Difference between revisions of "Villitis of unknown etiology"

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#redirect [[Placenta#Villitis_of_unknown_etiology]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Villitis_of_unknown_etiology_-_very_high_mag.jpg
| Width      =
| Caption    = Villitis of unknown etiology. [[H&E stain]].
| Micro      = lymphocytes in the villous stroma, no neutrophils, no significant plasma cells
| Subtypes  =
| LMDDx      = [[acute villitis]]
| Stains    =
| IHC        = lymphocytes predominantly CD8 +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[placenta]]
| Assdx      = [[IUGR]], recurrent pregnancy loss
| Syndromes  =
| Clinicalhx = +/-previous pregnancy loss
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    =
}}
'''Villitis of unknown etiology''', abbreviated '''VUE''', is rare recurrent pathology of the [[placenta]].
 
==General==
Features:<ref name=pmid17889674>{{cite journal |author=Redline RW |title=Villitis of unknown etiology: noninfectious chronic villitis in the placenta |journal=Hum. Pathol. |volume=38 |issue=10 |pages=1439–46 |year=2007 |month=October |pmid=17889674 |doi=10.1016/j.humpath.2007.05.025 |url=}}</ref>
*Usually term placenta.
*Prevalence: 5% to 15% of all placentas.
*Associated with:
**[[Intrauterine growth restriction]] (IUGR).
**Recurrent reproductive loss/adverse outcomes in subsequent pregnancies -- '''key point'''.
***Recurrence in up 37% of cases.<ref name=pmid20604650>{{cite journal |author=Feeley L, Mooney EE |title=Villitis of unknown aetiology: correlation of recurrence with clinical outcome |journal=J Obstet Gynaecol |volume=30 |issue=5 |pages=476–9 |year=2010 |pmid=20604650 |doi=10.3109/01443611003802339 |url=}}</ref>
 
Etiology:
*Unknown - as the name of the entity suggests.
**Suspected to be immune-mediated.
 
==Microscopic==
Features:<ref name=pmid17889674/>
*Lymphocytes in villous stroma - '''key feature'''.
**Usually focal/patchy.
**Lymphocytes: maternal derivation, T-lymphocytes -- mostly CD8-positive.
*+/-Intervillositis (lymphocytes between villi).
*+/-Histiocytes.
 
Notes:
*Lymphocytes are smaller and stain darker than the cells of the villi. (???)
*Neutrophils are usually absent.  A significant number of 'em is suggestive of an infectious villitis.
*Infective villitis is usu. B-cell predominant.
*'''No''' plasma cells - this suggests an infectious etiology.<ref>Sherman, C. 7 February 2011.</ref>
**Rare plasma cells may be seen in the decidua -- these can be ignored.
 
DDx:
*[[Acute villitis]].
 
===Images===
<gallery>
Image:Villitis_of_unknown_etiology_-_intermed_mag.jpg | VUE - intermed. mag. (WC)
Image:Villitis_of_unknown_etiology_-_very_high_mag.jpg | VUE - very high mag. (WC)
</gallery>
www:
*[http://jcp.bmj.com/content/61/12/1254/F6.large.jpg VUE (bmj.com)].<ref>URL: [http://jcp.bmj.com/content/61/12/1254.abstract http://jcp.bmj.com/content/61/12/1254.abstract]. Accessed on: 11 January 2011.</ref>
**[http://farm4.static.flickr.com/3501/3954021698_84a3542b43.jpg VUE (flickr.com)].<ref name=jian>URL: [http://www.flickr.com/photos/jian-hua_qiao_md/3954021698/ http://www.flickr.com/photos/jian-hua_qiao_md/3954021698/]. Accessed on: 11 January 2011.</ref>
*[http://www.flickr.com/photos/jian-hua_qiao_md/3954022678/in/photostream/ VUE (flickr.com)].<ref name=jian>URL: [http://www.flickr.com/photos/jian-hua_qiao_md/3954021698/ http://www.flickr.com/photos/jian-hua_qiao_md/3954021698/]. Accessed on: 11 January 2011.</ref>
 
