Chronic histiocytic intervillositis: A placental lesion associated with recurrent reproductive loss
Chronic histiocytic intervillositis: A placental lesion associated with recurrent reproductive loss
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DOI：
10.1053/hupa.2000.19454
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发表时间：
2000-11-01
期刊：
影响因子：
3.3
通讯作者：
Redline, RW
中科院分区：
文献类型：
--
作者：
Boyd, TK;Redline, RW
慢性（组织细胞）绒毛间炎（CHIV），在本研究中被定义为无绒毛炎的弥漫性组织细胞浸润于绒毛间间隙，是一种特发性病变，见于一些自然流产标本和胎盘的绒毛膜囊。在这项回顾性研究中，我们评估了1993年至2000年间2家医院诊断为hiv的所有患者，以及1977年的1例患者。组织病理学、白细胞浸润表型、围产期结局和其他相关临床特征通过回顾临床记录和所有可用的病理标本以及免疫组织化学染色来评估。在21例患者（31例妊娠早期的23例，5例妊娠中期的3例，9例妊娠晚期的5例）检查的45例标本中有31例发现hiv。复查一个以上标本的患者复发率为67%。总的围产期死亡率为77%，只有18%的孕妇达到37周。19例妊娠3次及以上的患者中有8例发生复发性自然流产（RSA）；5例为原发性RSA（大于或等于3次连续自然流产，无存活子女），3例为继发性RSA（大于或等于3次连续自然流产，有1个或更多存活子女）。8例妊娠中期和晚期胎盘中有5例出现严重的宫内生长受限。患者一般不高龄（平均29.8±6.2岁），11例患者未发现明显的种族倾向、自身免疫或过敏现象。绒毛间浸润的免疫组织化学染色显示，在不同的成熟和活化阶段，单核巨噬细胞几乎均匀分布：超过90%的CD45Rb和CD68阳性，30%至40%的MAC387阳性，不到5%的CD3阳性，CD1a、CD20、CD30和CD56阴性。我们得出结论，chv是一种罕见但重要的原因，反复自然流产，在某些情况下，在孕晚期流产，《美国医学杂志》31:1389-1396，版权(C) 2000 by W.B, Saunders Company。
Chronic (histiocytic) intervillositis: (CHIV), defined for the purposes of this study as diffuse histiocytic infiltration of the intervillous space without villitis, is an idiopathic lesion seen in the chorionic sacs of some spontaneous abortion specimens and placentas. In this retrospective study, we evaluated all patients diagnosed with CHIV from 2 hospitals between 1993 and 2000, plus 1 additional patient from 1977. Histopathology, phenotype of the leukocytic infiltrate, perinatal outcome, and other associated clinical features were assessed by review of clinical records and all available pathology specimens plus immunohistochemical staining. CHIV was found in 31 of 45 specimens examined from 21 patients (23 of 31 first trimester, 3 of 5 second trimester, and 5 of 9 third trimester). Recurrence rate was 67% for patients with more than one specimen reviewed. Overall perinatal mortality rate was 77%, and only 18% of pregnancies reached 37 weeks. Eight of 19 patients with 3 or more pregnancies had recurrent spontaneous abortion (RSA); 5 with primary RSA (greater than or equal to3 consecutive spontaneous abortions (SAB) with no living children) and 3 with secondary RSA (greater than or equal to3 consecutive SAB with 1 or more living children). Severe intrauterine growth restriction was seen in 5 of 8 second- and third-trimester placentas with CHIV. Patients were generally not of advanced maternal age (mean, 29.8 +/- 6.2 years), and there was no obvious racial predisposition, Autoimmune or allergic phenomena were identified in 11 patients. Immunohistochemical staining of the intervillous infiltrate showed a near uniform population of monocyte-macrophages at varying stages of maturity and activation: more than 90% CD45Rb and CD68 positive, 30% to 40% MAC387 positive, less than 5% CD3 positive, and CD1a, CD20, CD30, and CD56 negative. We conclude that CHIV is an uncommon but important cause of recurrent spontaneous abortion and, in some cases, loss at later gestational ages, HUM PATHOL 31:1389-1396, Copyright (C) 2000 by W.B, Saunders Company.