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'''Chorionic villi''' are part of a normal [[pregnancy]].  They are derived from the conceptus, i.e. NOT maternal.  
'''Trophoblast''' is part of a normal [[pregnancy]].  Trophoblasts are derived from the conceptus, i.e. '''not''' maternal.
Part of the trophoblast forms '''chorionic villi'''.


Tumours arising from the trophoblast are dealt with in ''[[gestational trophoblastic disease]]''.
Tumours arising from the trophoblast are dealt with in ''[[gestational trophoblastic disease]]''.


==Chorionic villi 101==
=Trophoblast table=
*Maternal blood is around villi.
*Fetal blood (nucleated (fetal) [[RBC]]s) in the villi.
 
===Basic histology===
*Outer layer of villus / closer to mother : syncytiotrophoblasts.
*Inner layer of villus / closer to fetus : cytotrophoblasts.
 
==Chorionic villi 102==
*Syncytiotrophoblasts (eosinophilic cytoplasm with vacuoles (contain hCG), multiple hyperchromatic nuclei).
**Large + many irreg. or lobular hyperchromatic nuclei.
**Eosinophilic vacuolated cytoplasm (contains hCG).
**Closest to mom - covers cytotrophoblast.<ref>[http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]</ref>
*Cytotrophoblasts (polygonal shape, distinct borders, clear cytoplasm, in cords, single nucleus).
**Polygonal shaped cells in cords/masses.
**Distinct cell borders.
**Covered by syncytiobrophoblast<ref>[http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]</ref> - closer to fetus than syncytiotrophoblasts.
**Clear cytoplasm.
**Single uniform nucleus.
 
==Intermediate trophoblast==
===General===
*Abbreviated: ''IT''.
 
*Thought to be the cell of origin for:<ref name=pmid11192071>{{cite journal |author=Shih IM, Kurman RJ |title=The pathology of intermediate trophoblastic tumors and tumor-like lesions |journal=Int. J. Gynecol. Pathol. |volume=20 |issue=1 |pages=31–47 |year=2001 |month=January |pmid=11192071 |doi= |url=}}</ref>
**Exaggerated placental site (EPS).
**Placental site nodule (PSN).
**Placental site trophoblastic tumor (PSTT).
**Epithelioid trophoblastic tumor (ETT).
 
===Subtypes===
Three subtypes of IT are recognized:<ref name=pmid11192071>{{cite journal |author=Shih IM, Kurman RJ |title=The pathology of intermediate trophoblastic tumors and tumor-like lesions |journal=Int. J. Gynecol. Pathol. |volume=20 |issue=1 |pages=31–47 |year=2001 |month=January |pmid=11192071 |doi= |url=}}</ref>
#Implanation site IT.
#Villous IT.
#Chorionic-type IT.
 
===Microscopic===
Features:
*Large cells.
*Eosinophilic cytoplasm.
**May be multi-nucleated.
 
====IHC====
Features:<ref name=pmid1694585>{{cite journal |author=Yeh IT, O'Connor DM, Kurman RJ |title=Intermediate trophoblast: further immunocytochemical characterization |journal=Mod. Pathol. |volume=3 |issue=3 |pages=282–7 |year=1990 |month=May |pmid=1694585 |doi= |url=}}</ref>
*hPL (human placental lactogen) +ve.
*beta-hCG -ve.
*Keratin +ve.
*EMA +ve in 2nd & 3rd trimester.
 
Notes:
*Cytotrophoblast and syncytiotrophoblast - keratin +ve.<ref name=pmid1694585/>
 
==Age of villi==
===Young villi===
*Do not have [[blood vessel]]s.
*No syncytial knots.
 
===Old villi===
*Blood vessels present and at the periphery of villus - contain nucleated (fetal) RBCs.
*Syncytial knots.
 
