Faggruppe perinatalpatologi og
placenta
Aktuelt faglig nytt, Årsmøtet i Den norske Patologforening
Stavanger, mars 2015
For gruppen, Borghild Roald, OUS-Ullevål
Gruppens sammensetning i 2014
Gitta Turowski, leder
OUS-Ullevål, Oslo
Borghild Roald
OUS-Ullevål, Oslo
Aage Erichsen
OUS-Ullevål, Oslo
Christina Vogt
St. Olavs Hospital, Trondheim
Karin Collet
Haukeland Universitetssykehus, Bergen
Cecilie Nordbakken
UNN, Tromsø
Ståle Sund
Førde Sentralsjukehus, Førde
Hege Dirdal
SUS, Stavanger
Gruppens arbeid hittil (siden 2010)
• Harmonisering og standardisering av relevante
diagnostiske prosedyrer (foster- og
barneobduksjoner og placentabeskjæring og
diagnostikk)
• Kasus-diskusjoner
• Histopatologisk placenta-klassifikasjon
Fremtidige planer
- Diskutere behov for standardiserte lister
med anbefalte spesialundersøkelser og
immunmarkører for bedret
placentadiagnostikk
- Mandag 12 – onsdag 14.oktober 2015 i Oslo
Kurs i Perinatalpatologi inkludert placenta
(med snittseminar)
Barnepatologirommet - OUS
Fotodokumentasjon
A new, clinically oriented, unifying and
simple placental classification system
1.
2.
3.
4.
5.
6.
7.
8.
9.
Placenta with normal morphology (according to gestational age)
Placenta with chorioamnionitis
Placenta with villitis and intervillositis
Placenta with maternal circulatory disorders
Placenta with fetal circulatory disorders
Placenta with delayed villous maturation
Placenta with findings, suggestive of genetic aberration
Placenta with implantation disorders
Placenta with other lesions
The report should include a clinical discussion/comment
Egen EP (etiologi-patogenese) kode
Turowski et al. Placenta 2012
Maturation in placenta correlated to gestational age
Villous maturation
Vascular maturation
Stromal maturation
Gestational week
Villi in %
Primary villi (stem villi):
Reticular stroma with fetal vessels,
paravascular collagen
Secondary villi, immature type (immature
intermediate villi):
Embryonic stroma, many Hofbauer cells
Secondary villi, mature type (mature
intermediate villi):
Cellular stroma, scattered Hofbauer cells
Tertiary villi (terminal villi):
Stroma with fetal capillaries dominated by
vasculosyncytial membranes
Branching from primary - to secondary and tertiary
villi with smaller diameter
Central fetal capillaries - to vasculosyncytial
membranes.
Arterial fibro-muscular hyperplasia in primary villi
Dominant embryonic, loose stroma with Hofbauer
cells - to stroma dominated by fetal capillaries in
tertiary villi
Fibromuscular stroma in primary villi
16
20
24
28
32
36
40
17
13
10
9
11
10
9
54
51
32
16
10
5
1
29
35
50
56
52
47
32
0
1
8
19
27
38
58
Turowski et al (Placenta 2012)
What causes placental dysfunction?
What makes a
plant small and
with failure to
thrive?
H. Kliman
Not enough water and sun, or…
There is something is wrong with
the soil or plant itself
Placenta med uttalte maternoplacentære sirkulasjonsforstyrrelser med ferske og
gamle infarkter
Materno-placental circulatory disturbances:
Maternal vascular pathology
1. Pre-existing maternal vascular disease,
i.e. essential hypertension, SLE and diabetes mellitus
2. Failure in the remodelling of maternal spiral
arteries in the placental bed
(pre-eclampsia / eclampsia. Acute atherosis)
3. Complicating lesions within uterine vessels,
i.e.mural or occluding thrombosis, [+/- normal physiological
adaptiation (remodelling)]
Akutt atherose
•Skumceller i karveggen på
maternelle deciduale kar
(remodellerte spiralarterier)
•Sees med/uten endotelial
dysfunksjon og trombose
•Sees i preeclamptiske graviditeter,
men også i normale graviditeter
? Relatert til øket risiko for CVD hos mor?
? Immunologisk prosess ?
Maternal circulatory disturbances
= maternal vascular (decidual) pathology
Vascular stenosis: Mainly microscopic changes
Acute: syncytial knots, intervillous fibrin, villous agglutinations
Chronic: ”distal villous hypoplasia” (lack of intermediate villi)
Acute atherosis ± trombosis in decidual remodelled arteries
Occluding thrombi: Macroscopic infarction
Focal decidual necrosis: retroplacental
bleeding (clinical: abruptio)
Akutte iskemiske forandringer i placenta
– og tegn til organisering / reparasjon
Snitt fra samme nær-termin placenta, to forskjellige cotyledon-områder
A new, clinically oriented, unifying and
simple placental classification system
1.
2.
3.
4.
5.
6.
7.
8.
9.
Placenta with normal morphology (according to gestational age)
Placenta with chorioamnionitis
Placenta with villitis and intervillositis
Placenta with maternal circulatory disorders
Placenta with fetal circulatory disorders
Placenta with delayed villous maturation
Placenta with findings, suggestive of genetic aberration
Placenta with implantation disorders
Placenta with other lesions
The report should include a clinical discussion/comment
Egen EP (etiologi-patogenese) kode
Turowski et al. Placenta 2012
CD 8
CD 3
CD 16
CD 4
Høygradig kronisk vilitt (VUE)