S M Jacques

Detroit Medical Center, Detroit, Michigan, United States

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Publications (89)193.8 Total impact

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    ABSTRACT: Abstract Objective: Acute atherosis is characterized by subendothelial lipid-filled foam cells, fibrinoid necrosis and perivascular lymphocytic infiltration. This lesion is generally confined to non-transformed spiral arteries and is frequently observed in patients with preeclampsia. However, the frequency of acute atherosis in the great obstetrical syndrome is unknown. The purpose of this study was to determine the frequency and the topographic distribution of acute atherosis in the placentas and placental bed biopsy samples obtained from women with normal pregnancy and those affected by the great obstetrical syndromes. We also examined the relationship between acute atherosis and pregnancy outcome in patients with preeclampsia. Material and methods: A retrospective cohort study of pregnant women who delivered between July 1998 and July 2014 at Hutzel Women's Hospital/Detroit Medical Center was conducted examine 16,345 placentas. Patients were classified into the following groups: 1) uncomplicated pregnancy; 2) spontaneous preterm labor and preterm prelabor rupture of membranes (PPROM); 3) preeclampsia; 4) gestational hypertension; 5) small for gestational age; 6) chronic hypertension; 5) fetal death; 6) spontaneous abortion; and 7) others. A subset of patients had placenta bed biopsy. The incidence of acute atherosis was compared among the different groups. Results: 1) The prevalence of acute atherosis in uncomplicated pregnancies was 0.4% (29/6,961) based upon examination of nearly 7,000 placentas; 2) the frequency of acute atherosis was 10.2% (181/1,779) in preeclampsia, 9% (26/292) in fetal death, 2.5% (3/120) in midtrimester spontaneous abortion, 1.7% (22/1,298) in small for gestational age neonates, and 1.2% (23/1,841) in spontaneous preterm labor and PPROM; 3) among patients with preeclampsia, those with acute atherosis had significantly more severe disease, earlier onset, and a greater frequency of small for gestational age neonates (p < 0.05 all); 4) the lesion was more frequently observed in the decidua (parietalis or basalis) than in the decidual segment of the spiral arteries in patients with placental bed biopsies. Conclusions: Acute atherosis is rare in normal pregnancy, and occurs more frequently in patients with pregnancy complications, including preeclampsia, spontaneous preterm labor, preterm PROM, midtrimester spontaneous abortion, fetal death, and SGA.
    Journal of Maternal-Fetal and Neonatal Medicine. 10/2014;
  • hieh Malekadeli, Nadya Kazzi, Suzanne Jacques
    2014 American Academy of Pediatrics National Conference and Exhibition; 10/2014
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    ABSTRACT: Abstract Objective: Acute atherosis is a lesion of the spiral arteries characterized by fibrinoid necrosis of the vessel wall, an accumulation of fat-containing macrophages, and a mononuclear perivascular infiltrate, which can be found in patients with preeclampsia, fetal death, small-for-gestational age, spontaneous preterm labor/premature prelabor rupture of membrane, and spontaneous mid-trimester abortion. This lesion is thought to decrease blood flow to the intervillous space which may lead to other vascular lesions of the placenta. The objective of this study was to test whether there is an association between acute atherosis and placental lesions that are consistent with maternal vascular underperfusion, amniotic fluid infection, fetal vascular thrombo-occlusive disease or chronic inflammation. Material and methods: A retrospective cohort study of pregnant women who delivered between July 1998 and July 2014 at Hutzel Women's Hospital/Detroit Medical Center was conducted examine 16,457 placentas. The frequency of placenta lesions (diagnosed using the criteria of the Perinatal Section of the Society for Pediatric Pathology) was compared between pregnancies with and without acute atherosis. Results: Among 16,457 women who were enrolled, 10.2% (1,671/16,457) were excluded, leaving 14,786 women who contributed data for analysis. Among them, the prevalence of acute atherosis was 2.2% (326/14,786). Women with acute atherosis were more than six times as likely as those without to have placental lesions consistent with maternal underperfusion (adjusted odds ratio- aOR: 6.7; 95% CI 5.2-8.6). To a lesser degree, acute atherosis was also associated with greater risks of having either lesions consistent with fetal vascular thrombo-occlusive disease (aOR 1.7; 95% CI 1.2-2.3) or chronic chorioamnionitis (aOR 1.9; 95% CI 1.3-3), but not with other chronic inflammatory lesions, after adjusting for gestational age at delivery. In contrast, women with acute atherosis were 60% less likely to have lesions consistent with amniotic fluid infection, adjusting for gestational age at delivery (aOR 0.4; 95% CI 0.3-0.5). Conclusions: Acute atherosis is associated with increased risks of having placental lesions consistent with maternal vascular underperfusion, and to a lesser extent, chronic chorioamnionitis and those consistent with fetal vascular thrombo-occlusive disease.
