Villitis of unknown etiology
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| 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 |
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| |
| 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:
- Intrauterine growth restriction (IUGR).
- Recurrent reproductive loss/adverse outcomes in subsequent pregnancies -- key point.
- Recurrence in up 37% of cases.[2]
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:
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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
- ↑ 1.0 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.
- ↑ 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.
- ↑ Sherman, C. 7 February 2011.
- ↑ URL: http://jcp.bmj.com/content/61/12/1254.abstract. Accessed on: 11 January 2011.
- ↑ 5.0 5.1 URL: http://www.flickr.com/photos/jian-hua_qiao_md/3954021698/. Accessed on: 11 January 2011.