Difference between revisions of "Placental infarct"

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#redirect [[Placenta#Placental_infarction]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Placental_infarct_-_low_mag.jpg
| Width      =
| Caption    = Placental infarct. [[H&E stain]].
| Synonyms  =
| Micro      = necrosis of villi (hyaline material replaces the stroma of the villi) with loss of intervillous space, increased numbers of villi with syncytial knots (adjacent to infarct), thickened trophoblastic basement membrane (below [[cytotrophoblast]]s), +/-changes seen in [[decidual vasculopathy]]
| Subtypes  =
| LMDDx      = [[perivillous fibrin deposition]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = lesion - red (early), white/grey (late)
| Grossing  =
| Site      = [[placenta]]
| Assdx      = +/-[[hypertension]]
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = dependent on size and location
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Placental infarct''' is the death of placental tissue due to a compromised blood supply.
 
It should be noted that a ''[[maternal floor infarct]]'' is '''not''' a true infarct,<ref name=Ref_TPoSP178>{{Ref TPoSP|178}}</ref> and is dealt with separately in its own article.
 
'''Placental ischemia''' can be thought of as a precursor to infarction; it redirects to this article.
 
==General==
*May be seen in conjunction with a retroplacental hematoma.
*Infarcts frequently associated with [[hypertension]].<ref>URL: [http://www.medind.nic.in/jae/t04/i1/jaet04i1p27.pdf http://www.medind.nic.in/jae/t04/i1/jaet04i1p27.pdf]. Accessed on: 16 April 2012.</ref><ref name=pmid11969346>{{Cite journal  | last1 = Becroft | first1 = DM. | last2 = Thompson | first2 = JM. | last3 = Mitchell | first3 = EA. | title = The epidemiology of placental infarction at term. | journal = Placenta | volume = 23 | issue = 4 | pages = 343-51 | month = Apr | year = 2002 | doi = 10.1053/plac.2001.0777 | PMID = 11969346 }}</ref>
*May be seen in [[fetal thrombotic vasculopathy]].
 
==Gross==
Features:<ref name=Ref_WMSP465>{{Ref WMSP|465}}</ref>
*Early - red.
*Late - white/grey.
 
===Significant infarcts===
*> 3cm --or-- central location --or-- in 1st or 2nd trimester.{{fact}}
**Small foci are accepted in term placentae - typically at periphery.
 
Images:
*[http://pathweb.uchc.edu/eatlas/gyn/681b.htm Placental infarcts (pathweb.uchc.edu)].
*[http://library.med.utah.edu/WebPath/PLACHTML/PLAC044.html Placental infarcts (med.utah.edu)].
 
==Microscopic==
Features:
#[[Necrosis]] of villi; hyaline material (acellular eosinophilic material) replaces the stroma of the villi.
#Loss of intervillous space.<ref name=Ref_WMSP465>{{Ref WMSP|465}}</ref>
#*Villi appear to be crowded.<ref>{{Ref PBoD|1109}}</ref>
#**Normal spacing is ~1x smallest villus or larger.
#***In perivillous fibrin deposition - spacing usu. larger than normal.
#Increased numbers of villi with syncytial knots. ‡
#Thickened trophoblastic basement membrane (below [[cytotrophoblast]]s).
#+/-Changes seen in decidual vasculopathy:
#*Acute atherosis (vaguely like [[atherosclerosis]]).
#**[[Fibrinoid necrosis]].
#**Vessel wall lipid deposition.
 
Note:
*‡ The normal number is dependent on the gestational age:<ref name=pmid20017638>{{Cite journal  | last1 = Loukeris | first1 = K. | last2 = Sela | first2 = R. | last3 = Baergen | first3 = RN. | title = Syncytial knots as a reflection of placental maturity: reference values for 20 to 40 weeks' gestational age. | journal = Pediatr Dev Pathol | volume = 13 | issue = 4 | pages = 305-9 | month =  | year =  | doi = 10.2350/09-08-0692-OA.1 | PMID = 20017638 }}</ref>
<center>
{| class="wikitable sortable"
! Gestational age
! Villi with knots<br> (average)
! Villi with knots<br> (range)
|-
| 40 weeks
| 29 %
| 27-36 %
|-
| 39 weeks
| 29 %
| 23-34%
|-
| 38 weeks
| 27 %
| 23-33 %
|-
| 37 weeks
| 28 %
| 24-33 %
|-
| 36 weeks
| 23 %
| 20-26 %
|-
| 35 weeks
| 22 %
| 15-32 %
|-
| 34 weeks
| 18 %
| 12-22 %
|-
| 32 weeks
| 13 %
| 10-16 %
|-
| 30 weeks
| 13 %
| 10-17 %
|-
| 26 weeks
| 11 %
| 10-13 %
|-
| 22 weeks
| 7 %
| 5-9 %
|}
</center>
 
===Images===
<gallery>
Image:Placental_infarct_-_low_mag.jpg | Placental infarct - low mag. (WC)
Image:Placental_infarct_-_intermed_mag.jpg | Placental infarct - intermed. mag. (WC)
</gallery>
www:
*[http://pathweb.uchc.edu/eatlas/gyn/1203b.htm Recent infarct (pathweb.uchc.edu)].
*[http://path.upmc.edu/cases/case75/images/micro1.jpg Placental infarct (umpmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case75/micro.html http://path.upmc.edu/cases/case75/micro.html]. Accessed on: 6 January 2011.</ref>
*[http://www.mda-sy.com/pathology/PLACHTML/PLAC024.HTM Placental infarct - necrotic villi (mda-sy.com)].
 
