Placenta
Umbilical cord
Umbilical vasculitis and funisitis

Author: Paul J. Kowalski, M.D. (see Authors page)

Revised: 17 October 2017, last major update June 2015

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Umbilical vasculitis and funisitis

Cite this page: Kowalski, P.J. Umbilical vasculitis and funisitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/placentaacutefunisitis.html. Accessed November 22nd, 2017.
Definition / general
  • Inflammation of umbilical vessels (vasculitis) and cord substance (funisitis) occurs in response to infection and constitutes the fetal inflammatory response
Terminology
  • Inflammation in the umbilical vein (phlebitis) can be seen separately from the umbilical arteries (arteritis)
  • Established or long standing infections can cause tissue necrosis and accumulation of cellular debris (necrotizing funisitis)
  • Inflammation located at the periphery or surface of the umbilical cord may be the primary pattern seen (peripheral funisitis)
Epidemiology
  • Occurs in patients with documented microorganisms (e.g. group B Streptococcus, Candida albicans) and patients with preterm labor
Sites
  • Progressive infiltration involves umbilical vein, umbilical arteries and umbilical cord substance (Wharton jelly)
Pathophysiology
  • Microorganisms gain access to placenta or umbilical cord by ascending from endocervical canal, by maternal bloodstream or by direct inoculation (such as from a diagnostic procedure)
  • In response, cytokines (IL8, interferon gamma, complement components, leukotriene B4) are released by endothelium, mast cells and macrophages, creating a chemoattractant chemical gradient for neutrophils
  • Chemical gradient may be augmented by certain peptides released by microorganisms
  • Activated neutrophils marginate against the vascular endothelium and transmigrate through the vascular wall
Etiology
  • Bacteria associated with intrauterine infection (group B Streptococcus, Escherichia coli, Fusobacterium or Bacteriodes species, Listeria monocytogenes)
  • Fungi (Candida species)
  • Less common causes are Actinomyces species, herpes simplex virus, Treponema pallidum
Clinical features
  • Typically associated with chorioamnionitis (maternal inflammatory response)
  • Minimal to mild inflammation (such as umbilical phlebitis) often associated with meconium exposure
Diagnosis
  • Presence of any neutrophilic infiltrate involving the umbilical vein, umbilical arteries, cord substance (Wharton jelly) or peripheral umbilical cord
  • Qualifying the location and degree of inflammation is encouraged over the generic use of the term "funisitis," historically used to inadequately describe the presence of any inflammation in any location
Prognostic factors
  • Severe inflammation has been linked to periventricular leukomalacia (Early Hum Dev 2004;77:77)
  • More severe inflammatory response seen when funisitis is present in preterm infants, possibly accounting for some differences in gestational age related morbidity (Hum Pathol 2001;32:623)
Case reports
Treatment
  • Antibiotic therapy can be initiated (particularly if accompanying symptoms of choriamnionitis are present)
Gross description
  • Peripheral funisitis may be seen as multiple, small, white or yellow plaques on the surface of the umbilical cord; often associated with Candida infection
  • Necrotizing funisitis on cut surface may appear as concentric perivascular rings resembling Ouchterlony immunodiffusion plates; may become calcified and appear chalky white
Gross images

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Listeria monocytogenes

Microscopic (histologic) description
  • Umbilical phlebitis: neutrophils in wall of umbilical vein (stage 1; early); most common histologic finding
  • Umbilical arteritis: neutrophils in wall of 1 - 2 umbilical arteries (stage 2; intermediate)
  • Necrotizing funisitis: typically shows 3 vessel panvasculitis, with degenerating neutrophilic and cellular debris present in cord substance, sometimes seen as concentric arcs of necrosis (stage 3; late)
  • Peripheral funisitis: epithelial necrosis and multiple microabscesses involving periphery of the umbilical cord; often Candida species
  • Evidence of meconium exposure may be observed, possibly with meconium induced myocyte necrosis
Microscopic (histologic) images

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Umbilical arteritis

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Vasculitis in umbilical vessel

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Necrotizing funisitis around artery

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Peripheral funisitis with Candida species

Positive stains
  • Typically not useful unless a specific causative organism is suspected based upon clinical or pathology findings (e.g. silver stain for Candida species in peripheral funisitis)