|Year : 2018 | Volume
| Issue : 2 | Page : 113-115
Umar Mohammed1, A Mohammed2, AO Jimoh3, UA Eze4, AA Panti4
1 Department of Pathology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Pathology, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
3 Department of Pharmacology and Therapeutics, Usmanu Danfodiyo University, Sokoto, Nigeria
4 Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
|Date of Web Publication||6-Jul-2018|
Dr. Umar Mohammed
Department of Pathology Usmanu Danfodiyo University Teaching Hospital, Sokoto
Chorioangioma is an expansile nodular lesion composed of capillary vascular channels, intervening stroma cells, and surrounding trophoblast. It is analogous to hemangioma at other body sites. Chorioangiomas are the most common placental tumors and are thought to be hamartomatous malformations. We present the case of a 22-year-old unbooked Para 3 + 0 at 32 weeks gestation who presented with history of premature rupture of membrane to the gynecology emergency clinic. Abdominopelvic ultrasound scan revealed polyhydramnios, no fetal cardiac activity, and suspected placenta cyst. She had stillbirth of male baby. The clinician made a provisional diagnosis of stillbirth with placental cyst with differential diagnosis of trophoblastic disease. The placental tissue revealed a fleshy nodular circumscribed lesion which is 10 cm × 6 cm × 4 cm in dimension, and microscopic examination led to the diagnosis of chorioangioma. Chorioangioma of the placenta, in a high-risk population, although small, is associated with significantly higher risk for preterm delivery; there is therefore need for regular color Doppler imaging for all obstetrics cases for prenatal differentiation between placental chorioangiomas and other nonvascular tumors and pathological examination of all placentas of patients with preterm delivery.
Keywords: Chorioangioma, color Doppler, examination, placenta, tumor, ultrasound
|How to cite this article:|
Mohammed U, Mohammed A, Jimoh A O, Eze U A, Panti A A. Placental chorioangioma. Sahel Med J 2018;21:113-5
| Introduction|| |
Chorioangioma is an expansile nodular lesion composed of capillary vascular channels, intervening stroma cells, and surrounding trophoblast. It is analogous to hemangioma at other body sites. Chorioangiomas are the most common placental tumors and are thought to be hamartomatous malformations. Chorioangioma are benign vascular tumors of the chorionic stroma; most chorioangiomas originate in large stem villi or the chorionic plate. Chorioangiomas may be circumscribed and solitary; locally expansive, involving contiguous villi; rarely, multifocal (chorioangiomatosis). Color Doppler imaging has contributed greatly to the prenatal differentiation between placental chorioangiomas and other nonvascular tumors of the placenta.
| Case Report|| |
A 22-year-old unbooked Para 3 + 0 at 32 weeks gestation presented with history of premature rupture of membrane to the gynecology emergency clinic of a tertiary hospital; abdominopelvic ultrasound scan revealed polyhydramnios, no fetal cardiac activity, and suspected placenta cyst. Her packed cell volume was 37%, temperature was 36.5°C, and urea and electrolytes were within normal limits. She eventually had stillbirth of male baby. Fetal scrotal swelling was noticed. The clinician made a provision diagnosis of placental cyst and a differential of trophoblastic disease. The placenta that was received in the laboratory measures 20 cm × 17 cm × 8 cm and weight 1115 g with centrally inserted umbilical cord that measure 29 cm in length with 2 coil/10 cm. The cotyledons show areas of pallor while there is a fleshy nodular circumscribed area which is 10 cm × 6 cm in diameter. Sections from the placental disc and umbilical cord show variegated appearance and two vein and one artery. Microscopic sections show a well-circumscribed tumor composed of numerous thin-walled vascular channels with scanty stroma and myxoid changes [Figure 1]; a diagnosis of placental chorioangioma was made. Ethical approval was obtained from Ahmadu Bello University Teaching Hospital Heath, Research and Ethics Committee on 30th August 2012.
