Multiple giant placental chorioangioma: A case report.

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.

Placental chorioangioma and pregnancy outcome: a ten-year retrospective study in a tertiary referral centre.

BACKGROUND: Placental chorioangioma is a rare disorder in pregnancy. We retrospectively reviewed the perinatal complications and long-term outcomes in pregnancies with placental chorioangioma and evaluated the factors affecting disease prognosis. METHODS: We reviewed pregnant women who delivered at our hospital in the past decade and whose diagnosis of placental chorioangioma was confirmed by pathological diagnosis. Information on maternal demographics, prenatal sonographic findings and perinatal outcomes was obtained by reviewing the medical records. In the latter part of the study, follow-up of children was conducted by phone interview. RESULTS: In the 10 years from August 2008 to December 2018, 175 cases(0.17%) were identified as placental chorioangioma histologically and 44(0.04%) of them were large chorioangiomas. Nearly one-third of cases with large chorioangiomas were associated with severe maternal and fetal complications or required prenatal intervention. Although one-fifth of fetuses/newborns complicated with large chorioangiomas were lost perinatally, the long-term prognosis for surviving fetuses was generally good. Further statistical analysis revealed that tumor size and location affect prognosis. CONCLUSION: Placental chorioangioma may cause an unfavorable perinatal outcome. Regular ultrasound monitoring can provide the tumor characteristics which can be referred to for predicting the tendency of those complications and indicate when intervention may be necessary. It is not clear which factors lead to complications with fetal damage as the main manifestation or polyhydramnios as the main manifestation.

Placental chorioangioma separation in third trimester after fetoscopic laser therapy: Report of a rare case.

A primigravida received fetoscopic laser photocoagulation treatment at 25+1 weeks gestation as a chorioangioma enlarged to 61 × 46 × 52 mm. However, a cesarean section was performed due to the chorioangioma separated from the placenta at 32+2 weeks gestation. As the chorioangioma's blood supply were blocked, it was possible to provide expectant treatment.

Radio frequency ablation for the intrauterine treatment of giant placental chorioangioma associated with fetal compromise: A case report.

Giant placental chorioangiomas associated with fetal hyperdynamic circulation complications are rare to see. Here, we summarized a case of giant placental chorioangioma associated with fetal anemia and heart failure treated by radiofrequency ablation (RFA) combined with cordocentesis and intrauterine transfusion. The sonographic appearance of the placental chorioangioma was atypical which was isoechoic with unclear boundary. RFA was performed successfully at 27 weeks of gestation, when the chorioangioma has increased to 17.0 × 10.6 × 12.3 cm3 . Unfortunately, intrauterine fetal demise was found on the first day after operation. After induction of labor, it was pathologically confirmed as placental chorioangioma.

Consecutive chorioangiomas in the same pregnancy: A clinical case and review of literature.

Background and Aims: Aetiopathogenesis of chorioangioma is already unknown. Among the risk factors, hypoxia, environmental and genetic factors are believed to induce the overexpression of angiogenic cytokines promoting vascular proliferation. We reported a case of prenatally diagnosed 67 mm-wide placental chorioangioma, which occurred at 32 weeks of gestational age, infarcted, and followed by the onset of a second infarcted chorioangioma at 35 weeks of gestational age. Besides, we discussed the hypothesis of chorioangioma aetiopathogenesis and behavior through a literature summary. Methods: We carried out a literature search of chorioangioma cases without a time interval. Therefore, we carried out a literature summary on chorioangioma risk factors and etiology, by selecting articles within a time interval from 1995 to 2021. Results: This is the first case of two consecutive chorioangiomas in the same pregnancy published in the literature. We found a possible genetic predisposition in women developing chorioangioma while infarction may be related to the abnormal structure of tumor vessels. The onset of a second lesion could reflect hypoxic stimuli following infarction and involves hypoxia-induced factor-1alpha, vascular endothelial growth factor, transforming growth factor-beta, and soluble Fms-like tyrosine kinase-1 pathways. Chorangiosis can be coexistent and may reflect a mutual etiology in susceptible individuals. Conclusion: In a predisposed placenta, that previously generated a chorioangioma, infarction of the chorioangioma should not represent a sign for pregnancy termination, but a marker for closer monitoring to early detect the possible onset of a second chorioangioma and a higher risk of umbilical cord thrombosis.

Prenatal diagnosis, management, and postnatal outcome of a fetus with massive cardiomegaly secondary to placenta chorioangioma.

Chorioangiomas are the most common non-trophoblastic benign vascular tumor of the placenta, highly associated with perinatal death rate. Herewith, we are reporting the prenatal diagnosis, management and postnatal outcome of a fetus referred at 33 weeks gestation with massive cardiomegaly secondary to placenta chorioangioma.

CD133 Expression in Placenta Chorioangioma Presenting as a Giant Asymptomatic Mass.

