PLACENTAL CHORIOANGIOMA

Introduction : Placental Neoplasms are classified in to two categories based on their origin: Trophoblastic and nontrophoblastic. Non trophoblastic tumors are common and benign ones include chorioangioma andteratoma. Chorioangioma of placenta is the commonest benign tumor of the placenta. It consists of abenign angioma arising from the chorionic tissue. It has been found to be associated with manyserious complications such as nonimmune hydrops, congenital abnormalities, hemolytic anemia,polyhydramnios, IUGR, and IUFD.Methods:A 21 years old pregnant female 2nd gravida with 32 weeks of gestation presented to Ob/Gydepartment at L.G. Hospital with complaints of abdominal distension for 2 weeks associated withlower abdominal pain for 2 days. She had a history of one full term normal delivery withoutsignificant peripartum events. General examination was unremarkable. P/A was grossly enlarged withFundal height more than gestational age, fetal heart rate was 144 /min. Per vaginal examinationrevealed 2 cm dilated and early effaced cervix with intact membrane. USG revealed a single live fetuswith 32 weeks of gestation and without structural malformations and hydrops AFI of 42 cmhyperechoic mass of 8.5 *6.5cm on placental surface, near cord insertion with hypervascularity,separate from placental tissue suggestive of placental chorioangioma. Estimated fetal weight was1.6kg. After a course of dexamethasone, therapeutic amniocentesis was done; She developed grosspolyhydramnios after 4 days of amniocentesis followed by spontaneous preterm normal labor anddelivered 1.7kg live baby without peripartum complications. Histopathological analysis of the massrevealed proliferation of capillary sized vascular channels with endothelial cells, hemorrhagic andfocal area of calcifications. The neonate was admitted to NICU and was discharged after a weekwithout complications.Conclusion :This case illustrates the prompt and accurate diagnosis of placental chorioangioma canhelp apply timely interventions improving patient outcome.

A case of placental chorioangioma

Chorioangioma is a benign tumor of placenta, incidence being 1 in 100 cases. It is mostly diagnosed ultrasonically in the second trimester of pregnancy. Large chorioangiomas render a challenge to obstetricians due to the foeto maternal complications and adverse outcomes. Here by authors present a case report of large chorioangioma with no fetomaternal complications but just for awareness of the importance of early diagnosis and to look out for possible adverse effects on mother and foetus.

Breus’ mole/chorangiosis/chorangioma of the placenta: a dilemma with a rare fetal outcome report

Massive Subchorionic Thrombohematoma (MST) is a rare condition in which there is a massive collection of blood between the placental membranes and uterine wall separating the villous chorionic plate from villous chorion. It is relatively rare and is poorly understood. Many theories have been proposed to explain the etiology of Breus mole; some suggest it is a fetal haemorrhage, while others claim it has a maternal-origin thrombosis of placental vessels. A 30-year-old healthy Indian pregnant woman was presented at Max Hospital, Shalimar Bagh Delhi, India, during her second pregnancy with a complaint of fever. On routine level-2 ultrasonography (USG) done at 18.6 weeks of gestation showed thick placenta. No fetal tumours or any other anomalies were noted on that scan which was followed by a detailed scan which confirmed a solitary mass arising from fetal side 103x64x82 mm S/O chorioangioma. Serial growth and doppler USG were conducted to monitor placental function, tumor characteristics and future anatomy. The subject received steroids to enhance fetal lungs maturation at Week 30, iron/calcium supplements, Ecosprin tablets, and progesterone support. At 32.5 weeks, the subject developed deranged sugars followed by gestational hypertension at 34.1 weeks. Ultrasonography also showed fetal growth restriction with large chorioangioma. The subject underwent a successful elective caesarean section at 34.4 weeks. On placental examination, 10 cm large mass encasing ¾ of the placenta was identified as a large subchorionic hematoma/chorioangioma (800 g). This study concludes that early identification of a large chorangioma aids in consequent fetal surveillance, management of maternal symptoms, and delivery planning discussions even if the pathological diagnosis turns out to be Breus’ mole with underlying chorangiosis postnatally.

