Fibrinoid and Trophoblastic Necrosis With Massive Chronic Intervillositis: An Extreme Variant of Villitis of Unknown Etiology

Abstract

A placental lesion, characterized by fibrinoid and trophoblastic necrosis with massive infiltration of the intervillous space by mononuclear cells (massive chronic intervillositis, MCI), was observed in six cases, five with intrauterine growth retardation (IUGR) and one with sudden intrauterine fetal death. Four out of six had chronic villitis of unknown etiology (CVUE) associated with this lesion, and five had lesions of anchoring villitis. In three cases, acute atherosislike lesions in spiral arteries of parietal and/or basal decidua were observed. Massive deposits of IgM, a smaller amount of C3 and Clq, and slight deposits of IgG and IgA were found in these vessels. Neither mothers nor infants had any clinical or serological evidence of infection. Cases with MCI were compared with those having CVUE without intervillositis. Patients with MCI showed lower values of infant weight, infant length, and ponderal index than controls. However, cases with MCI group showed a higher incidence of IUGR. Placentas from the MCI group had a greater number of acute atherosislike lesions than controls. Massive chronic intervillositis may represent an extreme variant of villitis of unknown etiology. A maternal immunological aggression toward fetal tissues is proposed as pathophysiological mechanism, although a nondetermined placental infection cannot be excluded.

Antiphospholipid syndrome and other autoimmune diseases associated with chronic intervillositis

“…Limitations of the present study, like those of other similar studies [1,2,[4][5][6][7][8]10] include the small number of patients as well as its retrospective design with the possibility of recruitment bias as placental analyses are requested because of the AOO. In addition, not all placentas can be analyzed, notably placentas in patients with early abortion that may have included CIUE [15].…”

“…Chronic intervillositis is a rare pathology, initially described by Labarrere and Mullen [1], and is defined by the presence of inflammatory placental lesions limited to the intervillous space and characterized by an intervillous infiltrate of mononuclear cells (monocytes, lymphocytes, histiocytes) from maternal origin [1,2]. This infiltrate, either massive or moderate, is frequently associated with villous and intervillous fibrinoid deposition.…”

“…This infiltrate, either massive or moderate, is frequently associated with villous and intervillous fibrinoid deposition. Although an infectious origin has been reported in some cases, in particular related to malaria [3], CIUE remains primarily of unknown etiology (CIUE), and is associated with placental insufficiency and adverse perinatal outcome [early and late spontaneous abortions, intrauterine growth restriction (IUGR) or fetal death] (1,2). CIUE has also been reported to have a very high risk of recurrence in subsequent pregnancies [2,4].…”

Review of Some Causes of Stillbirth

“…Myocardial calcification or extensive reparative villitis of the placenta may suggest an enterovirus infection, but culturing the organism is difficult [144]. Massive chronic intervillositis of unknown etiology is associated with stillbirth and resembles the lesion of placental malaria that causes stillbirth in endemic areas [145][146][147][148]. Trichomonads cause giant cell pneumonitis and fetal loss in animals [149].…”

A Series of Rare Chronic Histiocytic Intervillositis Cases and its Association With Fetal Growth Restriction

“…1 Yet, the exact etiology of histiocytic intervillositis is still unknown. CHI is characterized with extensive infiltration of inflammatory mononuclear cells (monocytes, lymphocytes, histiocytes), from maternal origin, predominantly in the intervillous space of the placenta with the accumulation of non-circulating histiocytic cells.…”