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This extensive article provides a complete review of the pathology of maternal mortality based on the conditions in the authors' 20 year experience (1966 to 1985) that led to maternal death. Two hundred eighty-one cases are reviewed. The term 'lesion' is used to represent abnormalities of structure or chemical function. Lesions not directly due to pregnancy may be the result of conditions already present that are enhanced by pregnancy; of disorders for which pregnancy is a minor enhancer; or of disorders that simply happen to occur in the pregnant woman. Each category of disorder is further subdivided into particular diseases, the pathology of which are described with illustrative data from case histories. Maternal death is defined as death during childbirth or immediately after the products of conception have been removed, or death up to 120 days after the placental sac, embryo, fetus, or infant is passed. In formulating this definition, the authors differ from the American College of Obstetricians and Gynecologists. The latter group has limited the definition in several ways, but the authors of this article believe that, since the contribution of pregnancy to the effects of other diseases is often not known, the best definition is one that temporally links pregnancy and death. For instance, accidents or homicides are included because psychological factors related to pregnancy could have been involved. Improvements in medical and prenatal care mean that a greater proportion of maternal deaths will occur after discharge. The perinatal mortality (infant death after the 28th gestational week or during the four weeks after delivery) for this group was 32.7 percent, three quarters of which were stillborn. Each maternal death needs careful and intensive study. Autopsies should be performed in all cases as a first step in improving the understanding of the causes of maternal death. (Consumer Summary produced by Reliance Medical Information, Inc.)

An adolescent girl with retarded development, delayed puberty, and hypergammaglobulinemia had anemia unresponsive to iron therapy that was cured when a mass of mediastinal giant lymph node hyperplasia was removed surgically. Rapid growth and development of secondary sexual characteristics occurred after operation. Follow-up studies made 20 years after operation showed compensated increased erythrocyte hemolysis and increased serum IgM. When mediastinal giant lymph node hyperplasia with abundant plasma cells is seen in childhood, there may be refractory anemia and immune disturbances. Similar giant lymph node hyperplasia without plasma cells may be found in an asymptomatic child or adult. The pertinent features of the few symptomatic cases reported are reviewed.

The slides of 233 patients included in a case-control study of estrogens and endometrial cancer were reviewed to determine how often endometrial cancer was misdiagnosed and whether patients with uterine cancer had other coexistent endometrial diseases. Reasonably close agreements were found among the original diagnoses and those of three additional reviewers (the total range of disagreements among all pathologists was from 2% to 16%). Proliferative and hyperplastic endometrium coexisted in many specimens from patients with endometrial cancer, and especially in those who had used estrogen replacement therapy. In contrast, estrogen therapy had seldom been used by patients whose cancers were not accompanied by these proliferative and hyperplastic lesions. In addition, these changes were found significantly more often in women with grade 1 cancers than grade 2 or 3 cancers. We conclude from these data that diagnostic misclassification is uncommon and that coexistent proliferative and hyperplastic lesions occur frequently, especially among women with grade 1 cancers. The data also suggest that the frequent finding of grade 1 cancer in estrogen users is due to bleeding that results from the stimulated coexistent benign proliferating endometrium.(JAMA 1981;246:1425-1427)

Of 99 patients with Crohn's disease whose rectal segment appeared normal on sigmoidoscopy, there was histologic inflammation in 45% and features characteristic of Crohn's disease in 30% of rectal biopsy specimens. Granulomas were found in 18% of patients, including 13% of those with ileitis, 13% of those with ileocolitis, and 37% of those with colitis. Eleven of the 17 granulomas were small, undemarcated microgranulomas. Rectal biopsy specimens are of value to confirm the diagnosis in Crohn's disease and to determine the state of clinical activity even when the sigmoidoscopic appearance is normal.(JAMA 237:2742-2744, 1977)