Department of Pathology, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Mod Pathol. 2021 Jun;34(6):1074-1092. doi: 10.1038/s41379-021-00747-4. Epub 2021 Feb 8.
The Amsterdam classification system defines four major patterns of placental injury, maternal vascular malperfusion, fetal vascular malperfusion, acute chorioamnionitis, and villitis of unknown etiology, and lists the histologic findings that characterize each. However, there continues to be uncertainty regarding specific definitions, histologic mimics, grading and staging, and what combination of findings is required to diagnose each pattern of injury in a reproducible fashion. The purpose of this review is to clarify some of these issues by suggesting a stepwise approach to more fully realize the potential of this new classification system. In our view, the critical steps for correctly identifying and communicating each pattern of injury are (1) familiarity with the underlying pathophysiology and known clinical associations, (2) incorporation of important gross findings, (3) learning to recognize underlying architectural alterations and defining features at low power, (4) using higher magnification to narrow the differential diagnosis and assess severity (grading) and duration (staging), and (5) adopting a template for generating standardized placental reports that succinctly provide useful information for patient care and research applications.
阿姆斯特丹分类系统定义了四种主要的胎盘损伤模式，即母体血管灌注异常、胎儿血管灌注异常、急性绒毛膜羊膜炎和原因不明的绒毛膜炎，并列出了每种模式的特征性组织学发现。然而，对于特定的定义、组织学模拟、分级和分期，以及需要哪些组合的发现来以可重复的方式诊断每种损伤模式，仍然存在不确定性。本综述的目的是通过提出一种逐步的方法来阐明其中的一些问题，以充分发挥这个新分类系统的潜力。在我们看来，正确识别和传达每种损伤模式的关键步骤是：(1)熟悉潜在的病理生理学和已知的临床关联；(2)纳入重要的大体发现；(3)学会识别潜在的结构改变和在低倍镜下定义特征；(4)使用更高的放大倍数来缩小鉴别诊断范围，并评估严重程度(分级)和持续时间(分期)；(5)采用模板生成标准化的胎盘报告，简洁地为患者护理和研究应用提供有用的信息。
