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Myeloid cell thrombus and fetal vascular malperfusion in placentas with transient abnormal myelopoiesis

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Abstract

Transient abnormal myelopoiesis (TAM), also known as transient myeloproliferative disorder or transient leukemia, is a self-regressing neoplasia that afflicts infants with trisomy 21. A recent review article documented “myeloid cell thrombus (MCT)” and “fetal vascular malperfusion (FVM)” in placentas with TAM, although the characteristic TAM placental findings have not been clarified. Here, we compared the clinical and pathological placental findings between trisomy 21 patients with or without TAM. In 13 cases of trisomy 21, we identified six placentas with TAM and seven placentas without TAM. The six placentas with TAM included two stillborn cases. Microscopically, MCT was noted in all the cases, and a high incidence of FVM (50%) was observed in TAM cases. Immunohistochemically, MCT was found to be a platelet-rich thrombus. The placentas were grouped according to the presence or absence of TAM and subsequently compared. Clinically, the incidences of abnormal fetal heart rate pattern and fetal or neonatal death were significantly higher in TAM cases. Pathologically, placenta in TAM cases weighted more than those in cases without TAM, and the incidence of MCT was significantly higher in placentas with TAM. Moreover, the incidence of FVM was higher in placentas with TAM, but this difference was not statistically significant. We propose that MCT is a diagnostic feature of placentas with TAM and may be associated with poor fetal outcomes.

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Acknowledgements

We thank Takako Tokumitsu and Nahoko Udatsu for their excellent technical assistance. We also thank Editage (http://www.editage.jp/) for English language editing.

Funding

This study was supported by JP21Ko7775 from the Japan Society for the Promotion of Science.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Kayo Tomimori, Yuki Kodama, Koutarou Doi & Shinji Katsuragi

  2. Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan

    Hiroyuki Tanaka, Atushi Yamashita, Toshihiro Gi, Yujiro Asada & Yuichiro Sato

Authors
  1. Kayo Tomimori
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  2. Yuki Kodama
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  3. Hiroyuki Tanaka
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  4. Atushi Yamashita
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  5. Toshihiro Gi
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  6. Yujiro Asada
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  7. Koutarou Doi
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  8. Shinji Katsuragi
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  9. Yuichiro Sato
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Contributions

Tomimori K, Kodama Y, and Sato Y conceived and designed the study and wrote the manuscript. Tomimori K, Kodama Y, Doi K, and Katsuragi S collected the clinical data. Tanaka H, Yamashita A, Gi T, and Asada Y analyzed the histological data. Tomimori K and Sato Y wrote, edited, and reviewed the manuscript. All authors participated in the interpretation of the results and writing of the report and approved the final version submitted. Sato Y takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.

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Correspondence to Yuichiro Sato.

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Tomimori, K., Kodama, Y., Tanaka, H. et al. Myeloid cell thrombus and fetal vascular malperfusion in placentas with transient abnormal myelopoiesis. Virchows Arch 480, 1181–1187 (2022). https://doi.org/10.1007/s00428-022-03289-5

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  • DOI: https://doi.org/10.1007/s00428-022-03289-5

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