Pathology of the Human Placenta

by Benirschke, Kurt; Kaufmann, Peter

• ISBN13: 9780387988948
• ISBN10: 0387988947
• Edition: 4th
• Format: Hardcover
• Copyright: 2000-04-01
• Publisher: Springer Verlag

Summary

Pathology of the Human Placenta remains the authoritative text in the field and is respected and used by pathologists and obstetrician-gynecologists alike. Advances in genetics and molecular biology continue to make the study of the placenta one of vast diagnostic and legal importance. New to this edition is author, Rebecca Baergen, M.D., Chief of Perinatal and Pediatric Pathology at The New York Hospital-Cornell Hospital Medical Center and author of the "Manual of Benirschke and Kaufmanna (TM)s Pathology of the Human Placenta." The fifth edition reflects new advances in the field and includes 173 new color illustrations.

Table of Contents

Preface	v
Examination of the Placenta	1	(12)
Storage	1	(1)
Selection	2	(1)
Photography	2	(1)
Examination	2	(5)
Placentas of Multiple Births	7	(2)
Fixation	9	(2)
Special Procedures	11	(1)
References	11	(2)
Macroscopic Features of the Delivered Placenta	13	(3)
References	15	(1)
Microscopic Survey	16	(13)
Typical Histological Features of the First Trimester Placenta	16	(4)
Typical Histological Features of the Third Trimester Placenta	20	(8)
Immunohistochemical Markers	28	(1)
Placental Types	29	(13)
Placental Shapes	31	(1)
Types of Maternofetal Interdigitation	31	(2)
Maternofetal Barrier	33	(2)
Maternofetal Blood Flow Interrelations	35	(4)
Placental Types and Phylogeny	39	(1)
Human Placenta	39	(1)
References	39	(3)
Early Development of the Human Placenta	42	(8)
Prelacunar Stage	42	(2)
Lacunar Stage	44	(2)
Early Villous Stages	46	(2)
References	48	(2)
Basic Structure of the Villous Trees	50	(66)
M. Castellucci
P. Kaufmann
Syncytiorophoblast	50	(15)
Syncytium or Multinucleated Giant Cells?	50	(3)
Syncytial Plasmalemmas and Microvilli	53	(2)
Syncytiotrophoblastic Cytoskeleton	55	(1)
Specialized Regions of the Villous Surface	55	(1)
Vasculosyncytial Membrances	55	(1)
Syncytial Lamellae Covering Langhans' Cells	56	(1)
Syncytiotrophoblast with Prevailing Rough Endoplasmic Reticulum	57	(1)
Syncytiotrophoblast with Prevailing Smooth Endoplasmic Reticulum	58	(1)
Syncytial Knots, Sprouts, and Bridges	59	(4)
Transtrophoblastic Channels	63	(1)
Trophoblastic Blebbing	64	(1)
Villous Cyttrophoblast (Langhans' Cells)	65	(7)
Langhans' Cells as Precursors of the Syncytiotrophoblast	65	(1)
Langhans' Cell Types	66	(3)
Nematosomes	69	(1)
Endocrine Activity of the Langhans' Cells	69	(3)
Syncytial Fusion and Trophoblast Turnover	72	(6)
Functional Aspects of Syncytial Fusion	72	(1)
Trophoblastic Apoptosis	73	(1)
Quantitation of Trophoblast Turnover	74	(2)
Regulation of Cytotrophoblastic Proliferation and Fusion	76	(2)
Trophoblastic Basement Membrane	78	(1)
Connective Tissue	78	(4)
Mesenchymal Cells (V Cells)	78	(1)
Fibroblasts (VD Cells and VDA Cells)	79	(1)
Myofibroblasts (VDAG Cells and VDAGM Cells)	80	(1)
Matrix Components of the Villous Stroma	81	(1)
Hofbauer Cells	82	(7)
