Microscopic Chorionic Pseudocysts in Placental Membranes: A Histologic Lesion of in-Utero Hypoxia

Stanek, Jerzy; Weng, Eric

doi:10.2350/06-06-0110

Cited by 7 publications

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“…17 Definitions of placental lesions used in this report are either well established 1,17,31 or defined in the author's previous publications. 6,[24][25][26][27]32 This is a retrospective study of all 1231 consecutive cases with chorangiosis and patterns of chronic hypoxic placental injury of which villous hypervascularity was a component, even if the hypervascularity did not meet the numerical criteria of chorangiosis. The cases were extracted from the placental database of all 5694 cases of more than 19 weeks pregnancy, signed by the author in years 1994-2014.…”

Section: Methodsmentioning

confidence: 99%

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Chorangiosis of Chorionic Villi: What Does It Really Mean?

Stanek

2016

Archives of Pathology &Amp; Laboratory Medicine

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Chorangiosis has been regarded as a result of low-grade placental hypoxia associated with pregnancy risk factors and abnormal outcomes. It is unknown whether these are a consequence of chorangiosis itself or of associated other placental pathology.Context.— To prove that chorangiosis itself does not portend an increased risk for pregnancy unless associated with other placental pathology.Objective.— This retrospective statistical study analyzes 1231 consecutive placentas with diffuse or focal hypervascularity of chorionic villi: 328 with preuterine pattern of chronic hypoxic placental injury (group 1), 297 with uterine type of chronic hypoxic placental injury (group 2), and 606 cases with chorangiosis (group 3) not fulfilling the inclusion criteria for groups 1 or 2.Design.— Group 2, with 33 cases of chorangiosis (11.1%), featured 10 and 11 statistically significant highest percentages of abnormal clinical and placental variables, respectively; group 3 featured the highest percentages of multiple pregnancy, the heaviest placentas, and the most common acute chorioamnionitis, fetal inflammatory response; and group 1 had the highest proportion of mild erythroblastosis of fetal blood. When comparing groups 1 and 3, 21 of 29 clinical risk factors/outcomes (72.4%) and 30 of 41 placental variables (73.2%) were more common in group 1.Results.— Presence of diffuse hypoxic patterns of placental injury adds prognostically negative significance to increased vascularity of chorionic villi. Chorangiosis without those patterns portends minimal risk for the pregnancy, and is associated with significantly fewer pregnancy risk factors, abnormal outcomes, and other placental abnormalities.Conclusions.—

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Section: Methodsmentioning

confidence: 99%

“…[24][25][26][27][28][29] Some authors express an opinion that although the presence of chorangiosis should be noted in pathology reports, both its pathogenesis and its clinical significance remain uncertain.…”

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Chorangiosis of Chorionic Villi: What Does It Really Mean?

Stanek

2016

Archives of Pathology &Amp; Laboratory Medicine

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“…22 The UH pattern is frequently associated with other placental features of uteroplacental malperfusion related to shallow, trophoblastic invasion, such as an accumulation of extra- and basal-plate myometrial fibers, and occult placenta accreta (Figure 3, F). 27,38,[48][49][50][51][52][53][54] Excessive amounts of extravillous trophoblasts must be distinguished from massive perivillous fibrin deposition/maternal floor infarction, 49 which is associated with FGR, impaired neurologic development, recurrent fetal loss, and stillbirth, 9,12,55 but not necessarily with UH. Pathogenesis of the massive, perivillous fibrin deposition is different, 9 but it can evoke fetal hypoxia by virtue of eliminating a substantial amount of functional placental parenchyma.…”

