Journal of Pathology and Translational Medicine

Original Articles

Placental Lesions in Meconium Aspiration Syndrome: Binnari Kim, Soo-young Oh, Jung-Sun Kim; J Pathol Transl Med. 2017;51(5):488-498. Published online August 9, 2017; DOI: https://doi.org/10.4132/jptm.2017.07.20

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Background
Meconium aspiration syndrome (MAS) is defined by respiratory distress requiring supplemental oxygen in a meconium-stained neonate. MAS is clinically subclassified as mild, moderate, and severe according to the oxygen requirement. The aims of this study were to compare the histological findings in the placentas of MAS neonates with those of meconium-stained but non-MAS neonates and to analyze the correlation between the severity of MAS and the grade of its histological parameters. Methods: We collected 160 singleton term placentas from neonates with meconium staining at birth from a tertiary medical center, Seoul, Republic of Korea. We reviewed hematoxylin and eosin sections of tissue samples (full-thickness placental disc, chorioamniotic membranes, and umbilical cord). Results: Funisitis was present more frequently in MAS than in non-MAS (p < .01), of which the stage was correlated with the severity of MAS (p < .001). The histological findings consistent with maternal underperfusion and chronic deciduitis were more frequent in MAS than in non-MAS (p < .05). There was a correlation between the degree of chorionic vascular muscle necrosis and the severity of MAS (p < .05). Conclusions: Our results suggest that fetal inflammatory response evidenced by funisitis occurs prenatally in MAS and that the stage of funisitis and of chorionic vascular muscle necrosis may be a predictive marker of the severity of MAS.

Citations

Citations to this article as recorded by

Impact of meconium-stained amniotic fluid thickness on maternal infectious morbidity: a comprehensive clinical and microbiological analysis
Raneen Abu Shqara, Lior Lowenstein, Maya Frank Wolf
Archives of Gynecology and Obstetrics.2024; 312(1): 59. CrossRef
Machine learning‐based placental clusters and their associations with adverse pregnancy outcomes
Julie M. Petersen, Samantha E. Parker, Kimberly A. Dukes, Jennifer A. Hutcheon, Katherine A. Ahrens, Martha M. Werler
Paediatric and Perinatal Epidemiology.2023; 37(4): 350. CrossRef
The risk of meconium aspiration syndrome (MAS) increases with gestational age at term
Clara Ward, Aaron B. Caughey
The Journal of Maternal-Fetal & Neonatal Medicine.2022; 35(1): 155. CrossRef
Protective placental inflammatory and oxidative stress responses are attenuated in the context of twin pregnancy and chorioamnionitis in assisted reproduction
Hayley R. Price, Nick Pang, Hugh Kim, Michael W. H. Coughtrie, Abby C. Collier
Journal of Assisted Reproduction and Genetics.2022; 39(1): 227. CrossRef
Correlation between Pregnancy Outcome and Placental Pathology in COVID-19 Pregnant Women
Sara A. Al-Rawaf, Enas T. Mousa, Noora M. Kareem, Atif Amin Baig
Infectious Diseases in Obstetrics and Gynecology.2022; 2022: 1. CrossRef
Differential impact of antiretroviral therapy initiated before or during pregnancy on placenta pathology in HIV-positive women
Nadia M. Ikumi, Thokozile R. Malaba, Komala Pillay, Marta C. Cohen, Hlengiwe P. Madlala, Mushi Matjila, Dilly Anumba, Landon Myer, Marie-Louise Newell, Clive M. Gray
AIDS.2021; 35(5): 717. CrossRef
Meconium Aspiration Syndrome: A Narrative Review
Chiara Monfredini, Francesco Cavallin, Paolo Ernesto Villani, Giuseppe Paterlini, Benedetta Allais, Daniele Trevisanuto
Children.2021; 8(3): 230. CrossRef
Isolated acute funisitis in the absence of acute chorioamnionitis: What does it mean?
Tracy B. Grossman, Debra S. Heller, Rebecca N. Baergen
Placenta.2019; 75: 42. CrossRef
Influence of foetal inflammation on the development of meconium aspiration syndrome in term neonates with meconium-stained amniotic fluid
Kyoko Yokoi, Osuke Iwata, Satoru Kobayashi, Kanji Muramatsu, Haruo Goto
PeerJ.2019; 7: e7049. CrossRef

Chronic Placental Inflammation in Twin Pregnancies: Heejin Bang, Go Eun Bae, Ha Young Park, Yeon Mee Kim, Suk-Joo Choi, Soo-young Oh, Cheong-Rae Roh, Jung-Sun Kim; J Pathol Transl Med. 2015;49(6):489-496. Published online October 13, 2015; DOI: https://doi.org/10.4132/jptm.2015.09.09

