Placental mesenchymal dysplasia: A cause of intrauterine growth restriction and intrauterine death

Objective

This study emphasizes the importance of recognizing and accurately diagnosing PMD and describes the clinical, gross, and histopathological findings of PMD in 18 cases. Placental mesenchymal dysplasia (PMD) was first recognized by Takayama et al. as a distinct pathologic entity of the placenta. The actual incidence and clinical outcomes of PMD haven’t been clarified yet.

Materials and methods

Eighteen patients diagnosed with PMD among 3760 placentas were reevaluated according to morphological diagnostic criteria and the immunohistochemical expression profile of p57.

Results

In all cases of PMD, abnormally enlarged stem villi, some of which had cisterns, hypercellular stroma, and thick-walled vessels, were present. Additionally, central thick-walled blood vessels with constricted lumens and scattered peripheral tiny capillaries were observed. In 14 cases of PMD, loss of p57 expression in stromal cells of dysplastic stem villi and chorangiomatoid changes was observed.

Conclusion

PMD is a rare and clinically significant lesion with high rates of IUFD and neonatal death. To diagnose PMD cases accurately and manage potential complications correctly, pregnancies with suspected PMD should be followed up in tertiary centers with resources for perinatal care and perinatal pathology testing.