title: Chronic histiocytic intervillositis of unknown etiology: clinical features in a consecutive series of 69 cases.
abstract: BACKGROUND
  Chronic histiocytic intervillositis of unknown etiology (CIUE) is a rare placental inflammatory disease, associated with severe obstetric complications. Its pathophysiologic mechanism remains to be elucidated.
  
  
  OBJECTIVE
  To establish anatomical-clinical correlations to improve our understanding of CIUE pathophysiology.
  
  
  METHODS
  Retrospective study of all cases of CIUE occurring during a 9-year period in a university tertiary hospital center.
  
  
  RESULTS
  CIUE was diagnosed in 69 pregnancies in 50 different women, after early spontaneous abortions (30.4%), late spontaneous abortions (13.0%), in utero deaths (26.1%), and live births (30.4%). Of 39 fetuses surviving to at least 22 weeks, 24 had severe intrauterine growth restriction (61.5%) and 18 died in utero (46.2%). Twelve in utero deaths occurred before 32 weeks of gestation (66.7%). Substantially elevated alkaline phosphatase levels (>600 IU/L) were observed in 55.6% of cases. Microscopic examination of placentas showed that both spontaneous early abortions and intrauterine growth restriction were significantly associated with more intense fibrin deposits.
  
  
  CONCLUSIONS
  A diagnosis of CIUE must be considered in cases of severe obstetric complications. We hypothesize that the elevated alkaline phosphatases (ALP) observed during the pregnancy demonstrate the presence of syncytiotrophoblastic lesions due to histiocytosis in the intervillous space, before fibrin deposits cover them.
authors.affiliation: Pôle d'Obstétrique, Hôpital Jeanne de Flandre, Univ Lille Nord de France, F-59000 Lille, France. valeriemarchaudon@yahoo.fr
authors.forename: V
authors.initials: V
authors.lastname: Marchaudon
authors.forename: L
authors.initials: L
authors.lastname: Devisme
authors.forename: S
authors.initials: S
authors.lastname: Petit
authors.forename: H
authors.initials: H
authors.lastname: Ansart-Franquet
authors.forename: P
authors.initials: P
authors.lastname: Vaast
authors.forename: D
authors.initials: D
authors.lastname: Subtil
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D002824:Chorionic Villi / Q000473:pathology*; D005260:Female; D005313:Fetal Death / Q000209:etiology / Q000473:pathology; D005317:Fetal Growth Retardation / Q000473:pathology; D005337:Fibrin / Q000378:metabolism; D006644:Histiocytes / Q000473:pathology; D015614:Histiocytosis / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000473:pathology; D010922:Placenta Diseases / Q000473:pathology*; D011247:Pregnancy; D047928:Premature Birth / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D005337:Fibrin; D000469:Alkaline Phosphatase