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Abstract PDF

Background
Chronic placental inflammation, such as villitis of unknown etiology (VUE) and chronic chorioamnionitis (CCA), is considered a placental manifestation of maternal anti-fetal rejection. The aim of this study is to investigate its frequency in twin pregnancies compared to singleton pregnancies. Methods: Three hundred twin placentas and 1,270 singleton placentas were consecutively collected at a tertiary medical center in Seoul, Republic of Korea from 2009 to 2012. Hematoxylin and eosin sections of tissue samples (full-thickness placental disc and chorioamniotic membranes) were reviewed. Results: Non-basal VUE was more frequent in twin placentas than in singleton placentas (6.0% vs 3.2%, p < .05). In preterm birth, CCA was found less frequently in twin placentas than in singleton placentas (9.6% vs 14.8%, p < .05), reaching its peak at an earlier gestational age in twin placentas (29–32 weeks) than in singleton placentas (33–36 weeks). CCA was more frequent in twin pregnancies with babies of a different sex than with those with the same sex (13.8% vs 6.9%, p = .052). Separate dichorionic diamniotic twin placentas were affected by chronic deciduitis more frequently than singleton placentas (16.9% vs 9.7%, p < .05). Conclusions: The higher frequency of non-basal VUE in twin placentas and of CCA in twin placentas with different fetal sex supports the hypothesis that the underlying pathophysiological mechanism is maternal anti-fetal rejection related to increased fetal antigens in twin pregnancies. The peak of CCA at an earlier gestational age in twin placentas than in singleton placentas suggests that CCA is influenced by placental maturation.

Citations

Citations to this article as recorded by

Amsterdam Placental Workshop Group Consensus Statement definitions revisited: Basal chronic villitis
T.Y. Khong, C.J. Kim, B.B. Rogers
Virchows Archiv.2025; 487(3): 501. CrossRef
Villitis of unknown etiology, chronic deciduitis, chronic chorioamnionitis and chronic histiocytic intervillositis in monozygotic and dizygotic twin pregnancies. A retrospective analysis of 16 cases
Henning Feist, Ulrich Lehmann, Simin Bajwa, Corinna Brüschke, Nora Schaumann
Placenta.2023; 133: 32. CrossRef
Discordant Eosinophilic/T-Cell Chorionic Vasculitis in a Dichorionic Diamniotic Placenta
Evelina Silvestri, Francesca Servadei, Ione Tamagnini, Laura Moretti, Maria Paola Bonasoni
International Journal of Molecular Sciences.2023; 24(11): 9207. CrossRef
Histopathologic evaluation of dichorionic twin placentas in unassisted and in vitro fertilized pregnancies affected by preeclampsia
Evelina Manvelyan, Karmaine A. Millington, Baruch S. Abittan, Matthew J. Blitz, Brittany Kwait, Weiwei Shan, Randi H. Goldman
The Journal of Maternal-Fetal & Neonatal Medicine.2022; 35(26): 10262. CrossRef
Microbiological safety of the Dr. Arabin cervical pessary in pregnant women with short cervix
Gabriel S. Sargsyan, Olesya N. Bespalova, Alevtina M. Savicheva, Tatyana A. Khusnutdinova, Olga V. Budilovskaya, Anna A. Krysanova, Kira V. Shalepo
Journal of obstetrics and women's diseases.2022; 71(5): 65. CrossRef
Disorders of placental villous maturation in fetal death
Sunil Jaiman, Roberto Romero, Percy Pacora, Eunjung Jung, Gaurav Bhatti, Lami Yeo, Yeon Mee Kim, Bomi Kim, Chong Jai Kim, Jung-Sun Kim, Faisal Qureshi, Suzanne M. Jacques, Offer Erez, Nardhy Gomez-Lopez, Chaur-Dong Hsu
Journal of Perinatal Medicine.2020;[Epub] CrossRef
Biochemical predictors of preterm birth in twin pregnancies: A systematic review involving 6077 twin pregnancies
Shemoon Marleen, Chamalika Dias, Rebecca MacGregor, John Allotey, Joseph Aquilina, Asma Khalil, Shakila Thangaratinam
European Journal of Obstetrics & Gynecology and Reproductive Biology.2020; 250: 130. CrossRef
Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
Duško Kljakić, Miloš Z. Milosavljević, Milan Jovanović, Vesna Čolaković Popović, Saša Raičević
Open Medicine.2020; 16(1): 81. CrossRef
The frequency and clinical significance of intra-amniotic inflammation in twin pregnancies with preterm labor and intact membranes
Kyung Joon Oh, Joon-Seok Hong, Roberto Romero, Bo Hyun Yoon
The Journal of Maternal-Fetal & Neonatal Medicine.2019; 32(4): 527. CrossRef
Discordance of Twin Placentas for Multifocal Eosinophilic/T-cell Chorionic Vasculitis
Erik W Nohr, James R Wright
Pediatric and Developmental Pathology.2019; 22(1): 40. CrossRef
Differential immunophenotype of macrophages in acute and chronic chorioamnionitis
Go-Eun Bae, Joon-Seok Hong, Jung-Sun Kim, Ha Young Park, Ja Yun Jang, Yi Seul Kim, Suk-Joo Choi, Soo-young Oh, Cheong-Rae Roh
Journal of Perinatal Medicine.2017; 45(4): 483. CrossRef
Fetal death: an extreme manifestation of maternal anti-fetal rejection
Kia Lannaman, Roberto Romero, Tinnakorn Chaiworapongsa, Yeon Mee Kim, Steven J. Korzeniewski, Eli Maymon, Nardhy Gomez-Lopez, Bogdan Panaitescu, Sonia S. Hassan, Lami Yeo, Bo Hyun Yoon, Chong Jai Kim, Offer Erez
Journal of Perinatal Medicine.2017; 45(7): 851. CrossRef

