Endgames Picture quiz

An interesting pathological specimen at delivery

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2453 (Published 13 November 2008) Cite this as: BMJ 2008;337:a2453
  1. Roshen Mathew, clinical preceptor1,
  2. K S Shakuntala Devi, professor and head of department2,
  3. Ganesh Rao, assistant professor2,
  4. Sheju Thomas, resident2
  1. 1Department of General Medicine and Family Practice, Sree Siddhartha Medical College, Tumkur, India
  2. 2Department of Obstetrics and Gynaecology, Sree Siddhartha Medical College, Tumkur, India
  1. dr_mrn{at}rediffmail.com

    A 26 year old gravida 2 para 1 woman presented in the third trimester of her pregnancy. She had not had antenatal check ups, but was in good health. She had attended a first trimester scan, and said that the doctor told her she was having twins. She had a family history of twins. Her first pregnancy had resulted in a full term normal vaginal delivery.

    Routine antenatal checks all were normal. Ultrasonography showed a normally growing fetus, appropriate for dates, and a cystic flattened mass near the placenta. No blood flow to the cystic mass could be seen.

    At term she delivered a 3200 g male infant by normal vaginal delivery. After the delivery, a pathological specimen was delivered along with the remnants of the placenta. The placenta showed a calcified and nodular area on the fetal surface. Microscopic examination of the placenta showed nests of epithelioid cells and deposits of fibrin. There were no postpartum complications.

    Fig 1 Specimen delivered after the normal fetus (top) and calcified nodular surface (arrow) of the placenta (bottom)


    • 1 What is the pathological specimen in the photograph?

    • 2 What are the possible complications of the condition to the mother and fetus?

    • 3 On the basis of the results of ultrasonography, what differential diagnosis would …

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