Morphologic considerations on the placenta in Congenital Nephrotic Syndrome of Finnish type

Summary

We have studied the morphological aspects of a thirty-six week gestational age placenta in the Congenital Nephrotic Syndrome of Finnish type. The study, conducted with histological, histochemical, morphometric and ultrastructural methods, demonstrates the presence of primary disorders of placentation consisting of persistent embryonic villi, arrested ramification and chorionangiomatosis. The villous development is compatible with the first-second trimester of pregnancy. Vasculo-syncytial membranes are quantitatively increased. Histochemical findings document placental immaturity further: Perls' reaction was positive for the trophoblast basement membrane (this is normally not observed beyond the second trimester), Alcian Blue positivity at pH 1 was also evident and was observed in three month gestational age placentae and in controls. Periodic Acid Silver Methenamine and Thioaldehyde Fuchsin documented abnormal thickenings of the trophoblast basement membrane. Electron microscopic observation reveals that the trophoblast basement membrane is thickened. Osmiophilic bodies are distributed throughout the trophoblast basement membrane and also within the basement membrane like material. Abundant microfibrils are present in the villous stroma. Lamination of basement membrane like material is observed in a subendothelial position. On the basis of their findings and in conjunction with the data in the literature regarding biochemical alterations of renal glomerular basement membranes in Congenital Nephrotic Syndrome Finnish type, the Authors suggest that a primitive membranopathy forms the basis for this pathological condition.