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Positive C4d Immunostaining of Placental Cytotrophoblasts Supports Host-Versus-Graft Rejection in Villitis of Unknown Etiology.
MedLine Citation:
PMID:  23137164     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Chronic villitis of unknown etiology (VUE) occurs in approximately 5-10% of third trimester placentas. It is characterized by lymphohistiocytic infiltration of the placental chorionic villi. VUE is associated with fetal growth restriction, preterm birth, and recurrent pregnancy loss. Accumulating evidence suggests that VUE may represent a host-versus-graft reaction, analogous to transplant rejection. Pathologists routinely screen for rejection in transplant biopsies by immunostaining for C4d, a classical complement component. Our objective was to test whether chronic villitis is more likely to immunostain for C4d than matched controls. Chronic villitis was diagnosed in 82/1986 (4%) singleton placentas submitted to the OHSU Pathology Department from 2007-2011. Forty cases of VUE and 40 gestational-age matched controls were randomly selected for immunohistochemical analysis using one representative section of the placenta from each case. A positive C4d result was defined as circumferential immunostaining of the syncytiotrophoblasts in at least one chorionic villous. We also scored fetal vessels in the chorionic plate as either negative, weak, or strong endothelial staining. Positive C4d villous staining was strongly associated with chronic villitis (35/40, 88%) compared with controls (2/40, 5%) (p<0.0001). Strong fetal blood vessel staining was also more common in cases versus controls (p<0.05). Positive C4d villous staining was more commonly seen in multiparous (35/66, 53%) than primiparous (2/14, 14%) women (p<0.05). The increased incidence of C4d staining in multiparous women and in placentas with chronic villitis supports the hypothesis that chronic villitis represents immune mediated rejection by the mother.
Authors:
Erin R Rudzinski; Meghan Gilroy; Colin Newbill; Terry K Morgan
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-8
Journal Detail:
Title:  Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society     Volume:  -     ISSN:  1093-5266     ISO Abbreviation:  Pediatr. Dev. Pathol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9809673     Medline TA:  Pediatr Dev Pathol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
a Oregon Health and Science University, Department of Pathology, L-471.
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