ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.