J Pathol Transl Med.  2015 Nov;49(6):462-471. 10.4132/jptm.2015.10.23.

Acute Atherosis of the Uterine Spiral Arteries: Clinicopathologic Implications

• Kim JY
• Kim YM

• KMID: 2381405
• DOI: http://doi.org/10.4132/jptm.2015.10.23

Abstract

Acute atherosis is unique vascular changes of the placenta associated with poor placentation. It is characterized by subendothelial lipid-filled foam cells, fibrinoid necrosis of the arterial wall, perivascular lymphocytic infiltration, and it is histologically similar to early-stage atherosclerosis. Acute atherosis is rare in normal pregnancies, but is frequently observed in non- transformed spiral arteries in abnormal pregnancies, such as preeclampsia, small for gestational age (SGA), fetal death, spontaneous preterm labor and preterm premature rupture of membranes. In preeclampsia, spiral arteries fail to develop physiologic transformation and retain thick walls and a narrow lumen. Failure of physiologic transformation of spiral arteries is believed to be the main cause of uteroplacental ischemia, which can lead to the production of anti-angiogenic factors and induce endothelial dysfunction and eventually predispose the pregnancy to preeclampsia. Acute atherosis is more frequently observed in the spiral arteries of the decidua of the placenta (parietalis or basalis) than in the decidual or myometrial segments of the placental bed. The presence and deeper location of acute atherosis is associated with poorer pregnancy outcomes, more severe disease, earlier onset of preeclampsia, and a greater frequency of SGA neonates in patients with preeclampsia. Moreover, the idea that the presence of acute atherosis in the placenta may increase the risk of future cardiovascular disease in women with a history of preeclampsia is of growing concern. Therefore, placental examination is crucial for retrospective investigation of pregnancy complications and outcomes, and accurate placental pathology based on universal diagnostic criteria in patients with abnormal pregnancies is essential for clinicopathologic correlation.

Keyword

Acute atherosis; Spiral artery; Physiologic transformation; Preeclampsia; Atherosclerosis; Lipid; Cholesterol

MeSH Terms

Arteries*
Atherosclerosis
Cardiovascular Diseases
Cholesterol
Decidua
Female
Fetal Death
Foam Cells
Gestational Age
Humans
Infant, Newborn
Ischemia
Membranes
Necrosis
Obstetric Labor, Premature
Pathology
Placenta
Placentation
Pre-Eclampsia
Pregnancy
Pregnancy Complications
Pregnancy Outcome
Retrospective Studies
Rupture
Cholesterol

Figure

• 

  Fig. 1. Spiral artery changes during pregnancy. (A) Normal physiologic transformation of spiral arteries in a normal pregnancy. The lumen of the spiral artery (asterisks) is dilated. Trophoblastic cells are infiltrating the wall of the spiral artery. (B) Failure of physiologic transformation of spiral arteries in a patient with preeclampsia. The lumen of the arteries (asterisk) is not dilated. The medial layers of the spiral arteries are intact. Although many interstitial trophoblasts surround the spiral artery, trophoblasts have not invaded the vessel wall.

• 

  Fig. 2. Acute atherosis in decidual spiral arteries. (A) Many lipid-laden macrophages (arrows) are seen in the spiral arteries. (B) Acute atherosis on oil-red O staining. Fat droplets (arrows) in the non-transformed spiral artery are stained red.

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