Manual of Pathology of the Human Placenta : Second Edition

Manual of Pathology of the Human Placenta, Second Edition is a concise, practical manual of placental pathology. While references are made to the more encyclopedic Pathology of the Human Placenta, this Manual is designed as a user-friendly, easy-to-read bench manual that can be used in the grossing room as well as at the microscope. Features of the text include: - A section on the approach to the placental specimen, providing suggestions on what to do, as well as when and how to do it. - Discussion of detailed development and normal histology of all parts of the placenta for those wanting to learn about specific areas of the placenta. - Discussion of placental lesions, disease processes related to the placenta, neoplasms, and trophoblastic lesions. - An overview of the legal implications of placental examination and future directions. - "Suggestions for Examination and Report" includes key points in gross examination, sectioning, and diagnosis. Suggestions for comments in the surgical pathology report guide the reader in problematic situations or when the diagnosis or diagnostic implications are unclear. - An abundance of tables summarize pertinent information and provide easy access to the differential diagnoses of various lesions. Manual of Pathology of the Human Placenta, Second Edition is a must-have reference for every pathologist, resident and pathology assistant. Manual of Pathology of the Human Placenta, Second Edition Front-matter Manual of Pathology of the Human Placenta Copyright Foreword Preface to the First Edition Preface to the Second Edition Contents Section I: Approach to the Specimen Chapter 1: Evaluation of the First-Trimester Products of Conception General Considerations Macroscopic Examination Cytogenetics, Flow Cytometry, and Other Special Studies Submission of Microscopic Sections Microscopic Examination Therapeutic or Induced Abortion Spontaneous Abortions Suggestions for Examination and Report Selected References Chapter 2: Evaluation of the Second-Trimester Products of Conception General Considerations Macroscopic Examination and Description Special Procedures Submission of Microscopic Sections Microscopic Description, Diagnosis, and Report Selected References Chapter 3: Macroscopic Evaluation of the Second- and Third-Trimester Placenta Selection of Placentas for Pathologic Examination Examination of All Placentas Selection Based on Consensus Indications Initial Selection with Storage of Remaining Placentas Gross Examination of All Placentas with Microscopic Examination on Selected Placentas Storage Macroscopic Examination Instruments Procedure for Examination Normal Macroscopic Appearance Suggested Gross Description Submission of Microscopic Sections Fixation Special Procedures Selected References Chapter 4: Microscopic Evaluation of the Second- and Third-Trimester Placenta Approach to the Specimen Routine and Special Stains Immunohistochemical Markers Selected References Section II: Development and Normal Histology Chapter 5: Early Placental Development General Considerations Prelacunar Stage: Day 1–8 Postconception Lacunar Stage: Day 8–13 Postconception Primary Chorionic Plate Lacunar System Trophoblastic Shell Early Villous Stage: Day 13–28 Postconception Second Month and Beyond Development of the Fetal Membranes Development of the Umbilical Cord Selected References Chapter 6: Chorionic Villi: Histology and Villous Development Histology Syncytiotrophoblast Syncytial Knots, Sprouts, and Bridges Villous Cytotrophoblast (Langhans’ Cells) Villous Stroma General Considerations of Villous Development and Villous Types Mesenchymal Villi Immature Intermediate Villi Stem Villi Mature Intermediate Villi Terminal Villi Selected References Chapter 7: Overview and Microscopic Survey of the Placenta Introduction Overview and Microscopic Survey of First-Trimester Placenta Overview and Microscopic Survey of Second- and Third-Trimester Placenta Chorionic Plate Villous Structures Nonvillous Structures Basal Plate Marginal Zone Anatomy of the Intervillous Space Calcification, Mineralization, and Pigment Fetal Membranes Amnion Chorion Laeve Trophoblast Layer Decidua Structure and Histology of the Umbilical Cord Umbilical Vessels Selected References Chapter 8: Extravillous Trophoblast, Trophoblastic Invasion, and Fibrinoid General Considerations Extravillous Trophoblast Trophoblastic Stem Cells Proliferative Phenotype Invasive Phenotype Interstitial Phenotype Multinucleated