PLACENTA PATHOLOGY SLIDE SEMINAR

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PLACENTA PATHOLOGYSLIDE SEMINAR

• PETER G.J. NIKKELS

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Part 1 placenta pathology associated with
maturation abnormalities case 3, 8, 12, 13
and 14Part 2 infectious disease of the
placenta case 5, 6, 10 and 17Part 3 other
placenta pathology case 1, 2, 4, 7, 9, 11 and 15
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PART 1PLACENTA PATHOLOGY ASSOCIATED WITH
MATURATION ABNORMALITIES case 3, 8, 12, 13 and
14
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Case 13 (T03-7669)

• G1P0, pre-eclampsia
• Caesarean section at 28 weeks GA because of
  maternal condition
• placental weight 230 gram (normal for pregnancy
  duration), 5 white solid lesions on cut surface

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Case 13 (T03-7669)

• advanced maturation with formation of terminal
  villi
• no signs of chronic foetal hypoxia (no NRBCs)
• foetus with low normal weight (Caesarean section
  because of maternal condition)

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Case 14 (T03-9542)

• G3P2, uncomplicated obstetrical history, pregnant
  from new partner
• pre-eclampsia and severe IUGR
• Caesarean section at 28 weeks GA because of
  foetal condition
• placental weight 184 gram (weight below p10 for
  GA), lt 5 white solid lesions on cut surface

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NRBC
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Case 14 (T03-9542)

• advanced maturation with formation of terminal
  villi
• severe signs of chronic foetal hypoxia (huge
  increase of NRBCs)
• foetus with weight below p3
• NRBC increase is the consequence of anemia or
  hypoxia of at least 6-12 hours duration. It is
  the reaction to acute elevation of epo with
  premature release of NRBC.

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Case 8 (T02-17859)

• G2P1, DM type 1
• emergency CS at 38 weeks because of foetal
  condition
• placental weight 590 gram, foetal weight 4000
  gram, pH 7.00

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NRBC
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Case 8 (T02-17859)

• decreased maturation with decreased formation of
  terminal villi
• groups of immature villi and hydropic villi can
  be found
• increase of NRBCs
• other DM associated abnormalities are
  chorangiosis and fibrinoid necrosis of villous
  stroma

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Case 12 (T03-6638)

• G1P0, normal pregnancy
• spontaneous birth at 39 weeks GA
• placental weight 714 gram, foetal weight 3710
  gram

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Case 12 (T03-6638)

• decreased maturation with decreased formation of
  terminal villi
• groups of immature villi and hydropic villi can
  be found
• increase of NRBCs
• histological abnormalities in macrosomia
  comparable with DM

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Case 3 (T01-7463)

• G3P2, uncomplicated obstetrical history
• felt no foetal movements for three day, IUFD at
  37 weeks GA
• placental weight 500 gram
• no signs of foetal anemia, Kleihauer negative

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NRBC
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Case 3 (T01-7463)

• (Almost) complete absent formation of terminal
  villi
• no formation of syncytio-vascular membranes
• severe increase of NRBCs
• defective placental maturation (Stallmach et al)

Stallmach et al. Rescue by birth defective
placental maturation and late fetal mortality.
Obstet Gynecol. 2001 Apr97(4)505-9.
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PART 2infectious disease of the placentacase
5, 6, 10 and 11
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Case 5 (T02-7650)

• G1P0, severe intra-uterine growth restriction
  (symmetrical) with microcephaly and hypoplasia of
  cerebellum on ultrasound.
• Born at 39 weeks gestational age.

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Case 5 (T02-7650)

• calcification in villi, a few plasma cells
• no owls eyes
• (calcified) thrombi in a chorionic vessel
• some avascular villi
• IHC, CMV in endothelial cells
• Fe deposits and plasma cells (IgG IgM)

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• A girl was born with Apgar score 7-9
• Weight 2100 gram, 39 weeks GA
• Microcephaly, generalised epilepsy, hearing loss
• The child is alive and performing much better
  than expected
• On MRI decreased gyral pattern, cerebellar
  atrophy and periventricular white matter cysts,
  suggesting injury before 18 weeks
• the mother mentioned flu-like disease at about 13
  weeks

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• CMV
• 2 seroconversion during pregnancy
• 20-50 transmission
• CMV infection during the first half of pregnancy
  is more destructive to the foetus
• sexually transmitted disease, maternal viremia
  and passage through trophoblast results in foetal
  infection

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• fetal/neonatal disease
• hydrops foetalis, macerated stillbirth
• obstructive uropathy
• meconium peritonitis
• cerebral palsy, hearing loss
• intracranial calcifications

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Case 6 (T02-14406)

• G3P1, at 25 weeks detected severe foetal hydrops
  due to Parvo-virus infection.
• Rescue with intra-uterine blood transfusion.
• Hydrops gradually disappeared and at 39 weeks
  gestational age a healthy child was born, weight
  2990 gram.
• Placental weight 370 gram, no abnormalities on
  cut surface.