First Descriptions	82	(1)
Morophology	82	(2)
Occurrence and Distribution	84	(1)
Origin	85	(1)
Immunological Aspects	85	(4)
Other Free Connective Tissue Cells	89	(1)
Development and Structure of Fetal Villous Vessels	89	(4)
Origin of the Hemangioblastic Cells	89	(1)
Capillary Formation During Early Pregnancy	89	(1)
Growth Factor Control of Early Vasculogenesis	89	(1)
Basic Structure of the Vessel Walls	90	(3)
Fibrinoid of the Intervillous Tree	93	(2)
Perivillous Fibrinoid	93	(2)
Intravillous Fibrinoid	95	(1)
In Vitro Approaches to the Study of Villous Components	95	(1)
References	96	(20)
Architecture of Normal Villous Trees	116	(39)
Structure of Villous Types	116	(14)
Stem Villi	116	(4)
Immature Intermediate Villi	120	(5)
Mature Intermediate Villi	125	(1)
Terminal Villi	126	(1)
Mesenchymal Villi	127	(2)
Immunohistochemical Characterization of Villous Types	129	(1)
Differentiation and Maturation of Villous Types	130	(4)
Development of the Mesenchymal Villi	131	(1)
Development and Fate of Immature Intermediate Villi	131	(1)
Development of Stem Villi	131	(1)
Development of the Mature Intermediate Villi	132	(1)
Development of the Terminal Villi	132	(2)
Angioarchitecture of Villi	134	(6)
Vascular Arrangement in Immature Villi	134	(1)
Larger Vessels of Stem Villi	134	(1)
Paravascular Capillary Net of Stem Villi	134	(1)
Arrangement of Vessels in Mature Intermediate and Terminal Villi	135	(2)
Sinusoids of Terminal Villi	137	(3)
Capillary Growth as Related to the Development of Terminal Villi	140	(1)
Intervillous Space as Related to the Villous Trees	140	(3)
Control of Villous Development	143	(4)
Oxygen and Oxygen-Controlled Growth Factors as Regulators of Villous Development	143	(2)
Types of Hypoxia and Its Effects on Villous Development	145	(1)
Hormones as Regulators of Villous Development	146	(1)
Fetomaternal Flow Interrelations	147	(1)
References	148	(7)
Characterization of the Developmental Stages	155	(16)
Stages of Development	155	(11)
Nucleated Red Blood Cells	166	(4)
References	170	(1)
Nonvillous Parts and Trophoblast Invasion	171	(102)
H.G. Frank
P. Kaufmann
Extravillous Trophoblast	171	(17)
Historical Aspects and Nomenclature	171	(1)
Extravillous Trophoblast Is a Tissue of Its Own	171	(2)
Proliferation Patterns of Extravillous Trophoblast	173	(1)
Cytokines and Growth Factors	173	(5)
Extracellular Matrix Receptors (Integrins)	178	(1)
Other Cell Adhesion Molecules and Gap Junction Molecules	179	(1)
Proteinases, Activators, and Inhibitors	179	(2)
Endocrine Activities of Extravillous Cytorophoblast	181	(1)
Nitric Oxide Synthase	182	(1)
Major Basic Protein	182	(1)
Blood Group Antigens	182	(2)
MHC Class I Molecules	184	(1)
Switching the Phenotypes of Extravillous Trophoblast	185	(1)
Oxygen-Mediated Regulation of the Invasive Pathway	185	(1)
One Stem Cell Origin for Villous Syncytiotrophoblast and the Extravillous Trophoblast?	186	(1)
Homogeneity of the Extravillous Trophoblast	187	(1)
Placental Site Giant Cells	187	(1)
Multinucleated Trophoblastic Giant Cells	188	(1)
Decidua	188	(8)
Composition of Decidua	188	(1)
