Laminar Necrosis, Membrane Chorionic Microcysts and Chorion Nodosum

  • Jerzy StanekEmail author


Three grossly inapparent lesions, membrane laminar necrosis (LN), membrane chorionic microcysts (MCM) and chorion nodosum (ChN), may be microscopically seen in placental membranes. LN is a relatively common and nonspecific acute hypoxic membrane lesion (membrane infarction) that may be seen in in utero hypoxia of various origins. It features laminar coagulative necrosis of the decidual layer, trophoblastic layer or both at the choriodecidual interphase of placental membranes. MCM is a chronic hypoxic membrane placental lesion associated with shallow placental implantation and increased amount of extravillous trophoblastic cells in placental membranes and chorionic disc. It features small pseudocysts, frequently confluent, in the invasive trophoblastic layer. MCM are typically seen in preeclampsia, maternal diabetes mellitus and fetal growth restriction. ChN is a placental lesion formed in the chorionic mesenchyme of membranes denuded of amnion in the extraamniotic pregnancy and the limb-body wall complex.


Placenta Laminar necrosis Chorionic microcysts Chorion nodosum Shallow placental implantation In utero hypoxia 


  1. 1.
    Stanek J. Acute and chronic placental membrane hypoxic lesions. Virchows Arch. 2009;455:315–22.CrossRefGoogle Scholar
  2. 2.
    Stanek J, Al-Ahmadie H. Laminar necrosis of placental membranes: a histologic sign of uteroplacental hypoxia. Pediatr Dev Pathol. 2005;8:34–42.CrossRefGoogle Scholar
  3. 3.
    Stanek J, Biesiada J. Clustering of maternal/fetal clinical conditions and outcomes and placental lesions. Am J Obstet Gynecol. 2012;206:493.a1–9.CrossRefGoogle Scholar
  4. 4.
    Salafia CM, Pezzullo JC, López-Zeno JA, Simmens S, Minior VK, Vintzileos AM. Placental pathologic features of preterm preeclampsia. Am J Obstet Gynecol. 1995;173:1097–105.CrossRefGoogle Scholar
  5. 5.
    Stanek J, Biesiada J, Trzeszcz M. Clinicoplacental phenotypes vary with gestational age: an analysis by classical and clustering methods. Acta Obstet Gynecol Scand. 2014;93:392–8.CrossRefGoogle Scholar
  6. 6.
    Stanek J, Biesiada J. Gestational age correlation of clinical conditions and placental lesions. Placenta. 2011;32:A15.CrossRefGoogle Scholar
  7. 7.
    McDonald B, Moore L. IUGR and laminar necrosis of the placental membranes. Pediatr Dev Pathol. 2006;9:170.CrossRefGoogle Scholar
  8. 8.
    Stanek J, Biesiada J. Clustering and classical analysis of clinical and placental phenotypes in fetal growth restriction and constitutional fetal smallness. Placenta. 2016;42:93–105.CrossRefGoogle Scholar
  9. 9.
    Stanek J. Association of coexisting morphological umbilical cord abnormality and clinical cord compromise with hypoxic and thrombotic placental histology. Virchows Arch. 2016;468:723–32.CrossRefGoogle Scholar
  10. 10.
    Stanek J. Placental hypoxic overlap lesions: a clinicopathologic correlation. J Obstet Gynecol Res. 2015;41:358–69.CrossRefGoogle Scholar
  11. 11.
    Stanek J, Biesiada J. Sensitivity and specificity of finding of multinucleate trophoblastic giant cells in decidua in placentas from high-risk pregnancies. Hum Pathol. 2012;43:261–8.CrossRefGoogle Scholar
  12. 12.
    Stanek J, Heil J. Direct evidence of hypoxia by immunohistochemistry in placental membranes with laminar necrosis from patients with severe preeclampsia. Pediatr Dev Pathol. 2006;9:406.CrossRefGoogle Scholar
  13. 13.
    Murthi O, Kee MW, Gude NM, Brennecke SP, Kalionis B. Fetal growth restriction is associated with increased apoptosis in the chorionic trophoblast cells of human fetal membranes. Placenta. 2005;26:329–38.CrossRefGoogle Scholar
  14. 14.
    Stanek J, Fenoglio-Preiser CM, Myatt L. Evidence of oxidative stress and upregulation of apoptosis/antiapoptosis in placentas from prolonged pregnancy. Placenta. 2001;22:A31.CrossRefGoogle Scholar
  15. 15.
    Stanek J. Hypoxic patterns of placental injury: a review. Arch Pathol Lab Med. 2013;137:706–20.CrossRefGoogle Scholar
  16. 16.