Pathologic Differences between Placentas from Intrauterine Growth Restriction Pregnancies with and without Absent or Reversed End Diastolic Velocity of Umbilical Arteries.: Changyoung Yoo, Dong Gyu Jang, Yun Sung Jo, Jinyoung Yoo, Guisera Lee; Korean J Pathol. 2011;45(1):36-44.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.1.36

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Abstract PDF

BACKGROUND
Abnormal umbilical artery Doppler velocimetry is one of the important findings of intrauterine growth restriction (IUGR) and IUGR is associated with high perinatal morbidity and mortality. In addition, this abnormal Doppler velocimetry is correlated with placental insufficiency. The aim of this study was to determine the pathologic differences in the placentas from IUGR pregnancies with and without the absent or reversed end diastolic velocity (AREDV).
METHODS
Among the cases that had undergone prenatal follow-up in our institute, a retrospective slide review was conducted for 18 cases of IUGR with AREDV and 17 cases with IUGR that had normal end-diastolic flow of the umbilical artery.
RESULTS
The birth weight and the other clinical parameters were not different among the two groups. Grossly, the placental weight percentiles were significantly smaller in AREDV group when they were adjusted according to gestational age. Histologically, chronic deciduitis, mural hypertrophy of the decidual arteries, an intimal fibrin cushion of the large fetal vessels, increased syncytial knots, villous agglutinations, avascular villi, villous stromal-vascular karyorrhexis, and acute atherosis were more frequently found in the AREDV group and their presence showed statistical significance.
CONCLUSIONS
These findings suggest that pathologic abnormalities due to fetal and maternal vasculopathies in the placenta may be the cornerstone for inducing AREDV in the umbilical artery.

Citations

Citations to this article as recorded by

Pathomorphological Patterns of Placental Dysfunction in Late Manifestation of Fetal Growth Restriction
Oksana Zhurakivska, Yuliia Yarotska, Dmytrо Govsieiev, Oksana Ostrovska, Mariana Rymarchuk
Acta medica Lituanica.2025; 32(2): 21. CrossRef
Histological Evaluation of Placentas in Idiopathic Intrauterine Growth Restriction
Saadi S Barwari
Cureus.2024;[Epub] CrossRef
Defining early vs late fetal growth restriction by placental pathology
Amir Aviram, Christopher Sherman, John Kingdom, Arthur Zaltz, Jon Barrett, Nir Melamed
Acta Obstetricia et Gynecologica Scandinavica.2019; 98(3): 365. CrossRef
HISTOPATHOLOGICAL CHANGES OF PLACENTA IN PRETERM PREGNANCY WITH SPECIAL REFERENCE TO INTRAUTERINE GROWTH RESTRICTION
Prathibha S.D, Anitha N, Samikshya Ray, Jayaprakash H.T
Journal of Evidence Based Medicine and Healthcare.2016; 3(63): 3430. CrossRef
Preliminary Study on Neurodevelopmental Outcome and Placental Pathology among Extremely Low Birth Weight Infants
Seong-Hee Oh, Jong-jae Kim, Hyun-jeong Do, Byong Sop Lee, Ki-Soo Kim, Ellen Ai-Rhan Kim
Korean Journal of Perinatology.2015; 26(1): 67. CrossRef
Chronic Placental Inflammation in Twin Pregnancies
Heejin Bang, Go Eun Bae, Ha Young Park, Yeon Mee Kim, Suk-Joo Choi, Soo-young Oh, Cheong-Rae Roh, Jung-Sun Kim
Journal of Pathology and Translational Medicine.2015; 49(6): 489. CrossRef

Histological and Immunohistochemical Findings of the Intermediate Trophoblasts in Normal Full Term and Pre-eclamptic Placentas.: Sang Hak Han, Kyu Rae Kim, Yonghee Lee, Jae Y Ro; Korean J Pathol. 2010;44(1):63-69.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.63

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Abstract PDF: BACKGROUND
Recent studies have suggested that implantation site intermediate trophoblasts (ISITs) and chorionic type intermediate trophoblasts (CTITs) show different immunohistochemical findings, and that each type has specific location in placentas. However, we observed that both subtypes are intimately admixed in many areas of the placentas and both types are proliferated around the infarcts.
METHODS
In order to examine the site specificity in their distribution and the changes of intermediate trophoblasts (ITs), if any, in the pre-eclamptic placentas, quantitative analyses of ISITs and CTITs using p63, CD146, placental alkaline phosphatase, human placental lactogen, and alpha-inhibin were performed in normal and pre-eclamptic placentas containing infarcts.
RESULTS
In the fetal membranes of both normal and pre-eclamptic placentas, CTITs and ISITs were equally identified, forming distinct layers. ISITs were predominant in the intervillous septum and basal plate, while CTITs were predominant in the subchorionic area. At the margin of infarcts in pre-eclamptic placentas, both subtypes were increased in number, forming distinct layers.
CONCLUSIONS
The subtypes of ITs do not have site specificity in placentas. Increased number of ITs and zonal distribution around infarcts suggest that CTITs and ISITs have differentiation associated relationship, and the differentiation might be related to the microenvironment of placenta, such as intraplacental oxygen concentration.

