Hypertrophic decidual vasculopathy

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Hypertrophic decidual vasculopathy, also known as decidual vasculopathy, is a pathology of the placenta seen in the context of (gestational) hypertension.

General

Microscopic

Features:[1]

  • Mild or moderate:
    1. Perivascular inflammatory cells.
    2. +/-Vascular thrombosis.
    3. Smooth muscle hypertrophy.
    4. Endothelial hyperplasia.
      • Above two lead to narrowing of the decidual spiral arteries[2] -- key feature.
  • Severe:[1]
    1. Atherosis of maternal blood vessels.
      • Foamy macrophages within vascular wall.
    2. Fibrinoid necrosis of vessel wall (amorphous eosinophilic material vessel wall).
  • Suggestive:[3]
    • Decidual vasculitis - lymphocyte predominant without plasma cells.

Note:

  • Smooth muscle hypertrophy can also be understood as lack of physiological conversion of spiral arteries of the uterus.[4]

Images

  • HDV - intermed. mag. (WC)

  • HDV - low mag. (WC)

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PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAREAN SECTION:
- DECIDUAL VASCULOPATHY.
- PLACENTA SMALL FOR GESTATIONAL AGE (222 GRAMS).
- PLACENTAL DISC WITH EARLY THIRD TRIMESTER VILLI WITH:
-- MULTIPLE PLACENTAL INFARCTS.
-- PERIVILLOUS FIBRIN DEPOSITION.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.

COMMENT:
The 10th percentile placental mass (pre-fixation) for 32 weeks and 6 
days is approximately 247 grams.

Suggestive of decidual vasculopathy

PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAREAN SECTION:
- CHANGES SUGGESTIVE OF DECIDUAL VASCULOPATHY (DECIDUAL VASCULITIS).
- PLACENTAL DISC WITH EARLY THIRD TRIMESTER VILLI AND A PLACENTAL INFARCT
  (2.5 CM IN MAXIMAL DIMENSION).
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.

See also

References

  1. ↑ 1.0 1.1 Roberts, DJ.; Post, MD. (Dec 2008). "The placenta in pre-eclampsia and intrauterine growth restriction.". J Clin Pathol 61 (12): 1254-60. doi:10.1136/jcp.2008.055236. PMID 18641412.
  2. ↑ AFIP - Placental Pathology. P.122. ISBN: 1-881041-89-1. 2004.
  3. ↑ Baergen, Rebecca N. (2011). Manual of Pathology of the Human Placenta (2nd ed.). Springer. pp. 339. ISBN 978-1441974938.
  4. ↑ Naicker, T.; Khedun, SM.; Moodley, J.; Pijnenborg, R. (Aug 2003). "Quantitative analysis of trophoblast invasion in preeclampsia.". Acta Obstet Gynecol Scand 82 (8): 722-9. PMID 12848643.
  5. ↑ URL: http://path.upmc.edu/cases/case75.html. Accessed on: 2 January 2012.
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