Monterrey, Mexico
The chorioangioma or hemangioma is the most frequently benign tumour in placenta, accordingly to data reports of “Pathological Anatomy Department”. This tumour can be found in 5-1% studied placentas, without any association of fetal repercussion. The incidence of chorioangioma is about 1:50,000 pregnancies.
These tumors are hamartomas that have their origin as a malformation of the primitive angioblastic cells of the placenta. There are two histological types:
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angiomatoid or adult; characterized by numerous blood vessels
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cellular or young; with poor vascularization
The large tumors can produce degenerative phenomenons like, necrosis, calcification, hyalinization, or myxomatous degeneration. The diagnosis is made by bi-dimensional ultrasound, identifying the chorioangioma as well as a delimited rounded mass, mostly hypoechoic, located near the chorial plate and also the umbilical cord insertion. Some heterogeneous areas caused by the degenerative processes can be seen. Colour Doppler can demonstrated the vascularization inside the tumour.
The differential diagnosis include: sub-amniotic hematoma, sub-chorial trombohaematoma, partial mole, fibroid and placenta teratoma.
The chorioangiomas, especially the ones that measure at least 5 cm, are frequently associated with polyhydramnios, premature delivery, fetal anemia and congestive cardiac insufficiency. With less frequency they can be associated with intrauterine growth restriction and placenta previa. The frequency of polyhydramnios varies from 14 to 33%. Kaufman and Kotz postulated that polyhydramnios results in a trespassing of liquid trough the walls of the blood vessels of the tumour, and then trough the chorial plate of the placenta. Due to these complications, the fetal mortality is about 30% in the large chorioangiomas.
Case report: This is a 35-year-old patient, G4P3, referred to our unit with moderate polyhydramnios and a tumour located in the placenta. She had Graves disease, treated successfully. The scan demonstrated a fetus with subcutaneous edema, moderated pericardial effusion, cardiomegaly, cardiac insufficiency, severe polyhydramnios and a placenta tumor (8x8 cm, hypoechoic image, with increased Doppler flow within internal areas).
At 28 weeks, a decompression amniocentesis (extraction of 1200 ml) and corticoids for induce lung maturity were performed. The procedure occurred without any complications. Another scan performed at 30 weeks, there were an increased pericardial effusion and cardiomegaly.
A cordocentesis to determinate the fetal hemoglobin and RH was proposed due to the possibility of a cardiac insufficiency associated with fetal anemia. The results revealed a fetal Hg=7.6gr, group O, RH +. We performed a blood transfusion of 100cc into the umbilical cord and 7 mg of digoxin intramuscular in the fetus.
The mother left the hospital 24 hours after the procedure with a healthy fetus, checked by cardiotocography. Indomethacin was used to the treatment of the polyhydramnios. The baby was delivered without any problems and in good heath.
Note the large placenta tumor