Immunolocalization of the Apoptotic Inhibiting Protein (bcl-2) in Early Normal Pregnancy and Abortion.: Jiae Lee, Jeong Wook Kim, Bum Chae Choi, Kwang Moon Yang, Young Youl Cho, Sung Ran Hong; Korean J Pathol. 2001;35(1):48-52.

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Abstract PDF: BACKGROUND
The human placenta is an important organ in the maintenance of pregnancy, having functions in maturation and differentiation until the end of pregnancy. The bcl-2 protein is a proto-oncogene that prevents apoptosis and maintains cell survival. However, the mechanism through which bcl-2 inhibits apoptosis is unclear. The aims of this study are to localize bcl-2 at the placenta and to determine whether the expression of bcl-2 in early normal pregnancy is different from that of a missed abortion.
METHODS
Immunohistochemistry was performed for bcl-2 in formalin-fixed chorionic villi and decidual tissue collected from five early normal pregnancies and eleven missed abortions having histories of recurrent abortions during the first trimester.
RESULTS
The bcl-2 protein was observed in the syncytiotrophoblasts of chorionic villi and decidua in both the normal pregnancy and the missed abortion, and the expression of bcl-2 significantly increased in the missed abortion group (p<0.05).
CONCLUSION
The bcl-2 may be necessary to maintain pregnancy through modulating the survival of the syncytiotrophoblast and decidua without affecting cell proliferation, and the increased bcl-2 expression is presumed to be a reparative process to the increased apoptotic activity.

Case Report

Placental Metastais of Maternal Gastric Adenocarcinoma: A case report.: Hye Seung Lee, Young Ah Kim, Chong Jai Kim, Je Geun Chi; Korean J Pathol. 1999;33(3):214-216.

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Abstract PDF: Metastasis of a maternal neoplasm to the products of conception is extremely rare. About 50% of the reported cases were not examined grossly or had no grossly visible tumor deposit. A case of placental micrometastasis of gastric adenocarcinoma in a 28-year-old woman is presented. Artificial termination was performed in 22 weeks of gestation and a female fetus weighing 440 gm was delivered. The placenta weighed 220 gm and was grossly normal. Microscopic examination revealed a small number of micrometastasis scattered in the intervillous space.

Original Articles

Morphohistometric Investigation and bcl-2 Expression in the Placenta of Chromosomally Abnormal Pregnancy.: Joung ho Han, Kyu Rae Kim, Yeon Lim Suh, Mi Kyung Kim, Young Hyeh Ko, Dae Shick Kim, Howe Jung Ree; Korean J Pathol. 1999;33(5):353-360.

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Abstract PDF: To evaluate the significance of placental histology, a collaborative histological and cytogenetic study was performed on the products of 88 spontaneous abortions, and subsequently bcl-2 immunostaining was performed on 62 cases. The morphometric parameters included were DCIRCLE, FORMSHAPE, CPRATIO, and the expression of bcl-2 immunostainig was graded in four categories (I to IV). The results were as follows: 1) 40% (n=35) were chromosomally abnormal: trisomies predominated (57%, n=20) and was followed by triploidy (14%, n=5), double trisomy (6%, n=2), monosomy X (6%, n=2), inversion (9) (6%, n=2). 2) mean of DCIRCLE in chromosomally abnormal pregnancy was 40 micrometer larger than that in chromosomally normal pregnancy (p=0.012, one side t-test), while no difference was found in FORMSHAPE and CPRATIO between chromosomally abnormal and normal pregnancy. 3) bcl-2 expression was found in syncytiotrophoblast and cytotrophoblast. bcl-2 expression was weaker in chromosomally abnormal pregnancy with intensity I and II of 59% than chromosomally normal pregnancy with intensity I and II of 24%. 4) In comparison bcl-2 expression with DCIRCLE, in chromosomally normal abortion one (10%) in I & II and one (3%) in III & IV showed large DCIRCLE (above 360 micrometer), while 11 (85%) in I & II and 3 (33%) in III & IV in chromosomally abnormal pregnancy. It would mean that bcl-2 protein is necessary in preservation of pregnancy and placental morphology. Abnormal villous diameter and weak bcl-2 expression may be suggestive of chromosomal anomaly. Besides other histologic parameters, application of bcl-2 immunostaining and morphometric analysis probably give more sensitive and specific results in identifying chromosomally abnormal abortion.

Telomerase activity and Expression of MIB-1, Fas and Fas Ligand in Placentas from Women with and without Intrauterine Growth Retardation.: Yi Kyeong Chun, Sung Ran Hong, Moon Ho Yang; Korean J Pathol. 2005;39(1):34-40.