==Sign out==
<pre>
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAREAN SECTION:
- FETAL MEMBRANES WITH MECONIUM-LADEN MACROPHAGES, NEGATIVE FOR CHORIOAMNIONITIS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITH:
-- FOCAL LYMPHOHISTOCYTIC VILLITIS, SEE COMMENT.
-- LARGE AVASCULAR VILLI.
-- MINUTE FOCUS OF ACUTE VILLITIS AND SMALL FOCUS OF INTERVILLITIS.
-- PLACENTAL INFARCTS, MULTIPLE, SMALL.
-- PERIVILLOUS FIBRIN DEPOSITION, MODERATE.
-- THROMBUS.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
 
COMMENT:
The change is suggestive with villitis of unknown etiology.
</pre>
==See also==
*[[Acute villitis]].
*[[TORCH infection]].
*[[Placenta]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Placenta]]

Latest revision as of 19:40, 28 January 2014

Villitis of unknown etiology
Diagnosis in short

Villitis of unknown etiology. H&E stain.
LM lymphocytes in the villous stroma, no neutrophils, no significant plasma cells
LM DDx acute villitis
IHC lymphocytes predominantly CD8 +ve
Site placenta
Associated Dx IUGR, recurrent pregnancy loss
Clinical history +/-previous pregnancy loss
Prevalence uncommon

Villitis of unknown etiology, abbreviated VUE, is rare recurrent pathology of the placenta.

General

Features:[1]

  • Usually term placenta.
  • Prevalence: 5% to 15% of all placentas.
  • Associated with:

Etiology:

  • Unknown - as the name of the entity suggests.
    • Suspected to be immune-mediated.

Microscopic

Features:[1]

  • Lymphocytes in villous stroma - key feature.
    • Usually focal/patchy.
    • Lymphocytes: maternal derivation, T-lymphocytes -- mostly CD8-positive.
  • +/-Intervillositis (lymphocytes between villi).
  • +/-Histiocytes.

Notes:

  • Lymphocytes are smaller and stain darker than the cells of the villi. (???)
  • Neutrophils are usually absent. A significant number of 'em is suggestive of an infectious villitis.
  • Infective villitis is usu. B-cell predominant.
  • No plasma cells - this suggests an infectious etiology.[3]
    • Rare plasma cells may be seen in the decidua -- these can be ignored.

DDx:

Images

  • VUE - intermed. mag. (WC)

  • VUE - very high mag. (WC)

www:

Sign out

PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAREAN SECTION:
- FETAL MEMBRANES WITH MECONIUM-LADEN MACROPHAGES, NEGATIVE FOR CHORIOAMNIONITIS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITH:
-- FOCAL LYMPHOHISTOCYTIC VILLITIS, SEE COMMENT.
-- LARGE AVASCULAR VILLI.
-- MINUTE FOCUS OF ACUTE VILLITIS AND SMALL FOCUS OF INTERVILLITIS.
-- PLACENTAL INFARCTS, MULTIPLE, SMALL.
-- PERIVILLOUS FIBRIN DEPOSITION, MODERATE.
-- THROMBUS.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.

COMMENT:
The change is suggestive with villitis of unknown etiology.

See also

References

  1. ↑ 1.0 1.1 Redline RW (October 2007). "Villitis of unknown etiology: noninfectious chronic villitis in the placenta". Hum. Pathol. 38 (10): 1439–46. doi:10.1016/j.humpath.2007.05.025. PMID 17889674.
  2. ↑ Feeley L, Mooney EE (2010). "Villitis of unknown aetiology: correlation of recurrence with clinical outcome". J Obstet Gynaecol 30 (5): 476–9. doi:10.3109/01443611003802339. PMID 20604650.
  3. ↑ Sherman, C. 7 February 2011.
  4. ↑ URL: http://jcp.bmj.com/content/61/12/1254.abstract. Accessed on: 11 January 2011.
  5. ↑ 5.0 5.1 URL: http://www.flickr.com/photos/jian-hua_qiao_md/3954021698/. Accessed on: 11 January 2011.
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