Faggruppe perinatalpatologi og placenta

Transkript

1 Faggruppe perinatalpatologi og placenta Aktuelt faglig nytt, Årsmøtet i Den norske Patologforening Stavanger, mars 2015 For gruppen, Borghild Roald, OUS-Ullevål

2 Gruppens sammensetning i 2014 Gitta Turowski, leder Borghild Roald Aage Erichsen Christina Vogt Karin Collet Cecilie Nordbakken Ståle Sund Hege Dirdal OUS-Ullevål, Oslo OUS-Ullevål, Oslo OUS-Ullevål, Oslo St. Olavs Hospital, Trondheim Haukeland Universitetssykehus, Bergen UNN, Tromsø Førde Sentralsjukehus, Førde SUS, Stavanger

3 Gruppens arbeid hittil (siden 2010) Harmonisering og standardisering av relevante diagnostiske prosedyrer (foster- og barneobduksjoner og placentabeskjæring og diagnostikk) Kasus-diskusjoner Histopatologisk placenta-klassifikasjon

4 Fremtidige planer - Diskutere behov for standardiserte lister med anbefalte spesialundersøkelser og immunmarkører for bedret placentadiagnostikk - Mandag 12 onsdag 14.oktober 2015 i Oslo Kurs i Perinatalpatologi inkludert placenta (med snittseminar)

5 Barnepatologirommet - OUS

6 Fotodokumentasjon

7 A new, clinically oriented, unifying and simple placental classification system 1. Placenta with normal morphology (according to gestational age) 2. Placenta with chorioamnionitis 3. Placenta with villitis and intervillositis 4. Placenta with maternal circulatory disorders 5. Placenta with fetal circulatory disorders 6. Placenta with delayed villous maturation 7. Placenta with findings, suggestive of genetic aberration 8. Placenta with implantation disorders 9. Placenta with other lesions The report should include a clinical discussion/comment Egen EP (etiologi-patogenese) kode Turowski et al. Placenta 2012

8 Maturation in placenta correlated to gestational age Villous maturation Vascular maturation Stromal maturation Branching from primary - to secondary and tertiary villi with smaller diameter Central fetal capillaries - to vasculosyncytial membranes. Arterial fibro-muscular hyperplasia in primary villi Dominant embryonic, loose stroma with Hofbauer cells - to stroma dominated by fetal capillaries in tertiary villi Fibromuscular stroma in primary villi Gestational week Villi in % Primary villi (stem villi): Reticular stroma with fetal vessels, paravascular collagen Secondary villi, immature type (immature intermediate villi): Embryonic stroma, many Hofbauer cells Secondary villi, mature type (mature intermediate villi): Cellular stroma, scattered Hofbauer cells Tertiary villi (terminal villi): Stroma with fetal capillaries dominated by vasculosyncytial membranes Turowski et al (Placenta 2012)

9 What causes placental dysfunction? What makes a plant small and with failure to thrive? H. Kliman Not enough water and sun, or There is something is wrong with the soil or plant itself

10 Placenta med uttalte maternoplacentære sirkulasjonsforstyrrelser med ferske og gamle infarkter

11 Materno-placental circulatory disturbances: Maternal vascular pathology 1. Pre-existing maternal vascular disease, i.e. essential hypertension, SLE and diabetes mellitus 2. Failure in the remodelling of maternal spiral arteries in the placental bed (pre-eclampsia / eclampsia. Acute atherosis) 3. Complicating lesions within uterine vessels, i.e.mural or occluding thrombosis, [+/- normal physiological adaptiation (remodelling)]

12 Akutt atherose Skumceller i karveggen på maternelle deciduale kar (remodellerte spiralarterier) Sees med/uten endotelial dysfunksjon og trombose Sees i preeclamptiske graviditeter, men også i normale graviditeter? Relatert til øket risiko for CVD hos mor?? Immunologisk prosess?

13 Maternal circulatory disturbances = maternal vascular (decidual) pathology Vascular stenosis: Mainly microscopic changes Acute: syncytial knots, intervillous fibrin, villous agglutinations Chronic: distal villous hypoplasia (lack of intermediate villi) Acute atherosis ± trombosis in decidual remodelled arteries Occluding thrombi: Macroscopic infarction Focal decidual necrosis: retroplacental bleeding (clinical: abruptio)

14 Akutte iskemiske forandringer i placenta og tegn til organisering / reparasjon

15 Snitt fra samme nær-termin placenta, to forskjellige cotyledon-områder

16 A new, clinically oriented, unifying and simple placental classification system 1. Placenta with normal morphology (according to gestational age) 2. Placenta with chorioamnionitis 3. Placenta with villitis and intervillositis 4. Placenta with maternal circulatory disorders 5. Placenta with fetal circulatory disorders 6. Placenta with delayed villous maturation 7. Placenta with findings, suggestive of genetic aberration 8. Placenta with implantation disorders 9. Placenta with other lesions The report should include a clinical discussion/comment Egen EP (etiologi-patogenese) kode Turowski et al. Placenta 2012

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18 CD 8 CD 3 CD 16 CD 4 Høygradig kronisk vilitt (VUE)