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Abstract PDF: BACKGROUND
The placenta from a pregnancy that is complicated by intrauterine growth retardation (IUGR) tends to be smaller than that from a normal pregnancy. To investigate this difference, we analyzed the telomerase activity, the proliferative activity and the mRNA levels of apoptosis mediators in placentas.
METHODS
In 20 placentas from normal third-trimester pregnancies and 22 placentas form pregnancies that were complicated by IUGR, the telomerase activity was detected by a telomeric repeat amplification protocol assay. The proliferative activity was assessed by immunohistochemical staining using the MIB-1 monoclonal antibody. The expression of the apoptosis mediator was evaluated by semi-quantitative reverse transcription-polymerase chain reactions for fas and fas ligand.
RESULTS
Telomerase activity was detected in 2 (10%) of 20 normal placentas, whereas it was not observed in all tested 13 placentas that were associated with IUGR. The proliferative activity was significantly low in the placentas that were associated with IUGR (7.44+/-2.96%), compared with the normal placentas (11.0+/-3.48%, p=0.002). There was no statistically significant difference in the mRNA levels of fas or fas ligand between two groups.
CONCLUSIONS
Low telomerase and proliferative activities in the placenta may play a role in the pathogenesis of IUGR.

Sequential Ultrastructural Change of Chorionic Villi in Human Placenta by Gestational Period.: Tae Dong Park, Tae Jung Kwon, Je G Chi; Korean J Pathol. 1993;27(5):468-484.

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Abstract PDF: A study was performed to observe the sequential morphological change of the human placental barrier by means of light microscopy, immunohistochemistry, scanning electron microscopy and transmission electron microscopy. The examined placentas ranged in age from 4 weeks gestation to the full-term(40 weeks). Sixty seven placental specimens were obtained immediately after delivery. With the progression of gestation, the microvilli on the surface of syncytinum tended to be fewer, shorter and blunter. The syncytiotrophoblasts were getting thinner with formation of vasculo-syncytial membrane. The cytotrophoblasts formed a continuous layer which progressively disappeared but still present in the mature villi. In view of presence of intermediate cells and remnant of desmosomes, the cytotrophoblasts appeared to form the syncytiotrophoblasts. In early pregnancy, capillary formation took place by the aggregation and differentiation of the proliferation and aggregation of endothelial cells and pericytes. Myofibroblasts in villous stroma were examined by desmin immunohistochemical staining, and detected from 19 weeks to the full-term. During last period of pregancy definitive smooth muscle cells could be demonstrated, suggesting that the presence of myofibroblasts or smooth muscle cells are closely related to the placental maturity. Scanning electron microscopy of the early placenta showed numerous syncytial sprouts representing stages in the formation of new villi, but in the late period of gestation syncytial sprouts were diminished. It is concluded that the syncytiotrophoblast is originated from the cytotrophoblast in early pregnancy as the placental barrier is formulated. Moreover, myofibroblasts and smooth muscle cells in villous stroma play important role in placental maturation.

Placental Pathology in Intrauterine Growth Retardation.: So Young Park, Moon Young Kim, Yee Jeong Kim, Yi Kyeong Chun, Hye Sun Kim, Hee Soo Kim, Sung Ran Hong; Korean J Pathol. 2002;36(1):30-37.

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Abstract PDF: BACKGROUND
Histologic examination of the placentas from intrauterine growth retardation (IUGR) fetuses can supplement clinical knowledge of the cause of IUGR. The present study was undertaken to observe the pathologic findings regarding the placentas in IUGR fetuses.
METHODS
Clinicopathologic findings in 45 cases with IUGR at the third-trimester were reviewed, and they were compared with those of 24 normal control cases. An IUGR fetus was defined as one with a birth weight less than those in the 10th percentile. Of the IUGR cases, 15 were hypertensive IUGR with or without preeclampsia, and 30 were normotensive IUGR.
RESULTS
The IUGR groups had significantly shorter mean gestational ages, lower mean placental weights, and higher incidences of oligohydramnios, compared to the normal controls (p<0.05). Histologically, IUGR was characterized by increased incidence of decidual vasculopathy (31.1%, p<0.05), multiple and severe infarct (p<0.05), villous fibrosis (31.1%, p<0.05), syncytiotrophoblastic knots (86.7%, p<0.05), and higher degree of increased perivillous fibrin deposition (p<0.05). However, there were no statistically significant differences in the placental lesions between hypertensive and normotensive IUGR cases, except for the presence of decidual vasculopathy.
CONCLUSIONS
Abnormal uteroplacental vasculature and chronic uteroplacental insufficiency, coagulation-related pathology in the uteroplacental, intervillous and/or fetoplacental vasculature, and chronic inflammatory lesions may be the primary disease processes related to the placental pathology of IUGR. Although the cause of IUGR pregnancies is heterogeneous, careful cilinicopathologic correlations in individual cases are necessary in the interpretation of placental lesions of IUGR, and the total burden of several placental lesions may be more important than a single histologic feature.

