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Ectopic Fetal Liver Tissue in the Placenta of a Twin Pregnancy: A Case Report and Review of Literature. Case Rep Pathol 2022; 2022:1966025. [PMID: 35733647 PMCID: PMC9208982 DOI: 10.1155/2022/1966025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Ectopic liver tissue represents a rare entity and is mostly attributed to events occurring during embryogenesis. Previous case reports documented the presence of fetal liver parenchyma within temporarily developed organs during pregnancy, such as the placenta or the umbilical cord. Moreover, the terminology of these benign findings varies from “ectopic liver” to “hepatocellular adenoma-like neoplasm” or “hepatocellular adenoma”. Ancillary tests performed on these lesions have shown positive immunohistochemical staining for hepatocellular origin marker HepPar-1. Only one recent case report comprising molecular analysis showed no beta-catenin gain-of-function mutation. We report a case of ectopic liver in one placenta of a twin pregnancy, with an updated review of literature.
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2
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Abstract
Background Hepatic and adrenocortical choristomas are unusual findings in the placenta. This meta-analysis includes our own case report and 23 previously reported cases. We searched for patterns of associated placental, fetal and maternal aberrations in order to determine whether these choristomas are clinically relevant. Case report: In our case, abortion was induced due to fetal central nervous system and renal malformations. In the placenta a hepatic choristoma (<0.1 cm), thrombangiitis obliterans and a single umbilical artery were found. Results: In the literature, the majority of lesions were ≤1.0 cm (n = 21/24, 87.5%) and two hepatic choristomas manifested within chorangiomas. In a subfraction of cases, we found an association with twin/triple pregnancies (n = 6/24, 25%) and heterogeneous non-hepatic/non-adrenal malformations in fetuses (n = 4/24, 17%). Conclusion: Hepatic and adrenocortical choristomas are benign, could be based on focal epigenetic changes and might be related to chorangiomas but are not associated with a particular disease pattern or risk profile.
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Affiliation(s)
- Nora Schaumann
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Kais Hussein
- Hannover Medical School, Institute of Pathology, Hannover, Germany
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3
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Ospina-Serrano JS, Salazar-Vargas AJ, Olaya-C M. Heterotopic Adipose Tissue in the Placental Parenchyma: Case Report. Int J Surg Pathol 2021; 30:419-421. [PMID: 34761696 DOI: 10.1177/10668969211055803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Reports of heterotopic tissue in the placenta are few and mainly include liver and adrenal cells. We report on adipose tissue found in the placenta. Case report: We present the case of a microscopic finding in a 25-year-old's placenta who suffered from hypertensive disorder in pregnancy. During routine microscopic study, we observed a heterotopic, benign, circumscribed and intervillous nodule of adipose tissue. Conclusion: To our knowledge, there is no other reported case of adipocytes among chorionic villi. Why foreign tissues show up in the placenta remains unknown; however, several new theories offer explanations.
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Affiliation(s)
- Johann Sebastián Ospina-Serrano
- Department of Pathology, The Medical School, 27964Pontificia Universidad Javeriana - San Ignacio University Hospital, Bogota, Colombia.,Department of Pathology, Institute of Human Genetics, The Medical School, 173049Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogota, Colombia
| | - Ana Janeth Salazar-Vargas
- Department of Pathology, Institute of Human Genetics, The Medical School, 173049Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogota, Colombia
| | - Mercedes Olaya-C
- Department of Pathology, The Medical School, 27964Pontificia Universidad Javeriana - San Ignacio University Hospital, Bogota, Colombia.,Department of Pathology, Institute of Human Genetics, The Medical School, 173049Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogota, Colombia
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Abstract
Intraplacental hepatic nodules are extremely rare and range from incidentally identified microscopic nodules to large mass-forming lesions. We describe the case of an incidentally identified intraparenchymal hepatic nodule in the placenta from a near-term delivery of a male infant at 36 weeks gestation. Lesional cells were positive for HepPar1, focally positive for glypican3, and negative for calretinin and alpha-fetoprotein, supportive of hepatocellular origin. Fluorescence in-situ hybridization and chromosomal microarray both showed a male sex chromosome complement (XY) within the nodule, confirming the fetal origin of this nodule. We provide the first report of the confirmed fetal origin of these rare lesions, lending support to the hypothesis that placental hepatic nodules may represent an embryonal rest or residua of abnormal cell migration.