Extravillous Trophoblast Decidua Fibrinoid Uteroplacental Vessels and Physiologic Conversion Selected References Section III: Multiple Gestation Chapter 9: Multiple Gestation: General Aspects General Considerations Zygosity Incidence Twin Placentation Pathogenesis Clinical Features and Implications Examination of the Placenta in Multiple Gestation Gross Examination Examination of Vascular Anastomoses Diamnionic–Dichorionic Twin Placenta Diamnionic–Monochorionic Twin Placenta Monoamnionic–Monochorionic Twin Placenta Suggestions for Examination and Report Selected References Chapter 10: Multiple Gestation: Twin Variants and Related Conditions Vanishing Twin and Fetus Papyraceous Clinical Features and Implications Pathogenesis Pathologic Features Suggestions for Examination and Report Acardiac Twins Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Conjoined Twins Pathogenesis Pathologic Features Suggestions for Examination and Report Twin Variants Triplets and Higher Multiple Births Suggestions for Examination and Report Twin-to-Twin Transfusion Chronic Twin-to-Twin Transfusion Pathogenesis Pathologic Features Clinical Features and Implications Treatment Considerations Acute Twin-to-Twin Transfusion Pathogenesis Clinical Features and Implications Acute on Chronic Twin-to-Twin Transfusion Suggestions for Examination and Report Chimerism and Mosaicism Heterokaryotypic Monozygotic Twins Sacrococcygeal Teratoma and Epignathus Selected References Section IV: Abnormalities of the Placenta Chapter 11: Abortion and the Placenta in Chromosomal Anomalies General Considerations Induced Abortions Clinical Features and Implications Pathologic Features Spontaneous Abortions Pathogenesis Clinical Features and Implications Pathologic Features Recurrent or Habitual Abortion Chromosomal Anomalies Trisomies Other Chromosomal Anomalies Ancillary Testing Suggestions for Examination and Report Confined Placental Mosaicism, Uniparental Disomy, and Imprinting Confined Placental Mosaicism Uniparental Disomy Imprinting Selected References Chapter 12: Postpartum Hemorrhage, Subinvolution of the Placental Site, and Placenta Accreta General Considerations Uterine Atony Pathogenesis Pathologic Features Suggestions for Examination and Report Retained Placental Tissue and Involution of the Placental Site Normal Involution of the Placental Site Subinvolution of the Placental Site Pathogenesis Pathologic Features Suggestions for Examination and Report Postpartum Endometritis Suggestions for Examination and Report Placenta Accreta, Placenta Increta, and Placenta Percreta Clinical Features and Implications Pathogenesis Pathologic Features Pitfalls in Diagnosis: Suggestions for Examination and Report Placental Polyp Suggestions for Examination and Report Involution of a Retained Placenta Suggestions for Examination and Report Selected References Chapter 13: Placental Shape Aberrations General Considerations The Multilobate Placenta The Bilobed Placenta Succenturiate Lobes (Accessory Lobes, Placenta Succenturiata) Pathogenesis Clinical Features and Implications Suggestions for Examination and Report Circumvallate and Circummarginate Placentas Pathologic Features Clinical Features and Implications Pathogenesis Extramembranous Pregnancy Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Placenta Membranacea (Placenta Diffusa) Suggestions for Examination and Report Miscellaneous Shape Abnormalities Placenta Previa Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Selected References Chapter 14: Pathology of the Fetal Membranes Cysts and Tumors Pathologic Features Pathogenesis Clinical Features and Implications Suggestions for Examination and Report Embryonic Remnants Vernix Caseosa Hematomas and Breus’ Mole Subamnionic Hematoma Retromembranous Hematoma Subchorionic Hematoma and Breus’ Mole Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Meconium and Other Pigments Pathologic Features Pathogenesis Clinical Features and Implications Suggestions for Examination and Report Gastroschisis Squamous Metaplasia Amnion Nodosum Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Amnionic Bands Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Selected References Chapter 15: Pathology of the Umbilical Cord Embryonic Remnants Allantoic Duct Remnants Pathogenesis Pathologic Features Clinical Features and Implications Omphalomesenteric Duct Remnants Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Umbilical Cord Coiling, Torsion, and Stricture Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Umbilical