Section: Patterns Of Chronic Hypoxic Placental Injurymentioning

confidence: 99%

Hypoxic Patterns of Placental Injury: A Review

Stanek

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.—In utero hypoxia is an important cause of perinatal morbidity and mortality and can be evaluated retrospectively to explain perinatal outcomes, to assess recurrence risk in subsequent pregnancies, and to investigate for medicolegal purposes by identification of many hypoxic placental lesions. Definitions of some placental hypoxic lesions have been applied relatively liberally, and many of them are frequently underreported. Objectives.—To present a comprehensive assessment of the criteria for diagnosing acute and chronic histologic features, patterns, and lesions of placental and fetal hypoxia and to discuss clinicopathologic associations and limitations of the use thereof. The significance of lesions that have been described relatively recently and are not yet widely used, such as laminar necrosis; excessive, extravillous trophoblasts; decidual multinucleate extravillous trophoblasts; and, most important, the patterns of diffuse chronic hypoxic preuterine, uterine, and postuterine placental injury and placental maturation defect, will be discussed. Data Sources.—Literature review. Conclusions.—The placenta does not respond in a single way to hypoxia, and various placental hypoxic features should be explained within a clinical context. Because the placenta has a large reserve capacity, hypoxic lesions may not result in poor fetal condition or outcome. On the other hand, very acute, in utero, hypoxic events, followed by prompt delivery, may not be associated with placental pathology, and many poor perinatal outcomes can be explained by an etiology other than hypoxia. Nevertheless, assessment of placental hypoxic lesions is helpful for retrospective explanations of complications in pregnancy and in medicolegal investigation.

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“…4,5 A previous study revealed that MCP originating from the chorion leave (involving mostly CT and A layers) of the FMs was demonstrated to be closely related to preeclampsia (p ≤ 0.001), 6 thus early diagnosis and evaluation of the progression of MCP could be of great clinical relevance. Current diagnosis is based on ex vivo histopathologic examination of the excised tissue specimens, whose clinical value is restricted by its invasive and destructive natures.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Although the results were based on an ex vivo FM specimen study and artifacts induced by pathological preparation (e.g., formalin fixation) could potentially be misinterpreted as MCP due to their similar appearances, the interesting finding that correlates MCP with preeclampsia may provide a new perspective in clinical prediction of preeclampsia. In this respect, an endoscopic imaging technique that enables instantaneous, noninvasive, or minimally invasive "optical biopsy" would be of high clinical relevance in the diagnosis of pathological conditions of pregnancy such as preeclampsia.…”

Section: Introductionmentioning

confidence: 99%

High-resolution imaging diagnosis of human fetal membrane by three-dimensional optical coherence tomography

et al. 2011

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Abstract. Microscopic chorionic pseudocyst (MCP) arising in the chorion leave of the human fetal membrane (FM) is a clinical precursor for preeclampsia which may progress to fatal medical conditions (e.g., abortion) if left untreated. To examine the utility of three-dimensional (3D) optical coherence tomography (OCT) for noninvasive delineation of the morphology of human fetal membranes and early clinical detection of MCP, 60 human FM specimens were acquired from 10 different subjects undergoing term cesarean delivery for an ex vivo feasibility study. Our results showed that OCT was able to identify the four-layer architectures of human FMs consisting of high-scattering decidua vera (DV, average thickness d DV ≈ 92 ± 38 μm), low-scattering chorion and trophoblast (CT, d CT ≈ 150 ± 67 μm), high-scattering subepithelial amnion (A, d A ≈ 95 ± 36 μm), and low-scattering epithelium (E, d E ≈ 29 ± 8 μm). Importantly, 3D OCT was able to instantaneously detect MCPs (low scattering due to edema, fluid buildup, vasodilatation) and track (staging) their thicknesses d MCP ranging from 24 to 615 μm. It was also shown that high-frequency ultrasound was able to compliment OCT for detecting more advanced thicker MCPs (e.g., d MCP >615 μm) because of its increased imaging depth. C 2011 Society of Photo-Optical Instrumentation Engineers (SPIE).

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Microscopic Chorionic Pseudocysts in Placental Membranes: A Histologic Lesion of in-Utero Hypoxia

Cited by 7 publications

References 0 publications

Chorangiosis of Chorionic Villi: What Does It Really Mean?

Chorangiosis of Chorionic Villi: What Does It Really Mean?

Hypoxic Patterns of Placental Injury: A Review

High-resolution imaging diagnosis of human fetal membrane by three-dimensional optical coherence tomography

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