    Journal of Maternal-Fetal and Neonatal Medicine. 09/2014;
  • Suzanne M Jacques, William J Kupsky, Faisal Qureshi
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    ABSTRACT: Abstract Objective: With advances in therapy, more neonates with severe congenital anomalies are surviving, albeit some with neurologic disorders, possibly related to antenatal low brain blood flow. This autopsy series reports antenatal brain injury in neonates expiring due to severe anomalies, and provides correlation with umbilical cord blood gas and acid-base analysis. Methods: We identified autopsies of 3(rd) trimester neonates expiring shortly following delivery due to severe anomalies or malformations. Brain injury classified as "older" included periventricular leukomalacia, gliosis, and karyorrhectic neurons, and "recent" included red neurons and reactive glial changes. Results: We identified 22 cases (9 term, 13 preterm). 16 (73%) had brain injury, including 11 with older injury. Cord arterial blood was analyzed in 17, and 6 had pH <7 or base deficit > 12 mmol/L. 4 of 5 (80%) neonates with neuronal necrosis compared to 2 of 12 (17%) without had a pH <7 or base deficit > 12 mmol/L (p=0.03). 5 of 9 (56%) neonates with white matter injury compared to 1 of 8 (13%) without had pH <7 or base deficit > 12 mmol/L (p=NS). Conclusions: Antenatal brain injury is frequent in neonates with severe congenital anomalies. Severely abnormal cord blood analysis results correlate significantly with neuronal necrosis and show a trend toward white matter injury; however, the absence of these abnormal results does not preclude the presence of brain injury.
    Journal of Maternal-Fetal and Neonatal Medicine. 08/2014;
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    ABSTRACT: Objective: To examine the association between an umbilical artery notch and fetal deterioration in monochorionic/monoamniotic (MC/MA) twins. Methods: Six MC/MA twin pregnancies were admitted at 24-28 weeks of gestation for close fetal surveillance until elective delivery at 32 weeks or earlier in the presence of signs of fetal deterioration. Ultrasound (US) examinations were performed twice weekly. The presence of cord entanglement, umbilical artery notch, abnormal Doppler parameters, a non-reassuring fetal heart rate pattern, or an abnormal fetal biophysical profile were evaluated. Results: Umbilical cord entanglement was observed on US in all pregnancies. The presence of an umbilical artery notch was noted in four out of six pregnancies and in two of them an umbilical artery notch was seen in both twins. The umbilical artery pulsatility index was normal in all fetuses. Doppler parameters of the middle cerebral artery and ductus venosus, fetal biophysical profile and fetal heart rate monitoring remained normal until delivery in all pregnancies. All neonates experienced morbidity related to prematurity; however, all were discharged home in good condition. Conclusion: The presence of an umbilical artery notch and cord entanglement, without other signs of fetal deterioration, are not indicative of an adverse perinatal outcome. © 2014 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 07/2014; · 1.90 Impact Factor
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    ABSTRACT: The lesion termed 'placental infarction hematoma' is associated with fetal death and adverse perinatal outcome. Such a lesion has been associated with a high risk of fetal death and abruption placentae. The fetal and placental hemodynamic changes associated with placental infarction hematoma have not been reported. This paper describes a case of early and severe growth restriction with preeclampsia, and progressive deterioration of the fetal and placental Doppler parameters in the presence of a placental infarction hematoma. © 2014 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 05/2014; · 1.90 Impact Factor
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    ABSTRACT: Soluble fms-like tyrosine kinase (sFlt)-1-e15a, a primate-specific sFlt-1-isoform most abundant in the human placenta in preeclampsia, can induce preeclampsia in mice. This study compared the effects of full-length human (h)sFlt-1-e15a with those of truncated mouse (m)sFlt-1(1-3) used in previous preeclampsia studies on pregnancy outcome and clinical symptoms in preeclampsia.