Case Reports

Massive Perivillous Fibrin Deposition in Placenta.: Dae Woon Eom, Gil Hyun Kang, Chung Hyun Cho, Sang Wook Yi, Han Moie Park, Sang Su Lee, U Seog Son; Korean J Pathol. 2008;42(4):236-239.

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Abstract PDF: Massive perivillous fibrin deposition (MFD) is a rare condition characterized by heavy accumulation of fibrin in intervillous or perivillous spaces encasing villi throughout the placenta. This condition may cause varying degrees of placental insufficiency, leading to a significantly increased risk of intrauterine growth retardation, intrauterine death, and pre-term delivery. However, the objective criteria for the diagnosis of MFD have not been clearly established. We report a case of MFD associated with intrauterine growth retardation and preterm premature rupture of membranes.

Placental Transmogrification of the Lung: A Brief Case Report.: Eun Su Park, Joungho Han, Won Jung Koh, Kyung Soo Lee, Jhingook Kim, Jinwon Seo, Jiyoung Kim; Korean J Pathol. 2008;42(5):308-310.

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Abstract PDF: Placental transmogrification (PT) is an unusual condition in which the alveoli develop a peculiar villous configuration that resembles the placental villi. We report a rare case of pulmonary PT in a 46-year-old man who presented with multiple cystic lesions and nodules on radiography. The patient was treated with a surgical excision. The cut surface of the lung lesion had a villous spongiform manifestation with a partly yellow granular appearance. Microscopically, multiple papillary cores mimicking the villous structures of the placenta were observed within the bullous airspaces. These papillary cores contained many vascular structures, lymphoid aggregates, interstitial clear cells, mature fat and dystrophic calcification. This case was solitary and not associated with other pulmonary or systemic diseases. The etiology is unknown, and further studies will be needed to understand the pathogenesis of the lesion.

Placetnal Findings of Septic Abortion Caused by Listeria Monocytogenes: A case report.: Kyu Rae Kim, Hee Mo Kim, Joo Yeon Cho, Kyung Sub Cha; Korean J Pathol. 1991;25(4):387-391.

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Abstract PDF: Since human listeriosis was firstly described by Nyfeldt in 1929, Listeria monocytogenes as a cause of septic abortion has been well known. It primarily affects pregnant woman and neonates, the elderly, and persons with immune-system dysfunction due to immunosuppressive drugs, malignant tumors or AIDS. Although several large epidemic listeriosis have been reported in the English literatures, it is still an underdiagnosed and underreported cause of congenital sepsis and septic abortion, because it is not always easy to isolate the organism in culture. There are 17 cases reports of Listeria monocytogenes infection in Korea, however, most of which were described about the bascteriologically proven cases. We describe placental findings of a septic abortion caused by Listeria monocytogenes at 15 weeks gestation in a 23-year-old primigravida woman. Placental examination showed characteristic and relatively specific patterns of granulomatous microabscesses composed of necrotic nuclear debris in the center and surrounding epithelioid histocytes enmeshed in fibrin between the acutely inflamed villi. There were numerous gram positive bacilli on Brown-Brenn stain.

Placental Site Trophoblastic Tumor(PSTT) with Vaginal Metastasis: A case report.: Yee Jeong Kim, Kyu Rae Kim, Soon Hee Jeong, Ho Geun Kim, Jang Yeon Kwon; Korean J Pathol. 1991;25(6):570-575.

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Abstract PDF: PSTT has been established as a separate entity distinct from choriocarcinoma since 1983, because of its different morphological features, biologic behavior and response to chemotherapy. Most cases of PSTT have indolent clinical courses, but there have been several reports showing malignant behavior resulted in death of the patient. We report a case of PSTT showing vaginal metastatis. In biopsy specimen, it was difficult to make differential diagnosis from squamous cell carcinoma of uterine cervix due to uniform and mononuclear cytologic characteristics. Immunohistochemical stains for hPL and hCG were not typical for either PSTT or choriocarcinoma. We suggest that poorly differentiated PSTT may synthesize the lesser amount of hPL than typical PSTT and it may behave more aggressively.

Original Articles

A Study for IL-6, IL-13 and TIMP-3 Expressions of Placenta, Fetus and Endometrium in Pregnant Mice after Treatment with Lipopolysaccharide.: Sung Ran Hong, In Gul Moon, Ju Young Seoh, Yee Jeong Kim, Sung Sook Kim, Woon Sup Han; Korean J Pathol. 1998;32(5):352-361.

