Difference between revisions of "Hypertrophic decidual vasculopathy"

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#redirect [[Placenta#Hypertrophic_decidual_vasculopathy]]
'''Hypertrophic decidual vasculopathy''', also known as '''decidual vasculopathy''', is a pathology of the placenta seen in the context of (gestational) [[hypertension]].
 
==General==
*A change seen in [[hypertension]].
*Seen in [[intrauterine growth restriction]] (IUGR).
 
==Microscopic==
Features:<ref name=pmid18641412>{{Cite journal  | last1 = Roberts | first1 = DJ. | last2 = Post | first2 = MD. | title = The placenta in pre-eclampsia and intrauterine growth restriction. | journal = J Clin Pathol | volume = 61 | issue = 12 | pages = 1254-60 | month = Dec | year = 2008 | doi = 10.1136/jcp.2008.055236 | PMID = 18641412 }}</ref>
*Mild or moderate:
*#Perivascular inflammatory cells.
*#+/-Vascular [[thrombosis]].
*#Smooth muscle hypertrophy.
*#Endothelial hyperplasia.
*#*Above two lead to narrowing of the decidual spiral arteries<ref>AFIP - Placental Pathology. P.122. ISBN: 1-881041-89-1. 2004.</ref> -- '''key feature'''.
*Severe:<ref name=pmid18641412/>
*#Atherosis of maternal blood vessels.
*#*Foamy macrophages within vascular wall.
*#[[Fibrinoid necrosis]] of vessel wall (amorphous eosinophilic material vessel wall).
*Suggestive:<ref>{{Ref Placenta|339}}</ref>
**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''.<ref name=pmid12848643>{{Cite journal  | last1 = Naicker | first1 = T. | last2 = Khedun | first2 = SM. | last3 = Moodley | first3 = J. | last4 = Pijnenborg | first4 = R. | title = Quantitative analysis of trophoblast invasion in preeclampsia. | journal = Acta Obstet Gynecol Scand | volume = 82 | issue = 8 | pages = 722-9 | month = Aug | year = 2003 | doi =  | PMID = 12848643 }}</ref>
 
===Images===
<gallery>
Image:Hypertrophic_decidual_vasculopathy_intermed_mag.jpg | HDV - intermed. mag. (WC)
Image:Hypertrophic_decidual_vasculopathy_low_mag.jpg | HDV - low mag. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case75/images/micro2.jpg Atherosis (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case75.html http://path.upmc.edu/cases/case75.html]. Accessed on: 2 January 2012.</ref>
*[http://www.surgpath4u.com/caseviewer.php?case_no=490 Decidual vasculopathy (surgpath4u.com)].
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/cardio/decidualvasculopathy.html Decidual vasculopathy (brown.edu)].
 
==Sign out==
<pre>
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.
</pre>
 
===Suggestive of decidual vasculopathy===
<pre>
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.
</pre>
 
==See also==
*[[Placenta]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Placenta]]

Revision as of 07:13, 13 February 2015

Hypertrophic decidual vasculopathy, also known as decidual vasculopathy, is a pathology of the placenta seen in the context of (gestational) hypertension.

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)

www:

Sign out

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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