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Affiliation(s)
- Fang Bu
- 2650Nationwide Children's Hospital, Columbus, Ohio, USA.,12305The Ohio State University, Columbus, Ohio, USA
| | - Ruthann Pfau
- 12305The Ohio State University, Columbus, Ohio, USA.,The Steve and Cindy Rasmussen Institute for Genomic Medicine, 2650Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carol Deeg
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, 2650Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jeff Wobser
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, 2650Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Selene C Koo
- 2650Nationwide Children's Hospital, Columbus, Ohio, USA.,12305The Ohio State University, Columbus, Ohio, USA
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Heerema-McKenney A, Rabinowitz L, Bendon R, Bruehl F, Blank A, Pinar H. Heterotopic Nodules in the Placenta, an Immunohistochemical Re-evaluation of the Diagnosis of Adrenocortical Heterotopia. Pediatr Dev Pathol 2021; 24:27-33. [PMID: 32988294 DOI: 10.1177/1093526620953361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rare nodules of heterotopic adrenocortical and hepatic tissue are reported in the placenta. A mechanism for adrenocortical tissue in the placenta has been perplexing, while hepatic tissue is generally considered related to yolk sac primordia. The clear cell morphology of these nodules is similar to the adrenal cortex of the adult; however, the fetal adrenal gland does not usually display clear cells. METHODS We stained 9 placental nodules, histologically identical to "adrenocortical" heterotopia of the placenta, to determine whether adrenocortical differentiation could be confirmed. These cases include 3 archival cases initially diagnosed as "adrenocortical" heterotopia. RESULTS Immunohistochemical staining with steroid factor-1 (SF-1), HepPar-1, and Arginase-1 showed that these nodules of clear cells are actually hepatic (SF-1 negative, HepPar-1, and Arginase-1 positive). PAS staining suggests that glycogen accumulation is responsible for the clear cytoplasm. In contrast, a nodule of adrenocortical heterotopia near the testis and the adrenal gland from a 38-week-old neonatal autopsy case confirm SF-1 reactivity as expected. CONCLUSION We propose that adrenocortical heterotopia in the placenta is a misnomer, and that these subchorionic nodules of clear cells demonstrate hepatic differentiation.
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Affiliation(s)
- Amy Heerema-McKenney
- Division of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Laura Rabinowitz
- Division of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Bendon
- Department of Pathology, Norton Children's Hospital, Louisville, Kentucky
| | - Frido Bruehl
- Division of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alexander Blank
- Division of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Halit Pinar
- Pathology and Laboratory Medicine, Women and Infants Hospital, Brown University, Providence, Rhode Island
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6
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Şahin Ç, Taylan E, Akdemir A, Zekioglu O, Seyidova P, Ergenoglu AM. Ovarian serous cystadenoma with ectopic adrenal tissue in a 65-year-old patient: A case report. Int J Surg Case Rep 2017; 33:89-91. [PMID: 28285211 PMCID: PMC5350495 DOI: 10.1016/j.ijscr.2017.02.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 11/10/2022] Open
Abstract
A very rare case of ectopic adrenal tissue (EAT) with ovarian serous cystadenoma is presented. EATs usually disappear by age, however it can remain until old stages of life. Surgically removal of all suspicious lesions is strongly recommended.
Introduction Ectopic adrenal tissue is a very rare entity in adult females, especially in the ovary, and is generally diagnosed incidentally during surgery. Although it can present at various sites during childhood, it becomes atrophic by adulthood due to normally functioning adrenal glands. Patients are predominantly asymptomatic; however, in some cases endocrine symptoms such as hypertension and fasciotruncal obesity due to hormonal activity can be seen or neoplastic transformation can appear. Presentation of case A 65-year-old patient with progressive pelvic pain and postmenopausal vaginal bleeding was evaluated by transvaginal ultrasound, which revealed bilateral adnexal masses measuring 5 cm in size and a normal uterus with an increased endometrial thickness of 7 mm. Initially the endometrial sampling result was reported as benign. The patient underwent abdominal hysterectomy and bilateral salpingo-oophorectomy and the pathological diagnosis was again benign, with serous ovarian cystadenoma being found in both ovaries. The pathologist also reported incidental ectopic adrenal tissue on the wall of the left ovarian cystadenoma. Discussion Ectopic adrenal tissue is infrequent in female genital organs especially at older ages. Only a few cases of ovarian ectopic adrenal tissue have been reported. To the best of our knowledge the present case is the fourth report in the English literature, and is of additional importance given the patient’s age. Conclusion Ectopic adrenal tissues are generally asymptomatic and revealed incidentally during surgery; however some cases have demonstrated the risk of neoplastic transformation. Therefore, surgeons must be aware of this rare entity that bears the risk of malignancy, and should surgically remove all suspicious lesions.