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Abstract: We examined C3H pregnant mice at 15 days (70% gestation) after treatment of lipopolysaccaride (LPS) to observe the changes of IL-6 concentration in maternal serum and amniotic fluid and expression of IL-6, IL-13 & TIMP-3 in placenta, fetus and endometrium, and to investigate the correlation among IL-6, IL-13 and TIMP-3. The results were as follows: 1) IL-6 in serum and amniotic fluid after treatment of LPS was significantly elevated; peaked at 1, 2, 4, 5 hours and decreased to control level at 8 hours (P<0.05). IL-6 in placental disc, chorioamnionic membrane, fetus, decidua and endometrial epithelium was overexpressed significantly at 1, 2, 4 hours after treatment of LPS (P<0.05). IL-6 overexpression was more significantly increased in maternal tissue than fetal tissue (P<0.05). 2) Increased concentration of amniotic fluid IL-6 was equally originated from transplacental crossage of maternal serum IL-6, and direct local production of IL-6 from placenta, fetus and endometrium (P<0.05). 3) IL-13 in placental disc, chorioamnionic membrane, fetus, decidua and endometrial epithelium was overexpressed after treatment of LPS, but not significant statistically. 4) TIMP-3 was overexpressed in placental disc, chorioamnionic membrane, fetus and decidua. TIMP-3 overexpression was more significant in placental disc than other tissues (P<0.05). 5) Overexpressions in IL-13 and IL-6 revealed direct proportional correlation coefficient (Spearman correlation coefficient, 0.5212 ; P<0.05). IL-6 expression was a head of overexpression of TIMP-3, but not significant. In conclusion, all of IL-6, IL-13 and TIMP-3 relate with inflammatory response, especially IL-6 in maternal serum, amniotic fluid and tissue of placenta, fetus and endometrium was so sensitive that it can be an indicator for antenatal diagnosis of chorioamnonitis, and amniotic fluid IL-6 is equally originated from maternal serum and from tissue of placenta, fetus and endometrium. IL-13 and TIMP-3 may have parallel correlation to the IL-6 in fetal and maternal tissue after treatment of LPS.

Placental Site Nodules & Plaques: A clinicopathologic analysis of 14 cases.: Kyu Rae Kim, Sun Won Hong, Kyung Sub Cha, In Pyong Kwak, Tae Ki Yoon; Korean J Pathol. 1992;26(1):53-61.

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Abstract PDF: Placental site nodules and plaques have been recently described to designated single or multiple, well-circumscribed, rounded lesions at the placental site, composed of viable or degenerating intermediate trophoblastic cells and extensive hyalinization between the cells. We described clinicopathologic findings of 14 cases of placental site nodules and plaques. The age of 14 patients ranged from 25 to 39(average 33) years and all of them had been pregnant in the past. Ten of them presented with vaginal spotting, which was preceded by recent pregnancy in only 3 cases. Three patients presented with secondary infertility and one with secondary infertility and vaginal spotting. Urine pregnancy tests were negative in all 14 cases at the time of presentation. Ultrasonographic examination disclosed abnormalities in only 3 cases and the remaining cases were normal. Hysterosalpingography was performed in 3 patients who presented with 2 degrees infertility and revealed moderate to severe intrauterine adhesions. Microscopically, chronic endometritis of varying degrees evidenced by plasma cells and eosinophiles were present in all cases and these were more prominent in the vicinity of the lesions. It is presumed that the placental site nodules and plaques are not sloughed at the time of menstruation and it may cause chronic endometritis or intrauterine adhesions at any time after previous delivery.

A Study of Umbilical Cord Length According to the Gestational Age.: Eun Kyung Kim, Je Geun Chi; Korean J Pathol. 1994;28(5):511-513.

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Abstract PDF: The umbilical cord length may be a reliable indicator of fetal activity during gestation because it grows in response to tensile forces related to fetal movement. But there has been little attention to normal range of the umbilical cord length. We analyzed the umbilical cord length of 2342 cases de1ivered in Seoul National University Hospital to determine mean values according to the gestational age. The umbilical cord length increased linearly from 15.5cm of 13 week to 50.6 cm of 44 week. After 42 week, the growth was nearly stopped. There was no difference by fetal sex. The length of umbilical cord was variable even within same gestational age.

Histological and Immunohistochemical Findings of the Endometrium in Ectopic and Intrauterine Pregnancy.: Yee Jeong Kim, Soon Won Hong, Kyu Rae Kim, Chanil Park; Korean J Pathol. 1995;29(1):33-39.

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Abstract PDF: We reviewed histological and immunohistochemical findings of the endometrium in 28 cases of ectopic pregnancy and 11 cases of intrauterine pregnancy without chorionic villi or syncytiotrophoblast. 1) Twenty cases(71.41/o) of ectopic pregnancy revealed gestational patterns and 8 cases(28.6%) showed non-gestational patterns, which were menstrual phase in 3 cases, proliferative phase in I case, early secretary phase in 3 cases and mid secretary phase in 3 cases, respectively. Implantation sites were present in 36.40/o of intrauterine pregnancy. 2) Endometrial spiral arterioles tend to be more prominent with frequent intimal proliferation and thickening of the wall in intrauterine pregnancy than in ectopic pregnancy although it was not statistically significant(p=0.271). 3) Deposition of fibrinoid material in the endometrium was present in 72.7% of intrauterine pregnancy and 25% of ectopic pregnancy. Thrombosis was present in 72.7% of intrauterine pregnancy and 5% of ectopic pregnancy. Hyalinized vessels were also present in 90.9% of intrauterine pregnancy and 200/o of ectopic pregnancy. These were statistically significant(p=0.0002, 0.0209 and 0.0004), but not diagnostic. 4) On immunohistochemical study for intrauterine pregnancy, the rates of positive reaction to human placental lactogen, cytokeratin and human chorionic gonadotropin were 45.5%, 45.5% and 9%, respectively. We concluded that HFIL and cytokeratin are reliable and sensitive markers for implantation site.

