Pediatric pathology / affiliated with the International Paediatric Pathology Association
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Chorioamnionitis is a frequent finding in the placenta in second-trimester premature labor. Seventy-six archival perinatal and fetal autopsies between 15 and 28 weeks of gestation with a morphologic diagnosis of chorioamnionitis were reviewed. Of the 76 cases, 52 (68%) had inflammatory cells in the lungs, which is higher than the reported incidence of clinical infection in neonates with chorioamnionitis. ⋯ Two of the tests were technical failures. The remaining five, and the positive controls, showed positivity for pHY 2.1 in 70-86% of luminal neutrophils. We conclude that luminal neutrophils in fetal lungs in this situation are fetal in origin.
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In a review of 96 consecutive perinatal autopsies (42 nonautolyzed stillborn and 54 liveborn infants 12 h or less of age) with histologic sections of placental tissues and an undistended lung, we were impressed by the frequent occurrence of lymphocytic infiltrates in the interstitium of the lung. To study this phenomenon further we analyzed the cases for 56 clinicopathologic variables. Lymphocytic interstitial infiltrates were present in 22 of the cases, 5 stillborn and 17 liveborn. ⋯ Two cases had interstitial lymphocytic infiltrates in the absence of fetal pneumonia, but both had chorioamnionitis. Two other cases had numerous giant cells, shown to be of macrophage origin by immunoperoxidase stains, in the airways in addition to severe fetal pneumonia and lymphocytic interstitial pneumonia. The observations show that lymphocytic interstitial infiltrates and giant cells may be a feature of fetal pneumonia.
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A 2-year-old boy with a relatively mild form of Proteus syndrome (PS) died suddenly during a previously uncomplicated postsurgical convalescence. Autopsy demonstrated massive acute pulmonary embolism, which has not been previously reported in PS. In addition, clinically occult mesodermal hamartomata, predominantly hemolymphangiomata, were found to be widespread in the pelvoabdominal viscera, including spleen, appendix, kidneys, adrenal gland, liver, and retroperitoneal soft tissues. Such lesions may well be common in PS patients but may not be detected by conventional radiographic imaging techniques unless they are fairly large.
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A 6-year-old white female was found to have an adenoid cystic carcinoma originating in a lacrimal gland. Eighteen months following diagnosis, the tumor recurred. ⋯ Our purpose is to record the unusual occurrence of an adenoid cystic carcinoma of the lacrimal gland in a child. An interim report, 32 months after diagnosis, is presented.
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Case Reports
Inflammatory cloacogenic polyp in a child: part of the spectrum of solitary rectal ulcer syndrome.
A 15-year-old boy with Marshall-Smith syndrome presented with increased frequency and urgency of stooling, hematochezia, and rectal pain. A polypoid mass was found at the anorectal junction and excised. Microscopically, the lesion was covered by both squamous and columnar mucosa. ⋯ These features are characteristic of an inflammatory cloacogenic polyp, a lesion not previously reported in the pediatric age group. Inflammatory cloacogenic polyp is related to solitary rectal ulcer syndrome and is most likely due to prolapse of the anorectal transition zone. Although rare in this age group, solitary rectal ulcer and its variants should be considered in the differential diagnosis of anorectal and rectal lesions in the pediatric patient.