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)
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