Incidence of Acute Placental Inflammation through Histopathological Analysis: One year experience in 1995 at Seoul National University Hospital.: Hyun Ju Yoo, Yun Kyung Kang, Chong Jai Kim, Jung Sun Kim, Tae Sook Kim, Kyung Cheun Jung, Kyo Hoon Park, Jong Kwan Jun, Bo Hyun Yoon; Korean J Pathol. 1996;30(12):1123-1128.

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Abstract PDF: The diagnosis of acute inflammation of the placenta, represented as acute chorioamnionitis, is important in that it is associated with a poor clinical outcome for both the mother and the fetus, including major perinatal morbidities such as sepsis, respiratory distress syndrome, and CNS damage. However, current medical trends in Korea seem to overlook the significance of a histopathological diagnosis of acute placental inflammation, mainly due to the indifferences of clinicians and pathologists. Since late 1993, histopathological examinations have been performed on preterm placentas at Seoul National University. These examinations have demonstrated acute placental inflammation in a significant number of cases. In the present study the incidence of acute placental inflammation was analyzed in 521 placentas which were submitted for pathological examinations in 1995. Examinations were performed to provide basic information on the incidence and profile of acute placental inflammation in this hospital and, thereby, to emphasize the significance of histopathological examinations of the placenta in the routine surgical pathology service. Among the 521 placentas, acute inflammation was found in 194 cases (37.2%). In preterm placentas acute inflammation was found in 39.6% of the cases (67/169), while 36.1% (127/352) of term placentas showed acute inflammation. Taking the delivery mode into account, 26.3% (49/186) of the placentas delivered by cesarean section showed acute inflammation, while 43.3% (145/335) of the transvaginally delivered placentas showed inflammation. The present analysis demonstrates the existence of acute inflammation in a significant proportion of placentas with different clinical settings. The importance of a histopathological examination in routine hospital practice should be emphasized.

Telomerase Activity and Expression of MIB-1 and bcl-2 in Human Chorionic Villi from Early and Term Normal Pregnancy.: Jung Sook Cho, Young Soon Kang, In Gul Moon, Bum Chae Choi, Jong Pyo Lee, Hoon Taek Lee, Sung Ran Hong; Korean J Pathol. 2000;34(11):927-933.

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Abstract PDF: Telomerase is an enzyme that maintains telomeres and prevents telomere shortening, and may be linked with cellular proliferation or the aging process. The purpose was to examine telomerase activity in human chorionic villi from early and term normal pregnancies, and to analyze the correlation of telomerase activity (TA) with MIB-1 & bcl-2. A total of 37 placentae were obtained from 16 early and 21 term pregnancies. TA was assayed by telomeric repeat amplification protocol, and immunohistochemical staining was performed for MIB-1 & bcl-2 expression. TA & MIB-1 expression were strong in early placenta, but bcl-2 was highly expressed in term placentae. Thirteen (81.25%) of 16 early placentae showed TA, but only 2 (9.52%) of 21 term placentae expressed TA (p<0.01). MIB-1 was observed in nuclei of cytotrophoblast, and the expression rate was 16.09% in early placentae and 2.87% in term placentae (p<0.01). bcl-2 was observed only in the cytoplasm of syncytiotrophoblast. Term placenta demonstrated stronger expression of bcl-2 compared to early placentae (p<0.05). These findings suggest that TA, MIB-1 & bcl-2 expression are critically regulated over the course of gestation: cytotrophoblast, main cells of early chorionic villi, may be a common source of telomerase and proliferative activity. The TA showed good correlation with cellular proliferative activity. Syncytiotrophoblast, may be a main source of bcl-2 expression which is stronger in the term placentae.

Case Report

Placental Findings of Listeria Monocytogenes Infection in Twin Pregnancy: A Case Report.: Dong Hoon Shin, Dong Eun Song, Kyu Rae Kim; Korean J Pathol. 2007;41(2):119-122.

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Abstract PDF: A Listeria monocytogenes infection is relatively rare in healthy adults. However, the chance of an infection increases almost 17 times in pregnancy due to changes in the immune function. A Listeria monocytogenes infection results in characteristic gross and microscopic features in the placenta, including multiple yellowish nodules showing microscopic intervillous abscess and intervillositis. We describe the placental findings of a Listeria monocytogenes infection that was complicated by maternal sepsis, myocarditis and congestive heart failure. The infection was discovered in the 34th week of a twin gestation in a 28 year-old woman. This case should emphasize the importance of this condition to pathologists. Antibiotic treatment was started based on the placental histologic findings before a maternal blood culture confirmed growth of Listeria monocytogenes. Both the mother and twin babies were healthy at the time of this report.

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