|Figure 1: (Placental tissue): Chorangioma showing juxtaposing of chorionic villi (left of the field) and well-demarcated aggregates of closely packed, thin-walled blood-filled capillaries, lined by flattened endothelium and are supported by inconspicuous, loose stroma (right of the field) (H and E, ×100)|
Click here to view
| Discussion|| |
The incidence of chorioangioma is reported to be about 0.5%–1% of all pregnancies., Small tumors are essentially asymptomatic (<5 cm). Large (>5 cm), clinically significant chorioangiomas occur much less frequently, with a reported incidence ranging from 1 in 3500 to 1 in 9000 births. As the index case, the lesion measures 10 cm × cm 6 × 4 cm in dimension. They may be brown, yellow, tan, red, or white and are usually firm and well demarcated from the surrounding parenchyma. The specific findings of chorioangioma are variable and depend largely on the histological composition of the tumor (angiomatous, cellular, or degenerative). Histological classification correlates well with the sonographic features. If the mass is predominantly vascular, color flow imaging reveals a hypervascularization pattern. Most chorioangiomas are composed of capillary-sized blood vessels supported by inconspicuous, loose stroma. Occasionally, they may be more cellular or show prominent myxoid change, hyalinization, necrosis, or calcification; the index case lacks these additional features. Mitotic figures and nuclear atypicality have been reported in some chorioangiomas, but these have not behaved aggressively., Trophoblastic hyperplasia may be prominent. Localized groups of large stem villi with similar alterations but without nodular expansion have been termed localized chorioangiomatosis. The tendency for chorioangiomas to be found beneath the chorionic plate and at the placental margin in addition to their association with preeclampsia and high-altitude pregnancy suggest that decreased oxygen tension may play a role in their development. Because large chorioangiomas are thought to act as peripheral arteriovenous shunts resulting in cardiac overload, complications associated with them include congestive heart failure, polyhydramnios, hydrops fetalis, premature labor, maternal and fetal coagulopathies, and hemolytic anemia.,,,
Color Doppler imaging has contributed greatly to the prenatal differentiation between placental chorioangiomas and other nonvascular tumors such as hematoma, infarcts, intervillous thrombosis, teratoma, and partial mole. A further refinement of this technique is the use of 3D power Doppler ultrasound which will show that the architecture of the vascular channels in the tumor is continuous with the fetal circulation. Therefore, the diagnosis of chorioangioma will be straightforward, and this will rule out other vascularized lesions. This procedure was not done in this patient due to presentation with premature rupture of membranes, an obstetric emergency, and due to nonavailability of the equipment. She subsequently had stillbirth, complication in keeping with other reports.,,,,
| Conclusion|| |
This case demonstrates the need for awareness of the presence of this lesion and emphasizes the importance of antenatal diagnosis confirmed by pathological examination of the placenta immediately after delivery.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Frederick TK, Raymond WR, Deborah JG, Michael DN, Jeffrey MD. Disorders of fetal vascular development: Disorders of placental development. In: Donald WK, editor. Placental Pathology, Atlas of Nontumour Pathology. First Series, Fascicle 3. Washington, DC: Published by the American Registry of Pathology, Armed Forces Institute of Pathology; 2004. p. 61-4.
Fox HF. Non-trophoblastic tumours of the placenta. In: Fox HF, editor. Pathology of the Placenta. London: W.B. Saunders; 1978. p. 343-67.
Rosai J. Female reproductive system: Uterus – Corpus. In: Rosai J, editor. Ackerman's Surgical Pathology. 9th
ed., Vol. 2. St. Louis: Mosby; 2004. p. 1569-603.
Shih JC, Ko TL, Lin MC, Shyu MK, Lee CN, Hsieh FJ, et al.
Quantitative three-dimensional power Doppler ultrasound predicts the outcome of placental chorioangioma. Ultrasound Obstet Gynecol 2004;24:202-6.
Mutter GL, Ferenczy A. Anatomy and histology of the uterine corpus. In: Blaustein's Pathology of the Female Genital Tract. 5th
ed. New Delhi: Springer-Verlag, Thomson (Press) India Ltd.; 2002. p. 383-419.
Kindelberger DW, Sirois KF, Boyd TK. Evaluation of the placenta. In: Crum CP, Nucci MR, Lee KR, editors. Diagnostic Gynaecologic and Obstetric Pathology Saunders. Philadelphia, PA: Elsevier; 2011. 1045-84.
Christopher PC, Yonghee L, David RG. Tumours of the placenta and gestational trophoblastic disease. In: Fletcher CD, editor. Diagnostic Histopathology of Tumours. 3rd
ed., Vol. 1. Boston: Churchill Living Stone; 2007. p. 672-4.
Ogino S, Redline RW. Villous capillary lesions of the placenta: Distinctions between chorangioma, chorangiomatosis, and chorangiosis. Hum Pathol 2000;31:945-54.