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Affiliation(s)
- Çağdaş Şahin
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Enes Taylan
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.
| | - Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Osman Zekioglu
- Department of Pathology, Ege University School of Medicine, Izmir, Turkey
| | - Parvane Seyidova
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ahmet Mete Ergenoglu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
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Growth patterns of placental and paraovarian adrenocortical heterotopias are different. Case Rep Pathol 2013; 2013:205692. [PMID: 24383032 PMCID: PMC3870631 DOI: 10.1155/2013/205692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/18/2013] [Indexed: 11/25/2022] Open
Abstract
Two cases of adrenocortical heterotopia are reported. One is in a full-term placenta. The other is adjacent to the ovarian hilum of an adult. Both are incidental findings. Despite sharing similar histological and immunological features, they show different growth patterns. The literature is reviewed and adrenocortical heterotopias of different locations are compared. New hypotheses of its histogenesis are discussed.
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Abstract
Placental pathology continues to be an underutilized, undertaught, and inadequately handled surgical subspecialty. The requests for placental pathology are soaring, due partly to demands from obstetricians and to the litigious environment in which they practice, and to improved obstetrical care leading to pregnancies in medically challenging situations. Evaluation of the placenta requires a good understanding of the questions and issues concerning both the fetus/infant and the mother. Information from placental pathology can be critical in early neonatal care and in reproductive planning for the family, and it can provide risk assessment for neurologic outcome of the infant. A comfortable interaction among the obstetric staff, mothers, and pathologists often obviates need for legal intervention in unexpected pregnancy outcomes. Some critical pathologic features that involve maternal and fetal management are illustrated herein. A template for gross examination and a few critical histopathologic diagnostic features with clincopathologic correlation are included.
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Affiliation(s)
- Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02115, USA.
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Roberts DJ, Oliva E. Clinical significance of placental examination in perinatal medicine. J Matern Fetal Neonatal Med 2006; 19:255-64. [PMID: 16753764 DOI: 10.1080/14767050600676349] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Complete pathologic evaluation of the placenta provides valuable information for perinatal care for the obstetrician, neonatologist, pediatrician, and family. The histopathology of the placenta can answer specific questions about in utero insults, give insight into management of subsequent pregnancies, and provide an assessment of the newborn risk. Placental pathology has been a key litigious informant in inferring timing of insults. Despite these well known advantages of placental pathologic examination, it remains an under-utilized part of perinatal medicine. This stems from a historically under-taught part of surgical and autopsy pathology resulting in inadequate reporting. This review will focus on the utility of the placental examination for fetal and maternal well-being. This review will be restricted to singleton births.
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Affiliation(s)
- Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Matsuyama TA, Kushima M, Yamochi-Onizuka T, Ota H. Placental Yolk Sac Tumor With Divergent Endodermal Differentiation. Int J Gynecol Pathol 2004; 23:398-402. [PMID: 15381911 DOI: 10.1097/01.pgp.0000139662.05916.70] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report an intraplacental germ cell tumor that was an incidental finding in the placenta of a 34-year-old woman. On pathologic examination, the 4.0-cm tumor was well circumscribed with a thin fibrous capsule. It exhibited three major histologic patterns within a mesenchyme-like myxoid background: a primitive endodermal component, a well-differentiated enteric glandular endodermal component, and a component of fetal hepatic tissue. The primitive endodermal component, the hepatic component, and many parts of the enteric endodermal glandular component were immunoreactive for alpha-fetoprotein. We considered the lesion to be a unique example of a placental yolk sac tumor and only the second reported case of a placental yolk sac tumor.
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Affiliation(s)
- Taka-Aki Matsuyama
- Second Department of Pathology, Showa University School of Medicine, Tokyo, Japan.
