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Biomedical subjects

A E Szulman

Publications and source records attributed to A E Szulman.

At least 19 recordsLinked to original sources
PubMed1992

Choriocarcinoma in a term placenta with maternal metastases.

Choriocarcinoma of the nonmolar placenta is presumptively a rare entity and is usually associated with widespread maternal metastases at the time of diagnosis. Nonmetastatic disease goes unrecognized and undiagnosed because placental carcinoma can be limited to a few villi, and grossly evident disease is often misinterpreted as a placental infarct. The optimal treatment for patients with choriocarcinoma of the placenta is not known but aggressive combination chemotherapy is suggested for patients with metastatic disease. Historically, the prognosis for both mother and infant has been poor.

Adult↗
PubMed1991

Examination of the early conceptus.

The pathologist encounters the early, first-trimester conceptus as a product of spontaneous or surgical abortion or as a specimen from ectopic, usually tubal, gestation. In the vast majority of cases of spontaneous abortion, the embryo/fetus has been dead for 1 week to several weeks and is most often lost in the process of uterine emptying; the placenta, accordingly, stands as the main "witness" of the abortive process. The fact of embryonic/fetal death is established and dated through an interpretation of gross and microscopic changes in the villous stroma, including its vessels and the embryonic erythrocytes therein. Elective abortions performed for social reasons occasionally yield abnormal findings that suggest gestations otherwise destined to eventual spontaneous abortion. Other therapeutic abortions are indicated by abnormal sonographic or cytogenetic findings that may be correlated with the morphologic features of the evacuated conceptus. Cytogenetic abnormalities correlate to a high degree with embryonic growth disorganization and with early death, usually before the fetal stage (30 mm) is reached. Adequate sampling of the placenta, its membranes, and of the embryo/fetus is recommended. For cytogenetic studies, clean, viable specimens must be obtained; these are most often required in cases of habitual abortion.

Abortion, Spontaneous↗
PubMed1988

Trophoblastic disease: clinical pathology of hydatidiform moles.

Hydatidiform moles are divided into two syndromes: those of complete and partial moles. Both forms are genetically, morphologically, and clinically distinct. Choriocarcinoma can be associated with the complete mole that has not been described for the partial syndrome. Residual trophoblastic disease, on the contrary, can be found with either syndrome, the substrate being locally invasive (nonembolic) behaviour.

Female↗
PubMed1987

Immunocytochemical localization of chorionic gonadotropin, placental lactogen, and placental alkaline phosphatase in the diagnosis of complete and partial hydatidiform moles.

Complete hydatidiform moles (CHMs) and partial hydatidiform moles (PHMs) represent different clinicopathologic entities with characteristic morphologic and cytogenetic findings. In the absence of cytogenetic data, the histologic distinction between these lesions and abortuses showing hydropic swelling (AHS) may be difficult. An immunocytochemical study analyzing the distribution of human chorionic gonadotropin (hCG), human placental lactogen (hPL), and placental alkaline phosphatase (PlAP) in CHMs, PHMs, and AHS was undertaken to determine whether the expression of these trophoblastic proteins might assist in the differential diagnosis. A total of 24 CHMs, 22 PHMs, and 13 AHS were selected on the basis of established morphologic criteria. Thirty-four specimens of abortuses without hydropic swelling and normal placentas, ranging from 6 to 24 weeks gestational age, were similarly analyzed. The immunocytochemical localization of the three trophoblastic proteins, predominantly in syncytiotrophoblast (ST), was scored using a semiquantitative scoring system. In CHMs hCG is widely distributed and PlAP is patchily distributed in ST regardless of the gestational age, whereas hPL tends to increase with increasing gestational age. In contrast, in PHMs hPL is more widely distributed in ST compared with CHMs regardless of gestational age, while PlAP increases with increasing gestational age; in PHMs the distribution of hCG is markedly less than in CHMs except early in the first trimester when the staining patterns are similar. The different patterns of distribution of hCG, hPL, and PlAP may reflect differences in the pathobiology of trophoblast in CHMs and PHMs and appear to be useful in the differential diagnosis of these conditions.

Abortion, Spontaneous↗
PubMed1987

Clinicopathologic features of partial hydatidiform mole.

Partial hydatidiform mole (PHM) is a distinct entity, a triploid, diandric conceptus the placenta of which shows focal trophoblastic hyperplasia (a sine qua non of diagnosis) and focal hydatidiform change; the fetus usually survives until eight to nine weeks' menstrual age. The clinical presentation is varied and preevacuation diagnosis often difficult. No choriocarcinoma has been documented in association with PHM, but residual, nonmetastatic disease can occur. The diagnosis rests ultimately with the pathologist, who has to distinguish PHM from a common abortus with villous edema and from twins in which the partners are a complete mole and a normal conceptus.

Female↗
PubMed1986

Tetraploid partial hydatidiform moles: two cases with a triple paternal contribution and a 92,XXXY karyotype.

