PMC4393328_01
PMC4393328_02
From patient 1, the placenta showed a focal cluster of acute villitis and intervillitis, which was positive for mycobacteria with an Auramine-O acid fast fluorescent stain (not shown). Hematoxylin and eosin, magnification x400.
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F1
A cluster of acute villitis and intervillitis, with a predominant neutrophilic and histiocytic response and no evidence of granulomatous inflammation, was identified in only 1 of the tissue blocks (Fig. 1).
The placenta from patient 2 showed multiple foci of acute villitis and intervillitis, with no evidence of granulomatous reaction. Hematoxylin and eosin, magnification x200.
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F2
(A) A Ziehl-Neelsen (Z-N) stain reveals multiple acid-fast mycobacteria within areas of inflammation in the placenta of patient 2 (Z-N stain, magnification x600). (B) The inflammatory infiltrate in both placentas contained abundant histiocytic cells, demonstrated by CD68 immunostains. Adjacent villi show an apparent proliferation of Hofbauer cells (arrow) (CD68, magnification x200). (C) The presence of abundant neutrophilic cells is confirmed with immunostains using Myeloperoxidase antibodies (Myeloperoxidase, magnification x400). (D) The inflammatory lesion in the placenta of patient 1 showed a small component of CD3+ T cells, also seen in adjacent chorionic villi (arrow). This influx of T cells may represent an early activation of the adaptive immune response (CD3, magnification x200).
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F3
Both placenta specimens showed intense and diffuse staining of inflammatory cells with CD68 and Myeloper-oxidase (Fig. 3B,C). Adjacent villi to these inflamed areas showed apparent proliferation of Hofbauer cells in the CD68-stained slides (Fig. 3B). The placenta from patient 1 showed some CD3-positive cells in the mixed cellular reaction and apparent activation of CD3 cells in adjacent villi (Fig. 3D).