Cord Length Pathologic Features Pathogenesis Clinical Features and Implications Cord Diameter Suggestions for Examination and Report Cord Entanglement and Cord Prolapse Clinical Features and Implications Pathologic Features Umbilical Cord Knots Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Cord Insertion Velamentous and Marginal Cord Insertion Pathologic Features Pathogenesis Clinical Features and Implications Furcate Cord Insertion Interpositional Cord Insertion Suggestions for Examination and Report Single Umbilical Artery Pathologic Features Clinical Features and Implications Pathogenesis Supernumerary Vessels Suggestions for Examination and Report Thrombosis of Umbilical Vessels Pathologic Features Pathogenesis Clinical Features and Implications Suggestions for Examination and Report Tumors Hemangiomas Teratomas Miscellaneous Cord Lesions Suggestions for Examination and Report Selected References Section V: Disease Processes and the Placenta Chapter 16: Infectious Diseases General Considerations Ascending Infection and Acute Chorioamnionitis Pathogenesis Acute Chorioamnionitis and Preterm Delivery Incompetent Cervix “Clinical” Acute Chorioamnionitis Pathologic Features Maternal Response, Fetal Response, and Fetal Infection Subacute Chorioamnionitis Suggestions for Examination and Report Specific Microorganisms Group B Streptococcus Clinical Features and Implications Pathologic Features Listeriosis Clinical Features and Implications Pathogenesis Pathologic Features Escherichia coli Fusobacterium Clostridia Mycoplasma Chlamydia Bacterial Vaginosis Candida Species Clinical Features and Implications Pathologic Features Suggestions for Examination and Report Chronic Villitis Syphilis Pathogenesis Pathologic Features Cytomegalovirus Clinical Features and Implications Pathogenesis Pathologic Features Herpes Simplex Virus Pathogenesis Pathologic Features Clinical Features and Implications Parvovirus B19 Clinical Features and Implications Pathologic Features Mycobacteria Toxoplasma Pathogenesis Clinical Features and Implications Pathologic Features Malaria Pathogenesis Clinical Features and Implications Pathologic Features Suggestions for Examination and Report Villitis of Unknown Etiology Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Chronic Chorioamnionitis Suggestions for Examination and Report Chronic Intervillositis Suggestions for Examination and Report Selected References Chapter 17: Maternal Diseases Complicating Pregnancy General Considerations Connective Tissue Disorders Renal Disease Liver Disease Cardiac Disease Hematologic Disorders Sickle Cell Anemia Clinical Features and Implications Pathologic Features Other Hematologic Disorders Thyroid Disease Diabetes Mellitus Clinical Features and Implications Pathologic Features Miscellaneous Conditions Maternal Drug Use Tobacco Clinical Features and Implications Pathogenesis Pathologic Features Alcohol Cocaine Miscellaneous Therapeutic Medications Suggestions for Examination and Report Selected References Chapter 18: Placental Malperfusion General Considerations Preeclampsia and Gestational Hypertension Clinical Features and Implications Pathologic Features Decidual Vascular Changes Infarcts Abruptio Placentae Villous Maldevelopment and Syncytial Knotting Villous Maldevelopment and Hypoxia: Terminal Villus Deficiency: Villous Hypoplasia: Other Placental Changes in Preeclampsia Pathogenesis Lupus Erythematosus Clinical Features and Implications Pathologic Features Lupus Anticoagulant and Antiphospholipid Antibodies Clinical Features and Implications Pathologic Features Thrombophilias Clinical Features and Implications Pathologic Features Suggestions for Examination and Report Selected References Chapter 19: Miscellaneous Placental Lesions Intervillous Thrombi Pathogenesis Pathologic Features Suggestions for Examination and Report Intravillous Hemorrhage Suggestions for Examination and Report Retroplacental Hematoma and Abruptio Placentae Pathogenesis Clinical Features and Implications Pathologic Features Suggestions for Examination and Report Chorangiosis and Chorangiomatosis Chorangiosis Pathologic Features Pathogenesis Clinical Features and Implications Suggestions for Examination and Report Chorangiomatosis Suggestions for Examination and Report Fibrinoid Deposition Normal Perivillous Fibrinoid Maternal Floor Infarction and Massive Perivillous Fibrin Deposition Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Placental Mesenchymal Dysplasia