Exaggerated Placental (Implantation) Site Reaction
Definition
Exaggerated placental (implantation) site reaction (EPS) is a nonneoplastic condition characterized by a more exuberant proliferation of extravillous, implantation site intermediate trophoblast within a placental implantation site than is typically seen following a recent gestation. EPS is considered to represent the upper end of the spectrum of trophoblast proliferation noted within a physiologic placental implantation site.
Clinical Features
Incidence
The incidence of EPS is uncertain, although EPS has been identified following both normal pregnancies and abortions.
Age
EPS is encountered in patients of reproductive age.
Sex
Female
Site
EPS is most commonly encountered in the uterus, with cases reported in both the endomyometrium and cervix (Shen et al. 2004).
Treatment
EPS, when identified in isolation, typically resolves following the procedure (i.e., curettage) by which they are diagnosed. As EPS is a benign finding, no...
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References and Further Reading
Banet, N., Gown, A. M., Shih Ie, M., Kay Li, Q., Roden, R. B., Nucci, M. R., Cheng, L., Przybycin, C. G., Nasseri-Nik, N., Wu, L. S., Netto, G. J., Ronnett, B. M., & Vang, R. (2015). GATA-3 expression in trophoblastic tissues: An immunohistochemical study of 445 cases, including diagnostic utility. The American Journal of Surgical Pathology, 39(1), 101–108. https://doi.org/10.1097/PAS.0000000000000315.
Kaur, B., Short, D., Fisher, R. A., Savage, P. M., Seckl, M. J., & Sebire, N. J. (2015). Atypical placental site nodule (APSN) and association with malignant gestational trophoblastic disease; a clinicopathologic study of 21 cases. International Journal of Gynecological Pathology, 34(2), 152–158. https://doi.org/10.1097/PGP.0000000000000128.
Mao, T. L., Seidman, J. D., Kurman, R. J., & Shih Ie, M. (2006). Cyclin E and p16 immunoreactivity in epithelioid trophoblastic tumor--an aid in differential diagnosis. The American Journal of Surgical Pathology, 30(9), 1105–1110. https://doi.org/10.1097/01.pas.0000209854.28282.87.
Shen, D. H., Liao, X. Y., Liu, Y. L., Wang, H., & Yu, Y. Z. (2004). Clinicopathological study of intermediate trophoblastic non-tumor lesions: Exaggerated placental site and placental site nodule. Zhonghua Bing Li Xue Za Zhi, 33(5), 441–444. https://www.ncbi.nlm.nih.gov/pubmed/15498215
Shih Ie, M. (2007). Trophogram, an immunohistochemistry-based algorithmic approach, in the differential diagnosis of trophoblastic tumors and tumorlike lesions. Annals of Diagnostic Pathology, 11(3), 228–234. https://doi.org/10.1016/j.anndiagpath.2007.04.001.
Shih, I. M., & Kurman, R. J. (1998). Ki-67 labeling index in the differential diagnosis of exaggerated placental site, placental site trophoblastic tumor, and choriocarcinoma: A double immunohistochemical staining technique using Ki-67 and Mel-CAM antibodies. Human Pathology, 29(1), 27–33. https://doi.org/10.1016/s0046-8177(98)90386-0.
Shih, I. M., & Kurman, R. J. (2001). The pathology of intermediate trophoblastic tumors and tumor-like lesions. International Journal of Gynecological Pathology, 20(1), 31–47. https://doi.org/10.1097/00004347-200101000-00004.
Shih, I. M., Seidman, J. D., & Kurman, R. J. (1999). Placental site nodule and characterization of distinctive types of intermediate trophoblast. Human Pathology, 30(6), 687–694. https://doi.org/10.1016/s0046-8177(99)90095-3.
Young, R. H., Kurman, R. J., & Scully, R. E. (1990). Placental site nodules and plaques. A clinicopathologic analysis of 20 cases. The American Journal of Surgical Pathology, 14(11), 1001–1009. https://doi.org/10.1097/00000478-199011000-00002.
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Ladwig, N.R., Rabban, J.T. (2022). Tumor-like Trophoblastic Lesions, Pathology of the Placenta. In: van Krieken, J. (eds) Encyclopedia of Pathology. Encyclopedia of Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-28845-1_5685-1
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DOI: https://doi.org/10.1007/978-3-319-28845-1_5685-1
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