==Sign out==
<pre>
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI AND TWO PLACENTAL INFARCTS (0.6 CM AND
  0.4 CM IN MAXIMAL DIMENSION).
</pre>
 
===Increased syncytial knots===
<pre>
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITH FOCALLY INCREASED SYNCYTIAL KNOTS,
  AND MILD PERIVILLOUS FIBRIN DEPOSITION, OTHERWISE WITHIN NORMAL LIMITS.
</pre>
 
==See also==
*[[Placenta]].
*[[Maternal floor infarct]].
*[[Infarct]].
*[[Perivillous fibrin deposition]].
 
==References==
{{Reflist|2}}
 
[[Category:Placenta]]
[[Category:Diagnosis]]

Latest revision as of 02:46, 22 January 2014

Placental infarct
Diagnosis in short

Placental infarct. H&E stain.
LM necrosis of villi (hyaline material replaces the stroma of the villi) with loss of intervillous space, increased numbers of villi with syncytial knots (adjacent to infarct), thickened trophoblastic basement membrane (below cytotrophoblasts), +/-changes seen in decidual vasculopathy
LM DDx perivillous fibrin deposition
Gross lesion - red (early), white/grey (late)
Site placenta
Associated Dx +/-hypertension
Prognosis dependent on size and location

Placental infarct is the death of placental tissue due to a compromised blood supply.

It should be noted that a maternal floor infarct is not a true infarct,[1] and is dealt with separately in its own article.

Placental ischemia can be thought of as a precursor to infarction; it redirects to this article.

General

Gross

Features:[4]

  • Early - red.
  • Late - white/grey.

Significant infarcts

  • > 3cm --or-- central location --or-- in 1st or 2nd trimester.[citation needed]
    • Small foci are accepted in term placentae - typically at periphery.

Images:

Microscopic

Features:

  1. Necrosis of villi; hyaline material (acellular eosinophilic material) replaces the stroma of the villi.
  2. Loss of intervillous space.[4]
    • Villi appear to be crowded.[5]
      • Normal spacing is ~1x smallest villus or larger.
        • In perivillous fibrin deposition - spacing usu. larger than normal.
  3. Increased numbers of villi with syncytial knots. ‡
  4. Thickened trophoblastic basement membrane (below cytotrophoblasts).
  5. +/-Changes seen in decidual vasculopathy:

Note:

  • ‡ The normal number is dependent on the gestational age:[6]
Gestational age Villi with knots
(average) 		Villi with knots
(range)
40 weeks 29 % 27-36 %
39 weeks 29 % 23-34%
38 weeks 27 % 23-33 %
37 weeks 28 % 24-33 %
36 weeks 23 % 20-26 %
35 weeks 22 % 15-32 %
34 weeks 18 % 12-22 %
32 weeks 13 % 10-16 %
30 weeks 13 % 10-17 %
26 weeks 11 % 10-13 %
22 weeks 7 % 5-9 %

Images

  • Placental infarct - low mag. (WC)

  • Placental infarct - intermed. mag. (WC)

www:

Sign out

PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI AND TWO PLACENTAL INFARCTS (0.6 CM AND 
  0.4 CM IN MAXIMAL DIMENSION).

Increased syncytial knots

PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITH FOCALLY INCREASED SYNCYTIAL KNOTS,
  AND MILD PERIVILLOUS FIBRIN DEPOSITION, OTHERWISE WITHIN NORMAL LIMITS.

See also

References

  1. ↑ Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 178. ISBN 978-0387744858.
  2. ↑ URL: http://www.medind.nic.in/jae/t04/i1/jaet04i1p27.pdf. Accessed on: 16 April 2012.
  3. ↑ Becroft, DM.; Thompson, JM.; Mitchell, EA. (Apr 2002). "The epidemiology of placental infarction at term.". Placenta 23 (4): 343-51. doi:10.1053/plac.2001.0777. PMID 11969346.
  4. ↑ 4.0 4.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 465. ISBN 978-0781765275.
  5. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1109. ISBN 0-7216-0187-1.
  6. ↑ Loukeris, K.; Sela, R.; Baergen, RN.. "Syncytial knots as a reflection of placental maturity: reference values for 20 to 40 weeks' gestational age.". Pediatr Dev Pathol 13 (4): 305-9. doi:10.2350/09-08-0692-OA.1. PMID 20017638.
  7. ↑ URL: http://path.upmc.edu/cases/case75/micro.html. Accessed on: 6 January 2011.
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