Address correspondence to: Molly S. Chatterjee, M.D., University of New Mexico, Department of Obstetrics and Gynecology, 2211 Lomas Blvd., NE, Albuquerque, New Mexico 87131-5286. Ph: 505-272-6381 Fax 505-272-6385

MESH: Placenta; Tumor, ICD9 747.5 CDC 747.500, 762.200

Introduction

Since 1700, these benign lesions of the human placenta have been considered as an obstetrical curiosity¹. The incidence is about 10:10,000 birth. They occur as single or multiple lesions that vary in size from small to as large as the placenta itself^2,3. Obstetrical complications associated with chorioangioma include polyhydramnios, abruption, fetal thrombocytopenia and umbilical artery thrombosis. We present a case report where this lesion was diagnosed prenatally and complications were managed appropriately.

Case report

A 23-year-old, white, G₃P₁ patient was referred to the University of New Mexico, Tertiary Care Center with polyhydramnios at 26.5 weeks of gestation. The patient had had a right nephrectomy at age 10 for chronic pyelonephritis. The pregnancy was complicated by hyperemesis at 10 - 12 weeks of gestation. A sonogram confirmed polyhydramnios and demonstrated a 55 mm chorioangioma of the placenta (Figure 1).

Figure 1: Examination showing chorioangioma and polyhydramnios.

The patient was placed on indomethacin for preterm labor and polyhydramnios. Ductal flow was normal. The patient was Rh negative, and triple test was reported to be negative. The patient was sent back to her referring obstetrician on home uterine activity monitoring. A follow-up scan was done weekly. At 29.5 weeks, the patient had spontaneous rupture of membranes and was transported back to the University of New Mexico Hospital. Thirty-six hours after admission, fetal heart rate tracing showed sinusoidal pattern and severe variables (fig. 2, 3).

Figure 2: Sinusoidal fetal heart rate.

Figure 3: Severely variables heart rate.

A cesarean section was done for fetal distress. The placenta was sent for histopathology, which confirmed the diagnosis (fig. 4, 5). The female neonate was appropriate for 27 weeks, had a hematocrit of 25% and needed a blood transfusion due to fetomaternal hemorrhage. The neonate developed respiratory distress syndrome and necrotizing enterocolitis.

Figure 4: Macroscopy of placenta.

Figure 5: Microscopic section.

Discussion

Chorioangioma of the placenta is a rare benign tumor which can cause polyhydramnios and preterm labor^4-6,8,9. This case report illustrates the complications which are associated with chorioangioma of the placenta (Table 1). Application of color flow mapping may help delineate the diagnosis by hypervascularization of the tumor.

Table 1: Complications of chorioangiomas.

About 20 cases have been reported in the literature, and our case demonstrates almost all possible complications that could be associated with this tumor. Acute hydramnios could be very distressing to the patient and may necessitate fluid withdrawal by amniocentesis. Fetal cardiomegaly and high output cardiac failure have been reported to be associated with chorioangioma of the placenta^4,5. Preterm labor and consequences of prematurity are other concerning issues. The complications associated with this tumor could vary from mild to severe, depending on the size of the lesion.

Acknowledgement

We appreciate the help from the Department of Pathology at The University of New Mexico.

References

1. Lewis SH, Richart RM. Large placental lesion. Contemporary Ob-Gyn 95-102 , 1991.

2.Wallenburg HCS. Chorioangioma of the placenta. Thirteen new cases and a review of the literature from 1939 - 1970 with special reference to the clinical complications. Obstet Gynecol Surv 26:41, 1971.

3. Battaglia FC, Woolever CA. Fetal and neonatal complications associated with recurrent chorioangiomas. Pediatrics 41:62, 1968.

4. Benson PF, Joseph MC. Cardiomegaly in a newborn due to placental chorioangioma. Br Med J 1:102, 1961.

5. Eldar-Geva T, Hochner-Celnikier D, Ariel I, et al. Fetal high output cardiac failure and acute hydramnios caused by large placental chorioangioma. Case report. Br J Obstet Gynecol 95:1200, 1988.

6. McIntory RA, Kelsey HA. Chori-angioma (haemangioma of placenta) associated with acute hydramnios. J Pathol Bacteriol 68:519, 1954.

7. Hirata GI, Masaki DI, O"Toole M, et al: Color flow mapping and Doppler velocimetry in the diagnosis and management of a placental chorioangioma associated with nonimmune fetal hydrops. Obstet Gynecol 81:850-2, 1993

8. Achiron R, Shaia M, Schimmel M, et al: Chorioangioma with hydrops in twins. The Fetus 2:3 7622-1-3, 1992.

9. Shulman H, Kriner M, Farmakides G ,et al: Chorioangioma. The Fetus 2:5 7622-5-6, 1992.