Estudo imunoistoquimico do infiltrado inflamatorio em vilosite de etiologia desconhecida, vilosites causadas por parasitas e intervilosite fungica : estudo comparativo com analise qualitativa e quantitativa

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

Villitis is characterized by an inflammatory infiltrate within the villous stroma and can be caused by a large number of infectious agents, although most are of unknown etiology. Villitis, not rarely, is associated with intrauterine fetal death, abortion, malformations and fetal growth retardation. The latter has been the major clinical association of villitis of unknown etiology (VUE). Two hypotheses has been advocated to explain this lesion: a maternal immune attack against fetal tissue or an unidentified infection. Histology alone cannot distinguish VUE from an infectious villitis, unless microorganisms or viral inclusions are found in tissue. Both lesions are characterized by chronic inflammatory cells, mainly lymphocytes and macrophages, in the placental villous stroma. Granulomas and trophoblast damage, very typical of some infectious villitis, can also be a feature of VUE. Therefore, immunohistochemical phenotyping of the inflammatory cells could be of diagnostic value in villitis. There are few immunomorphological studies about the inflammatory cells in infectious villitis as well as in VUE. We studied the inflammatory cells by immunohistochemistry in 23 placentas with villitis (8 cases of Trypanosoma cruzi villitis, 5 cases of Toxoplasma gondii villitis and 8 cases of VUE). Two cases of P. brasiliensis intervillositis and 8 control placentas without inflammation were also analysed. Paraffin sections of all placentas were submitted for immunohistochemistry analysis according the avidin-biotin-peroxidase technique. Antibody panel consisted of UCHL1 (CD45RO), L26 (CD20), CD45RO/OPD4, CD8, NK-like, M1 (CD15), Mac387, HAM 56 (CD68) and S-100 protein. In all cases of villitis (infectious and of unknown etiology) the inflammatory infiltrate consisted mainly of HAM 56+ macrophages and T lymphocytes. Among T cells, CD8+ cells outnumbered CD4+ cells in all placentas. B lymphocytes were absent or very rare (<2%). A small number of Mac 387+ monocytes, NK cells and S-100+ cells were also detected. Paracoccidiodomycosis intervillositis consisted of Mac387+ histiocytes and M1+ granulocytes. Our findings showed that immunohistochemical study of the inflammatory cells cannot distinguish VUE from infectious villitis. The same cellular composition of the inflammatory infiltrate in the two studied groups (VUE and infectious villitis) favors the hypothesis that VUE could result from an infectious cause. In addition, this finding raises the possibility that different etiologic factors acts through a common pathway to cause villitis which is an inflammatory lesion mediated by CD8+ T lymphocytes and macrophages

ASSUNTO(S)

doenças placentarias - patologia imunohistoquimica placenta inflamação gravidez - complicações e sequelas

ACESSO AO ARTIGO

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