From the Guidelines
Decidua tissue on histopathological examination is characterized by the presence or absence of decidua, which is a critical factor in the diagnosis of basal plate myometrial fibers (BPMF) and placenta accreta spectrum (PAS) disorders. According to the classification and reporting guidelines for the pathology diagnosis of PAS disorders, the presence or absence of decidua is used to stage BPMF, with Stage 1 indicating decidua present and Stage 2 indicating decidua absent 1. The decidua is a specialized endometrial tissue that forms during pregnancy, and its presence or absence can have significant implications for the diagnosis and management of pregnancy-related complications. In the context of BPMF, the decidua can be seen separating the myometrial smooth muscle fibers from the basal fibrinoid/chorionic villi, and its thickness can vary 1. The diagnosis of BPMF requires an explanatory note, including a stage and size, as well as clinical correlation to determine the significance of the finding 1. Some key features of decidua tissue on histopathological examination include:
- Enlarged stromal cells with abundant eosinophilic cytoplasm and round to oval nuclei
- Arrangement in sheets or clusters
- Presence of prominent spiral arteries, glandular elements, and variable immune cell populations
- Transformation of endometrial stromal cells into decidual cells in response to progesterone, essential for successful implantation, placentation, and maintenance of pregnancy 1. Overall, the presence or absence of decidua tissue on histopathological examination is a critical factor in the diagnosis and management of pregnancy-related complications, and its characterization is essential for understanding the underlying pathology of BPMF and PAS disorders.
From the Research
Histopathological Examination of Decidua Tissue
- Decidua tissue is characterized by the presence of decidua cells, which are large polygonal and eosinophilic, with some having vacuolated cytoplasm, forming small nodules under the mesothelium of the peritoneum 2.
- Microscopic examination of decidua tissue shows typical features of decidua, including decidualized cells with positive staining of the cell cytoplasm with vimentin and positive staining of the cell nucleus with the progesterone receptor antibody 2.
- Histopathological examination of placenta accreta spectrum cases may show an abnormally adherent placenta, with a complete or partial absence of the decidua on histology 3.
- In cases of placental abruption, histopathological examination may show a complete or partial separation of the placenta from the uterine decidua 4.
Immunohistochemical Characteristics
- Immunohistochemical staining of decidua tissue shows positive staining of the cell cytoplasm with vimentin and positive staining of the cell nucleus with the progesterone receptor antibody 2.
- Calretinin, keratin, and HMB-45 stains are negative in decidua tissue 2.
- Immunohistochemistry may help in the differential diagnosis of peritoneal deciduosis, where problems are experienced differentiating the case from malignant mesothelioma or metastatic tumor 2.
Clinical Correlation
- Decidua tissue can be found in the peritoneum during pregnancy, and its presence is associated with the effect of progesterone 2.
- Placenta accreta spectrum is a complex obstetric complication associated with high maternal morbidity, and its diagnosis can be made by histopathological examination of the placenta 3.
- Placental abruption is a complete or partial separation of the placenta from the uterine decidua, and its diagnosis can be made by clinical manifestations and ultrasound evaluation 4.