Neonatal outcome of a giant placental chorioangioma in a late preterm newborn

Chorioangioma, the most common benign placental tumor, is found in 1% of placental pathology. Tumors greater than 4 cm are classified as giant and associated with multiple maternal and fetal complications. Authors are presenting a case report of a rare 16 cm giant chorioangioma, discovered at time of delivery, complicated with pregnancy induced hypertension and presenting with minimal fetal complication. This patient exhibited eventually a satisfactory perinatal outcome, complicated by severe anemia and thrombocytopenia requiring transfusion of blood products and bilateral, self-resolved spontaneous cephalohematomas. Chorioangiomas should be considered in the differential diagnosis of any newborn that presents with anemia.

Giant chorioangioma of placenta: a rare placental cause of polyhydramnios

Chorioangioma belongs to benign nontrophoblastic primary vascular neoplasms of placenta, originating from primitive chorionic mesenchyme and has a cited prevalence of around 0.6% to 1% of all pregnancies. Though majority of them are asymptomatic, clinical course depends mainly on the size of the neoplasm. Giant chorioangiomas (> 4-5 centimetres in diameter) with an approximate prevalence of around one in 9000 to one in 50,000 pregnancies, have been associated with many adverse maternal and fetal complications. We report a case of 21-year-old primigravida lady, who presented to us at 37weeks 4 days period of gestation with backache and with clinically evident increased liquor. On evaluating the cause of her polyhydramnios, ultrasonography revealed a well-defined echogenic vascular mass measuring ~ 8х8 centimetres in the placenta, suggestive of chorioangioma. Though the condition is infrequent, through this case report, we emphasize that even placental factors need to be ruled out in evaluating causes of polyhydramnios. Despite large size of chorioangioma and associated hydramnios, our patient exceptionally didn’t have any fetal complications. With proper antenatal surveillance, optimal feto-maternal outcome can be expected as seen in our case.

Corioangioma placentario gigante: a propósito del primer caso sometido a fetoscopia y fotocoagulación láser en el Perú / Giant placental chorangioma: Apropos of the first case treated by fetoscopy and laser photocoagulation in Peru

Placental chorioangioma is a non-trophoblastic benign tumor of rare presentation. It may be associated with complications of pregnancy when larger than 4 cm. We present the case of a pregnant adolescent with 25 weeks of gestation referred for prenatal management of a giant placental chorangioma that complicated pregnancy with hydramnios and severe fetal anemia. Fetoscopic laser ablation of the main nutrient vessel of the tumor was performed for the first time in Peru, which reversed complications and improved fetal prognosis.

El corioangioma placentario es una tumoración benigna no trofoblástica de muy rara presentación. Se asocia a complicaciones del embarazo cuando tiene dimensiones mayores a 4 cm. Se presenta el caso de una gestante adolescente de 25 semanas referida a nuestro servicio para manejo prenatal de un corioangioma placentario gigante que complicó el embarazo con polihidramnios y anemia fetal severa. Se realizó por primera vez en el Perú la ablación láser del vaso nutricio principal de la tumoración por fetoscopia, lo que logró revertir las complicaciones y mejorar el pronóstico fetal.

Corioangioma gigante de la placenta con buenos resultados perinatales / Giant Placenta Chorioangioma with Good Perinatal Outcomes

El corioangioma fue descrito por primera vez en 1798 por Clarke. Este es un tumor no trofoblástico de la placenta, constituye una entidad poco usual y se reporta en 1 por ciento de las placentas examinadas microscópicamente, con evidencia clínica en aproximadamente 1:3 500 a 1:9 000 nacimientos. Presentamos el caso de una paciente de 21 años, con una historia obstétrica de embarazos 2, abortos 1, que es valorada en servicio de emergencias con embarazo a término con corioangioma gigante de la placenta. El ultrasonido muestra una imagen redondeada hipoecogénica que se interpreta como: cotiledón placentario aberrante. Se le realizó cesárea y se observa una tumoración redondeada en borde placentario con presencia de una red vascular evidente en su superficie. El ultrasonido es el medio que más favorece el diagnóstico, sobre todo el Doppler. La detección precoz y oportuna de esta afección permite la vigilancia fetal y la prevención de las complicaciones(AU)