==Trophoblast table==
Based on Shih ''et al.'':<ref name=pmid11192071/>
Based on Shih ''et al.'':<ref name=pmid11192071/>
{| class="wikitable"
{| class="wikitable"
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| '''Syncytiotrophoblast'''
| '''Syncytiotrophoblast'''
| '''Villous intermediate<br>trophoblast'''
| '''Villous intermediate<br>trophoblast'''
| '''Implanation site<br>intermediate trophoblast'''
| '''Implantation site<br>intermediate trophoblast'''
| '''Chorionic-type<br>intermediate trophoblast'''
| '''Chorionic-type<br>intermediate trophoblast'''
|-
|-
Line 90: Line 30:
| Cytoplasm
| Cytoplasm
| minimal, clear to granular
| minimal, clear to granular
| abundant, vacuolated
| abundant, vacuolated, basophilic (???)
| abundant & eosinophilic to clear
| abundant & eosinophilic to clear
| abundant & eosinophilic
| abundant & eosinophilic
Line 103: Line 43:
|-
|-
| Function
| Function
| stem cell
| stem cell, produces beta-hCG<ref name=pmid12242037>{{Cite journal  | last1 = Kovalevskaya | first1 = G. | last2 = Genbacev | first2 = O. | last3 = Fisher | first3 = SJ. | last4 = Caceres | first4 = E. | last5 = O'Connor | first5 = JF. | title = Trophoblast origin of hCG isoforms: cytotrophoblasts are the primary source of choriocarcinoma-like hCG. | journal = Mol Cell Endocrinol | volume = 194 | issue = 1-2 | pages = 147-55 | month = Aug | year = 2002 | doi =  | PMID = 12242037 }}</ref>
| produces hormones
| produces hormones
| ???
| ???
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|-
|-
| IHC
| IHC
| beta-hCG ???
| beta-hCG -ve (???), p63 +ve<ref name=pmid19188816>{{Cite journal  | last1 = Zhang | first1 = HJ. | last2 = Xue | first2 = WC. | last3 = Siu | first3 = MK. | last4 = Liao | first4 = XY. | last5 = Ngan | first5 = HY. | last6 = Cheung | first6 = AN. | title = P63 expression in gestational trophoblastic disease: correlation with proliferation and apoptotic dynamics. | journal = Int J Gynecol Pathol | volume = 28 | issue = 2 | pages = 172-8 | month = Mar | year = 2009 | doi = 10.1097/PGP.0b013e318189555b | PMID = 19188816 }}</ref>
| beta-hCG
| beta-hCG +ve
| ???
| p63 +ve,<ref name=pmid19188816/> PLAP +ve
| inhibin+, hPL+, beta-hCG-<ref name=pmid1694585>{{cite journal |author=Yeh IT, O'Connor DM, Kurman RJ |title=Intermediate trophoblast: further immunocytochemical characterization |journal=Mod. Pathol. |volume=3 |issue=3 |pages=282–7 |year=1990 |month=May |pmid=1694585 |doi= |url=}}</ref>
| inhibin +ve, hPL +ve, beta-hCG -ve<ref name=pmid1694585>{{cite journal |author=Yeh IT, O'Connor DM, Kurman RJ |title=Intermediate trophoblast: further immunocytochemical characterization |journal=Mod. Pathol. |volume=3 |issue=3 |pages=282–7 |year=1990 |month=May |pmid=1694585 |doi= |url=}}</ref> CD146+,<ref name=pmid10451481>{{Cite journal  | last1 = Shih | first1 = IM. | title = The role of CD146 (Mel-CAM) in biology and pathology. | journal = J Pathol | volume = 189 | issue = 1 | pages = 4-11 | month = Sep | year = 1999 | doi = 10.1002/(SICI)1096-9896(199909)189:14::AID-PATH3323.0.CO;2-P | PMID = 10451481 }}</ref> p63 -ve
| ???
| hPL +ve/-ve, p63 +ve, CD146 -ve
|-
|-
| Image
| Image
| [http://pathology2.jhu.edu/trophoblast/images/intro_sm.jpg ST (jhu.edu)]<ref name=jhu>URL: [http://pathology2.jhu.edu/trophoblast/introduction.cfm http://pathology2.jhu.edu/trophoblast/introduction.cfm]. Accessed on: 13 August 2011.</ref>
| [http://pathology2.jhu.edu/trophoblast/images/intro_sm.jpg CT (jhu.edu)]<ref name=jhu>URL: [http://pathology2.jhu.edu/trophoblast/introduction.cfm http://pathology2.jhu.edu/trophoblast/introduction.cfm]. Accessed on: 13 August 2011.</ref>
|  
|  
| [http://commons.wikimedia.org/wiki/File:Intermediate_trophoblast_-_high_mag.jpg (WC)]
|
|
|  
|-
| [http://commons.wikimedia.org/wiki/File:Intermediate_trophoblast_-_high_mag.jpg]
| Associated tumour
|
| [[Choriocarcinoma]]
| Choriocarcinoma
| ?
| [[Placental site trophoblastic tumour]]
| [[Epithelioid trophoblastic tumour]]
|-
 
