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Hashemi A, Moradi Alamdarloo S, Vafaei H, Barzegar H, Jafari F, Haseli S, Abbaspour E. Multiple giant placental chorioangioma: A case report. Clin Case Rep 2024; 12:e9219. [PMID: 39070544 PMCID: PMC11272946 DOI: 10.1002/ccr3.9219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/14/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Key Clinical Message Giant chorioangiomas, despite being rare, pose significant fetal and maternal risks. Timely and individualized treatment plans are crucial to reduce morbidity and mortality when fetal compromise occurs. Additionally, successful conservative management relies on consistent ultrasound monitoring, Doppler flowmetry assessments, and amniotic fluid level measurements. Abstract Chorioangiomas are benign placental tumors that manifest in approximately 1% of pregnancies. Giant chorioangiomas, characterized by tumors exceeding 4 cm, are exceptionally rare and pose substantial risks to maternal and fetal health. This case report details a patient with multiple giant chorioangiomas, emphasizing the rarity and consequential complications associated with these tumors. A 23-year-old woman, G3P2, at 28 weeks gestational age, was diagnosed with multiple large, well-defined placental masses with increased vascularity, indicative of giant placental chorioangiomas. Subsequent ultrasound revealed various fetal anomalies such as cleft palate and lip, as well as lung and heart abnormalities. At 34+5 weeks of gestation, an emergency cesarean section was performed due to preeclampsia. Subsequently, a female neonate was born with hydrops fetalis. Unfortunately, she passed away within the first hour of her life. Complications associated with chorioangiomas primarily arise from arteriovenous shunts, which potentially lead to compromised fetal perfusion and cardiac failure. Although small-sized chorioangiomas are often discovered incidentally, Doppler ultrasound and magnetic resonance imaging can reliably distinguish these tumors from other placental lesions. Additionally, management strategies tailored to gestational age and maternal-fetal symptoms typically necessitate a multidisciplinary approach. However, additional research is essential to understand the mechanisms of chorioangiomas and to develop comprehensive management guidelines.
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Affiliation(s)
- Atefe Hashemi
- Maternal‐Fetal Medicine Research Center, Department of Obstetrics and Gynecology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Shaghayegh Moradi Alamdarloo
- Maternal‐Fetal Medicine Research Center, Department of Obstetrics and Gynecology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Homeira Vafaei
- Maternal‐Fetal Medicine Research Center, Department of Obstetrics and Gynecology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Hamide Barzegar
- Neonatal Research CenterShiraz University of Medical SciencesShirazIran
| | - Firouzeh Jafari
- Department of Pathology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Sara Haseli
- Department of Radiology, Division of Musculoskeletal Imaging and InterventionUniversity of WashingtonSeattleWashingtonUSA
- The OncoRad Research Core, Department of RadiologyUniversity of Washington/Fred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Elahe Abbaspour
- Department of Radiology, Poursina HospitalGuilan University of Medical SciencesRashtIran
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Burlacu D, Burlacu A, Belenyessy R, Szabo B, Mezei T. When a Chorangioma Becomes a Burden in Fetal Survival: A Reported Case with an Updated Literature Review. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:601-606. [PMID: 38559833 PMCID: PMC10976218 DOI: 10.12865/chsj.49.04.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/24/2023] [Indexed: 04/04/2024]
Abstract
Chorangioma is a rare non-trophoblastic benign vascular neoplasm originating from the primitive chorionic mesenchyme. Usually asymptomatic, it affects approximately 1% of female fetuses. We present the case of a giant placental chorangioma (GPC) in a preterm male pregnancy coexisting with a maternal neuroendocrine carcinoma. A 30-week primigravida was admitted to the Obstetrics and Gynecology Clinic of the Targu-Mures Emergency Clinical Hospital, with abdominal discomfort, and an emergency C-section was performed for fetal congestive heart failure. Medical history revealed an advanced-stage rectal neuroendocrine carcinoma. At 20th gestational week, a well-vascularized placental mass was diagnosed. A 1500g premature male fetus was delivered. Histopathologically, the placental mass revealed an unencapsulated but well-circumscribed tumor with lobular architecture composed of congested vascular capillaries and thin-walled vessels. Diagnosis of giant placental chorangioma (GPC) was rendered. GPC is a challenging condition typically occurring in hypertensive or diabetic primigravidas with female fetuses. Antenatal management is suggested at an early stage for a desirable perinatal outcome.
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Affiliation(s)
- Diana Burlacu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Targu-Mures Emergency Clinical Hospital, Department of Pathology
| | - Agnes Burlacu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | | | - Bela Szabo
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Targu-Mures Emergency Clinical Hospital, Obstetrics and Gynecology Clinic
| | - Tibor Mezei
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Targu-Mures Emergency Clinical Hospital, Department of Pathology
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Shiraga A, Ohsuga T, Kawasaki K, Mogami H, Minamiguchi S, Mandai M. A case of placental multiple giant chorangioma leading to neonatal death from fetal hydrops. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Although placental chorangiomas are often asymptomatic, larger tumors (>4–5 cm) can cause various perinatal complications, including polyhydramnios, preterm birth, fetal anemia, fetal hydrops, and intrauterine fetal death. Symptomatic placental chorangiomas are often diagnosed prenatally on ultrasonography as a mass on the fetal side of the placenta.
