Placental Villotrophoblastic Pulmonary Emboli After Elective Abortion

Abstract

Although pulmonary trophoblastic embolism is now considered a physiologic phenomenon of normal pregnancy, this phenomenon has not been demonstrated in a living asymptomatic patient. Recently we encountered a 26-year-old woman suspected of pulmonary embolism of villotrophoblastic tissues after therapeutic abortion. Although her serum beta-hCG was low, a computed tomography scan showed multiple nodules in both lungs. Histological examination of a nodule in a lung-biopsy specimen showed granulation tissue surrounding a hemorrhagic mass within which were structures resembling degenerating chorionic villi. Immunohistochemical study on the patient's lung nodule, and a second endometrial-curettage specimen, six control endometrial and tubal specimens containing degenerating chorionic villi, and four endometrial specimens containing viable chorionic villi were performed. The patterns of immunostaining for cytokeratin, human chorionic gonadotropin, human placental lactogen, placental alkaline phosphatase, and inhibin-alpha of the chorionic villus-like structures in the lung nodule were almost identical to those in the degenerating chorionic villi, but different from those of viable villi. This is a unique case of embolism of chorionic villi and trophoblast to the lung in a living patient after therapeutic abortion.

Gestational trophoblastic neoplasia with concurrent metastasis to the mother and child: a systematic literature review

“…Trophoblastic tissue embolizing into the systemic circulation was first reported by Schmorlin in 1893 in a post-mortem study of eclamptic patients ( 34 ). There have also been isolated case reports of trophoblastic embolism during curettage or caesarean section ( 35 , 36 ). Trophoblastic pulmonary embolism is also common, predominantly in patients with difficult parturition, following manual removal of placenta, in cases of placenta praevia, preeclampsia and eclampsia and in cases of uterine tears ( 34 ).…”

Fatal massive pulmonary thromboembolism and concomitant pulmonary trophoblastic embolism associated with exaggerated placental site reaction: a case study

“…He described knots of multinucleated syncytiotrophoblast in the myometrial vessels and in the lung microcirculation. TE was then described in gestational trophoblastic diseases, after elective abortion [7] and conservative treatment of placenta accreta [8]. Garner et al [9] reported on trophoblastic pulmonary embolization in a 27-year-old woman following abdominal hysterectomy for invasive gestational trophoblastic disease (Mola destruens), with complete recovery after 72 h without long-term sequelae.…”

Acute trophoblastic pulmonary embolism during conservative treatment of placenta accreta: case report and review of literature

“…Tews et al [ 13 ] report on sudden death in a young woman following cesarean section and histological investigation revealed trophoblastic cells within the lumen of small-sized pulmonary vessels and thought that microscopic injuries during decompression punctures might have favored the deportation of trophoblastic tissue into the maternal circulation. Seiryu et al [ 17 ] report on trophoblastic PE in a young woman during the curettage procedures of 7-week gestation and thought that the trophoblastic PE was caused by direct access of trophoblastic tissues to the uterine veins draining the maternal intervillous space during the curettage procedures.…”