Placenta · 2025
The monster villus: A rare, but characteristic, feature of human placentas in diabetes mellitus.
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Huppertz Berthold, Ivanisevic Marina, Desoye Gernot
Аннотация
CONTEXT: Villous tree development of the human placenta is mostly driven by spatial organization of vessels. Diabetes in pregnancy is associated with structural alterations of the placenta, including hypervascularization of terminal villi.
OBJECTIVE: To assess pathological alterations of villous tree formation in cases with gestational diabetes (GDM) and type 1 diabetes mellitus (T1D) and alteration-associated maternal and fetal traits.
DESIGN: Placentas (n = 5 per group) from GDM treated with diet or insulin, from T1D without and with additional pathologies and from healthy term controls were stained with H&E and for CD34, desmin, vimentin and smooth-muscle actin to assess villous architecture and vascular patterns. Maternal and cord blood glucose and cord blood C-peptide (insulin proxy) were measured. In women with T1D, maternal glycosylated hemoglobin was determined in each trimester.
RESULTS: Only in cases with T1D and additional pathologies, chorangiosis and a distinct structural organization of the villous tree, called monster villus, were identified. Diameters of these monster villi were significantly higher compared to normal villi or those with chorangiosis. Monster villus features did not significantly associate with any trait, but two extreme cases with monster villi had the highest cord blood C-peptide levels.
CONCLUSIONS: Presence of paw-shaped stem villi branching into multiple functional villi, i.e. monster villi, may indicate the missing switch from branching to non-branching angiogenesis during villous development at 26-28 weeks of gestation. This specific morphological and vascular arrangement of the villous tree only occurred in cases with T1D and additional pathologies, conditions with elevated fetal insulin.
OBJECTIVE: To assess pathological alterations of villous tree formation in cases with gestational diabetes (GDM) and type 1 diabetes mellitus (T1D) and alteration-associated maternal and fetal traits.
DESIGN: Placentas (n = 5 per group) from GDM treated with diet or insulin, from T1D without and with additional pathologies and from healthy term controls were stained with H&E and for CD34, desmin, vimentin and smooth-muscle actin to assess villous architecture and vascular patterns. Maternal and cord blood glucose and cord blood C-peptide (insulin proxy) were measured. In women with T1D, maternal glycosylated hemoglobin was determined in each trimester.
RESULTS: Only in cases with T1D and additional pathologies, chorangiosis and a distinct structural organization of the villous tree, called monster villus, were identified. Diameters of these monster villi were significantly higher compared to normal villi or those with chorangiosis. Monster villus features did not significantly associate with any trait, but two extreme cases with monster villi had the highest cord blood C-peptide levels.
CONCLUSIONS: Presence of paw-shaped stem villi branching into multiple functional villi, i.e. monster villi, may indicate the missing switch from branching to non-branching angiogenesis during villous development at 26-28 weeks of gestation. This specific morphological and vascular arrangement of the villous tree only occurred in cases with T1D and additional pathologies, conditions with elevated fetal insulin.