Department of Gynecology & Obstetrics, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Department of Pathology, Jinan University School of Medicine, Guangzhou, China.
Acta Obstet Gynecol Scand. 2022 Oct;101(10):1120-1128. doi: 10.1111/aogs.14435. Epub 2022 Aug 4.
The increasing cesarean section rate has led to an increase in the number of subsequent pregnancies resulting in a cesarean scar pregnancy. There appears to be preferential attachment of the blastocyst to the scar site, which may be associated with defective decidua in that region, resulting in abnormal implantation, which can in turn negatively affect the success of the pregnancy. The aim of the current study was to evaluate the extravillous trophoblast, decidua, and myometrium in scar and adjacent non-scar regions of the implantation site of a cesarean scar pregnancy.
Samples containing a gestational mass were obtained by laparoscopic excision from patients with a cesarean scar pregnancy at 6-11 weeks of gestation as diagnosed by transvaginal or transabdominal ultrasound (n = 8 type II cesarean scar pregnancy). Cesarean scar pregnancy tissues were separated into scar and non-scar regions, and the scar regions were sub-separated into non-implantation and implantation sites. Serial sections were histologically examined after hematoxylin and eosin, Masson's trichrome and immunochemical staining, and changes in the myometrium, extravillous trophoblast, and decidua were evaluated.
In cesarean scar pregnancy, compared with scars not in the implantation site, scars in the implantation site displayed increased fibrosis, and had disrupted myometrium, which was related to varying patterns of E-cadherin expression as a response to extravillous trophoblast invasion. In addition, local decidua was found at the non-scar implantation sites, with multinucleated trophoblast giant cell accumulation and shallow invasion. These features were not evident in the scar implantation sites.
This study emphasizes that the decidua drives multinucleated trophoblast giant cell differentiation, limiting the degree of invasion. Better characterization of this differentiation process may be helpful for better management and avoidance of the consequences of cesarean scar pregnancy.
剖宫产率的上升导致了越来越多的后续妊娠导致剖宫产瘢痕妊娠。胚胎似乎优先附着在瘢痕部位，这可能与该区域的蜕膜缺陷有关，导致异常着床，从而对妊娠的成功产生负面影响。本研究旨在评估剖宫产瘢痕妊娠着床部位的绒毛外滋养层、蜕膜和子宫肌层在瘢痕和非瘢痕部位的情况。
对经阴道或经腹超声诊断为 6-11 周妊娠的剖宫产瘢痕妊娠患者，通过腹腔镜切除含有妊娠囊的组织标本（n=8 例 II 型剖宫产瘢痕妊娠）。将剖宫产瘢痕妊娠组织分为瘢痕和非瘢痕部位，将瘢痕部位进一步分为非着床和着床部位。对苏木精-伊红、Masson 三色和免疫化学染色的连续切片进行组织学检查，评估子宫肌层、绒毛外滋养层和蜕膜的变化。
与非着床部位的瘢痕相比，着床部位的瘢痕纤维化程度增加，子宫肌层中断，这与绒毛外滋养层浸润时 E-钙黏蛋白表达模式的变化有关。此外，在非瘢痕着床部位发现局部蜕膜，伴有多核滋养细胞巨细胞聚集和浅层浸润。这些特征在瘢痕着床部位并不明显。
本研究强调蜕膜驱动多核滋养细胞巨细胞分化，限制浸润程度。更好地描述这种分化过程可能有助于更好地管理和避免剖宫产瘢痕妊娠的后果。
