GPR: 2021 - Week 13

From MGH Learn Pathology

Clinical history

G3P1 w/ IVF, s/p SVD


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Fetus papyraceus
  • Rare complication of multiple gestation (1:12,000 pregnancies; 1:200 twin pregnancies)
  • Increased incidence with fertility drugs, in vitro fertilization
  • Failure to completely reabsorb dead fetus in second or third trimesters
  • Non-viable fetus compressed by growing twin to flattened, parchment-like state
  • May contain bones
  • Risks to living twin especially if monochorionic: cerebral palsy, aplasia cutis, microcephaly, hydrocephalus, DIC



Subchorionic fibrin deposition

  • Laminated white plaque, frequently roughly triangular.
  • Sharply demarcated from normal placental tissue.
  • Fresh laminated thrombus at interface between fibrin plaque and intervillous space.
  • Normal finding
  • Complete absence of fibrin has been postulated as a marker of fetal hypoactivity (Naeye 1990)



Subchorionic cyst

  • Cytotrophoblastic cysts located under fetal plate
  • Incidence of 5-7%
  • Cyst wall consists of amniotic and chorionic membranes
  • No vasculature in the cyst wall
  • Sonographically observed
  • May cause complications if involves cord insertion




  • Green brown discoloration of the cord, fetal surface and membranes
  • Membranes may be edematous or slimy
  • Fetuses can pass meconium after ~20 weeks GA
  • Stress response
  • Time of exposure impacts depth of pigment uptake into membranes
  • Dr. Vanda Torous
  • Kara Tassarini
  • Emily Schlotterbeck
  • Stefanie Flores
  • Baker VV and Doering MC. Fetus papyraceus: An unreported congenital anomaly of the surviving infant. Am J Obstet Gynecol 1982;143:234.
  • Hargitai B, Marton T, Cox PM. Best practice no 178. Examination of the human placenta. J Clin Pathol 2004; 57(8):785-92.
  • Naeye RL. The clinical significance of absent subchorionic fibrin in the placenta. Am J Clin Pathol

. 1990 Aug;94(2):196-8.

  • Raga F, Ballester MJ, Osborne NG, Bonilla-Musoles F. Subchorionic placental cyst: a cause of fetal growth retardation--ultrasound and color-flow Doppler diagnosis and follow-up. J Natl Med Assoc. 1996 May; 88(5): 285–288.

This week's Gross Pathology Roundup was presented by Soma Jobbagy, MD, PhD on Mon, Mar 29, 2021.