    Stanek J. Diagnosing placental membrane hypoxic lesions increases the sensitivity of placental examination. Arch Pathol Lab Med. 2010;134:989–95.PubMedGoogle Scholar
  17. 17.
    Stanek J. Utility of diagnosing various histological patterns of diffuse chronic hypoxic placental injury. Pediatr Dev Pathol. 2012;15:13–23.CrossRefGoogle Scholar
  18. 18.
    Stanek J. Membrane microscopic chorionic pseudocysts are associated with increased amount of placental extravillous trophoblasts. Pathology. 2010;42:125–30.CrossRefGoogle Scholar
  19. 19.
    Stanek J. Placental membrane and placental disc microscopic chorionic cysts share similar clinicopathologic correlations. Pediatr Dev Pathol. 2011;14:1–9.CrossRefGoogle Scholar
  20. 20.
    Stanek J, Weng E. Microscopic chorionic pseudocysts in placental membranes: a histologic lesion of in utero hypoxia. Pediatr Dev Pathol. 2007;10:192–8.CrossRefGoogle Scholar
  21. 21.
    Reister F, Heyl W, Kaufmann P, Rath W. Trophoblast invasion in pre-eclampsia. Zentralbl Gynakol. 1999;121:587–90.PubMedGoogle Scholar
  22. 22.
    Stanek J. Placental pathology varies in hypertensive conditions of pregnancy. Virchows Arch. 2018;472:415–23.CrossRefGoogle Scholar
  23. 23.
    Stanek J. Comparison of placental pathology in preterm, late-preterm, near-term, and term births. Am J Obstet Gynecol. 2014;210:234.e1–6.CrossRefGoogle Scholar
  24. 24.
    Shchegolev AI, Lyapin VM, Tumanova UN, Vodneva DN, Shmakov RG. Histological changes in the placenta and vascularization of its villi in early- and late-onset preeclampsia. Arkh Patol. 2016;78:13–8.CrossRefGoogle Scholar
  25. 25.
    Redline RW, Patterson P. Pre-eclampsia is associated with an excess of proliferative immature intermediate trophoblast. Hum Pathol. 1995;26:594–600.CrossRefGoogle Scholar
  26. 26.
    Stanek J. Decidual arteriolopathy with or without associated hypertension modifies the underlying histomorphology in placentas from diabetic mothers. J Obstet Gynaecol Res. 2017;43:839–47.CrossRefGoogle Scholar
  27. 27.
    Stanek J. Chorionic disc extravillous trophoblasts in placental diagnosis. Am J Clin Pathol. 2011;136:540–7.CrossRefGoogle Scholar
  28. 28.
    Avila C, Santorelli J, Mathai J, Ishkin S, Jabsky M, Willins J, Figueroa R, Kaplan C. Anatomy of the fetal membranes using optical coherence tomography: Part 1. Placenta. 2014;35:1065–9.CrossRefGoogle Scholar
  29. 29.
    Huppertz B, Kertschanska S, Frank HG, Gaus G, Funayama H, Kaufmann P. Extracellular matrix components of the placental extravillous trophoblast: immunohistochemistry and ultrastructural distribution. Histochem Cell Biol. 1996;106:291–301.CrossRefGoogle Scholar
  30. 30.
    Ӧzerkan K, Demir BC, Baykara S, Aslan K. Clinical importance of placental membrane microscopic chorionic pseudocysts in preeclampsia. Clin Exp Obstet Gynecol. 2016;43:401–5.Google Scholar
  31. 31.
    Kocovski L, Stein N, Arredondo J. Pleura nodosum: fetal squamous debris in an unusual location. Pediatr Dev Pathol. 2015;18:159–63.CrossRefGoogle Scholar
  32. 32.
    deSa DJ. Polypoidal organization of aspirated amniotic fluid squamous debris (amnion nodosum) in middle-ear cavity of newborn infant. Arch Dis Child. 1977;52:148–51.CrossRefGoogle Scholar
  33. 33.
    Stanek J, Adeniran A. Chorion nodosum: a placental feature of the severe early amnion rupture sequence. Pediatr Dev Pathol. 2006;9:353–60.CrossRefGoogle Scholar
  34. 34.
    Yang SS, Sanborn JR, Levine AJ, Delp RA. Amniotic rupture, extraamniotic pregnancy, and vernix granulomata. Am J Surg Pathol. 1984;8:117–22.CrossRefGoogle Scholar
  35. 35.
    Donnefeld AE, Dunn LK, Rose NC. Discordant amniotic band sequence in monozygotic twins. Am J Med Genet. 1985;20:685–94.CrossRefGoogle Scholar
  36. 36.
    Adeniran A, Stanek J. Amnion nodosum revisited: clinicopathologic and placental correlations. Arch Pathol Lab Med. 2007;131:1829–33.PubMedGoogle Scholar
  37. 37.
    Heerema-McKenney A, Popek EJ, DePaepe ME, editors. Diagnostic pathology: placenta. Amirsys. Philadelphia: Elsevier; 2015.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of PathologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations