title: Acute atherosis in vacuum suction biopsies of decidua basalis: An evidence based research definition.
abstract: BACKGROUND
  Acute atherosis (AA) of the uteroplacental spiral arteries has been characterised by subendothelial lipid-laden foam cells, perivascular leukocyte infiltrates (PVI) and fibrinoid necrosis. Because precise diagnostic criteria are not available for comparative research studies we developed and tested new simplified criteria based on 237 cases.
  
  
  METHODS
  Decidual basalis samples were collected by vacuum suction at elective cesarean deliveries. Spiral arteries were evaluated in serial decidual tissue sections from women with normal pregnancy, preeclampsia, and diabetes. Features of AA were sought in parallel sections stained with H&E and immunostained for CD68, cytokeratin CK7 and desmin, and costained with Periodic Acid Schiff (PAS).
  
  
  RESULTS
  Foam cell lesions were defined as two or more adjacent, intramural, vacuolated CD68 positive cells, PVI as a focal perivascular lymphocyte accumulation, more dense than in the surrounding decidua. Increased fibrinoid (PAS positive) was identified if present in ≥75% of the arterial wall circumference. PVI and increased fibrinoid were significantly associated with preeclampsia but not specifically associated with the presence of foam cell lesions. Hence we diagnosed decidua basalis AA lesions solely by the presence of foam cell lesions, occurring in preeclampsia (37%), diabetes (10%) and healthy normotensive women (11%). The simplified criterion was reproducible by different investigators. Decidua basalis AA occurred most commonly and extensively in preeclampsia, but did not distinguish between preterm and term disease.
  
  
  CONCLUSIONS
  Our evidence based criterion for decidua basalis AA diagnosis in vacuum suction biopsies may not apply to myometrial or decidua parietalis arteries. In decidual basalis samples it should facilitate comparisons between research studies, to improve pathophysiological understanding of AA and preeclampsia.
authors.affiliation: Department of Obstetrics and Department of Gynecology, Oslo University Hospital, Ullevål and Faculty of Medicine, University of Oslo, Norway.
authors.forename: Patji
authors.initials: P
authors.lastname: Alnaes-Katjavivi
authors.affiliation: University of Glasgow, School of Medicine, Glasgow, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lyall
authors.affiliation: Department of Pathology, Oslo University Hospital, Ullevål and Faculty of Medicine, University of Oslo, Norway.
authors.forename: Borghild
authors.initials: B
authors.lastname: Roald
authors.affiliation: Department of Obstetric Medicine, University of Oxford, Oxford, UK.
authors.forename: Christopher W G
authors.initials: CW
authors.lastname: Redman
authors.affiliation: Department of Obstetrics and Department of Gynecology, Oslo University Hospital, Ullevål and Faculty of Medicine, University of Oslo, Norway. Electronic address: uxnnaf@ous-hf.no.
authors.forename: Anne Cathrine
authors.initials: AC
authors.lastname: Staff
mesh_terms: D000208:Acute Disease; D000328:Adult; D050197:Atherosclerosis / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D002585:Cesarean Section; D003656:Decidua / Q000473:pathology*; D016640:Diabetes, Gestational / Q000473:pathology; D055317:Evidence-Based Practice; D005260:Female; D005487:Foam Cells / Q000473:pathology; D006801:Humans; D010920:Placenta / Q000473:pathology; D021041:Placental Circulation; D011225:Pre-Eclampsia / Q000473:pathology; D011247:Pregnancy; D013396:Suction; D055988:Uterine Artery / Q000473:pathology; D014618:Vacuum
keywords: Acute atherosis; Criteria; Decidua; Immunohistochemistry; Morphology; Placenta; Preeclampsia