In the course of a systematic study of cytogenetics, morphology, and clinical follow-up of hydatidiform moles we encountered two unusual cases of partial hydatidiform moles each with a 92,XXXY karyotype. Previously reported cases of tetraploidy, of 92,XXXX or 92,XXYY karyotype, resulted from a failure of the first mitotic division of a normal zygote. This is to our knowledge the first report of tetraploidy with XXXY sex chromosomes. Study of chromosomal heteromorphisms, isozymes, and restriction fragment length polymorphisms reveal that both present cases resulted from a combination of a haploid ovum with three haploid sets of paternal chromosomes either by the mechanism of trispermy (involving three separate haploid spermatozoa) or through dispermy (involving one haploid and one diploid sperm). Both cases resembled closely partial moles in their morphology; one gave a highly typical clinical picture while the other was recognized at an early voluntary abortion. Partial moles are ordinarily triploids of nearly always diandric constitution that evince focal villous swelling with cistern formation and focal trophoblastic hyperplasia. The findings here presented point to an association of molar phenotype with an excess of paternal over maternal haploid sets.

Adolescent↗
PubMed1985

Effect of hydatidiform molar vesicular fluid on blood coagulation.

The effect of fluids from both complete and partial hydatidiform moles on blood coagulation was determined. Coagulation was evaluated with use of the one-stage prothrombin time and the activated partial thromboplastin time. These studies demonstrated that the fluids shortened the activated partial thromboplastin time but not the prothrombin time. The use of plasmas deficient in factors V, VIII, IX, and X as substrate showed that the fluids shortened the activated partial thromboplastin time in the presence of plasmas deficient in factors VIII and IX but had no effect on the activated partial thromboplastin time in the presence of plasmas deficient in factors V and X. These data suggest that hydatidiform mole fluids possess procoagulant activity and that the activation of blood coagulation takes place at the level of factor X. These findings may have relevance to the placental and decidual focal necrosis seen in molar pregnancies, especially those of the complete variety.

Amniotic Fluid↗
PubMed1984

Human chorionic gonadotropin levels in complete and partial hydatidiform moles and in nonmolar abortuses.

The rates of regression of human chorionic gonadotropin (hCG) in patients with complete hydatidiform moles, partial hydatidiform moles, and nonmolar abortions were compared. No difference in rates of regression was found among the three groups, but levels of hCG immediately after uterine evacuation were significantly higher in the group with complete hydatidiform moles. Differences in the time required for hCG levels to become undetectable were attributed to the difference in the degree of initial elevation of hCG.

Abortion, Spontaneous↗
PubMed1984

Complete hydatidiform mole in Hawaii: an epidemiological study.

An analysis of hydatidiform moles occurring in Hawaii over a 14-year period (1968-1981) was undertaken. The pathology of all 278 reported molar pregnancies was reviewed and showed 69.4% to be complete, 24.5% to be partial, and 6.1% to be nonmolar. A case-control epidemiological investigation of the complete moles showed maternal age and race to be important, moles being significantly more prevalent in women under 20 and over 40 yr of age and also in women of Japanese, Filipino, and other Oriental ancestry. However no difference was seen in the prevalence of moles between Oriental women born in the Orient and those born and raised in Hawaii. No significant difference was found in paternal age, paternal race, socioeconomic status, or reproductive history, suggesting that these factors do not play an important role in the etiology of complete hydatidiform mole. Incidence rates for complete moles were calculated taking age and race into consideration and ranged from a high of 1 in 150 to a low of 1 in 2,000 naturally terminating pregnancies.

Adolescent↗
PubMed1984

Syndromes of hydatidiform moles. Partial vs. complete.

Comparative cytogenetic studies of hydatidiform moles delineated two separate syndromes, the classic complete mole with a diploid karyotype and the partial mole with 69 chromosomes. The two syndromes are pathologically distinct, and although they have morphologic resemblances, they differ in their biology, and no transition between them is possible. In contrast to the complete mole, no choriocarcinoma has been found in association with the partial mole.

Adult↗
PubMed1983

Morphologic anomalies in triploid liveborn fetuses.

Analysis of the morphologic features of 43 complete and 11 mosaic triploid infants delivered at or after 22 weeks of gestation revealed, in addition to well-delineated gross features, a number of new or previously little emphasized histopathologic features. These included testicular Leydig cell hyperplasia, increased levels of hematopoiesis, and ovarian, adrenal, and pulmonary hypoplasia. Some of these findings appeared to be linked to partial hydatidiform mole replacing the normal placenta, which was present in about 70 per cent of the triploid cases. It is important to recognize the breadth of the triploidy spectrum, which ranges from near normalcy to multisystem involvement, and to pay special attention to the placenta. The importance of correct morphologic diagnosis of triploidy is stressed in view of the fact that its occurrence apparently does not prejudice the future reproductive performance of the parents.

Adolescent↗
PubMed1982

Dispermic origin and clinical outcome of three complete hydatidiform moles with 46,XY karyotype.

Three new cases of complete, classic hydatidiform mole with a 46,XY karyotype are described. They originated by dispermy as demonstrated by chromosome and enzyme analyses. Levels of human chorionic gonadotropin decreased to normal spontaneously within a short time, indicating a benign course in these three cases. Of a total of 18 cases reported to data, postoperative clinical information was available for 10 patients. Two of these 10 patients had a malignant course with lung metastases. It is of theoretical and clinical importance to establish the magnitude of the risk of malignancy for hydatidiform mole with a 46,XY karyotype.

Adult↗