Specific infiltration pattern of FOXP3+regulatory T cells in chronic histiocytic intervillositis of unknown etiology

Introduction: Chronic histiocytic intervillositis of unknown etiology (CIUE) is a rare placental lesion characterized by an intervillous mononuclear inflammatory infiltrate of maternal origin. Although the mechanism and origin of these lesions are currently not understood, they appear to be related to an immune conflict between mother and fetus cells. Aim: To clarify the inflammatory cell profile and evaluate the T regulatory lymphocyte (Treg) status in CIUE. Materials and methods: All cases of CIUE that occurred over an 8-year period were analyzed using immunohistochemistry. Results: The inflammatory profile of CIUE was characterized by a clearly predominant component of histiocytic cells (80% +/- 6.9) associated with some T cells (24% +/- 5.7). The ratio of CD4+ versus CD8+ T cells was close to 1. This profile differs from infectious disease and chronic histiocytic villitis, the main differential diagnoses of CIUE. As for normal pregnancies most regulatory T cells were localized in the decidua basalis. Nevertheless, their appearance was also noted in the intervillous space. In both the intervillous space and the deciduas the number of Tregs gradually increased from grade 1 to 3. Conclusion: We found that CIUE is associated with an increase in Treg lymphocytes in the decidua basalis and the intervillous space. Contrary to previously published data on human miscarriage, this result appears to be specific to CIUE and would support the hypothesis of an immunopathological disorder for CIUE. (C) 2012 Elsevier Ltd. All rights reserved.