Fetal thrombotic vasculopathy

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Fetal thrombotic vasculopathy
Diagnosis in short

Fetal thrombotic vasculopathy. H&E stain.
Synonyms fibrinous vasculosis, fibromuscular sclerosis, fetal artery stem thrombosis
LM thrombus in the fetal vasculature +/- recanalization (eosinophilic (light pink on H&E), moderately granular intravascular material (fibrin) with layering), +/-clustered fibrotic villi without blood vessels (chronic)
Site placenta
Associated Dx fetal death, cerebral palsy
Clinical history +/-prothrombotic condition in mother
Prognosis dependent on severity and underlying cause

Fetal thrombotic vasculopathy, abbreviated FTV, is characterized by thrombi in the fetus. In the context of a placenta, it is thrombi in the fetal blood vessels of the placenta.

A large number of terms are used for this including:[1] fibrinous vasculosis, fibromuscular sclerosis and fetal artery stem thrombosis.

The multitude of terms reflects the confusion about this finding and that it has numerous etiologies.[1]

General

  • May cause IUGR.
  • Associated with cerebral palsy and common in perinatal deaths.[2]
  • Mother may have a prothrombotic condition.[3]

Microscopic

Features:[2]

  • Thrombus in the fetal vasculature +/- recanalization.
    • Eosinophilic (light pink on H&E), moderately granular intravascular material (fibrin) with layering.
  • Clustered fibrotic villi without blood vessels - key feature.
    • This is a chronic change.

Images

Case 1:

  • FTV - low mag. (WC)

  • FTV - intermed. mag. (WC)

  • FTV - high mag. (WC)

  • FTV - very high mag. (WC)

Case 2:

  • FTV - low mag. (WC)

  • FTV - intermed mag. (WC)

  • FTV - intermed mag. (WC)

  • FTV - high mag. (WC)

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PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- FETAL THROMBOTIC VASCULOPATHY, SEE COMMENT.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI INCREASED PERIVILLOUS FIBRIN DEPOSITION
  AND CALCIFICATIONS.
- PLACENTAL INFARCT (1.5 CM IN MAXIMAL DIMENSION).
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.

COMMENT:
Mother and baby should be worked up for prothrombotic conditions.

See also

References

  1. ↑ 1.0 1.1 Marchetti, D.; Belviso, M.; Fulcheri, E. (Mar 2009). "A case of stillbirth: the importance of placental investigation in medico-legal practice.". Am J Forensic Med Pathol 30 (1): 64-8. doi:10.1097/PAF.0b013e318187387e. PMID 19237859.
  2. ↑ 2.0 2.1 Kraus, FT.; Acheen, VI. (Jul 1999). "Fetal thrombotic vasculopathy in the placenta: cerebral thrombi and infarcts, coagulopathies, and cerebral palsy.". Hum Pathol 30 (7): 759-69. PMID 10414494.
  3. ↑ Magnetti, F.; Bagna, R.; Botta, G.; Viano, A.; Dorati, G.; Raia, M.; Bertino, E.; Saracco, P. (Oct 2013). "Fetal Thrombotic Vasculopathy and Perinatal Thrombosis: Should all Placentas be Examined?". Am J Perinatol. doi:10.1055/s-0033-1357267. PMID 24108664.
  4. ↑ URL: http://jcp.bmj.com/content/61/12/1254.abstract. Accessed on: 12 January 2011.
  5. ↑ URL: http://gut.bmj.com/content/41/3/354.full. Accessed on: 12 January 2011.
  6. ↑ URL: http://www.womenandinfants.org/fertilityandpregnancy/current-topics-in-perinatal-pathology.cfm. Accessed on: 17 December 2012.
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