Diffuse decidual leucocytoclastic necrosis and NK cell aggregates: two distinct features of miscarriage.
OBJECTIVE
Primary histopathology of miscarriage remains undetermined in the majority of cases. This study was conducted to determine histological characteristics pertinent to miscarriage.


METHODS
The study groups were composed of elective abortions (n=29) and miscarriages (n=45) comprised of chromosomally normal (n=15) and abnormal cases (n=30). Immunohistochemistry was done against CD3, CD8, TIA-1 and CD56.


RESULTS
Two histological features--diffuse decidual leucocytoclastic necrosis (DDLN) and decidual natural killer cell aggregates (NKCA)--were relatively common in miscarriages. The frequencies of DDLN and NKCA were different between the groups (p<0.05 and p<0.05, respectively). DDLN was found in 13.8% (4/29) of elective abortions, while it was observed in 60.0% (9/15) and 23.3% (7/30) of chromosomally normal and abnormal miscarriages, respectively. DDLN was more frequent in chromosomally normal miscarriages than in elective abortions (p=0.004). NKCA was present in 13.8% (4/29) of elective abortions, while being found in 33.3% (5/15) and 43.3% (13/30) of chromosomally normal and abnormal miscarriages, respectively. NKCA was more frequent in chromosomally abnormal miscarriages than in elective abortions (p=0.020).


CONCLUSIONS
The findings strongly suggest that defective placentation and abnormal maternal immune response are associated with miscarriage. DDLN and NKCA seem to have diagnostic values in the pathological evaluation of miscarriage.
Hamchoon Women's Clinic, Seoul, Republic of Korea.
Joong Yeup
JY
Lee
Asan Laboratory of Perinatal Science, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Eun Na
EN
Kim
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
Joon-Seok
JS
Hong
Asan Laboratory of Perinatal Science, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Jae-Yoon
JY
Shim
Hamchoon Women's Clinic, Seoul, Republic of Korea.
Doyeong
D
Hwang
Hamchoon Women's Clinic, Seoul, Republic of Korea.
Ki Chul
KC
Kim
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
JungBok
J
Lee
Asan Laboratory of Perinatal Science, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Chong Jai
CJ
Kim
D000028:Abortion, Induced; D000022:Abortion, Spontaneous / Q000235:genetics / Q000276:immunology / Q000473:pathology*; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D017252:CD3 Complex / Q000032:analysis; D019002:CD56 Antigen / Q000032:analysis; D016827:CD8 Antigens / Q000032:analysis; D016022:Case-Control Studies; D002449:Cell Aggregation; D002869:Chromosome Aberrations; D003656:Decidua / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007694:Killer Cells, Natural / Q000276:immunology / Q000473:pathology*; D007962:Leukocytes / Q000276:immunology / Q000473:pathology*; D008875:Middle Aged; D009336:Necrosis; D039102:Poly(A)-Binding Proteins / Q000032:analysis; D011237:Predictive Value of Tests; D011247:Pregnancy; D012307:Risk Factors; D000074019:T-Cell Intracellular Antigen-1; D055815:Young Adult
D015415:Biomarkers; D017252:CD3 Complex; D019002:CD56 Antigen; D016827:CD8 Antigens; C522918:NCAM1 protein, human; D039102:Poly(A)-Binding Proteins; D000074019:T-Cell Intracellular Antigen-1; C071558:TIA1 protein, human
FERTILITY; GYNAECOLOGICAL PATHOLOGY; PREGNANCY