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绒毛纤维素沉积的正常和异常情况
2012-04-23 01:00 阅读(5214) 评论(3) 分类：病理学习
胎盘的病理切片我看的不多，看的时候也老是觉得不踏实，尤其是绒毛涉及纤维素沉积那一块，不知道如何判断，今天看书小小的总结一下：
1、成熟绒毛周围有纤维素沉积是正常的。
2、母体蜕膜的血管病变：评估纤维素性坏死，早期发现先兆子癫。
3、足月胎盘绒毛膜下的纤维素沉积是正常的，不要误以为是梗死。
4、如何鉴别绒毛梗死和绒毛周围正常纤维素沉积。
Decidual vasculopathy: The membrane roll usually shows a nice lining of decidua, which is where you will find maternal vessels. Evaluate these for fibrinoid necrosis, a common finding in preeclampsia (Figure 18.8).
Figure18.8. Fibrinoid necrosis. The dark pink condensation of the wall of this small artery (arrow) is an early sign of fibrinoid necrosis, which may be seen in preeclampsia.
Subchorionic fibrin: Subchorionic fibrin is normal, and you may see large deposits in full-term placentas (Figure 18.9). Do not call it an infarct.
Figure18.9. Fibrin, subchorionic. Subchorionic deposits of fibrin (arrow) are normal in a term placenta and should not be mistaken for infarct. The amnion lies atop the fetal surface (arrowhead).
Infarct: Usually visible grossly as dense white patches, a true infarct has the look of coagulative necrosis (loss of nuclei and cell structure) with the mummified villi touching each other (Figure 18.11). Do not confuse this with perivillous fibrin deposition, in which fibrin encases a wide area of villi (encased villi should still show nuclear detail and be separated by abundant surrounding fibrin).
Mature villi acquire syncytial knots and perivillous fibrin (like hyaline membranes lining the villi). They become tiny-------just large enough to hold a few capillaries.
Figure 18.11. Infarct versus perivillous fibrin. (A) In an infarct, there is loss of basaphilia and cellular detail with residual apoptotic bodies, as in coagulative necrosis elsewhere. (B) In a mass of perivillous fibrin, while the low power impression is a sheet of consolidated pink, on high power you can see the villi remain viable, with good nuclear detail.
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