Clarke first described Chorioangioma in 1798. This is a placenta non-trophoblastic tumor; it is an unusual entity and is reported in 1 percent of the placentas examined microscopically, with clinical evidence in approximately 1: 3 500 to 1: 9 000 births. We present the case of a 21-year-old patient, with an obstetric history of two pregnancies and one abortions, who is evaluated in emergency services with full-term pregnancy with giant placenta chorioangioma. Ultrasound shows a rounded hypoechoic image that is interpreted as aberrant placental cotyledon. A caesarean section was performed and a rounded tumor was observed on the placental border with the presence of an evident vascular network on the surface. Ultrasound is the way that most favors diagnosis, especially Doppler. Early and timely detection of this condition allows fetal monitoring and prevention of complications(AU)

Quistes subamnióticos en el contexto de restricción de crecimiento fetal / Subamniotic cysts in the context of growth restriction fetal

RESUMEN La restricción de crecimiento fetal (RCF) es el término con el que se define a aquellos fetos que no alcanzan el potencial de crecimiento intraútero esperado debido a factores genéticos o ambientales. Dentro de las causas de RCF asociadas a la placenta encontramos mosaicismo confinado a la misma, enfermedad isquémica placentaria y anomalías estructurales a este nivel. Se presenta el caso de una paciente de 32 años con diagnóstico de RCF que asocia múltiples quistes econegativos subamnióticos en la cara fetal de la placenta. Se finaliza la gestación en semana 34 mediante cesárea electiva por ausencia de diástole en el estudio Doppler de la arteria umbilical, evidenciando cinco quistes subamnióticos de 4 a 6 cm que alteran la superficie del amnios.

ABSTRACT Fetal growth restriction (FGR) is the term used to define those fetuses that do not reach the expected intrauterine growth potential due to genetic or environmental conditions. The causes of FGR associated with the placenta are confined placental mosaicism, placental ischemic disease and placental structural abnormalities. We report a case of a 32-year-old patient with a diagnosis of FGR associated with multiple subamniotic econegative cysts overlaying the fetal plate of the placenta. The gestation is ended in week 34 by elective cesarean section due to absence of diastolic flow in the umbil-ical artery, showing five subamniotic cysts from 4 to 6 cm that disrupt the surface of the amnion.

Corioangioma placentario gigante. Reporte de un caso / Giant placental chorioangioma. A case report

Resumen Antecedentes: El corioangioma es el tumor placentario benigno más frecuente (1%). Cuando miden más de 5 cm pueden causar complicaciones materno-fetales, por lo que es importante establecer el diagnóstico prenatal. Caso clínico: Paciente de 25 años, atendida en el Hospital Español de Beneficencia de Pachuca, con fetometría de 19.2 semanas, acorde con el ultrasonido del primer trimestre. En la evaluación del estudio de imagen se observó edema craneal; área cardiacatorácica 0.55 (anormal), compatible con cardiomegalia severa. El ultrasonido Doppler materno mostró la placenta en localización anterior y una tumoración de 7.53 x 6.74 x 6.33 cm, con zonas hiper e hipoecoicas, que protruía la superficie fetal de la placenta, arriba de la inserción del cordón umbilical. Los vasos de alimentación con diámetro máximo de 3 mm, ubicados superficialmente y cerca de la inserción del cordón. En la valoración del ultrasonido Doppler fetal: ACM-PVS: 33.5 cm/s, 1.37 MoM, anemia leve y DV IP 1.02 (> p95 anormal); en la vena umbilical del cordón se observó flujo pulsátil, pool máximo de 5.81 cc y longitud cervical de 4 cm. Mientras se integraba un equipo multidisciplinario se acordó tratamiento expectante hasta el nacimiento; debido a las repercusiones hemodinámicas el feto falleció. El estudio histopatológico confirmó el diagnóstico de corioangioma (hemangioma placentario), de 7 cm de diámetro mayor. Conclusiones: Es importante reportar los casos de corioangioma placentario, con la finalidad de contribuir al conocimiento y estimar las tasas de morbilidad y mortalidad materno-fetal.

Abstract Background: Chorioangioma is the most common benign placental tumour (1%). If these are greater than 5 cm, it can cause various maternal-fetal complications, so it is important to perform your prenatal diagnosis. Clinical case: Female patient of 25 years-old, attended at the Hospital Español de Beneficencia de Pachuca with suggestive diagnosis with fetus of 19.2 weeks, according to the ultrasound of the first trimester; in the imaging study cranial oedema was observed; cardiac-thoracic area 0.55 (abnormal), compatible with severe cardiomegaly. The maternal Doppler ultrasound showed the placenta in the anterior location and tumour of 7.53 x 6.74 x 6.33 cm, with hyperechoic and hypoechoic zones, which protruded the fetal surface of the placenta, above the insertion of the umbilical cord; the feeding vessels with a maximum diameter of 3 mm, located superficially and close to the insertion of the cord. In the evaluation of fetal Doppler ultrasound: ACM-PVS: 33.5 cm/s, 1.37 MoM, mild anaemia and DV IP 1.02 (> p95 abnormal); In the cord umbilical vein pulsatile flow was observed, maximum pool of 5.81 cc and cervical length of 4 cm. While a multidisciplinary team was formed, expectant treatment was agreed upon until birth; however, soon after, the fetus died due to hemodynamic repercussions. The histopathological study confirmed the diagnosis of chorioangioma (placental hemangioma), 7 cm in greatest diameter. Conclusions: It is important to report the cases of placental chorioangioma, with the purpose of contributing with the knowledge and estimating maternal-fetal morbidity and mortality rates.

Spontaneous necrosis of a giant placental chorioangioma: case report / Necrose espontânea de um corioangioma placentário gigante: relato de caso

Chorioangiomas are the most common benign placental tumors, with an estimated prevalence of 1%. Whilst small chorioangiomas usually remain asymptomatic and are of no clinical significance, larger tumors (>4cm) can be associated with a variety of complications, ranging from fetal anemia to in-utero demise in up to 40% of cases. Despite size being a major determinant for the risk of complications, the degree of the chorioangioma's vascularity also seems to play a role. In fact, in selected cases, occluding the tumors vessels (e.g. with alcoholic instillation) appears to improve the prognosis due to the subsequent tumor ischemia. We present the case of a 40-year-old woman who at 29 weeks was found to have a large placental hypervascular mass (93mm×66mm) and polyhydramnios, with an elevated peak systolic volume in the middle cerebral artery. She was given corticosteroids for fetal lung maturation, and throughout her admission both the volume of amniotic fluid stabilized and the peak systolic volume in the middle cerebral artery normalized, with changing of the ultrasonographic characteristics of the chorioangioma, with apparent progressive necrosis. At 34 weeks, a large subchorionic hematoma was found and, due to the risk of impending placental abruption, we opted to deliver by cesarean section, with a favorable outcome.(AU)

Corioangiomas são os tumores placentários benignos mais comuns, com uma prevalência estimada de 1%. Embora pequenos corioangiomas geralmente permaneçam assintomáticos e não tenham significância clínica, tumores maiores (> 4cm) podem estar associados a diversas complicações, que variam de anemia fetal até a morte intraútero em até 40% dos casos. Ainda que o tamanho do tumor seja um determinante principal para o risco de complicações, o grau da vascularidade do corioangioma também parece desempenhar um papel importante. De fato, em casos selecionados, a oclusão dos vasos tumorais (por exemplo, através de instilação de álcool) parece melhorar o prognóstico devido à subsequente isquemia tumoral. Apresentamos o caso de uma mulher de 40 anos a qual, com 29 semanas de gestação, apresentava grande massa hipervascular placentária (93×66mm) e poli-hidrâmnio, com elevação do peak systolic volume in the middle cerebral artery. Ela recebeu corticosteroides para a estimulação da maturação pulmonar fetal e durante a sua internação o volume de líquido amniótico foi estabilizado e o peak systolic volume in the middle cerebral artery normalizado, com mudança nas características ultrassonográficas do corioangioma, com necrose progressiva aparente. Com 34 semanas de gestação, observou-se a presença de hematoma subcoriônico de grande porte e, devido ao risco de descolamento prematuro da placenta, optou-se por parto cesariano, com desfecho favorável.(AU)

Corioan gioma placentario gigante: Reporte de caso / Giant plancental chorioangioma: case report

Los corioangiomas placentarios son tumores vasculares benignos y los tumores placentarios más comunes, con una prevalencia de 1%. Raras veces sobrepasan los 4 a 5 centímetros y, cuando esto ocurre, es descrito como corioangioma gigante. Los embarazos con corioangiomas gigantes están asociados con complicaciones maternas y fetales, tales como anemia hemolítica microangiopática severa, parto pretérmino, polihidramnios, restricción del crecimiento intrauterino del feto, trombocitopenia e hidropesía. Se presenta un caso de un corioangioma gigante diagnosticado a las 22 semanas. A pesar del seguimiento estricto, el parto se produjo a las 30 semanas debido a polihidramnios y rotura prematura de membranas. Tanto la madre como el recién nacido se recuperaron sin complicaciones.

Placental chorioangiomas are benign vascular tumors and are the most common placental tumors, with a prevalence of 1%. It rarely surpasses 4 - 5 centimeters in length and, when it happens, is referred to as giant chorioangioma. Pregnancies with giant chorioangiomas are associated with maternal and fetal complications, such as severe microangiopathic haemolytic anemia, preterm labor, polyhidramnios, intrauterine growth restriction, thrombocytopenia and hydrops. A case of giant chorioangioma diagnosed at 22 weeks is presented. Despite close follow-up, delivery occurred at 30 weeks of pregnancy due to polyhidramnios and premature rupture of membranes. Both mother and newborn recovered without complications.

Chorioangioma: Prenatal Diagnosis By Ultrasound And MRI.

Chorioangioma is a benign tumour of the placenta consisting of blood vessels and stroma that proliferates beyond normally developing chorionic villi. Most of the small tumours are asymptomatic but large placental tumours are associated with unfavourable outcomes for foetus and mother.

A Case of Hydrops Fetalis due to Placental Chorangiomatosis / 대한주산의학회잡지

Apart from the common etiologies of neonatal hydrops fetalis, a miscellaneous group of rare causes of them include abnormalities of the placenta, namely, chorangioma (chorioangioma). Chorangiomatosis is multiple small chorangiomas, a rare tumor occurring in 1% of pregnancies, of varying sizes in the placenta. When chorangioma is large enough it can cause high output cardiac failure of the fetus and results in non-immune hydrops. We report a case of neonatal hydrops fetalis caused by placental chorangiomatosis in which the placenta could have been easily overlooked. We suggest evaluating every placenta for biopsy in cases of neonatal hydrops fetalis especially when the other causes of hydrops fetalis have been ruled out.

A case of chorioangioma of placenta complicated by fetal anemia and fetal hydrops / 대한산부인과학회지

Benign chorioangioma of the placenta is the most common primary tumor of the placenta similar to hamartoma. Most small-sized tumors do not make any clinical problem, but uncommon large tumors (>5 cm in diameter) may produce both maternal and fetal complications, such as polyhydramnios, preterm labor, fetal hydrops, microangiopathic hemolytic anemia, disseminated intravascular coagulation, intrauterine growth restriction, preeclampsia and placental abruption. In this respect, the diagnosis and management of chorioangioma and its complication should be done appropriately. We report a case of chorioangioma presenting with polyhydramnios, preterm labor, fetal anemia and fetal hydrops, diagnosed by antenatal ultrasonography and postnatal placental histologic examination, and live born baby with the brief review of the literature related to this type of tumor.

Chorioangioma Syndrome: Co-relation of Color Doppler Ultrasound and Pregnancy Outcome

Large chorioangiomas are rare and associated with significant fetal and maternal risks. A case of chorioangioma syndrome is presented with polyhydramnios, pre-eclampsia, preterm labor and fetomaternal hemorrhage. Antenatal diagnosis is possible with ultrasound, and the prognosis for pregnancy outcome can be predicted by evaluating the vascularity of the tumor on color doppler sonography.

