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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