Chronic histiocytic intervillositis (CHI): an under-recognised condition with potential serious sequelae in pregnancy

Abstract

Chronic histiocytic intervillositis (CHI) is a rare placental disorder associated with adverse pregnancy outcomes and high recurrence rates in subsequent pregnancies. We discuss a case of CHI diagnosed incidentally in a young primigravida who presented with a first trimester miscarriage. CHI is usually diagnosed after an adverse pregnancy outcome by microscopic placental histopathology. Currently, CHI is a poorly understood condition by clinicians in many aspects, including its aetiology and subsequent management of patients in their future pregnancies. This is due to the lack of awareness and underdiagnosis of CHI among general pathologists and obstetricians. The authors would like to highlight this interesting case to encourage more research on CHI to understand its pathophysiology and optimal management better. Clinicians should also focus on providing holistic care to this group of patients by considering the impact of adverse pregnancy outcomes on their emotional well-being.

Keywords: materno-fetal medicine; obstetrics and gynaecology; pathology; pregnancy; psychiatry.

Figure 1

Chronic histiocytic intervillositis seen in central placental disc sections from a 31-year-old woman with an infant delivered at 36 weeks. (A) Histology shows prominent intervillous mononuclear histiocytes with increased fibrin deposition between villi (200× magnification, H&E). (B) High-powered photomicrograph showing mononuclear histiocytes in the intervillous spaces (400× magnification, H&E). (C) CD68 immunostaining confirms CD68 positive histiocytes in the intervillous spaces (400× magnification).