Endometrial Stromal Cells and Decidual Cells	189	(1)
Endocrine and Pracrine Aspects of Decidua	190	(1)
Functional Considerations of Decidualization	191	(1)
B Cells and T Cells	192	(1)
Endometrial Large Granular Lymphocytes (Endometrial NK Cells)	193	(1)
Macrophages	194	(1)
Glandular Residues	195	(1)
Extracellular Matrix	195	(1)
Fibrinoid	196	(6)
Definition and Historical Remarks	196	(1)
Types of Fibrinoid	196	(2)
Origin of Fibrinoids	198	(2)
Interactions Between Matrix-Type and Fibrin-Type Fibrinoid	200	(1)
Functions of Fibrinoid	200	(2)
Trophoblast Invasion as a Result of Deciduo-Trophoblastic Interactions	202	(1)
Calcification	203	(5)
Chorionic Plate	208	(2)
Development	208	(1)
Structure at Term	208	(1)
Amnion	209	(1)
Spongy Layer	209	(1)
Chorionic Mesoderm	209	(1)
Extravillous Cytotrophoblast	209	(1)
Langhans' Fibrinoid Layer	210	(1)
Marginal Zone	210	(4)
Subchorial Closing Ring	211	(1)
Trabeculae	212	(1)
Marginal Sinus	212	(2)
Basal Plate	214	(3)
Trophoblastic Shell and Development of the Basal Plate	214	(1)
Layers of the Basal Plate at Term	214	(3)
Uteroplacental Vessels	217	(9)
Development of Uteroplacental Vessels	217	(2)
Number and Position of the Uteroplacental Vessels	219	(1)
Physiological Changes of Uteroplacental Arteries	220	(3)
Molecular Mechanisms of Arterial Trophoblast Invasion	223	(1)
Structure of Uteroplacental Veins	223	(1)
Intramural Fibrinoid of Uteroplacental Arteries and Veins	224	(1)
Functional Aspects of Uteroplacental Vessels	224	(2)
Septa, Cell Islands, and Cell Columns	226	(3)
Septa	226	(1)
Cell Islands	227	(1)
Cell Columns	228	(1)
Pathology of Trophoblast Invasion	229	(21)
Placenta Accreta	229	(3)
Placenta Increta and Percreta	232	(4)
Placenta in Ectopic (Tubal) Pregnancy	236	(2)
Placenta in Abdominal Pregnancy	238	(2)
Cysts and Breus' Mole	240	(2)
Maternal Floor Infarction	242	(6)
Decidual Degeneration	248	(2)
References	250	(23)
Involution of Implantation Site and Retained Placenta	273	(8)
Involution of the Placental Site	273	(3)
Subinvolution	276	(1)
Placental Polyps	276	(2)
Involution of a Remaining Placenta	278	(1)
References	279	(2)
Anatomy and Pathology of the Placental Membranes	281	(54)
Overview	281	(1)
Development	282	(2)
Amnion	284	(10)
Amnionic Epithelium: Different Cell Types or Cell Degeneration	285	(1)
Cytological and Functional Aspects of the Amnionic Epithelium	286	(3)
Amnionic Fluid	289	(1)
Chromosomal Determinations	290	(1)
Cellular Metaplasia and Glycogen	291	(1)
Amnionic Mesoderm	292	(1)
A Medley of Themes	293	(1)
Clinical and Research Applications	293	(1)
Chorion Laeve	294	(3)
Intermediate (Spongy) Layer	294	(1)
Chorionic Mesoderm	294	(1)
Trophoblast Layer	295	(1)
Immunological Considerations Concerning the Trophoblast	296	(1)
Decidua	296	(1)
Tensile Properties of the Membranes	297	(1)
Pathology of the Membranes	297	(25)
Preterm Rupture of the Membranes	297	(2)
Cysts, Tumors, and Hemorrhage	299	(2)
Amnionic Fluid Embolism	301	(3)
Meconium	304	(6)
Gastroschisis	310	(1)
Epidermolysis Bullosa	311	(1)
Amnion Nodosum	311	(3)
Amnionic Bands	314	(6)