|}
|}
hPL = human placental lactogen.
hPL = human placental lactogen.
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Notes:
Notes:
*Keratin is positive in all trophoblastic tissue and negative in decidual tissue.<ref name=pmid1694585/>
*Keratin is positive in all trophoblastic tissue and negative in decidual tissue.<ref name=pmid1694585/>
=Chorionic villi=
==Chorionic villi 101==
*Maternal blood is around villi.
*Fetal blood (nucleated (fetal) [[RBC]]s) in the villi.
===Basic histology===
*Syncytiotrophoblasts: outer layer of villus / closer to mother.
*Cytotrophoblasts: inner layer of villus / closer to fetus.
*Hofbauer cells: cells in the stroma of the villi, abundant bubbly cytoplasm - villus macrophages.<ref name=pmid21401637>{{Cite journal  | last1 = Tang | first1 = Z. | last2 = Abrahams | first2 = VM. | last3 = Mor | first3 = G. | last4 = Guller | first4 = S. | title = Placental Hofbauer cells and complications of pregnancy. | journal = Ann N Y Acad Sci | volume = 1221 | issue =  | pages = 103-8 | month = Mar | year = 2011 | doi = 10.1111/j.1749-6632.2010.05932.x | PMID = 21401637 }}</ref>
====Images====
<gallery>
Image: Chorionic villi - low mag.jpg | Chorionic villi - low mag. (WC)
Image: Chorionic villi - intermed mag.jpg | Chorionic villi - intermed. mag. (WC)
Image: Chorionic villi - high mag.jpg | Chorionic villi - high mag. (WC)
Image: Chorionic villi - very high mag.jpg | Chorionic villi - very high mag. - image has numerous annotations. (WC)
</gallery>
www:
*[http://courseweb.edteched.uottawa.ca/medicine-histology/english/reproduction/Placenta/Fig08Placenta.htm Placental villi - histology (uottawa.ca)].
==Chorionic villi 102==
===Syncytiotrophoblasts===
*Multiple hyperchromatic nuclei, eosinophilic cytoplasm with vacuoles (contain hCG).
**Large + many irreg. or lobular hyperchromatic nuclei.
**Eosinophilic vacuolated cytoplasm (contains hCG).
**Closest to mom - covers cytotrophoblast.<ref>[http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]</ref>
Note:
*Syncytiotrophoblasts arise from cytotrophoblasts.<ref name=pmid24595308>{{Cite journal  | last1 = Díaz | first1 = P. | last2 = Wood | first2 = AM. | last3 = Sibley | first3 = CP. | last4 = Greenwood | first4 = SL. | title = Intermediate conductance Ca2+-activated K+ channels modulate human placental trophoblast syncytialization. | journal = PLoS One | volume = 9 | issue = 3 | pages = e90961 | month =  | year = 2014 | doi = 10.1371/journal.pone.0090961 | PMID = 24595308 }}</ref>
====Images====
<gallery>
Image: Seminoma with syncytiotrophoblasts -- low mag.jpg | Syncytiotrophoblasts in seminoma - low mag.
Image: Seminoma with syncytiotrophoblasts -- intermed mag.jpg | Syncytiotrophoblasts in seminoma - intermed. mag.
Image: Seminoma with syncytiotrophoblasts -- high mag.jpg | Syncytiotrophoblasts in seminoma - high mag.
Image: Seminoma with syncytiotrophoblasts -- very high mag.jpg | Syncytiotrophoblasts in seminoma - very high mag.
</gallery>
===Cytotrophoblasts===
*Polygonal shape, distinct borders, clear cytoplasm, in cords, single nucleus.
**Polygonal shaped cells in cords/masses.
**Distinct cell borders.
**Covered by syncytiobrophoblast<ref>[http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]</ref> - closer to fetus than syncytiotrophoblasts.
**Clear cytoplasm.
**Single uniform nucleus.
==Age of villi==
===Young villi===
*Few [[blood vessel]]s, central location.
*Few syncytial knots.
===Old villi===
*Blood vessels present and at the periphery of villi.
*Syncytial knots.


