decidual

Decidua
	Diagrammatic sections of the uterine mucous membrane: A. The non-pregnant uterus. B. Decidua parietalis; the mucous membrane] in the pregnant uterus and not beneath the placenta.
	Sectional plan of the gravid uterus in the third and fourth month.
Identifiers
Gray's	p.59
MeSH	A16.759.289
Code	TE E6.0.1.4.0.0.7
	Anatomical terminology

adj.

脱落膜の

関: decidua、deciduous membrane、deciduum

WordNet

the epithelial tissue of the endometrium

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/08 15:24:04」(JST)

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Decidua is the term for the uterine lining (endometrium) during a pregnancy, which forms the maternal part of the placenta. It is formed under the influence of estrogen and forms highly characteristic cells.

Etymology

The word comes from the Latin deciduus, meaning falling off or shedding.

Background

After ovulation, in mammals, the endometrial lining becomes transformed into a secretory lining in preparation of accepting the embryo. Without implantation, the secretory lining will be absorbed (estrous cycle) or shed (menstrual cycle).

With implantation the lining now termed decidua evolves further during the pregnancy.

The decidua is shed during the parturition process.

Structure

Different layers of the deciduas have been described:

Compact outer layer (stratum compactum)
Intermediate layer (stratum spongiosum)
Boundary layer adjacent to the myometrium (stratum basalis)

That part of the decidua that interacts with the trophoblast is the decidua basalis (also called decidua placentalis). The remainder of the decidua is termed the decidua parietalis or decidua vera. Also, there is the decidua capsularis, which grows over the embryo on the luminal side, enclosing it into the endometrium and surrounding the embryo together with decidua basalis.

Micrograph of decidualized endometrium due to exogenous progesterone. H&E stain.

The decidua has a histologically-distinct appearance, displaying large polygonal decidual cells in the stroma. These are enlarged endometrial stromal cells, which resemble epithelium (and are referred to as "epithelioid").

Formation of a specialized decidua is called decidualization, which is a special property of endometrium seen only in hemochorial placentation.

Decidualization includes the process of differentiation of the spindle-shape stromal fibroblasts into the plump secretory decidual cells, which create a pericellular extracellular matrix rich in fibronectin and laminin (similar to epithelial cells).

Vascularity, as well as vascular permeability, is enhanced in the decidualizing endometrium.

Its leukocyte population is distinct, with the presence of large endometrial granular leukocytes being predominant, while polynuclear leukocytes and B cells are scant.

The large granular lymphocytes (CD56 bright) are called "uterine NK cells" or "uNK cells" in mice, and "decidual NK cells" or "dNK cells" in humans.

The region of fibrinoid degeneration where trophoblasts meet decidua is called Nitabuch's layer. This layer is absent in placenta accreta.^[1]

Role

As the maternal interface to the embryo the decidua participates in the exchanges of nutrition, gas, and waste with the gestation. It also protects the pregnancy from the maternal immune system. Further, the decidua has to allow a very controlled invasion of the trophoblast.

In invasive placental disorders like placenta accreta decidualization have been consistently found to be deficient.

Hormone production

The decidua secretes hormones, growth factors, and cytokines. It has receptors for estrogen, progesterone, growth hormone, and others.

Among its products are hormones commonly associated with other organs such as cortisol, CRF, GnRH, prolactin, and relaxin. Decidual prolactin is not under dopaminergic control.

Pregnancy protein 14 (PP-14), also called placental protein 12, and Insulin-like growth factor-binding protein 1(IGFBP1) appear to be specific products of the secretory and decidual lining.

Other factors released include interleukin-15 and vascular endothelial growth factor (VEGF). A reasonable understanding of the role and interplay of these hormones and factors has not been evolved.

Other

Micrograph of decidua in a lymph node. H&E stain.

In case of an extrauterine pregnancy, the endometrium nevertheless becomes decidualized. A woman may shed the lining in the form of a decidual cast, which may be mistaken as a miscarriage, when, in fact, the ectopic still persists.
A decidual reaction can be observed in tissue of the peritoneum and ovary during a pregnancy, and represents a response of stromal tissue to progesterone.
Decidua in a lymph node may mimic metastatic carcinoma.^[2]

Pathology

Micrograph of chronic deciduitis. H&E stain.

A long-lasting infection of the decidua, chronic deciduitis, is associated with pre-term labour.^[3]

Additional images

Scheme of placental circulation.

References

^ Cunningham, F. Gary, ed. (2005). Williams obstetrics (22nd ed.). New York ; Toronto: McGraw-Hill Professional. ISBN 9780071413152.
^ Wu, DC.; Hirschowitz, S.; Natarajan, S. (May 2005). "Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall". Arch Pathol Lab Med 129 (5): e117–20. doi:10.1043/1543-2165(2005)129e117:EDOPLN2.0.CO;2 (inactive 2015-01-12). PMID 15859655.
^ Edmondson, N.; Bocking, A.; Machin, G.; Rizek, R.; Watson, C.; Keating, S. (2009). "The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis". Pediatr Dev Pathol 12 (1): 16–21. doi:10.2350/07-04-0270.1 (inactive 2015-01-12). PMID 18171100.