Case presentation
A 37-year-old pregnant woman underwent emergency cesarean delivery at 34 weeks’ gestation due to rapidly progressive fetal hydrops leading to fetal dysfunction, resulting in neonatal death. Placental pathology indicated multiple placental giant chorangiomas that occupied 40% of the placenta. Because of the disk shape of the placenta, prenatal diagnosis by ultrasonography was difficult.
Conclusions
Some placental chorangiomas are difficult to diagnose and lead to fetal hydrops and poor prognosis, even if ultrasonography does not show an obvious mass in the placenta.
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Affiliation(s)
- Aoi Shiraga
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Takuma Ohsuga
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Haruta Mogami
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology , Kyoto University Hospital , Kyoto , Japan
| | - Masaki Mandai
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
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Reddy R. Prenatal diagnosis of placental chorioangioma on ultrasound. SONOGRAPHY 2022. [DOI: 10.1002/sono.12329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Zou J, Ding W, Chen Q, Bai X, Li B. Safety of vaginal delivery in women with placental chorioangiomas diagnosed by prenatal ultrasound: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29672. [PMID: 35866806 PMCID: PMC9302376 DOI: 10.1097/md.0000000000029672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study aimed to examine the maternal and neonatal outcomes in different mode of delivery in pregnant women with placental chorioangiomas, in order to determine the safety of vaginal delivery. We conducted a retrospective study of 54 women with placental chorioangioma diagnosed by prenatal ultrasound and subsequently proven histologically, excluding those who underwent cesarean section for obstetric indications. The mode of delivery was divided into a vaginal delivery group (23 women) and a cesarean section group (31 women). The indication of cesarean section group was only for placental chorioangioma, no other obstetric indications. The maternal characteristics, pregnancy outcomes and the color doppler imaging characteristics of placental chorioangioma of the 2 groups were compared, and the clinical characteristics of women in the vaginal delivery group were described in detail. The incidence of placental chorioangioma was nearly 0.43‰ in our study. There was no significant difference in the maternal characteristics and pregnancy outcomes between the 2 groups. 82.6% (19/23) of the women successfully delivered vaginally and 4 failed who turned to cesarean section in the vaginal delivery group; among them, 17 women had giant chorioangiomas (>4 cm in diameter). The direct cause of vaginal delivery failure was fetal distress, persistent occiput posterior fetal position and cephalopelvic disproportion. Pregnant women with placental chorioangiomas and no other obstetric indications for cesarean section may attempt a vaginal delivery, even with giant chorioangiomas. If there are risk factors of vaginal delivery failure, the progress of labor needs to be closely monitored.
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Affiliation(s)
- Jiashan Zou
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
| | - Weimin Ding
- Zhejiang University School of Medicine, Hangzhou 310006, People’s Republic of China
| | - Qin Chen
- Department of Pathology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, People’s Republic of China
| | - Xiaoxia Bai
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
| | - Baohua Li
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
- *Correspondence: Baohua Li, Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China (e-mail: )
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Zacharis K, Kravvaritis S, Charitos T, Chrysafopoulou E, Fouka A. A rare case of a giant placental chorioangioma with favorable outcome. Pan Afr Med J 2020; 36:214. [PMID: 32963680 PMCID: PMC7490129 DOI: 10.11604/pamj.2020.36.214.21635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/23/2020] [Indexed: 11/11/2022] Open
Abstract
Chorioangioma is the most common type of placental tumor. A primigravida woman was noted on routine scan at 21 weeks of gestation to have a placental mass measuring 1.8 x 2.2cm. A detailed ultrasound scan revealed a well circumscribed, hypoechoic lesion protruding into the amniotic cavity; hence a preliminary diagnosis of placental chorioangioma was made and close prenatal surveillance was scheduled. At 34 weeks of gestation, the mass was measuring 6.27 x 5.38cm. The patient experienced reduced fetal movements at 37 weeks gestation. A small-for-gestational age but normal female neonate was delivered by caesarean section. Histopathological analysis of the placenta confirmed the diagnosis. According to our case, a giant placental chorioangioma may have a favorable outcome without any medical intervention.
