Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Arch Gynecol Obstet. 2020 Feb;301(2):499-507. doi: 10.1007/s00404-020-05453-1. Epub 2020 Feb 5.
To characterize the immune cell infiltrate associated with maternal vascular remodeling in 12 cases of cesarean hysterectomy from women with placenta accreta spectrum (PAS) disorder.
Myometrial vessels were evaluated by hematoxylin and eosin and immunohistochemistry stains on tissue microarrays that included samples from the myometrium, deep to the implantation site. Vessels were quantified based on physiologic conversion and immune cell infiltrates. Placental bed biopsies from cases of repeat cesarean section, and decidual vessels from delivered non-PAS placentas were used as controls.
Immune cells, predominantly macrophages and T-cells, were present as a band along the placental-myometrial interface in PAS cases. However, within the myometrium, the infiltrate showed a perivascular accentuation. The infiltrates around and within vessel walls were composed of T-cells (CD3) and macrophages (CD68), with fewer NK (CD56), Treg (FoxP3) and rare B-cells (CD20). Plasma cells (CD138) were absent. The majority of vessels with immune cell infiltrates had undergone complete or partial physiologic conversion by trophoblast. However, a subset of unconverted vessels in the myometrium had a similar immune cell infiltration. Control blood vessels showed a similar pattern of leukocytes infiltration in the decidua and placental bed biopsies, but with a lower density.
Our findings suggest that myometrial vascular changes in PAS resemble the physiological changes of vessels noted in the implantation site of normal pregnancies. The presence of perivascular immune cell infiltrates in the absence of adjacent trophoblast suggests that the process may be initiated by paracrine effects rather than direct contact or endovascular growth of trophoblast.
在 12 例胎盘植入谱系（PAS）疾病剖宫产子宫切除术中，对与母体血管重塑相关的免疫细胞浸润进行特征描述。
通过组织微阵列的苏木精和伊红以及免疫组织化学染色评估肌层血管，该微阵列包括来自植入部位深部的肌层样本。根据生理性转化和免疫细胞浸润对血管进行定量。将重复剖宫产的胎盘床活检和非 PAS 胎盘的蜕膜血管用作对照。
在 PAS 病例中，免疫细胞（主要是巨噬细胞和 T 细胞）作为一条带存在于胎盘-子宫肌层界面。然而，在子宫肌层中，浸润呈血管周围强化。血管壁周围和内部的浸润物由 T 细胞（CD3）和巨噬细胞（CD68）组成，NK（CD56）、Treg（FoxP3）和罕见的 B 细胞（CD20）较少。浆细胞（CD138）不存在。大多数有免疫细胞浸润的血管已经被滋养细胞完成或部分完成生理性转化。然而，子宫肌层中未转化的血管存在类似的免疫细胞浸润。对照血管在蜕膜和胎盘床活检中显示出类似的白细胞浸润模式，但密度较低。
我们的发现表明，PAS 中的子宫肌层血管变化类似于正常妊娠植入部位观察到的血管的生理性变化。在没有邻近滋养细胞的情况下，血管周围存在免疫细胞浸润表明，该过程可能是由旁分泌作用而不是滋养细胞的直接接触或血管内生长引发的。