Extramembranous Pregnancy	320	(2)
References	322	(13)
Anatomy and Pathology of the Umbilical Cord and Major Fetal Vessels	335	(64)
Development	335	(1)
Amnionic Epithelium	335	(2)
Wharton's Jelly	337	(1)
Umbilical Vessels	338	(3)
Structure of Umbilical Vessels	338	(1)
Innervation	339	(1)
Contractility of Umbilical Vessels	339	(2)
Hyrtl Anastomosis, False Knots, and Hoboken Nodes	341	(1)
Embryonic Remnants	341	(5)
Allantois	341	(2)
Omphalomesenteric Duct	343	(3)
Spiral Turns of the Cord	346	(2)
Length of the Cord	348	(11)
Abnormal Length, Nuchal Cord	349	(3)
Site of Cord Insertion	352	(1)
Furcate Cord Insertion	353	(1)
Velamentous Cord Insertion	353	(6)
Placental Surface Vessels	359	(3)
Nucleated Red Blood Cells	362	(1)
Cysts and Edema	362	(1)
Single Umbilical Artery	363	(3)
Placental Transfusion	366	(1)
Knots	367	(1)
False Knots	368	(1)
Strictures	369	(2)
Rupture	371	(1)
Hematoma	371	(2)
Varices and Aneurysms	373	(2)
Thrombosis of the Umbilical Vessels	375	(4)
Thrombosis of the Placental Vascular Tree	379	(5)
Tumors of the Umbilical Cord	384	(2)
References	386	(13)
Placental Shape Aberrations	399	(20)
Site of Placental Attachment	399	(1)
Volumetric Growth	400	(1)
Abnormal Shapes (``Errors in Outline'')	401	(3)
Placenta Previa	404	(4)
Placenta Membranacea	408	(2)
Circumvallate Placenta (Extrachorial, Circummarginate Placentas)	410	(5)
References	415	(4)
Histopathological Approach to Villous Alterations	419	(18)
Microscopic Evaluation	419	(7)
Assessment of Villous Maturation	419	(3)
Placental Insufficiency	422	(1)
Examination of Fetal Stem Vessels	423	(1)
Examination of the Fetal Capillary Bed	423	(1)
Villous Architecture and Fibrinoid	424	(1)
Intervillous Space, Infarcts	425	(1)
Abruptio Placentae	425	(1)
Major Histopathological Findings	426	(8)
Syncytiotrophoblast	426	(1)
Knotting of the Syncytiotrophoblast	426	(2)
Langhans' Cells	428	(1)
Vasculosyncytial Membranes	428	(1)
Trophoblastic Basement Membrane	428	(1)
Perivillous Fibrinoid	428	(1)
Intravillous Fibrinoid	428	(1)
Villous Calcification	429	(1)
Stem Vessels	429	(1)
Nucleated Red Blood Cells	430	(1)
Villous Capillarization	430	(1)
Stromal Architecture and Stromal Fibrosis	431	(1)
Hofbauer Cells (Macrophages)	431	(1)
Inflammatory Changes	432	(1)
Villous Edema or Immaturity	432	(2)
References	434	(3)
Classification of Villous Maldevelopment	437	(24)
Syncytial Knotting	437	(3)
Syncytial Knotting: Artifact or Meaningful Pathological Finding	437	(1)
Interpretation of Syncytial Knotting	437	(1)
Artificial Knotting as Related to Villous Shapes in Paraffin Sections	438	(2)
Conclusions Concerning Knotting	440	(1)
Classificatin of Villous Maldevelopment	440	(5)
Summarizing Diagram of Villous Maldevelopment	443	(1)
Villous Maturation Score	443	(2)
Cases of Villous Maldevelopment	445	(13)
Synchronous Villous Immaturity	445	(2)
Persisting Villous Immaturity and Rhesus Incompatibility	447	(1)
Normal Mature Placenta	448	(1)
Preterm Villous Maturation and Villous Hypermaturity	449	(1)
Prolonged Pregnancy	450	(2)
Placentas at High Altitude and Maternal Anemia (Preplacental Hypoxia)	452	(1)
