

INTRODUCTION

The decidua can be classified into the decidua basalis, decidua capsularis and decidua parietalis. This study aimed to visually identify these three kinds of decidual tissues from fresh samples obtained in early pregnancy based on their macroscopic appearances, which can be discerned visually.

METHODS

Decidual samples were collected from 15 pregnant women between 6 and 8 weeks of gestation after elective termination of pregnancy. We identified the three different kinds of fresh decidual tissues in early pregnancy according to their different macroscopic appearances by only the naked eye. H&E staining, in situ immunofluorescence and flow cytometry were performed to confirm the accuracy of this method.

RESULTS

We developed a method to discern the three different kinds of decidual tissues according to their individual macroscopic features. We found that the decidua parietalis was a thick tissue with less blood, with one side being intact epidermis and the other side being rough tissue. The decidua basalis had rough surfaces, a dense texture and high blood content. The decidua capsularis was a thin membrane tissue with or without blood clots. CK+/HLA-G+ extravillous trophoblast cells (EVTs) and heme oxygenase-1+ (HMOX1+) decidual macrophages were present in large quantities in the decidua basalis and decidua capsularis but were nearly undetectable in the decidua parietalis. We also found a wide distribution of endovascular extravillous trophoblast cells (enEVTs), which participate in spiral artery remodelling in the decidua basalis.

DISCUSSION

We successfully identified three kinds of human decidual tissues from early pregnancy with the naked eye for the first time. This breakthrough method will greatly assist studies related to decidua during early pregnancy.

Characterization of the 'White' Appearing Clots that Cause Acute Ischemic Stroke

OBJECTIVES

Most clots retrieved from patients with acute ischemic stroke are 'red' in color. 'White' clots represent a less common entity and their histological composition is less known. Our aim was to investigate the composition, imaging and procedural characteristics of 'white' clots retrieved by mechanical thrombectomy.

MATERIALS AND METHODS

Seventy five 'white' thrombi were selected by visual inspection from a cohort of 760 clots collected as part of the RESTORE registry. Clots were evaluated histopathologically.

RESULTS

Quantification of Martius Scarlett Blue stain identified platelets/other as the major component in 'white' clots' (mean of 55% of clot overall composition) followed by fibrin (31%), red blood cells (6%) and white blood cells (3%). 'White' clots contained significantly more platelets/other (p<0.001*) and collagen/calcification (p<0.001*) and less red blood cells (p<0.001*) and white blood cells (p=0.018*) than 'red' clots. The mean platelet and von Willebrand Factor expression was 43% and 24%, respectively. Adipocytes were found in four cases. 'White' clots were significantly smaller (p=0.016*), less hyperdense (p=0.005*) on computed tomography angiography/non-contrast CT and were associated with a smaller extracted clot area (p<0.001*) than 'red' clots. They primarily caused the occlusion of middle cerebral artery, were less likely to be removed by aspiration and more likely to require rescue-therapy for retrieval.

CONCLUSIONS

'White' clots represented 14% of our cohort and were platelet, von Willebrand Factor and collagen/calcification-rich. 'White' clots were smaller, less hyperdense, were associated with significantly more distal occlusions and were less successfully removed by aspiration alone than 'red' clots.

Meckel diverticulum in children: Evaluation of macroscopic appearance for guidance in subsequent surgery

BACKGROUND

The treatment of incidentally encountered asymptomatic Meckel diverticulum (MD) is controversial. We evaluated whether the macroscopic appearance correlates with clinical features, histopathological findings, future complications, and management decisions.

METHODS

Patients who underwent MD resection at a single institution from 2000 to 2012 were retrospectively analyzed in terms of age, sex, clinical features, laboratory data, perioperative findings (diverticulum length, diameter, depth, thickening, and height-to diameter ratio [HDR]), pathology, and postoperative follow-up.

RESULTS

Fifty children were enrolled. Sixteen percent of the resected MDs were found incidentally. Of 42 complicated MDs, 17 (40%) were long (HDR ≥2), 14 (33%) were thickened, and 29 (70%) exhibited base widening. Histopathologically, ectopic mucosa was found in 32 (64%) of all MDs and in 5 (62%) of incidentally removed MDs. There was no statistical difference between the macroscopic appearance and clinical signs, sex, or presence of ectopic tissue based on palpation.

CONCLUSION

The macroscopic appearance of MD does not indicate the presence or absence of HGM and cannot be used to guide subsequent surgery. Additionally, 40% of symptomatic patients in our study had life-threatening complications requiring prompt fluid resuscitation. We consider that incidentally detected MD should be removed regardless of its macroscopic appearance.

Further exploration during open appendicectomy; assessment of some common intraoperative findings

OBJECTIVE

Very few studies are available to relate the final histology of excised appendix with the detailed intra-operative findings during appendectomy, both open and laparoscopic. This study was aimed to correlate the histological features of appendix specimen with the intra operative findings at open appendicectomy (OA) in a bid to determine when to change the planned procedure to include further exploration. Methods : A prospective study that observes the condition of the greater omentum (GO), the vermiform appendix and peritoneal exudates at all OA done for uncomplicated appendicitis. Histological examination of the appendices done using the H&E stain. Results : Eighty-five patients had emergency open OA, their(') ages range from 6 to 62 yrs (median = 23yrs). Histology showed 7 normal appendix (HNA), 56 acute (HAA) and 22 "non acute" appendicitis (HNAA). Negative appendicectomy rate was 8.2%. The GO was sighted more in patients with HAA than HNAA (p=0.00015) and also significantly more inflamed in the former (p=0.00028). It is not significantly inflamed in those with HNAA (p=0.945). The negative predictive value (NPV) of absent GO is 35.7% while the positive predictive value (PPV) of sighted normal GO and inflamed GO are 92.8% and 100% respectively. The PPV and NPV of presence of pus for diseased appendix are 95.8% and 9.8% respectively while those of excess fluid are 94.8% and 10.8%. The PPV and NPV of macroscopic assessment of the appendix for inflammation are 97% and 45.5% respectively giving the diagnostic accuracy of 90.6%. A significant trend of increasing probability of histologically inflamed appendix with increasing severity of macroscopic feature was seen (X(2) = 004 df=1, p<0.005).

CONCLUSION

High positive and low negative predictive values are similar for all the three parameters assessed. The macroscopic appearance of the appendix has a predictive likelihood ratio for further exploration.