Background: Placental chorioangioma is the most common benign non-trophoblastic neoplasm of the placenta. Its clinical relevance lies in the size of the tumor since larger masses cause pregnancy complications, including an unfavorable neonatal outcome. Case presentation: We report the case of a 34-year-old second gravida and nullipara at the 35th week of gestation, admitted to the gynecological department for antibiotic-resistant fever. The cardiotocography performed during hospitalization showed an abnormal fetal pattern. A 2250 g newborn was delivered by cesarean section. No complications were observed during childbirth and postpartum was insignificant. On gross inspection a white fleshy intraparenchymal mass blooming on the maternal surface was noted; routinely stained sections revealed features consistent with chorioangioma with vascular channels lined by inconspicuous endothelial cells immunoreactive for CD31 and CD133. Focal expression of CD133 was also observed in placental villi. Discussion: CD133 expression indicated the presence of stem cells in chorioangioma, suggesting their possible role in the development of mesenchymal lesions including chorioangioma.

Giant placental chorioangioma followed by circulatory failure of the newborn and infantile hemangioma: Case report.

Placental chorioangioma (CA) is a benign placental tumor. No specific treatment is required for asymptomatic cases. We report a female infant born to a mother with giant placental CA. However fetal growth was normal and, fetal hydrops was not detected by ultrasound examination until delivery, she had hydrops, subgaleal hematoma, thrombocytopenia, hemolytic anemia, respiratory distress and circulatory failure after birth. She was successfully treated without any neurological sequelae. At 2 months of age, infantile hemangioma appeared in her lower lip. The present case suggested that giant placental CA might cause postnatal problems and be associated with the development of infantile hemangioma.

Severe fetal cardiomegaly caused by multiple non-giant placental chorioangiomas.

A pregnant woman was referred to our hospital due to fetal cardiomegaly. We recognised a dilated umbilical vein, which raised a suspicion of placental chorioangioma. A male neonate was delivered at 37 weeks of gestation. The cardiomegaly was gradually improved. Pathological examination identified five non-giant placental chorioangiomas. Multiple non-giant chorioangiomas may cause fetal complications despite the difficulty of prenatal diagnosis.

In utero embolization for placental chorioangioma and neonatal multifocal hemangiomatosis.

Placental chorioangioma is a limited non trophoblastic vascular tumour that may causes fetal complications as well as post-natal ones. We reported in here the first case of an in utero embolization of chorioangioma diagnosed at 22 W G with a post-natal diagnosis of neonatal multifocal hemangioma with a good outcome. The chorioangioma was embolized using GLUBRAN 2 ® (cyanolacrylate) a biologic surgical glue at 26 W G. Premature rupture of membrane occurred at 28 W G. A cesarean section at 32 W G was performed for retro placental hematoma. The neonate was 1400 g healthy girl with an anemia (hemoglobin 9.7 g/dl). After one month of life, the child met a neonatal multifocal hemangioma (skin and liver were involved) with superficial erosion of skin hemangiomas that required post-natal transfusions. We propose a literature review related to the various technics of in utero treatment of placental chorioangioma and the links with neonatal multifocal hemangiomatosis as well. The girl is now 7 year old and has a normal neurodevelopmental outcome.

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 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.

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.

Natural history and pregnancy outcome in patients with placental chorioangioma.

PURPOSE: To evaluate the natural history and outcome of pregnancies in patients with placental chorioangioma. METHODS: A total of 16 placentas with a histologic diagnosis of chorioangioma were identified, and the natural history and outcome of pregnancy were evaluated. This study was approved by the Institutional Ethics Committees of our unit, and written informed consent was obtained from all study participants. RESULTS: Thirteen of the 16 cases were associated with a wide variety of fetal complications. Two-thirds of the cases developed complications that either required elective delivery because of fetal distress (n = 4), fetal heart failure (n = 1), oligohydramnion (n = 1), and premature labor of dichorionic twins (n = 1) or resulted in intrauterine fetal death and termination of pregnancy (n = 2). CONCLUSIONS: Placental chorioangioma was associated with the development of polyhydramnios, fetal growth restriction, and fetal distress in a significant number of cases. The size, vascularity, and location of the chorioangioma may be three independent factors of maternal and fetal complications. Any of these three factors can influence the outcome of pregnancy. Close antenatal examination should be routinely practiced to allow the timely diagnosis of early fetal heart failure.

Uterine vascular lesions.

Vascular lesions of the uterus are rare; most reported in the literature are arteriovenous malformations (AVMs). Uterine AVMs can be congenital or acquired. In recent years, there has been an increasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, cesarean delivery, and curettage. It can be seen from these reports that there is confusion concerning the terminology of uterine vascular lesions. There is also a lack of diagnostic criteria and management guidelines, which has led to an increased number of unnecessary invasive procedures (eg, angiography, uterine artery embolization, hysterectomy for abnormal vaginal bleeding). This article familiarizes readers with various vascular lesions of the uterus and their management.