Dr Anna Lee
Dr Rose Chami
Trained in Anatomical Pathology with Fellowship training in Perinatal and Pediatric Pathology. Based at The Hospital of Sick Children, my clinical practice involves mainly Renal and Lung Pathology, and solid tumour and soft tissue Pathology as well as Placental Pathology and General Surgical Pathology. I am the director of the Immunohistochemistry Lab at SickKids. I am also actively involved in the University of Toronto Anatomical Pathology Residency Training Program, being the coordinator and education lead for The Hospital for Sick Children Training Site.
At the end of this session participants will be able to:
1. Approach the gross and microscopic placental examination in a systematic and informative manner.
2. Identify common and rare placental lesions and understand their clinical significance.
3. Improve the completeness and the quality of placental reports.
4. Improve the management of subsequent pregnancies by identifying conditions known to have recurrence risks or which may be treatable and/or preventable.
The placenta is a commonly encountered specimen, yet most pathologists have little to no formal training in its examination. The placenta is a unique organ in that it reflects diseases that may occur in the mother and/or fetus. Its examination provides important insights into certain maternal and fetal disorders that may have significance for subsequent pregnancies. For the fetus, it reflects the inutero milieu and often gives useful insights into the diagnosis and treatment of the sick neonate. In the setting of fetal or neonatal demise, the placental exam frequently provides answers to the cause of demise thereby providing closure for the family, as well as providing useful information for the management of future pregnancies. The workshop will start with an introductory discussion of 1) when placentas should be examined (indications for placental examination), 2) how they should be examined (placental handling, transport, and grossing), and 3) how placental histology changes with gestational age.
The introduction will be followed by a presentation of the more common placental lesions with a focus on their clinical relevance, such as abnormalities of the umbilical cord, pathology of the fetal membranes (including meconium), infectious diseases, villitis of unknown etiology, maternal and fetal vascular disease, placental hematomas (e.g. abruption), and villous dysmaturity.
The workshop will conclude with a demonstration of the rare or less common, but clinically significant, placental lesions (e.g. massive perivillous fibrin deposition, and chronic histiocytic intervillositis).
The workshop will be structured around clinical scenarios in both liveborn and stillborn settings.