A Case of Multiple Placental Chorioangioma Combined with Oligohydramnios / 대한산부인과학회잡지

Chorioangioma is the most common benign tumor of the placenta and associated with adverse perinatal outcome. The prevalence of chorioangioma of the placenta is about 1 percent. The most placental chorioangioma has no clinical significance. But the uncommon large (greater than 5 cm in diameter) chorioangioma may produce both maternal and fetal complications, such as polyhydramnios, preterm labor, fetal heart failure, hydrops fetalis, fetal growth restriction, fetal microangiopathic hemolytic anemia, fetal thrombocytopenia, toxemia of pregnancy, maternal thrombocytopenia, and maternal coagulopathy. The ultrasonography and Color Doppler are used for diagnosis of these lesions. If chorioangioma is suspected, Color Doppler study is informative to confirm the presence of the vascular channels. We report a case of multiple chorioangioma combined with oligohydramnios and discuss the noxious effects of this benign tumor on the mother and the fetus.

A Case of Prenatal diagnosed Chorioangioma of Placenta / 대한산부인과학회잡지

Benigh chorioangioma of the placent is the most common primary tumor of the placenta that similar to hamartoma. Most small sized tumor is not important because it is asymptomatic and not make any clinical problem, but large tumor more than 4 cm in diameter are clinically important, because that can make hydramnios, preterm labor, fetal hydrops, Disseminated intravascular coagulopathy, intrauterine growth retardation, preeclampsia, placenta abruptio, postpartum bleeding. In this respect, the predictional diagnosis and management of chorioangioma and its complication should be done. In this paper, a case of chorioangioma associated with hydramnios, preterm labor, IUGR that diagnosis by antepastun ultrasonography and postpartum histologic study is presented with the brief review of the literature related to this type of tumor.

Clinical Significance of Large Placental Chorioangioma / 대한주산의학회잡지

Our purpose was to evaluate the clinical significance of large (>5cm) placental chorioangioma. Obstetrical and neonatal records which were confirmed chorioangioma in pathology and greater than 5 cm in diameter, were reviewed retrospectively from April. 1, 1991, to March. 31, 1996. 11 cases of placental chorioangioma greater than 5 cm were diagnosed prenatally by ultrasonography except one. I'hey were associated with maternal or fetal complications-6 cases of polyhydramnios, 2 cases of PIH, 1 case of neonatal anemia, 2 cases of preterm birth, 2 cases of neonatal hyperbilirubinemia, 1 case of cardiomegaly, 1 case of IUGR and 1 case of oligohydramnios. Nevertheless, there were not remarkable neonatal morbidity and mortality. These uncommon large tumors were often associated with maternal or fetal complications. But, we could get good neonatal outcome through thorough antenatal surveillance.

A Case of Nonimmune Hydrops Fetalis due to Placental Chorioangioma

Fetal hydrops describes the infant who has generalized edema due to accumulation of exess fluid, in serious case, ascites and pleural and pericardial effusions are commonly combined. The chorioangioma is considered the most common primary tumor of the placenta, which is about 1% of all pregnancy. However, the majority of the cases are asymptomatic but larger ones, usually more than 5cm in diameter, are commonly associated with maternal and fetal complications. We report a case of nonimmune hydrops fetalis due to large chorioangioma with associated polyhydramnios. The newborn infant was managed conservatively and had excellent outcome.

A Case of Nonimmune Hydrops Fetalis due to Placental Chorioangioma

Fetal hydrops describes the infant who has generalized edema due to accumulation of exess fluid, in serious case, ascites and pleural and pericardial effusions are commonly combined. The chorioangioma is considered the most common primary tumor of the placenta, which is about 1% of all pregnancy. However, the majority of the cases are asymptomatic but larger ones, usually more than 5cm in diameter, are commonly associated with maternal and fetal complications. We report a case of nonimmune hydrops fetalis due to large chorioangioma with associated polyhydramnios. The newborn infant was managed conservatively and had excellent outcome.