COVID-19 Infection and Placental Histopathology in Women Delivering at Term
BACKGROUND:- There is a paucity of data describing the effects of COVID-19, especially in asymptomatic patients, on placental pathology. Although the pathophysiology of COVID-19 is not completely understood, there is emerging evidence that it causes a severe systemic inflammatory response and results in a hypercoagulable state with widespread microthrombi. We hypothesized that it is plausible that a similar disease process may occur in the fetal-maternal unit. OBJECTIVE:- The aim of this study was to determine whether COVID-19 in term patients admitted to Labor and Delivery, including women without COVID-19 symptomatology, is associated with increased placental injury compared to a cohort of COVID-19 negative controls. STUDY DESIGN/METHODS:- This was a retrospective cohort study performed at NYU Winthrop Hospital between 3/31/2020 and 6/17/2020. During the study period all women admitted to Labor and Delivery were routinely tested for SARS-CoV-2 regardless of symptomatology. The placental histopathological findings of COVID-19 patients (n=77) who delivered a singleton gestation at term were compared to a control group of term patients without COVID-19 (n=56). Controls were excluded if they had obstetric or medical complications including fetal growth restriction, oligohydramnios, hypertension, diabetes, coagulopathy or thrombophilia. Multivariable logistic regression models were performed for variables that were significant in univariable analyses. A subgroup analysis was also performed comparing asymptomatic COVID-19 cases to negative controls. RESULTS:- In univariable analyses, COVID-19 cases were more likely to have evidence of fetal vascular malperfusion, i.e. presence of avascular villi and/or mural fibrin deposition (32.5% (25/77) vs. 3.6% (2/56), p<0.0001) and villitis of unknown etiology (20.8% (16/77) vs. 7.1% (4/56), p=0.030). These findings persisted in a subgroup analysis of asymptomatic COVID-19 cases compared to COVID-19 negative controls. In a multivariable model adjusting for maternal age, race/ethnicity, mode of delivery, preeclampsia, fetal growth restriction and oligohydramnios, the frequency of fetal vascular malperfusion abnormalities remained significantly higher in the COVID-19 group (OR= 12.63, 95% CI [2.40, 66.40]). While the frequency of villitis of unknown etiology was more than double in COVID-19 cases compared to controls, this did not reach statistical significance in a similar multivariable model (OR=2.11, 95% CI [0.50, 8.97]). All neonates of mothers with COVID-19 tested negative for SARS-CoV-2 by PCR. CONCLUSIONS:- Despite the fact that all neonates born to mothers with COVID-19 were negative for SARS-CoV-2 by PCR, we found that COVID-19 in term patients admitted to Labor and Delivery is associated with increased rates of placental histopathologic abnormalities, particularly fetal vascular malperfusion and villitis of unknown etiology. These findings appear to occur even among asymptomatic term patients.
A clinically aggressive, poorly recognized, unique, non-HPV-associated endocervical adenocarcinoma: Report of 3 cases [Meeting Abstract]
Case Presentation: We describe three cases of non-HPV-associated gastric-type mucinous endocervical adenocarcinoma in patients (ages 24, 28, and 58 years) at NYU-Winthrop. All patients presented with high-stage tumors; two patients were treated with pelvic exenteration and long-term chemotherapy, and one is receiving neoadjuvant chemotherapy. Although these are aggressive tumors, all patients are currently clinically stable. Literature Review: In the WHO 2014 classification, gastric- type mucinous endocervical adenocarcinoma (GAC) of the cervix was classified as a subtype of cervical mucinous carcinoma. Clinically, patients range from 32 to 84 years and may be asymptomatic or may present with vaginal bleeding. The cervix may be enlarged and indurated or may be normal. Often, routine Pap smears are normal, with negative HPV studies. On histologic examination, this tumor has distinctive features-abundant glandular epithelium comprising mucin-rich columnar cells, with bland basal nuclei, no significant mitotic activity, and voluminous clear cytoplasm with foamy cells. No in situ component is identified. The tumor cells are negative for p16 and HPV but contain gastric-type mucin (HIK 1083). Clinical Significance and
Conclusion(s): GAC is an aggressive tumor, often seen in young patients, characterized by advanced stage at presentation and an aggressive clinical course with unusual patterns of spread, with a propensity for peritoneal, omental, and adnexal dissemination. The 5-year disease-free survival for GAC is around 42% and about 91% for usual type endocervical adenocarcinoma. Routine Pap smears and HPV screening are not useful. With large-scale HPV vaccination programs under way, the prevalence of non-HPV-positive tumors such as GAC will increase in proportion. Therefore, awareness of the lesion, a high index of suspicion in the correct clinical context, and pathologic recognition of this morphologically subtle lesion are mandatory