==Villi and age - table==
==Villi and age - table==
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| '''Other'''
| '''Other'''
|-
|-
| First trimester
| First trimester (<13 weeks<ref name=pmid22712058>{{Cite journal  | last1 = Haggerty | first1 = CL. | last2 = Seifert | first2 = ME. | last3 = Tang | first3 = G. | last4 = Olsen | first4 = J. | last5 = Bass | first5 = DC. | last6 = Karumanchi | first6 = SA. | last7 = Ness | first7 = RB. | title = Second trimester anti-angiogenic proteins and preeclampsia. | journal = Pregnancy Hypertens | volume = 2 | issue = 2 | pages = 158-163 | month = Apr | year = 2012 | doi = 10.1016/j.preghy.2012.01.005 | PMID = 22712058 }}</ref>)
| present
| present
| both can be identified
| both can be identified
Line 144: Line 148:
|
|
|-
|-
| Second trimester
| Second trimester (>=13 weeks and <28 weeks<ref name=pmid22146095>{{Cite journal  | last1 = Grewal | first1 = E. | last2 = Kansara | first2 = S. | last3 = Kachhawa | first3 = G. | last4 = Ammini | first4 = AC. | last5 = Kriplani | first5 = A. | last6 = Aggarwal | first6 = N. | last7 = Gupta | first7 = N. | last8 = Khadgawat | first8 = R. | title = Prediction of gestational diabetes mellitus at 24 to 28 weeks of gestation by using first-trimester insulin sensitivity indices in Asian Indian subjects. | journal = Metabolism | volume = 61 | issue = 5 | pages = 715-20 | month = May | year = 2012 | doi = 10.1016/j.metabol.2011.10.009 | PMID = 22146095 }}</ref>)
| rare
| rare
| cytotrophoblast difficult to identify; syncytial knots uncommon
| cytotrophoblast difficult to identify; syncytial knots uncommon
Line 158: Line 162:
| focal calcifications
| focal calcifications
|}
|}
Notes:
*The villi size is not very helpful in differentiating second and trimester placentas.
=Intermediate trophoblast=
*Abbreviated: ''IT''.
===General===
*Thought to be the cell of origin for:<ref name=pmid11192071>{{cite journal |author=Shih IM, Kurman RJ |title=The pathology of intermediate trophoblastic tumors and tumor-like lesions |journal=Int. J. Gynecol. Pathol. |volume=20 |issue=1 |pages=31–47 |year=2001 |month=January |pmid=11192071 |doi= |url=}}</ref>
**[[Exaggerated placental site]] (EPS).
**[[Placental site nodule]] (PSN).
**[[Placental site trophoblastic tumour]] (PSTT).
**[[Epithelioid trophoblastic tumour]] (ETT).
===Subtypes===
Three subtypes of IT are recognized:<ref name=pmid11192071>{{cite journal |author=Shih IM, Kurman RJ |title=The pathology of intermediate trophoblastic tumors and tumor-like lesions |journal=Int. J. Gynecol. Pathol. |volume=20 |issue=1 |pages=31–47 |year=2001 |month=January |pmid=11192071 |doi= |url=}}</ref>
#Implanation site IT.
#Villous IT.
#Chorionic-type IT.


==See also==
===Microscopic===
Features:
*Large cells.
*Eosinophilic cytoplasm.
**May be multi-nucleated.
 
====Images====
<gallery>
Image:Intermediate trophoblast - intermed mag.jpg | IT - intermed. mag. (WC/Nephron)
Image:Intermediate trophoblast 2 - intermed mag.jpg | IT - intermed. mag. (WC/Nephron)
Image:Intermediate_trophoblast_-_high_mag.jpg | IT - high mag. (WC/Nephron)
Image:Intermediate_trophoblast_-_lmwk_-_high_mag.jpg | IT - LMWK - high mag. (WC/Nephron)
</gallery>
www:
*[http://pathology2.jhu.edu/trophoblast/introduction.cfm IT - high mag. (jhu.edu)].
 
====IHC====
Features:<ref name=pmid1694585>{{cite journal |author=Yeh IT, O'Connor DM, Kurman RJ |title=Intermediate trophoblast: further immunocytochemical characterization |journal=Mod. Pathol. |volume=3 |issue=3 |pages=282–7 |year=1990 |month=May |pmid=1694585 |doi= |url=}}</ref>
*hPL (human placental lactogen) +ve.
*beta-hCG -ve.
*Keratin +ve.
**[[CK7]] +ve.<ref name=pmid19069710>{{Cite journal  | last1 = Trenkić | first1 = M. | last2 = Basić | first2 = M. | last3 = Milentijević | first3 = M. | last4 = Petrović | first4 = A. | last5 = Zivković | first5 = V. | last6 = Lazarević | first6 = V. | title = Immunohistohemical evidences of pregnancy in uterine curettage tissue by the use of a double immunocytochemical staining technique using cytokeratin 7 and vimentin antibodies. | journal = Vojnosanit Pregl | volume = 65 | issue = 11 | pages = 810-3 | month = Nov | year = 2008 | doi =  | PMID = 19069710 }}
</ref>
*[[EMA]] +ve in 2nd & 3rd trimester.
*CD146 +ve.<ref>URL: [http://www.epitomics.com/diagnostics/product/5618 http://www.epitomics.com/diagnostics/product/5618]. Accessed on: 14 August 2011.</ref>
 
Notes:
*Cytotrophoblast and syncytiotrophoblast - keratin +ve.<ref name=pmid1694585/>
 
=See also=
*[[Endometrium]].
*[[Endometrium]].
*[[Products of conception]].
*[[Products of conception]].
*[[Ectopic pregnancy]].
*[[Ectopic pregnancy]].
*[[Choriocarcinoma]].
*[[Choriocarcinoma]].
*[[Arias-Stella reaction]] - benign atypical changes associated with chorionic tissue.


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]
=External links=
*[http://www.med.yale.edu/obgyn/kliman/placenta/articles/AJP%20Commentary.html Uteroplacental Blood Flow: The Story of Decidualization, Menstruation and Trophoblast Invasion (yale.edu)].
Michael
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