Pathology of placenta

Pathology of placenta
Updated: 04/16/2019
© Jun Wang, MD, PhD

Anatomy/histology
  • Fetomaternal organ
  • Three parts
Umbilical cord: 1 vein, 2 arteries, Wharton’s jelly, NO inflammatory infiltrate
Fetal membrane: Amnion, chorion, decidua, NO inflammatory infiltrate in amnion
Placental plate: Cotyledons, primary chorionic villi (solid outgrowth of cytotrophoblast into the syncytiotrophoblast), secondary chorionic villi (primary villi +loose connective tissue core), tertiary chorionic villi (secondary chorionic villi + blood vessel)
Physiology
  • Material and gas exchange between fetus and mother
  • Cytotrophoblast replacing endothelial cells of uterine spiral artery to maintain sufficient blood flow to placenta
Hormone production
  • Estrogen:
Converted from fetal androgen
Maintain endometrium during pregnancy
Suppress gonadotropin secretion
Stimulate mammary gland development
Inhibit prolactin secretion
Promote uterine sensitivity to oxytocin
  • Progesterone
Maintains a non-contractile uterus
Fosters development of an endometrium conducive to pregnancy
  • Human chorionic gonadotropin (hCG)
Heterodimer of alpha and beta subunits
Synthesized primarily by the villous syncytiotrophoblast
Detectable 7–10 days after implantation, the basis for early pregnancy tests
Peak levels reached at 8-10 weeks
Maintains maternal corpus luteum
Elevation of beta-hCG only: trophoblast tumors, or pregnancy
Elevation of alpha-hCG only: pituitary tumors
Hyperglycosylated hCG: invasive cytotrophoblasts, pregnancy
  • Placental alkaline phosphatase
Regulate primordial germ cells migration in developing fetus
  • Others: activin, inhibin, human chorionic thyrotropin, etc
Frequently discussed non neoplastic conditions
Gestational trophoblastic disease
  • Hydatidiform mole
Complete mole
Partial mole
Practice questions

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Pathology notes Jun Wang, MD, PhD 1. General information Frequently discussed syndromes Terms of dermatology Terms of hematology 2. Primary immunodeficiency disorders 3. Hemodynamic abnormalities Shock Thrombosis and embolism Bleeding disorders 4. Benign white cell disorders 5. Hematopoietic neoplasms Lymphoid neoplasms Myeloid neoplasms Histiocytic neoplasms: Langerhans cell histiocytosis 6. Cardiovascular system Pulmonary hypertension Cardiovascular system tumors 7. Respiratory tract tumors 8. Gastrointestinal tract Congenital disorders Infectious gastroenteritis Oral cavity Esophagus Stomach Intestinal tumors Salivary glands Exocrine pancreas and gallbladder 9. Urinary system Kidney masses Lower urinary tract 10. Male reproductive system 11. Female genital tract 12. Breast 13. Endocrine organs Pituitary gland Adrenal gland Thyroid gland Parathyroid gland Endocrine pancreas Multiple endocrine neoplasms 14. B
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