Placenta and POC

Question 1

Chorionic villi which are hydropic, with cistern formation, circumferential trophoblastic proliferation and atypia in trophoblastic cells. No fetal RBCs can be seen in capillaries.

Answer 1

Features of molar pregnancy favouring complete hydatidiform mole

Differential diagnosis:
Partial hydatidiform mole
Hydropic abortus

Plan:
Correlate with clinical history and radiology (?bHCG measurement ?USS findings ?evidence of fetal parts)
Correlate with any concurrent cytogenetic testing
IPX to support Dx: p57 (loss of staining in villous cytoplasmic and stromal cells)

Question 2

Placental membrane roll with acute inflammation (neutrophils), +/- necrosis of amnion

Answer 2

Acute chorioamnionitis

Differential diagnosis:
Acute chorioamnionitis with meconium effect

Plan:
Correlate with clinical features and macroscopic features (?maternal / fetal sepsis ?prolonged rupture of membranes)
Correlate with concurrent microbiology investigations (e.g. placental swab) - if not done send fresh tissue urgently
Examine further sections (to formally stage and grade maternal and fetal inflammatory response)

Question 3

Well circumscribed mass within placenta formed of fetal capillaries and surrounding stroma

Answer 3

Placental chorangioma

Plan:
Correlate with clinical history and radiology (?placental mass ?fetal monitoring/haemodynamic compromise)
Examine further blocks (e.g. for total size, areas of differing morphology)
IPX to support Dx: Not required
Advice to clinician: May be assiociated with infantile haemangiomas. Clinical correlation is required.

Question 4

Placental membrane roll with decidual arterioles exhibiting fibrinoid necrosis, accumulation of intramural foamy macrophages (atherosis), and often a perivascular lymphocytic infiltrate.

Answer 4

Decidual arteriopathy

Plan:
Correlate with clinical history and radiology features (?maternal smoking / hypertension ?fetal growth restriction)
Examine further blocks - remainder of placenta for other features of maternal vascular malperfusion (e.g. low weight, infarcts, distal villous hypoplasia)
Advice to clinician: Associated with maternal vascular malperfusion