    PLoS ONE 01/2014; 9(11):e110867. · 3.53 Impact Factor
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    ABSTRACT: Purpose: Vitamin D deficiency remains prevalent among pregnant women despite the recommended prenatal multivitamin supplementation. Low serum levels of 25 OH D were associated with adverse pregnancy outcomes such as preeclampsia, gestational diabetes mellitus, and increased mother to child HIV transmission. The effect of vitamin D deficiency on placental inflammation in humans has not been examined. Objective: To examine the relationship between levels of vitamin D at birth and risk and /or severity of chorioamnionitis among VLBWI Methods: Serum levels of 25 OHD were determined the first day of life in a cohort of VLBWI (BW≤ 1250g) with respiratory distress. Maternal and fetal chorioamnionitis (MCA and FCA) were graded for severity (0-2) and staged (1-3) for extent (chronicity).Total 25OH vitamin D levels were determined using HPLC tandem mass spectrometry method. Infants were divided into 2 groups based on presence (chorio +) or absence (chorio -) of histological chorioamnionitis. Vitamin D status was categorized as sufficient (> 30ng/ml, insufficient (10-30 ng/ml) and deficient (< 10 ng/ml). Results : Infants in chorio + group (n=17) had similar BW but lower GA than infants in chorio - group (n=15) [mean (±SD): 754±183g vs 870±282, p=.171 and 25±1 vs 28±2 wks, respectively, p=.000). Mean(±SD) vitamin D levels among all infants was 13.93±8.11ng/ml. Fourteen out of 32 (41%) infants had vitamin D deficiency(< 10 ng/ml), and 59% of infants were vitamin D insufficient. Infants with chorioamnionitis had vitamin D levels similar to infants without chorioamnionitis (15.59±7.92 ng/ml vs 11.80±7.24 ng/ml, respectively, p=0.170). Logistic regression analysis failed to reveal an association between MCA or FCA and levels of vitamin D at birth (p=.102 and .441, respectively). Similarly, among infants with histological chorioamnionitis, there was no association between severity of MCA or FCA and vitamin D levels. Conclusion : All VLBWI had insufficient or deficient 25 OH D levels at birth. There was no stastistically significant association between levels of vitamin D on first day of life and presence and or severity of histological chorioaminionitis.
