Chronic Histiocytic Intervillositis: A Rare Cause of Placenta Mediated Obstetrical Events Associated with Isolated Alkaline Phosphatase Elevation?
DOI:
https://doi.org/10.24950/rspmi/CC25/16/2017Keywords:
Alkaline Phosphatase, Chorionic Villi, Histiocytes, Placenta Diseases, Pregnancy ComplicationsAbstract
The authors report a case of a 31-year-old woman, pregnant
for the third time, with a medical history of severe placental
mediated obstetrical complications, referred for exclusion of
a pro-thrombotic state. Thrombophilia testing was negative,
however isolated alkaline phosphates elevation (10 times superior
to the upper reference limit) was detected. Alkaline
phosphatase elevation that does not surpass twice the upper
reference limit during the third trimester of pregnancy is
considered normal. Elevation beyond those levels requires
differential diagnosis with liver, bone and renal disease.
Off-label anti-thrombotic therapy was offered during the entire
pregnancy, which carried on. The patient gave birth to
a healthy baby. Evaluation of the placenta revealed chronic
histiocytic intervillositis, a rare pathology yet to be fully understood,
linked to autoimmune placental phenomena and
elevated alkaline phosphatase.
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Vongthavaravat V, Nurnberg MM, Balodimos N, Blanchette H, Koff RS. Isolated elevation of serum alkaline phosphatase level in an uncomplicated pregnancy: A case report. Am J Obstet Gynecol. 2000; 183:505-6.
Boronkai A, Than NG, Magenhiem R, Bellyei S, Szigeti A, Deres P, et al. Extremely high maternal alkaline phosphatase serum concentration with syncytiotrophoblastic origin. J Clin Pathol. 2005;58:72-6.
Ferianec V, Linhartova L. Extreme elevation of placental alkaline phosphatase as a marker of preterm delivery, placental insufficiency and low birth weight. Neuro Endocrinol Lett. 2011;32:154-7.
Gagnon A, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA, et al. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can. 2008;30:918–49.
Marchaudon V, Devisme L, Petit S, Ansart-Franquet H, Vaast P, Subtil D. Chronic histiocytic intervillositis of unknown etiology: Clinical features in a consecutive series of 69 cases. Placenta. 2011;32:140-5.
Parant O, Capdet J, Kessler S, Aziza J, Berrebi A. Chronic intervillositis of unknown etiology (CIUE): Relation between placental lesions and perinatal outcome. Eur J Obstet Gynecol Reprod Biol. 2009;143:9-13.
Reus AD, Besouw NM, Molenaar NM, Steegers E, Visser W, Kuiper RP, et al. An immunological basis for chronic histiocytic intervillositis in recurrent fetal loss. Am J Reprod Immunol. 2013;70:230-7.
Boyd TK, Redline RW. Chronic histiocytic intervillositis: a placental lesion associated with recurrent reproductive loss. Hum Pathol. 2000;31:1389-96.
Jacques SM, Qureshi F. Chronic intervillositis of the placenta. Arch Pathol Lab Med. 1993;117:1032-5.
Doss BJ, Greene MF, Hill J, Heffner LJ, Bieber FR, Genest DR. Massive chronic intervillositis associated with recurrent abortions. Hum Pathol. 1995;26: 1245-51.
Mekinian A, Costedoat-Chalumeau N, Masseau A, Botta A, Chudzinski A, Theulin A, et al. Chronic histiocytic intervillositis: Outcome associated disease and treatment in a multicenter prospective study. Autoimmunity.
;48:40-5.
Revaux A, Mekinian A, Micaise P, Bucourt M, Cornelis F, Lachassinne E, et al. Antiphospholipid syndrome and other autoimmune diseases associated with chronic intervillositis. Arch Gynecol Obstet. 2015;291:1229-36.
Rodger M. An update on thrombophilia and placenta mediated pregnancy complications: What should we tell our patients? Thrombosis Res. 2013;131:S25-S27.
Boog G, Le Vaillant C, Alnoukari F, Jossic F, Barrier J, Muller JY. Combining corticosteroid and aspirin for the prevention of recurrent villitis or intervillositis of unknown etiology. J Gynecol Obstet Biol Reprod- 2006;35:396-404.
Contro E, deSouza R, Bhide A. Chronic intervillositis of the placenta: A systematic review. Placenta. 2010;31:1106-10.
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