Monday, September 13, 2004

Chorioangioma of Placenta- A Case Report

Chorioangioma of Placenta- A Case Report
SK SETHI, U HEMAL, RS SOLANKI, A BHAGRA

Ind J Radiol Imag 2004 14:1:65-66

Key Words: Chorioangioma, Placenta



Chorioangioma constitutes the commonest benign growth of placenta. It consists of a benign angioma arising from chorionic tissue. Chorioangioma is often associated with unfavourable effects on the mother as well as on the fetus. With the advent of gray scale and color flow ultrasonography in prenatal diagnosis these tumours can be easily detected antenatally. We present a case of Choriangioma with associated polyhydramnios and PIH, detected antenatally on gray scale and color flow imaging.


CASE REPORT

A healthy 22year old primigravida presented at 28 weeks of gestation by dates with history suggestive of PIH and severe edema. On admission the physical examination revealed blood pressure of 150/100, respiration rate of 18/min with mild pallor. The patient had evidence of pitting edema of her lower extremities. Her Hb was 8.6gm% and her VDRL was negative. Urine examination revealed evidence of albuminuria.

Ultrasonography revealed a single fetus. Lie was transverse. The biparietel diameter was 74mm and femur length being 51mm both corresponding to a 28 weeks Gestation. Abdominal circumference (240mm) and head circumference (268mm) both corresponded to a 28 weeks period of gestation. There was no craniospinal anomaly. Fetal stomach, kidneys and bladder were normal and the umbilical cord was trivascular. Fetal cardiac four chamber view was normal and there was no pleural effusion or ascites. Polyhydramnios was present. The placenta was on the right lateral wall, was not low lying and was grade II. A well-defined oval echogenic mass measuring 7.5 x 6 cm having echogenicity different from the rest of placenta with focal area of peripheral hypoechogenicity was noted in the central part of the placenta close to the insertion of the umbilical cord causing a lobulated bulge on its fetal side. On color Doppler imaging a central feeding vessel was seen which showed a branching pattern and on pulsed Doppler it showed a pulsatile flow at a rate similar to that of umbilical artery. Patient was admitted and was advised absolute bed rest. The patient delivered vaginally at 34 weeks of gestation. The female infant weighed 1200 gm and had apgar scores of 7 and 7 at one and five minutes respectively. The placenta contained a lobular gray and tan coloured mass measuring 8 x 6 cm. histology showed marked proliferation of small capillaries with intervening loose, fibrous stroma compatible with chorioangioma.

DISCUSSION

Placental chorioangioma is the most common benign tumour of the placenta, occurring in approximately 1% of all pregnancies or in 0.5-1% of all placentas examined at term. It consists of a benign angioma arising from chorionic tissue. Three histological patterns of chorioangiomas have been described: angiomatous, cellular and degenerate. The angiomatous is the most common, with numerous small areas of endothelial tissue, capillaries and blood vessels surrounded by placental stroma. The cellular pattern has abundant endothelial cells within a loose stroma. The degenerate pattern has calcification, necrosis or hyalinization. These lesions are sometimes classified as placental hamartomas rather than true neoplasia. [1]

Most chorioangiomas are of no clinical importance. Those measuring more than 5 cms in diameter may be associated with complications that can affect the mother, the fetus or the neonate. [2]

Of the various reported clinical complications, the correlation of chorioangioma with hydramnios and premature delivery is significant, latter being a sequela of the hydramnios. The association with hydramnios is significantly correlated with the presence of large tumours. Fetal congestive heart failure may develop because of the increased blood flow through the low resistance vascular channels in the chorioangioma acting as an arteriovenous shunt. Other associated complications

being hydrops, anemia, and growth retardation. [3]

Antenatal ultrasound has made diagnosis and follow up possible before delivery. Usual gray scale findings include intraplacental subchorionic location, well-defined circumscription, complex echogenicity different from rest of the placenta, single or multiple tumours and protusion into the amniotic cavity near the insertion of the umbilical cord. [4]

Chorioangiomas show vascular channels in the tumour, which show pulsatile flow in the vascular spaces of the tumour, at the same pulsation rate as the umbilical cord. Color Doppler imaging is important not only for differentiating chorioangioma from other placental lesions but also for confirming that vascular channels in the tumour are continuous with the fetal circulation, thus ruling out other diagnosis such as degenerated myoma, placental teratoma, and incomplete hydatidiform mole. [5,6]

Due to the apparently high fetal death rate associated with large chorioangiomas, early diagnosis is necessary so that fetal surveillance can be instituted. In the present case characterstic gray scale and Doppler findings confirmed the diagnosis of chorioangioma. Doppler studies were particularly useful in confirming the presence of vascular channels with a pulse rate equal to the fetal heart rate.