    2013 American Academy of Pediatrics National Conference and Exhibition; 10/2013
  • Suzanne M Jacques, William J Kupsky, Faisal Qureshi
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    ABSTRACT: Abstract Objective: Third trimester fetal deaths occurring in the hospital at the time of delivery are unusual. We report an autopsy series of such cases with emphasis on neuropathological injury and other lesions predating delivery. Methods: We identified autopsies performed on third trimester fetuses documented to be alive shortly before delivery, but that expired during, or very close to, time of delivery, and we correlate autopsy and placental findings. Fetuses with major congenital anomalies were excluded. Results: 10 cases were identified (6 term, 4 preterm). All were delivered by cesarean-section and had attempted resuscitation. Established or recent brain injury was identified in 9 of 10 cases, including 3 with established neuronal damage and 1 with periventricular leukomalacia. Additional autopsy findings included thymic involution in 8 (5 mild; 3 severe), myocardial infarcts in 2; intrathoracic petechiae in 5, and ascites or pleural or pericardial effusions in 6. Severe thymic involution and myocardial infarcts correlated with established brain injury. Placental lesions adaptive to decreased oxygenation (increased nucleated red blood cells or villous hypervascularity) were seen in 5 cases and correlated with established brain injury. Acute chorioamnionitis with funisitis was present in 1, and chronic inflammatory placental lesions were present in 6. Conclusions: These findings indicate brain injury predated the time period immediately before delivery in 9 of 10 fetuses, and in the fetuses with established brain injury the onset of acute illness was possibly >72 hours before delivery.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 08/2013; · 1.36 Impact Factor
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    ABSTRACT: INTRODUCTION: We found isolated or clustered trophoblasts in the chorionic connective tissue of the extraplacental membranes, and defined this novel histologic feature as the "trophoblast islands of the chorionic connective tissue" (TICCT). This study was conducted to determine the clinical significance of TICCT. METHODS: Immunohistochemistry for cytokeratin-7 was performed on the chorioamniotic membranes (N = 2155) obtained from singleton pregnancies of 1199 uncomplicated term and 956 preterm deliveries. The study groups comprised 1236 African-American and 919 Hispanic women. Gestational age ranged from 24+0 weeks to 41+6 weeks. Multiple logistic regression analysis was performed to investigate the magnitude of association between patient characteristics and the presence of TICCT. RESULTS: The likelihood of TICCT was significantly associated with advancing gestational age both in term (OR: 1.29, 95% CI: 1.16-1.45, p < 0.001) and preterm deliveries (OR: 1.19, 95% CI: 1.07-1.32, p = 0.001) . Hispanic women were less likely than African-American women to have TICCT across gestation in term (OR: 0.23, 95% CI: 0.18-0.31, p < 0.001) and preterm pregnancies (OR: 0.41, 95% CI: 0.29-0.58, p < 0.001). Women with a female fetus were significantly more likely to have TICCT than women with a male fetus, in both term (OR: 1.64, 95% CI: 1.28-2.11, p < 0.001) and preterm gestations (OR: 2.04, 95% CI: 1.46-2.85, p < 0.001). TICCT was 40% less frequent in the presence of chronic placental inflammation [term (OR: 0.60, 95% CI: 0.45-0.81, p = 0.001) and preterm gestations (OR: 0.58, 95% CI: 0.40-0.84, p = 0.003)] and in parous women at term (OR: 0.60, 95% CI: 0.44-0.81, p = 0.001). CONCLUSIONS: Our findings suggest that the duration of pregnancy, fetal sex, and parity may influence the behavior of extravillous trophoblast and placental mesenchymal cells.
    Placenta 02/2013; · 3.12 Impact Factor
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    ABSTRACT: Only a few cases of adenocarcinoma (ACA) metastatic to the female lower genital tract diagnosed on cervicovaginal Pap smear have been reported during the past several decades. Both conventional and liquid based cytology (LBC) have limited sensitivity and specificity in diagnosing metastatic disease and immunocytochemical (ICC) staining may be needed for confirming the diagnosis. We present two cases of metastatic colorectal ACA diagnosed on cervicovaginal ThinPrep (TP) Pap smears, with one confirmed by ICC staining method. Recognition of extra-uterine malignancy in the cervicovaginal cytology specimen is critical for the disease diagnosis, prognosis, and the treatment. ICC staining performed on the residual LBC specimen is an important methodology to confirm the diagnosis.
    CytoJournal 01/2013; 10:9.
