Anatomic Pathology/Neuropathology

A 52-year-old man presented with right-sided upper and lower extremity weakness. He was previously diagnosed with HIV infection, though he is not currently on antiretroviral therapy. Brain MRIs demonstrated a T2-hyperintense, non-enhancing lesion within the left posterior frontal lobe, in the region of the motor cortex.

He subsequently underwent a brain biopsy.

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Kathryn Eschbacher, M.D.
Resident, Anatomic Pathology/Neuropathology
Mayo Clinic
Aditya Raghunathan, M.D., M.P.H.
Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

 

Anatomic Pathology

A 37-year-old G4P1212 patient presented to labor and delivery for preterm premature rupture of membranes (PPROM) at 25 3/7 weeks gestation. Prior to presentation, the patient’s pregnancy was uncomplicated. Immediately following rupture of membranes, the patient noticed a non-malodourous milky discharge. A bacterial urine culture was negative. The patient was afebrile, but due to fetal and maternal tachycardia, there was clinical concern for acute chorioamnionitis. Prenatal steroids and latency antibiotics (gentamicin and clindamycin) were administered, and a classical cesarean section was performed.

Macroscopic and microscopic evaluation of the placenta demonstrated the following findings:

Figure 1 –Placenta, Fetal Surface
Figure 2 – Umbilical cord with numerous white-yellow plaques
Figure 3 – Umbilical cord, H&E
Figure 4 – Umbilical cord, GMS stain

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E. Heidi Cheek, M.H.S., PA(ASCP)CM
Pathologists' Assistant
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
J. Kenneth Schoolmeester, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

 

Special Coagulation

A 72-year-old man with a history of chronic atrial fibrillation on warfarin anticoagulation and a questionable history of immune-mediated heparin-induced thrombocytopenia was admitted for elective abdominal surgery. His warfarin anticoagulation was bridged with argatroban in the peri-operative period. Two days after the procedure, a DIC/ICF profile was ordered due to a fall in platelet count and hematocrit and operative site oozing. The results of the coagulation laboratory studies are shown below.

Test Result Units Reference Range
Prothrombin time (PT) 25.1 sec 10.3 – 12.8
PT 1:1 mix 14.5 sec 10.3 – 12.8
Activated partial thromboplastin time (APTT) 58 sec 26 - 36
APTT 1:1 mix 50 sec 26 - 36
Dilute Russell viper venom time (DRVVT) screen ratio 2.3 ratio 0.0 – 1.1
DRVVT mix ratio 2.0 ratio 0.0 – 1.1
DRVVT confirm ratio 0.9 ratio 0.0 – 1.1
Thrombin time (TT) 276 sec 15 - 23
Reptilase time (RT) 17 sec 14.0 – 23.9
Clauss fibrinogen 125 mg/dL 200 – 430
PT-derived fibrinogen 480 mg/dL 261 - 595
D-dimer 750 D-dimer units (DDU) 0 - 250
Soluble fibrin monomer complexes (SFMC) <8 mcg/mL 0.0 – 7.9

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Jansen Seheult, M.B., B.Ch., B.A.O.
Resident, Special Coagulation
Mayo Clinic
Nahla Heikal, M.D.
Senior Associate Consultant, Hematopathology
Mayo Clinic

 

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Michelle Odean

Michelle Odean, Editorial Assistant at Mayo Clinic Laboratories, supports internal and client-facing communications. Outside of work, she enjoys running, rock climbing, yoga, and snuggling with her two bunnies.

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