Intrauterine Growth Restriction with Preserved End-Diastolic Umbilical Flow with or Without Preeclampsia (Uteroplacental Hypoxia)	453	(1)
Intrauterine Growth Restriction Combined with Absent or Reverse End-Diastolic Umbilical Blood Flow, With or Without Preeclampsia (Postplacental Hypoxia)	454	(2)
Maternal Diabetes Mellitus	456	(2)
References	458	(3)
Erythroblastosis Fetalis and Hydrops Fetalis	461	(31)
Erythroblastosis Fetalis	461	(7)
Placental Pathology in Erythroblastosis	462	(6)
Nonimmune Hydrops	468	(14)
α-Thalassemia	468	(2)
Fetal Hemorrhage	470	(1)
Fetal Tumors	471	(3)
Congenital Anomalies and Hydrops Fetalis	474	(1)
Congenital Heart Disease	475	(1)
Cardiac Arrhythmias	476	(1)
Nephrotic Syndrome	476	(1)
Parvovirus Anemia	477	(4)
Hydrops of Unknown Etiology	481	(1)
References	482	(10)
Transplacental Hemorrhage, Cell Transfer, Trauma	492	(24)
Transplacental Blood and Cell Transfer	492	(1)
Trauma	492	(5)
Placenta in Hemorrhage	497	(2)
Technique for Identification of Fetal Red Blood Cells	499	(2)
Significant Transplacental Hemorrhage	501	(2)
Fetal Consequences of Massive Hemorrhage Across the Placenta	503	(4)
Other Fetal Blood Elements Passing Through the Placenta	507	(1)
Mother-to-Fetus Transfer of Cells	508	(1)
References	509	(7)
Fetal Storage Disorders	516	(7)
References	520	(3)
Maternal Diseases Complicating Pregnancy: Diabetes, Tumors, Preeclampsia, Lupus Anticoagulant	523	(68)
Maternal Diseases	523	(19)
Hematological Disorders	530	(4)
Endocrine Disorders	534	(1)
Diabetes Mellitus During Pregnancy	534	(4)
Maternal Neoplasms	538	(4)
Hypertensive Disorders	542	(20)
Preeclampsia	542	(1)
Animal Models	542	(1)
Placental Pathology of Preeclampsia	543	(1)
Decidual Arteriopathy	543	(6)
Infarcts	549	(2)
Abruptio Placentae	551	(6)
Fetal Effects of Abruptio Placentae	557	(1)
Other Placental Changes in Preeclampsia	557	(3)
Etiology of Toxemia, Pregnancy-Induced Hypertension, or Preeclampsia	560	(2)
Lupus Erythematosus and Lupus Anticoagulant	562	(9)
Lupus Erythematosus	562	(3)
Lupus Anticoagulant	565	(6)
References	571	(20)
Infectious Diseases	591	(94)
Chorioamnionitis	591	(31)
Macroscopic Appearance	591	(1)
Microscopic Appearance	592	(14)
General Considerations of Chorioamnionitis	606	(2)
Specific Microorganisms	608	(14)
Bacterial Vaginosis	622	(1)
Syphilis	622	(3)
Necrotizing Funisitis	625	(3)
Other Spirochetal Diseases	628	(1)
Fungus Infections	629	(3)
Virus Infections and Villitides	632	(14)
Cytomegalovirus Infection	632	(4)
Herpes Simplex Virus Infection	636	(4)
Varicella (Chickenpox)	640	(1)
Epstein--Barr Virus	641	(1)
Smallpox, Vaccinia, Alastrim, and Parvovirus B 19	641	(1)
Enteroviruses	642	(1)
Influenza, Mumps, Rabies	643	(1)
Hepatitis	643	(1)
Rubella (German Measles)	644	(1)
Rubeola (Measles)	645	(1)
Human Immunodeficiency Virus Infection	645	(1)
Toxoplasmosis	646	(4)
Kala-Azar	650	(1)
Changas' Disease	650	(1)
Babesiosis, Trichomoniasis, Rickettsia, and Ehrlichia	651	(1)
Malaria	652	(1)
Other Parasitic Infections	653	(1)
Villitis of Unknown Etiology	653	(6)
References	659	(26)
