International Journal of Legal Medicine

, Volume 108, Issue 4, pp 210–214 | Cite as

Immunohistochemical identification of syncytiotrophoblastic cells and megakaryocytes in pulmonary vessels in a fatal case of amniotic fluid embolism

  • P. Lunetta
  • A. Penttilä
Case Report

Abstract

The histological diagnosis of amniotic fluid embolism (AFE) is based on finding amniotic fluid components in the pulmonary microvasculature. In addition to the distinctive constituents of AFE, placental and decidual tissue fragments as well as isolated trophoblastic cells and megakaryocytes are potentially detectable within pulmonary vessels. The identification of single syncytiotrophoblastic cells (STC), and their differentiation from circulating megakaryocytes (MK) within the lumen of small and medium-sized pulmonary vessels is difficult by classical morphological methods. In a fatal case of AFE, we have successfully detected the simultaneous presence of STC and MK in the pulmonary microvasculature by means of a panel of specific monoclonal (CD61-GpIIIa, β-hCG) and polyclonal (FVIII-vW hPL) antibodies. The immunohistochemical analysis for identification of STC and MK should provide more precise data on their incidence and distribution in physiological and pathological conditions as well providing new insights into their physiopathological implications and their correlation with AFE and other gynaecological complications.

Key words

Amniotic fluid embolism Syncytiotrophoblastic cells Megakaryocytes Immunohistochemistry 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Clark SL (1990) New concepts of amniotic fluid embolism: a review. Obstet Gynecol Surv 45: 360–368PubMedGoogle Scholar
  2. 2.
    Hernandez M, Bajanowski T (1991) Tödliche Fruchtwasserembolie. Z Rechtsmed 1: 35–38Google Scholar
  3. 3.
    Lau G (1994) Amniotic fluid embolism as a cause of sudden maternal death. Med Sci Law 34: 213–220PubMedGoogle Scholar
  4. 4.
    Mirchandani HG, Mirchandami IH, Parikh SR (1988) Hypernatriaemia due to amniotic fluid embolism during a saline-induced abortion. Am J Forensic Med Pathol 9: 48–50PubMedGoogle Scholar
  5. 5.
    Garland IW, Thompson WD (1983) Diagnosis of amniotic fluid embolism using an antiserum to human keratin. J Clin Pathol 36: 625–627PubMedGoogle Scholar
  6. 6.
    Ishiyama I, Mukaida M, Komuro E, Keil W (1986) Analysis of a case of generalized amniotic fluid embolism by demonstrating the fetal isoantigen (A blood type) in maternal tissues of B blood type, using immunoperoxidase staining. Am J Clin Pathol 85: 239–241PubMedGoogle Scholar
  7. 7.
    Ohi H, Kobayashi H, Terao T (1993) A new histological diagnosis for amniotic fluid embolism by monoclonal antibody TKH-2 that recognize mucin-type glycoprotein. Nippon Sanka Fujinka Gakkai Zasshi 45: 464–470PubMedGoogle Scholar
  8. 8.
    Covone AE, Johnson PM, Mutton D, Adinolfi M (1984) Trophoblast cells in peripheral blood from pregnant women. Lancet 1: 841–843Google Scholar
  9. 9.
    Holzgreve W, Garritsen HS, Ganshirt-Ahlert D (1992) Fetal cells in the maternal circulation. J Reprod Med 37: 410–118PubMedGoogle Scholar
  10. 10.
    Tingaard Pedersen N (1978) Occurrence of megakaryocytes in various vessels and their retention in the pulmonary capillaries in man. Scand J Haematol 21: 369–375PubMedGoogle Scholar
  11. 11.
    Aabo K, Hansen KB (1978) Megakaryocytes in pulmonary blood vessels. 1. Incidence at autopsy, clinicopathological relations especially to disseminated intravascular coagulation. APMIS 86: 285–291Google Scholar
  12. 12.
    Pierucci G, Borlotti-Carraro P (1978) L' embolia megacariocitaria post-traumatica. Pathologica 70: 5–18PubMedGoogle Scholar
  13. 13.
    Attwood HD (1958) The histological diagnosis of amniotic fluid embolism. J Pathol Bacteriol 76: 211–215PubMedGoogle Scholar
  14. 14.
    Silverberg SG, Kurman RJ (1992) Tumors of the uterine corpus and gestational trophoblastic disease, 3rd ser, fasc 3. Armed Forces Institute of Pathology, Washington, pp 219–232Google Scholar
  15. 15.
    Janssen W (1984) Forensic histopathology. Springer, Berlin Heidelberg New YorkGoogle Scholar
  16. 16.
    Slimka K, Berent JA (1993) Are pulmonary megakaryocytes the shock marker? Proceedings of 13th Meeting of the International Association of Forensic Sciences, Dusseldorf, 22–28 August, p A17Google Scholar
  17. 17.
    Bulmer JN, Johnson PM (1985) Antigenic expression by trophoblast populations in the human placenta and their possible immunobiological relevance. Placenta 6: 127–140PubMedGoogle Scholar
  18. 18.
    Chua S, Wilkins T, Sargent I, Redman C (1991) Trophoblast deportation in pre-eclamptic pregnancy. Br J Obstet Gynaecol 98: 973–979PubMedGoogle Scholar
  19. 19.
    Trowbridge EA, Martin JF, Slater DN (1984) Evidence for a theory of physical fragmentation of megakaryocytes, implying that all platelets are produced in the pulmonary circulation. Thromb Res 29: 461–475Google Scholar
  20. 20.
    Levine RF, Eldor A, Shoff PK, Kirwin S, Tenza D, Cramer EM (1993) Circulating megakaryocytes: delivery of a large number of intact, mature megakaryocytes to the lungs. Eur J Haematol 51: 233–246PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • P. Lunetta
    • 1
    • 2
  • A. Penttilä
    • 1
  1. 1.Department of Forensic MedicineUniversity of HelsinkiFinland
  2. 2.Post-Graduate School of Forensic MedicineUniversity of PaviaPaviaItaly

Personalised recommendations