Chronic Intervillositis of Unknown Etiology: Development of a Grading and Scoring System That Is Strongly Associated With Poor Perinatal Outcomes.
Journal
The American journal of surgical pathology
ISSN: 1532-0979
Titre abrégé: Am J Surg Pathol
Pays: United States
ID NLM: 7707904
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
11
8
2020
medline:
28
11
2020
entrez:
11
8
2020
Statut:
ppublish
Résumé
Chronic intervillositis of unknown etiology (CIUE) is a rare placental disease characterized by intervillous infiltration of maternal macrophages and associated with poor pregnancy outcomes and a high risk of recurrence in subsequent pregnancies. Its pathophysiology remains unclear and prognostic factors have not yet been established. In addition, clear relationships between the histologic extent of lesions and the severity of perinatal outcomes have not been demonstrated. Our objectives were to validate a CIUE classification system based on the gradation of macrophagic infiltration of the intervillous space, and to attempt to correlate these results with perinatal outcomes. For this multicenter retrospective study, 3 pathologists reviewed all cases diagnosed with "intervillositis" between 1997 and 2018. Confirmed CIUE cases were semiquantitatively graded based on the percentage of macrophagic infiltrate in the intervillous space: grade 1 (5% to 10%), grade 2 (10% to 50%), and grade 3 (>50%). Multiple pregnancies and pregnancies with medical follow-up completed outside of the study centers were excluded. In total, 122 cases of CIUE in 102 patients were included in the study. Microscopic classification based on one criterion was easy to perform, and interobserver correlation was good. Grade 3 infiltration was strongly associated with poor perinatal outcomes and fetal growth restriction (P<0.0001). After delivery, only 16.1% of newborns from the grade 3 CIUE group were alive, compared with 59% from the grade 2 and 86.5% from the grade 1 group (P=0.0002). Recurrence risk was associated with CIUE gradation of the index case (P=0.004), with 95% of recurrent CIUE cases being from patients with grades 2 and 3 CIUE. In this study, conducted with the largest CIUE cohort to date, a classification based only on the degree of macrophagic infiltration of the intervillous space was validated, and this classification was shown to be strongly associated with poor perinatal outcomes and risk of recurrence.
Identifiants
pubmed: 32773529
doi: 10.1097/PAS.0000000000001549
pii: 00000478-202010000-00007
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1367-1373Références
Labarrere C, Mullen E. Fibrinoid and trophoblastic necrosis with massive chronic intervillositis: an extreme variant of villitis of unknown etiology. Am J Reprod Immunol Microbiol. 1987;15:85–91.
Jacques SM, Qureshi F. Chronic intervillositis of the placenta. Arch Pathol Lab Med. 1993;117:1032–1035.
Boyd TK, Redline RW. Chronic histiocytic intervillositis: a placental lesion associated with recurrent reproductive loss. Hum Pathol. 2000;31:1389–1396.
Marchaudon V, Devisme L, Petit S, et al. Chronic histiocytic intervillositis of unknown etiology: clinical features in a consecutive series of 69 cases. Placenta. 2011;32:140–145.
Redline RW, Zaragoza M, Hassold T. Prevalence of developmental and inflammatory lesions in nonmolar first-trimester spontaneous abortions. Hum Pathol. 1999;30:93–100.
Doss BJ, Greene MF, Hill J, et al. Massive chronic intervillositis associated with recurrent abortions. Hum Pathol. 1995;26:1245–1251.
Parant O, Capdet J, Kessler S, et al. Chronic intervillositis of unknown etiology (CIUE): relation between placental lesions and perinatal outcome. Eur J Obstet Gynecol Reprod Biol. 2009;143:9–13.
Contro E, deSouza R, Bhide A. Chronic intervillositis of the placenta: a systematic review. Placenta. 2010;31:1106–1110.
Rota C, Carles D, Schaeffer V, et al. Perinatal prognosis of pregnancies complicated by placental chronic intervillitis. J Gynecol Obstet Biol Reprod. 2006;35:711–719.
Bos M, Nikkels PGJ, Cohen D, et al. Towards standardized criteria for diagnosing chronic intervillositis of unknown etiology: a systematic review. Placenta. 2018;61:80–88.
Traeder J, Jonigk D, Feist H, et al. Pathological characteristics of a series of rare chronic histiocytic intervillositis of the placenta. Placenta. 2010;31:1116–1119.
Vayssiere C, Sentilhes L, Ego A, et al. Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol. 2015;193:10–18.
Almog B, Shehata F, Aljabri S, et al. Placenta weight percentile curves for singleton and twins deliveries. Placenta. 2011;32:58–62.
Khong TY, Mooney EE, Ariel I, et al. Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016;140:698–713.
Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009;114:1326–1331.
Mamelle N, Munoz F, Martin JL, et al. Fetal growth from the AUDIPOG study. II. Application for the diagnosis of intrauterine growth retardation. J Gynecol Obstet Biol Reprod. 1996;25:71–77.
Cain MD, Siebert JR, Iriabho E, et al. Development of novel software to generate anthropometric norms at perinatal autopsy. Pediatr Dev Pathol. 2015;18:203–209.
Heller DS. CD68 immunostaining in the evaluation of chronic histiocytic intervillositis. Arch Pathol Lab Med. 2012;136:657–659.
Ongaro D, Terry J. Reproducibility of grading in chronic intervillositis of unknown etiology. Pediatr Dev Pathol. 2020;23:210–214.
Mekinian A, Costedoat-Chalumeau N, Masseau A, et al. Chronic histiocytic intervillositis: outcome, associated diseases and treatment in a multicenter prospective study. Autoimmunity. 2015;48:40–45.
Kramer MS, Olivier M, McLean FH, et al. Impact of intrauterine growth retardation and body proportionality on fetal and neonatal outcome. Pediatrics. 1990;86:707–713.
Van Hoof VO, De Broe ME. Interpretation and clinical significance of alkaline phosphatase isoenzyme patterns. Crit Rev Clin Lab Sci. 1994;31:197–293.
Conover CA, Bale LK, Overgaard MT, et al. Metalloproteinase pregnancy-associated plasma protein A is a critical growth regulatory factor during fetal development. Development. 2004;131:1187–1194.
Kaijomaa M, Ulander VM, Hamalainen E, et al. The risk of adverse pregnancy outcome among pregnancies with extremely low maternal PAPP-A. Prenat Diagn. 2016;36:1115–1120.
Koby L, Keating S, Malinowski AK, et al. Chronic histiocytic intervillositis—clinical, biochemical and radiological findings: an observational study. Placenta. 2018;64:1–6.
Crawford A, Moore L, Bennett G, et al. Recurrent chronic histiocytic intervillositis with intrauterine growth restriction, osteopenia, and fractures. Am J Med Genet A. 2016;170:2960–2964.