Chronic Histiocytic Intervillositis: A Placental Histopathologic Feature in Vertical Transmission of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

Introduction/Objective

Vertical transmission of severe acute respiratory syndrome associated with coronavirus-2 (SARS-CoV-2) infection has been reported as a rare occurrence. The purpose of this study is to identify any specific placental histopathologic abnormalities associated with SARS-CoV-2 infection, compare differences between mothers with symptomatic and asymptomatic coronavirus disease 2019 (COVID-19), and determine the frequency of vertical transmission.

Methods/Case Report

Placentas from mothers diagnosed with COVID-19 during pregnancy and delivered at Stony Brook University Hospital were identified. A control group of mothers with a negative COVID-19 test was selected from the same period. The frequency of histopathologic characteristics defined by the Amsterdam Placental Workshop Group Consensus was compared using chi-square tests between the following cohorts: COVID-19 positive mothers against COVID-19 negative mothers and symptomatic COVID-19 mothers against asymptomatic COVID-19 positive mothers.

Results (if a Case Study enter NA)

A retrospective study reviewed 23 placentas from mothers with COVID-19 for features of maternal vascular malperfusion, fetal vascular malperfusion, and inflammatory changes. 11 mothers displayed symptomatic COVID-19, and 12 mothers were asymptomatic. One neonate tested positive for SARS-CoV-2. No significant differences were identified in the frequency of the examined placental histopathologic characteristics between COVID-19 positive and negative mothers. The degree of COVID-19 severity did not significantly impact the frequency of examined histopathologic features. Interestingly, in the case with vertical transmission, the placenta demonstrated the only finding of chronic histiocytic intervillositis (CHI) with associated trophoblast necrosis.

Conclusion

Comparing across groups based on COVID-19 status, this study found no specific placental histopathologic features associated with maternal SARS-CoV-2 infection, regardless of symptom severity. However, in one case of vertical transmission, CHI was a unique histopathologic feature. These findings are consistent with the current literature. Further large-scale investigations are needed to establish additional patterns of specific placental histopathology, incidence and contributing factors of vertical transmission of COVID-19, and the impact of CHI in future pregnancies of affected women.

High complete response (CR) rate in patients (pts) with esophageal carcinoma (EC) undergoing neoadjuvant combination of docetaxel and cisplatin (DC) ± cetuximab(DCE) chemoradiation therapy—a retrospective analysis

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Background: EC is a highly lethal disease with 5 year survival less than 15%. Surgery offers a chance for cure in early disease. Still, fewer than 20% of pts treated with surgery alone are alive at 5 years. Neoadjuvant chemoradiation offers the theoretical advantage of increasing R0 resections and reducing early local and distal metastases which may translate into improved survival. Several clinical trials have resulted in pathologic complete response (pCR) rates of 20–30%. Methods: Newly diagnosed pts with EC Stage 2A (T3) to 4 received weekly Docetaxel (D)25–30mg/m2 and Cisplatin (C)25–30mg/m2.for 6–8 weeks concurrently with radiation, 5040 cGy in 28 fractions. Cetuximab (E) 200mg/m2 was added after it became accepted treatment in head and neck cancers. Pts were scheduled 4 - 6 weeks later for surgery followed by the same chemotherapy for total of 16 weeks of treatment. Pts were assessed for time to progression, overall survival and toxicities. Results: Fifteen pts treated in 2005–6 underwent IRB approved evaluation; 11 male and 4 female, median age of 62(range 44–78) . Four had squamous cell (SCC) and 11 adenocarcinomas. Nine pts had Stage II, 4 pts stage III and 2 pts stage IV disease. Seven pts underwent surgery, all R0 resections. Four of them had pCR, one pPR (downstaged from T3 to T1) and two pts had stable disease. An additional 3 pts had radiological and endoscopic proven CR (medically not surgical candidates) for an objective response (CR+PR) in 8 out of 15 pts (3 SCC and 5 adenoca). Five out of 9 receiving DC had an objective response while 3 of 6 receiving DCE responded. Five pts progressed prior to surgery. Grade 3/4 neutropenia occurred in 2, nausea in 3, and 1 pt experienced Grade 3 dehydration. Four patients required dose reductions by 20%. Six patients had one cycle and 2 had 3 cycles delayed by one week each. Conclusions: Neoadjuvant chemoradiation treatment with weekly Docetaxel and Cisplatin ± Cetuximab is tolerable with high rate of CRs. There was no observed difference in response with the addition of cetuximab. A Phase III study is suggested.

No significant financial relationships to disclose.

Splenic micro-anatomical localization of small lymphocytic lymphoma/chronic lymphocytic leukemia using a novel combined silver nitrate and immunoperoxidase technique

Small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) may be histologically difficult to differentiate from reactive lymphoid hyperplasia (RLH) in the spleen. Because routine hematoxylin and eosin (H&E) staining delineates splenic microanatomy poorly, we have developed a method that simultaneously stains reticulin fibers and B-lymphocytes. B3 or formalin-fixed, paraffin-embedded archival splenic tissue with diagnoses of SLL/CLL (11 cases), RLH (10 cases), and trauma (seven cases) were studied using a novel silver nitrate immunoperoxidase (SNIP) double-staining technique. Gordon and Sweet's reticulin stain was followed by immunoperoxidase staining for B-lineage marker CD20 (Dakopatts, Carpinteria, CA) using the avidin-biotin method. This allowed us to clearly localize B cells to Malpighian bodies, periarteriolar lymphoid sheaths, sinuses, or cords. Features identified by SNIP found only in SLL/CLL, but not in RLH or traumatized spleens, were trabecular infiltration (eight of 11 cases), subendothelial infiltration (seven of 11 cases), and prominent sinus involvement (seven of 11 cases). One or more of these features were seen in 10 of 11 cases of SLL/CLL. Other distinguishing features were the percentage area occupied by B-lymphocytes in each section (SLL/CLL = 74%; RLH = 46%; traumatized spleens = 36%); and mean spleen weight (SLL/CLL = 1,603 g; RLH = 287 g; traumatized spleens = 126 g). We have found the SNIP technique to be superior to traditional H&E staining in identifying B cells in the context of splenic microanatomy.

Juvenile xanthogranuloma of the tongue

Oral juvenile xanthogranuloma is a rare condition, with only 10 histologically proven cases previously described. A histologically unusual variant is reported here, diagnosis of which was aided by the use of immunohistochemical stains. Previously reported cases are reviewed, and their characteristics are tabulated and discussed.

The Occurrence of Transfer Cells in the Vascular Tissues of the Coleoptilar Node of Wheat

Wooding and Northcote (1965), Gunning, Pate, and Briarty (1968), Gunning and Pate (1969), and Pate and Gunning (1969) have drawn attention recently to the presence of cells with wall ingrowths in a number of sites in plants at which one might expect short-distance transport of considerable quantities of solutes. Gunning and Pate (1969) suggested that these cells be called "transfer cells" and surveyed their distribution in the leaves of a large sample of Angiosperms. These cells have not been found in the leaves of any grasses, and they have been demonstrated in the Gramineae only in the embryo sac of maize (Diboll 1968). In this paper, transfer cells are illustrated in the vascular tissue at the coleoptilar node in wheat, and the possible functions of these cells at this site are discussed.