Manual of Pathology of the Human Placenta

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