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.

Hypertrophic decidual vasculopathy
Diagnosis in short

Hypertrophic decidual vasculopathy. H&E stain.
Synonyms decidual vasculopathy
LM Mild or moderate: perivascular inflammatory cells, +/-vascular thrombosis, smooth muscle hypertrophy, endothelial hyperplasia; severe: atherosis of maternal blood vessels, foamy macrophages within vascular wall, fibrinoid necrosis of vessel wall
Site placenta
Associated Dx intrauterine growth restriction
Signs hypertension
Prevalence uncommon
Clin. DDx gestational hypertension, HELLP syndrome
Treatment dependent on severity

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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