  • Faisal Qureshi, Suzanne M Jacques
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2012; 31(12):2046-8. · 1.40 Impact Factor
  • Suzanne M Jacques, Faisal Qureshi
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    ABSTRACT: A case of hemangioma of the umbilical cord with an associated amnionic epithelial inclusion cyst (4.5 cm in maximum dimension), diagnosed by pathological examination at 26 weeks of gestation following in utero fetal demise, is reported. These are both uncommon lesions of the umbilical cord, and to our knowledge, have not been reported together. Prenatal ultrasound at 20 weeks of gestation had shown no fetal or placental abnormalities. The cyst formation may have been secondary to the hemangioma, possibly the result of damage to the amnion caused by the associated edema and myxomatous degeneration of Wharton's jelly.
    Fetal and pediatric pathology 09/2012; · 0.36 Impact Factor
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    ABSTRACT: Abstract We report the neuropathologic findings and clinicopathologic associations in 63 third trimester singleton stillborn fetuses. All were {greater than or equal to}28 weeks (wks) estimated gestational age (EGA) with complete autopsies including placental examination. Fetuses with chromosomal abnormalities, major congenital anomalies, and intrapartum demise were excluded. The cases were divided into those with abruption (n=12) and those with unexplained fetal demise (n=51). The latter group was then subdivided by gestational age with three subgroups (preterm 28 to <32 weeks EGA (n=16), preterm 32 to <37 weeks EGA (n=13), and term 37-41 weeks EGA (n=22). Each group was further subdivided as appropriate-for-gestational age/large-for-gestational age (AGA/LGA) or small-for-gestational age (SGA). Placental lesions were also evaluated and correlated with brain lesions. Established or recent injury involving gray or white matter was seen in 88% of the fetuses with unexplained demise versus 42% with abruption (p=0.001). The most common form of brain injury was established gray matter damage, seen in 65% of the fetuses with unexplained demise versus 25% with abruption (p=0.021), the most common pattern being established pontosubicular neuronal necrosis plus established neuronal necrosis in other sites. There was no significant difference in the frequency of brain injury between the SGA fetuses and AGA/LGA fetuses or between the unexplained stillbirth preterm and term subgroups, and no unequivocal correlation between placental lesions and brain lesions. Brain injury, most frequently established gray matter damage, is seen in the majority of stillborn infants with unexplained demise, indicating that the brain injury predates the period immediately before the death.
    Pediatric and Developmental Pathology 07/2012; · 0.86 Impact Factor
  • Diagnostic Cytopathology 01/2012; · 1.49 Impact Factor
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    ABSTRACT: Chronic chorioamnionitis is a histological manifestation of maternal anti-fetal cellular rejection. As failure of graft survival is the most catastrophic event in organ transplantation, we hypothesized that fetal death could be a consequence of maternal rejection. The aim of this study was to assess whether there is evidence of cellular and antibody-mediated rejection in fetal death. Placental histology was reviewed for the presence of chronic chorioamnionitis in unexplained preterm fetal death (n=30) and preterm live birth (n=103). Amniotic fluid CXCL10 concentrations were measured with a specific immunoassay. Chronic chorioamnionitis was more frequent in fetal death than in live birth (60.0% versus 37.9%; P<0.05) and fetal death had a higher median amniotic fluid CXCL10 concentration than live birth (2.0 versus 1.8 ng/ml, P<0.05), after adjusting for gestational age at amniocentesis. Maternal anti-human leucocyte antigen class II panel-reactive seropositivity determined by flow cytometry was higher in fetal death compared to live birth (35.7% versus 10.9%; P<0.05). Chronic chorioamnionitis is a common pathologic feature in unexplained preterm fetal death. This novel finding suggests that cellular and antibody-mediated anti-fetal rejection of the mother is associated with fetal death (graft failure) in human pregnancy.
