Division of Pathology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
Placenta. 2019 Oct;86:20-27. doi: 10.1016/j.placenta.2019.07.011. Epub 2019 Jul 24.
This retrospective analysis was performed to find out if clusters of mineralized chorionic villi can be regarded as an independent feature of fetal vascular malperfusion (FVM).
Of all 1698 placentas reviewed by the author during the last 10 years, 39 (2.3%) showed clusters of mineralized chorionic villi (Group 1), 100 cases (5.9%) showed randomly scattered mineralized chorionic villi with without clustering (Group 2), and the remaining 1559 placentas showed no villous mineralization (comparative Group 3). In doubtful cases, histochemistry stains were performed to determine the pattern of villous mineralization. Twenty three independent clinical and 43 placental variables were statistically compared among the groups: descriptive statistics (Chi-square, Fisher test or signed rank test), and logistics regression model.
Clinically, Group 1 featured shorter gestational age than Group 2, and in addition to shorter gestational age, more common oligohydramnios, polyhydramnios, induction of labor, macerated stillbirth and fetal growth restriction than Group 3. Of placental variables, fetal vascular ectasia, and clusters of avascular chorionic villi were more common in Group 1 than in Group 2, and in addition, segmental villous stromal vascular karyorrhexis was more common than in Group 3. By the logistics regression mode, segmental villous mineralization was independently associated with other histological features of FVM as a group and particularly with clusters of sclerotic chorionic villi.
FVM is characterized by temporal heterogeneity, i.e. coexistence of lesions of various duration, and strongly and independently correlates with clusters of mineralized chorionic villi. Therefore, segmental villous mineralization should be included into the category of segmental FVM. It can be seen even in totally fibrotic placentas of prolonged stillbirth when other histological features of segmental vascular malperfusion can be obscured by global villous sclerosis.
本回顾性分析旨在探讨是否可以将矿化绒毛簇视为胎儿血管功能不良（FVM）的一个独立特征。
在作者过去 10 年中检查的所有 1698 个胎盘当中，有 39 个（2.3%）显示出矿化绒毛簇（第 1 组），100 个（5.9%）显示出随机散在的矿化绒毛，没有聚集（第 2 组），其余 1559 个胎盘没有绒毛矿化（对照组 3）。在有疑问的情况下，进行组织化学染色以确定绒毛矿化的模式。对 23 个独立的临床和 43 个胎盘变量在组间进行了统计学比较：描述性统计（卡方检验、Fisher 检验或符号秩检验）和逻辑回归模型。
从临床角度来看，第 1 组的胎龄比第 2 组短，而且除了胎龄较短外，与第 3 组相比，羊水过少、羊水过多、引产、胎死宫内和胎儿生长受限更为常见。在胎盘变量方面，第 1 组的胎儿血管扩张和无血管绒毛簇比第 2 组更为常见，此外，节段性绒毛间质血管核碎裂比第 3 组更为常见。通过逻辑回归模型，节段性绒毛矿化与 FVM 的其他组织学特征独立相关，尤其是与硬化性绒毛簇相关。
FVM 的特点是时间异质性，即各种不同病程的病变共存，并且与矿化绒毛簇强烈且独立相关。因此，节段性绒毛矿化应归入节段性 FVM 类别。即使在因胎儿死亡时间延长而导致胎盘完全纤维化的情况下，当其他节段性血管功能不良的组织学特征可能因整体绒毛硬化而变得模糊时，也可以观察到这种情况。