REFERENCES

Grundy HO, Byers L, Walton S, Burblaw J, Dannar C. Antepartum Ultrasonographic evaluation and management of Placental chorioangioma. The J Reproductive Medicine 1986;31(6): 520-522.
Naik RD, Lobo FD, Kamath AS. Chorioangioma of Placenta: report of three cases. Indian J Pathol Microbiol 1993; 36(3): 285-288.
Wallenburg HCS. Chorioangioma of the placenta-review. Obstetrical and Gynecological Survey. 1971; 26: 411-425.
Dao AH, Rogers W, Wong SW. Chorioangioma of the placenta: Report of 2 Cases with Ultrasound Study in 1. Obstet Gynecol 1981; 57(6S): 46-49.
Zalel Y, Gamzu R, Weiss Y, Schiff E, Shalmon B, Dolizky M. Role of Color Doppler Imaging in Diagnosing and managing pregnancies complicated by Placental chorioangioma. J Clin Ultrasound 2002; 30: 264-269.
Kung FT, Chen WJ, Hsu PH, Wu JF, Chang SY. Large chorioangioma: antenatal color flow Doppler ultrasonographic imaging and its correlation with post-partum pathology. Acta Obstet Gynecol Scand 1997;76: 277-279.

6 comments:

pramod said...

i had similar case which was 22 wks pregnancy and eas predominently with the arterial flow though venous flow was also present .it was a 5 into 4 cm hypoechoich round lesion on maternal side of the placenta at the site of insertion of the cord.we labelled it as chorioangioma .
it was showing small spects of calcification in it which was rare in this case.

Anonymous said...

I'm curious to know the outcome of the babies - as I was recently diagnosed with this condition.

dr.r.kiran said...

i have a case of chorioangoma placenta.iwant to know comlication during delivery.

Raja said...

My wife is now in the 38th week of Pregnancy and the doctor was told by the ultrasound technician that the placenta was not smooth and wrote chorioangioma on the Rx.

The gync told that the baby and mother are fine with the baby weight as 2.8 Kg and she would request one unit of blood in case of any bleeding.

Please can you let me know if the condition needs more attention as after reading your article it seems it is a very major problem.

dghnfgj said...

This momentousdecree warcraft leveling came as a great beacon light wow lvl of hope to millions of negroslaves wow power level who had been seared power leveling in the flames of power leveling withering wrath of the lich king power leveling injustice.wrath of the lich king power leveling it came as a WOTLK Power Leveling joyous daybreak to end the long WOTLK Power Leveling night ofcaptivity.WOTLK Power Leveling but one hundred years wlk power leveling later, we must face aoc gold the tragic fact thatthe age of conan power leveling negro is still not free. aoc power leveling one hundred years later,age of conan power leveling the lifeof the negro ffxi gil is still sadly crippled by the final fantasy xi gil manacles ofsegregation guild wars gold and the chains of discrimination. one hundred yearslater, maplestory mesos the negro lives on a lonely island of poverty in themidst of a vast ocean of material prosperity.dog clothes one hundred yearslater, the negro is still languishing in the corners of americansociety and finds himself an exile in his own land.

Anonymous said...

I was diagnosed with chorioangioma with my first child two years ago. We went to a specialist, and were monitored closely with stress tests. I was given the chance to try for a vaginal birth induced two weeks before my estimated due date. Unfortunately, due to lack of progression from a large ovarian cyst (not related)I was delivered via c-section. I gave birth to a very healthy baby girl, and my recovery was great. It was a nerve racking process, but turned out for the good in the end. I hope this helps alleviate fears for those of you who may feel the uncertainty of the condition with the lack of information available. Also, I am type O- blood, and took my rhogam shots for my Rh factor. I was told this had no correlation, but I still feel uncertain. I wonder if anyone else might have this factor?

Blog Archive