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

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:

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

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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. 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.
  2. 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.
  3. Sherman, C. 7 February 2011.
  4. URL: http://jcp.bmj.com/content/61/12/1254.abstract. Accessed on: 11 January 2011.
  5. 5.0 5.1 URL: http://www.flickr.com/photos/jian-hua_qiao_md/3954021698/. Accessed on: 11 January 2011.