Clinical Features and Implications Pathogenesis Pathologic Features Suggestions for Examination and Report Villous Edema and Villous Immaturity Suggestions for Examination and Report Selected References Chapter 20: Placental Abnormalities in Fetal Conditions Hydrops Fetalis Immune Hydrops Pathogenesis Pathologic Features Clinical Features and Implications Hematologic Disorders Clinical Features and Implications Pathologic Features Trauma Miscellaneous Causes of Fetal Hydrops Suggestions for Examination and Report Fetomaternal Hemorrhage Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Fetal Nucleated Red Blood Cells Suggestions and Examples for Report Transplacental Passage of Cellular Elements Fetal Metabolic Storage Disorders Pathologic Features Specific Disorders Suggestions for Examination and Report Placental Changes in Intrauterine Fetal Demise Suggestions for Examination and Report Selected References Chapter 21: Fetal Thrombotic Vasculopathy General Considerations Thrombosis in the Fetal Circulation Pathologic Features Thrombosis Avascular Villi Intimal Fibrin Cushions Fibromuscular Sclerosis Hemorrhagic Endovasculopathy: Villous Stromal Karyorrhexis Pathogenesis Clinical Features and Implications Suggestions for Examination and Report Selected References Section VI: Neoplasms and Gestational Trophoblast Disease Chapter 22: Neoplasms General Considerations Primary Placental Neoplasms Chorangioma (Angioma) Pathogenesis Pathologic Features Clinical Features and Implications Chorangiocarcinoma Suggestions for Examination and Report Leiomyoma Endometrial Stromal Lesions Teratomas Versus Acardiac Twinning Hepatocellular Adenoma Heterotopia Suggestions for Examination and Report Maternal Neoplasms Metastatic to the Placenta Clinical Features and Implications Pathologic Features Suggestions for Examination and Report Fetal Neoplasms Metastatic to the Placenta Malignant Fetal Tumors Benign “Metastatic” Lesions Suggestions for Examination and Report Selected References Chapter 23: Hydatidiform Moles General Considerations Hydatidiform Moles Pathogenesis Incidence and Epidemiologic Factors Complete Hydatidiform Moles Pathologic Features Embryonic and Fetal Tissue in Complete Hydatidiform Moles Clinical Features and Implications Early Complete Hydatidiform Moles Biparental Complete Hydatidiform Moles Ectopic Molar Pregnancy Partial Hydatidiform Mole Pathologic Features Clinical Features and Implications Differential Diagnosis Hydropic Abortus Versus Partial Mole Partial Mole Versus Complete Mole Early Mole Versus Hydropic Abortus Versus Partial Mole Partial Mole Versus Twin Pregnancy with Complete Mole Ancillary Testing Suggestions for Examination and Report Invasive Hydatidiform Mole Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Selected References Chapter 24: Choriocarcinoma General Considerations Clinical Features and Implications Pathologic Features Metastasis Choriocarcinoma-In Situ: Placental Choriocarcinoma Pathogenesis Pathologic Features Clinical Features and Implications Suggestions for Examination and Report Selected References Chapter 25: Lesions of Extravillous Trophoblast General Considerations Placental-Site Nodule Clinical Features and Implications Pathologic Features and Pathogenesis Exaggerated Placental Site Clinical Features and Implications Pathologic Features Placental-Site Trophoblastic Tumor Clinical Features Pathologic Features Clinical Implications Differential Diagnosis Differential Diagnosis: PSTT Versus Lesions of EVT Differential Diagnosis: PSTT Versus Choriocarcinoma Differentiation of PSTT from Other Tumors Epithelioid Trophoblastic Tumor Clinical Features and Implications Pathologic Features Extrauterine Lesions of Extravillous Trophoblast Suggestions for Examination and Report Selected References Section VII: Legal Considerations and New Directions Chapter 26: Legal Considerations General Considerations The Placenta in Litigation Twinning Problems Inflammatory Processes Acute Chorioamnionitis Chronic Villitis Vascular Abnormalities Fetal Thrombotic Vasculopathy Umbilical Cord Meconium – the “Green” Placenta Uteroplacental Malperfusion Abruptio Placentae Infarcts Miscellaneous Maternal Floor Infarction – Massive Perivillous Fibrin Deposition Chorangiosis Nucleated Red Blood Cells Placental Pallor Villous Changes Timing of Fetal Death Conclusion Selected References Chapter 27: New Directions: What is New in Placental Studies? References Back-matter Appendix A Abbreviations and Definitions Appendix B Index