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• normal placenta for gestational age
• no villitis/intervillositis
• NRBC absent, no nuclear inclusions
• Parvo B19, 5th disease, erythema infectiosa,
• highly contagious
• 40-60 of adults have IgG antibodies
• Recovery without therapy is witnessed,
• intra-uterine transfusion therapy is rewarding
• The risk for fetal hydrops and second trimester
  abortion is relatively low

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Case 10 (T06-10358)

• G2P1, IUFD detected by ultrasound at 19 weeks GA
• measurements of the foetus normal for 17 weeks.
• No congenital anomalies.
• Placenta weight 98 gram, foetal weight 138 gram.
• Placenta showed no abnormalities on cut surface.

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CD 68
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CD 68
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Parvo IHC
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Parvo IHC
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Case 10 (T06-10358)

• Placenta with mild chronic villitis,
  intervillositis and Parvo virus infection.
• Usually no signs of inflammation are seen with a
  Parvo virus infection
• Only very few NRBC with inclusions in the
  placenta.
• Nuclear inclusions are autolysis resistant.
• In the lung many inclusions.

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Case 11 (T04-14508)

• G1P0, severe hydrocephalus and ascites detected
  at 24 weeks GA.
• Termination of pregnancy at 26 weeks.
• Placental weight 338 gram, no abnormalities on
  cut surface.

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CD68
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Brain from foetus with congenital toxoplasmosis
Renal vein trombosis
Toxoplasma in lung
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Case 11 (T04-14508)

• Congenital toxoplasmosis infection
• Toxoplasma parasites (bradyzoites) in amnion and
  very occasionally in placenta parenchym
• Chronic villitis
• Foetus with massive cerebral destruction due to
  toxoplasmosis

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Part 3other placenta pathologycase 1, 2, 4,
7, 9, 11 and 15
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Case 1 (T06-21331)

• Termination of pregnancy because of severe
  cardiac malformation and mosaic chromosome 9
• Placental weight 45 gram, no macroscopical
  abnormalities

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Case 1 (T06-21331)

• Placental parenchyma with normal maturation
• Extensive mineralisation of trophoblast basal
  membrane
• Due to decreased foeto-placental perfusion as in
  cardiac decompensation (or IUFD)

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Case 2 (T03-5714)

• G2P0, severe IUGR
• IUFD detected on ultrasound at 29 1/7 weeks
• Placental weight 80 gram
• foetal weight 325 gram

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ISH for chromosome 1
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Case 2 (T03-5714)

• Very small placenta with triploidie
• Triploidie with two maternal sets and one
  paternal set is very small without trophoblast
  hyperplasia and trophoblast pseudo-inclusions,
  triploidie with two paternal sets and one
  maternal set show partial mole

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Case 4 (T06-13255)

• G3P2, this pregnancy known with insulin dependent
  diabetes.
• Caesarean section because of suboptimal CTG at 39
  weeks GA.
• Girl born with weight 2652 gram.
• Dysmature neonate with mild dysmorphic features.
• Placental weight 575 gram, no abnormalities on
  cut surface.

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Colloidal Fe
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Case 4 (T06-13255)

• Placenta with vacuolated trophoblast and
  vacuolated Hofbauer cells
• Lysosomal storage disorder
• This pattern is caused by
• Niemann-Pick type A
• Salla disease
• Sialidosis
• mucolipodosis II (I cell disease)
• GM1 gangliosidose.

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Case 7 (T05-915)

• G1P0, IUFD at 31 weeks GA
• Severe IUGR
• felt less movement for 2 weeks
• Placental weight 243 gram, no abnormalities on
  cut surface.

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CD68
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CD3
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Case 7 (T05-915)

• Small placenta (weight below p10)
• Villitis of unknown etiology
• Signs of IUFD
• Foetus with severe IUGR, no other abnormalities
• Combination of abnormalities probably cause of
  IUFD

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Case 9 (T03-2194)

• G2P1
• IUGR and PROM at 36 weeks GA after amniocentesis
• placental weight 330 gram
• several small grey-white lesions, lt 5 of
  placental volume

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Case 9 (T03-2194)

• Mother and foetus with factor V Leiden mutation
• large groups of avascular fibrotic villi as
  result of foetal vessel thrombosis
• incidence of groups of avascular villi in
• normal placentas 2
• placentas with overcoiled cords 20
• pre-eclampsia 20-30
• macrosomia without DM 30-40

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Case 15 (T06-17225)

• G2P1, pre-eclampsia and IUGR
• Mother was born in Suriname
• Child was born at 31 6/7 weeks
• Placental weight 290 gram. lt5 white solid
  lesions on cut surface.

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Case 15 (T06-17225)

• Small placenta (weight below p10) with
  accelerated maturation
• Mother with sickle cell trait
• Sickled erythrocytes in the intervillous space,
  visible both in sickle cell anemia and sickle
  cell trait due to the low oxygen levels

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Case 17 (T06-9652)

• G2P0, severe IUGR and pre-eclampsia.
• Caesarian section at 31 weeks because of CTG
  abnormalities.
• Birth weight 620 gram.
• Placental weight 357 gram.

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Case 17 (T06-9652)

• Placenta with massive perivillous fibrin
  depositions
• Gitter infarct / maternal floor infarct
• High recurrence rate in next pregnancies
• Sometimes associates with hyperlucent bones in
  the foetus

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ENJOY YOUR PLACENTAS PETER