External links

Histologic picture at med.utah.edu
Gray's s12
Histology image: 19904loa – Histology Learning System at Boston University

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 自然早産の病因 pathogenesis of spontaneous preterm birth
2. 胎盤早期剥離：臨床的特徴および診断 placental abruption clinical features and diagnosis
3. 部位不明妊娠の超音波検査 ultrasonography of pregnancy of unknown location
4. 母体 - 胎児接点の免疫 immunology of the maternal fetal interface
5. 分娩の生理学 physiology of parturition

English Journal

Placental pathology in smoking and non-smoking preeclamptic women.

Vinnars MT1,2, Falkare S1, Papadogiannakis N3,4, Nasiell J1,4.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2016 Mar;29(5):733-6. doi: 10.3109/14767058.2015.1016421. Epub 2015 Feb 26.
OBJECTIVE: To ascertain whether the protective effect of smoking during preeclampsia (PE) can be visualized in the placenta.METHODS: The study cohort consisted of placentas (n = 523) from pregnancies complicated by PE, delivered at Karolinska University Hospital in Stockholm during the period 20
PMID 25716079

Expression and localization of collectins in feto-maternal tissues of human first trimester spontaneous abortion and abortion prone mouse model.

Yadav AK1, Chaudhari H2, Shah PK2, Madan T3.
Immunobiology.Immunobiology.2016 Feb;221(2):260-8. doi: 10.1016/j.imbio.2015.10.010. Epub 2015 Nov 2.
Dysregulation of immune response at the feto-maternal interface during first trimester of pregnancy is one of the leading causes of spontaneous abortion. Previously, we reported differential expression of collectins, soluble pattern recognition molecules involved in immunoregulation, in placental an
PMID 26603976

Expression of surfactant proteins SP-A and SP-D in murine decidua and immunomodulatory effects on decidual macrophages.

Madhukaran SP1, Koippallil Gopalakrishnan AR2, Pandit H2, Marri ED3, Kouser L3, Jamil K4, Alhamlan FS5, Kishore U6, Madan T7.
Immunobiology.Immunobiology.2016 Feb;221(2):377-86. doi: 10.1016/j.imbio.2015.09.019. Epub 2015 Sep 16.
Surfactant proteins SP-A and SP-D are pattern recognition innate immune molecules that belong to the C-type lectin family. In lungs, they play an important role in the clearance of pathogens and control of inflammation. SP-A and SP-D are also expressed in the female reproductive tract where they pla
PMID 26421960

Japanese Journal

Histopathological and Immunohistochemical Characterization of Spontaneously Occurring Uterine Deciduomas in Young Adult Rats

Yoshizawa Katsuhiko,Emoto Yuko,Kinoshita Yuichi [他],Kimura Ayako,Uehara Norihisa,Yuri Takashi,Shikata Nobuaki,Tsubura Airo
Journal of Toxicologic Pathology 26(1), 61-66, 2013
… Histopathologically, the nodules were composed of three areas, each with a distinct type of proliferating cells: large epithelioid decidual cells with round nuclei, prominent nucleoli and abundant eosinophilic cytoplasm (antimesometrial region); … The proliferating cells were positive for vimentin, and large decidual cells were positive for common acute lymphoblastic leukemia antigen 10, a marker of uterine interstitial cells. …
NAID 130003362357

症例報告内膜症性囊胞が妊娠中に脱落膜変化を呈した2例

堂園渓,谷垣伸治,真山麗子 [他]
東京産科婦人科学会会誌 61(3), 387-391, 2012-10
NAID 40019492616

症例報告帝王切開時に発見され悪性腫瘍との鑑別が困難であった卵巣脱落膜変化の一例

佐藤玲南,望月昭彦,野村可之 [他]
関東連合産科婦人科学会誌 49(4), 555-559, 2012
NAID 40019781159

Related Pictures

[1] Cunningham, F. Gary, ed. (2005). Williams obstetrics (22nd ed.). New York ; Toronto: McGraw-Hill Professional. ISBN 9780071413152.

[pmid15859655-2] Wu, DC.; Hirschowitz, S.; Natarajan, S. (May 2005). "Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall". Arch Pathol Lab Med 129 (5): e117–20. doi:10.1043/1543-2165(2005)129e117:EDOPLN2.0.CO;2 (inactive 2015-01-12). PMID 15859655.

[pmid18171100-3] Edmondson, N.; Bocking, A.; Machin, G.; Rizek, R.; Watson, C.; Keating, S. (2009). "The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis". Pediatr Dev Pathol 12 (1): 16–21. doi:10.2350/07-04-0270.1 (inactive 2015-01-12). PMID 18171100.

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