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11
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De Paepe ME, Friedman RM, Poch M, Hansen K, Carr SR, Luks FI. Placental findings after laser ablation of communicating vessels in twin-to-twin transfusion syndrome. Pediatr Dev Pathol 2004; 7:159-65. [PMID: 15022066 DOI: 10.1007/s10024-003-9099-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Accepted: 11/14/2003] [Indexed: 11/28/2022]
Abstract
As laser ablation of placental vascular communications gains acceptance as treatment option for severe twin-to-twin transfusion syndrome (TTTS), pathologists are increasingly confronted with the interpretation of laser-treated placentas. We present our preliminary institutional experience with the gross and microscopic analysis of these specimens. Patients underwent selective ablation for severe TTTS (Quintero stages II to V) between 16 and 25 wk gestation and the placentas were examined between < 24 h and 19 wk postoperatively. The placental vasculature was injected with gelatin-dye mixtures. The type and number of vascular anastomoses were recorded, followed by routine histopathological analysis of the placenta. Foci of laser impact were identified in all placentas examined within 1 month after laser coagulation. Located along the recipient side of the dividing membrane, the laser-treated vessels appeared hemorrhagic and showed a characteristic abrupt interruption of dye filling after vascular injection. In placentas examined more than 1 month after intervention, the most frequent gross finding was the absence or relative paucity of intertwin anastomoses, associated with subchorionic fibrin deposition. Microscopically, laser-treated vessels showed varying degrees of necrosis, associated with focal hemorrhage, avascular villi, and fibrin deposition in the underlying parenchyma. In some cases of intrauterine fetal demise or placental disruption, no definite laser scars were identified. As expected, the number of residual anastomoses (all types) was significantly smaller in laser-treated placentas than in control monochorionic placentas (2.4 +/- 2.2 [ n = 10] vs. 6.2 +/- 3.2 [ n = 70], P < 0.01). Velamentous cord insertion was noted in 50% of cases; markedly uneven placental sharing in 60%. Detailed analysis of laser-treated placentas and clinicopathological correlation may lead to a better understanding of the pathophysiology of TTTS and continued refinement of therapeutic approaches for this often lethal condition.
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Affiliation(s)
- Monique E De Paepe
- Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA.
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12
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Abstract
Heterotopic adrenal tissue is not uncommon, especially in the urogenital system. Adrenocortical tissue in the placenta, however, is presumably very rare. To our knowledge, four cases have been published. There are several different theories to explain such a heterotopia. According to our findings, an embolic spread of adrenal precursor cells via fetal vascular shortcuts is the most likely mechanism. Apart from that hypothesis, the possibility of a monodermal teratoma as well as of an aberrant differentiation of cells of the extraembryonic mesoderm are considered in the literature.
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Affiliation(s)
- M Guschmann
- Abteilung für Paidopathologie und Plazentologie, Universitätsklinikum Charite, Virchow-Klinikum, Medizinische Fakultät der Humboldt Universität zu Berlin, Germany.
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13
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Abstract
Neoplasms of the placenta, other than trophoblastic tumors and chorangiomas, are exceedingly rare and predominantly include teratomas and metastatic maternal tumors. There has been a single case report of a hepatocellular adenoma-like neoplasm of the placenta that was characterized as most likely representing a specialized monodermal teratoma. We report a second apparent case of a hepatocellular adenoma-like lesion occurring in a preterm placenta with compelling morphologic, immunohistochemical, and ultrastructural validation of tissue hepatic in origin. It remains inconclusive that this lesion represents a neoplasm rather than a rare ectopic or heterotopic occurrence.
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Affiliation(s)
- Z Vesoulis
- Akron City Hospital, Summa Health Systems, Ohio 44309, USA
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14
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Qureshi F, Jacques SM. Adrenocortical heterotopia in the placenta. PEDIATRIC PATHOLOGY & LABORATORY MEDICINE : JOURNAL OF THE SOCIETY FOR PEDIATRIC PATHOLOGY, AFFILIATED WITH THE INTERNATIONAL PAEDIATRIC PATHOLOGY ASSOCIATION 1995; 15:51-6. [PMID: 8736597 DOI: 10.3109/15513819509026939] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report two cases of term third-trimester placentas with microscopic nodules of cells histopathologically identical to adrenocortical tissue. Adrenocortical tissue within the placenta is exceedingly rare, with only one previous case reported. We discuss the possible histogenesis of this entity.
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Affiliation(s)
- F Qureshi
- Department of Pathology, Hutzel Hospital, Detroit, Michigan 48201, USA
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Labarrere CA, Caccamo D, Telenta M, Althabe O, Gutman R. A nodule of adrenocortical tissue within a human placenta: light microscopic and immunocytochemical findings. Placenta 1984; 5:139-43. [PMID: 6237324 DOI: 10.1016/s0143-4004(84)80057-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A case of adrenocortical tissue within a human placenta is described, this being the second example of such a phenomenon. Immunocytochemistry showed that the adrenal tissue reacted positively for DHEA-S but negatively for 17-OH progesterone and cortisol. This suggests that the heterotopic adrenal tissue resembled metabolically the fetal zone of the adrenal cortex.
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