    Histopathology 11/2011; 59(5):928-38. · 2.86 Impact Factor
  • Suzanne M Jacques, Faisal Qureshi
    International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists 07/2011; 30(4):364-5. · 2.07 Impact Factor
  • Tamar Giorgadze, Suzanne M Jacques, Faisal Qureshi
    International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists 07/2011; 30(4):398-9. · 2.07 Impact Factor
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    ABSTRACT: Small cell carcinoma (SMCC) is rarely diagnosed in urine specimens. Cytologically, this tumor is similar to pulmonary SMCC. However, clinicopathologic correlation may be required to differentiate between primary urinary bladder SMCC and metastatic SMCC from a remote primary or secondary bladder involvement by direct extension of the tumor from nearby organs (prostate, uterus, or ovary). A unique case of a rare pulmonary-type ovarian SMCC, the tumor cells of which were detected in a voided urine specimen, is described herein. A 79-year-old female presented to the urologic clinic with a history of metastatic SMCC of unknown primary with hematuria. The voided urine specimen examination revealed tumor cells cytomorphologically consistent with small cell neuroendocrine carcinoma. Following cytologic diagnosis, cystoscopic examination and bladder biopsy were performed. The histopathology revealed a widely invasive tumor with a morphology typical of SMCC. The overlying urothelium was unremarkable. By immunohistochemistry, tumor cells were found positive for neuroendocrine markers, EMA and WT-1. The morphologic and immunohistochemical features of the tumor were most consistent with urinary bladder involvement by pulmonary-type primary ovarian SMCC. It is justified to think that SMCC cell detection in urine specimens does not necessarily imply their origin from primary bladder malignancy. Performing additional studies may be prudent in order to exclude secondary involvement of the bladder in this tumor as the correct diagnosis has significant clinical implications.
    Acta cytologica 01/2011; 55(3):291-5. · 0.69 Impact Factor
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    ABSTRACT: We report 51 placentas diagnosed with eosinophilic/T-cell chorionic vasculitis (E/TCV), an unusual form of chorionic vasculitis characterized by an infiltrate composed predominantly of CD3+ T cells and eosinophils. The placentas were all 3rd trimester, with 48 (94.1%) being term. Forty-seven (92.2%) were singleton placentas, and the remaining 4 were twins. The E/TCV was limited to 1 chorionic surface vessel in 40 (78.4%) and involved 50% or less of the vessel circumference in 30 (58.8%) placentas. The inflammation faced the intervillous space in 12 (23.5%) and the amniotic cavity in 8 (15.7%) and had no distinct predominant direction in the remaining 31 (60.8%) placentas. Twelve (25.5%) placentas showed mural thrombi or intramural fibrin in association with the E/TCV. One hundred six term singleton placentas were selected as the control group, and the 47 singleton placentas with E/TCV made up the study group for comparison of demographic and histopathologic features. Villitis of unknown etiology was identified more frequently in study group placentas (20 [42.6%]) compared with control group placentas (14 [13.2%]) (P < 0.001). Vascular changes of fetal vascular thrombo-occlusive disease were identified away from the E/TCV more frequently in study group placentas (8 [17.0%]) compared with control group placentas (4 [3.8%]) (P  =  0.008). There were no significant differences in the frequencies of other placental lesions studied, including acute inflammatory lesions and lesions related to maternal underperfusion. There were no significant differences in maternal age, race, parity, birth weight, allergy history, blood type, or medication use.
    Pediatric and Developmental Pathology 11/2010; 14(3):198-205. · 0.86 Impact Factor

Publication Stats

948 Citations
193.80 Total Impact Points

Institutions

  • 1990–2014
    • Detroit Medical Center
      • Division of Pathology
      Detroit, Michigan, United States
  • 1993–2013
    • Wayne State University
      • • Department of Pathology
      • • Department of Obstetrics and Gynecology
      Detroit, Michigan, United States
  • 2003–2012
    • Harper University Hospital
      Detroit, Michigan, United States
  • 2002
    • University of Illinois at Chicago
      • Department of Pathology (Chicago)
      Chicago, IL, United States
  • 1997
    • Children's Hospital of Michigan
      Detroit, Michigan, United States
  • 1996
    • Harvard Medical School
      • Department of Pathology
      Boston, Massachusetts, United States