Abortion, Placentas of Trisomies, and Immunological Considerations of Recurrent Reproductive Failure	685	(33)
Anatomical Findings	687	(3)
Summary of Placental Findings in Chromosomally Defined Abortions	690	(5)
Trisomies	690	(2)
Polyploidies	692	(1)
Monosomy X	693	(2)
Induced Abortions	695	(4)
Incomplete Abortion	699	(1)
Placenta in Chorionic Villus Sampling	700	(3)
Trisomic Placentas	703	(1)
Chemical Markers and Trisomy	704	(1)
Other Findings	704	(1)
Recurrent or Habitual Abortion	705	(4)
References	709	(9)
Molar Pregnancies	718	(36)
Hydatidiform Moles and Partial Moles	718	(1)
Hydatidiform Moles	718	(14)
Incidence	721	(1)
Genetics	722	(4)
Morphology	726	(5)
Other Attributes	731	(1)
Deportation	732	(5)
Chorioadenoma Destruens (Invasive Mole)	734	(1)
Therapy	735	(2)
Ectopic Moles	737	(1)
Partial Hydatidiform Mole	737	(6)
Mole and Fetus	740	(1)
Partial Hydatidiform Mole with Twin Gestation	741	(2)
References	743	(11)
Trophoblastic Neoplasm	754	(24)
Choriocarcinoma	754	(3)
Choriocarcinoma In Situ and Choriocarcinoma Coincident with Pregnancy	757	(4)
Trophoblastic Psedotumor--Exaggerated Placental Site--Placental Site Trophoblastic Tumor (PSTT)--Placental Site Nodule (PSN)--Epithelioid Trophoblastic Tumor	761	(10)
Ultrastructure of Trophoblastic Tumors	767	(1)
Antigenic Studies of Trophoblastic Tumors	767	(1)
Epidemiology of Choriocarcinoma	768	(1)
Endocrine Aspects of Gestational Trophoblastic Neoplasia	768	(1)
Ectopic Choriocarcinomas; Tumors in Men	769	(1)
Therapy of Gestational Trophoblastic Neoplasia	770	(1)
Choriocarcinoma in Animals	771	(1)
Choriocarcinoma in Cell Lines and Genetics	771	(1)
References	771	(7)
Benign Tumors and Chorangiosis	778	(12)
Angiomas	778	(7)
Other Benign Tumors	785	(1)
Chorangiosis---Chorangiomatosis	786	(1)
References	787	(3)
Multiple Pregnancy	790	(113)
Zygosity	790	(2)
The Placenta in the Study of Zygosity	792	(4)
Causes and Incidence of Multiple Births	796	(5)
Third Type of Twin	801	(1)
Twinning Incidence	801	(3)
Superfetation and Superfecundation	804	(1)
Vascular Anatomy of Twin Placentas	804	(8)
Monoamnionic, Monochorionic Twin Placenta	812	(12)
Diamnionic, Monochorionic Twin Placenta	824	(2)
Diamnionic, Dichorionic Twin Placenta	826	(1)
Vanishing Twin Phenomenon	827	(6)
Fetus Papyraceus	833	(4)
Transfusion Syndrome	837	(13)
Acardiac Twins	850	(8)
Conjoined Twins	858	(4)
Sacrococcygeal Teratoma and Epignathus	862	(1)
Congenital Anomalies	862	(2)
Cytogenetics and ``Heterokaryotypic MZ Twins''	864	(1)
Chimerism, Mosaicism	865	(1)
Whole-Body Chimerism	866	(1)
Triplets and Higher Multiple Births	867	(8)
Twins in Abortion and Ectopic Pregnancy	875	(1)
Morbidity and Mortality	876	(2)
Hormones in Twin Pregnancy	878	(1)
References	878	(25)
Legal Considerations	903	(14)
Twinning Problems	906	(1)
Inflammation	907	(1)
The Green Placenta	908	(2)
Vascular Abnormalities	910	(1)
Umbilical Cord	910	(1)
Placental Villous Color	911	(1)
Other Types of Pathology	912	(2)
References	914	(3)
Glossary	917	(3)
Bibliography	919	(1)
Normative Values and Tables	920	(9)
References	925	(4)
Index	929