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Affiliation(s)
- Konstantinos Zacharis
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
| | - Stavros Kravvaritis
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
| | - Theodoros Charitos
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
| | - Eleni Chrysafopoulou
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
| | - Anastasia Fouka
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
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Merry-Sperry AD, Chaffin DG, Denning KL, Shamma B, Massey C, Werthammer J. Placental Chorioangioma with Nonimmune Hydrops Fetalis. South Med J 2019; 111:457-459. [PMID: 30075468 DOI: 10.14423/smj.0000000000000840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 38-year-old woman was found to have a large placental chorioangioma. The fetus was studied using ultrasound. The pregnancy became complicated by hydrops fetalis, polyhydramnios, and abruptio placenta. The infant delivered at 29 weeks' gestational age. The neonatal course was complicated by nonimmune hydrops fetalis, respiratory distress syndrome, anemia, pulmonary hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia. The infant was discharged home with breastfeeding and off oxygen at 50 days of life. This case represents the multidisciplinary approach to the pregnancy complicated by a large placental chorioangioma and the resulting premature neonate with nonimmune hydrops fetalis.
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Affiliation(s)
- Andrea D Merry-Sperry
- From the Department of Pediatrics, West Virginia University School of Medicine, Charleston, and the Departments of Obstetrics and Gynecology, Pathology, and Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV
| | - David G Chaffin
- From the Department of Pediatrics, West Virginia University School of Medicine, Charleston, and the Departments of Obstetrics and Gynecology, Pathology, and Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV
| | - Krista L Denning
- From the Department of Pediatrics, West Virginia University School of Medicine, Charleston, and the Departments of Obstetrics and Gynecology, Pathology, and Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV
| | - Bassam Shamma
- From the Department of Pediatrics, West Virginia University School of Medicine, Charleston, and the Departments of Obstetrics and Gynecology, Pathology, and Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV
| | - Cynthia Massey
- From the Department of Pediatrics, West Virginia University School of Medicine, Charleston, and the Departments of Obstetrics and Gynecology, Pathology, and Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV
| | - Joseph Werthammer
- From the Department of Pediatrics, West Virginia University School of Medicine, Charleston, and the Departments of Obstetrics and Gynecology, Pathology, and Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV
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Migda M, Gieryn K, Migda B, Migda MS, Maleńczyk M. Utility of Doppler parameters at 36-42 weeks' gestation in the prediction of adverse perinatal outcomes in appropriate-for-gestational-age fetuses. J Ultrason 2018; 18:22-28. [PMID: 29844937 PMCID: PMC5911715 DOI: 10.15557/jou.2018.0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/03/2018] [Accepted: 02/07/2018] [Indexed: 12/15/2022] Open
Abstract
Aim To investigate the potential value of Doppler ultrasound and to assess cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome defined as Apgar score < 7 at 1 minute. Material and methods This was a retrospective cross-sectional study in selected pregnant women undergoing an ultrasound examination between 36 and 42 weeks of gestation. We measured estimated fetal weight (EFW), mean umbilical artery pulsatility index (UA PI), mean middle cerebral artery pulsatility index (MCA PI), CPR, and Apgar score in 1 minute. Multiples of medians (MoM) were calculated for MCA PI and UA PI. Results The study group consisted of 446 women, 236 were primipara and 210 were multipara. The average age was 29.6 years (range 16–46 years). The average week of delivery is 39.5 weeks of gestation (range 36–42). Mean MCA PI and UA PI were 1.3 (0.1–2.45) and 0.8 (0.39–1.66), respectively. The mean values were 1.03 (0.1–1.9) for MCA PI MoM and 1.04 (0.5–2.1) for UA PI MoM. Primiparas had lower values of MCA PI (1.27 vs. 1.34), MCA PI MoM (1.00 vs. 1.05), CPR (1.62 vs. 1.73), EFW (3479.53 g vs. 3579.25 g) and birth weight (3513.50 g vs. 3617.79 g). For CPR cut-off point of 1.08: sensitivity was (0.945), specificity 0.1, positive predictive values 0.979, negative predictive values 0.04 and accuracy 0.926. The ROC curves for CPR were: area under the curve was 0.52 at CI 95% (0.342–0.698), p = 0.8271. Conclusion Screening in pregnancies with appropriate-for-gestational-age fetuses at 36–42 weeks of gestation using Doppler parameters is not useful in the prediction of adverse perinatal outcomes like an Apgar score < 7 at 1 minute.
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Affiliation(s)
- Michał Migda
- Obstetrics, Women's Disease and Gynecological Oncology Teaching Department, Voivodeship Hospital Complex, Collegium Medicum of the Nicolaus Copernicus University in Toruń, Poland.,Civis Vita Medical Center in Toruń, Poland
| | - Katarzyna Gieryn
- Obstetrics, Women's Disease and Gynecological Oncology Teaching Department, Voivodeship Hospital Complex, Collegium Medicum of the Nicolaus Copernicus University in Toruń, Poland
| | - Bartosz Migda
- Diagnostic Imaging Division, Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | | | - Marek Maleńczyk
- Obstetrics, Women's Disease and Gynecological Oncology Teaching Department, Voivodeship Hospital Complex, Collegium Medicum of the Nicolaus Copernicus University in Toruń, Poland
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