Large Placental Chorioangioma Research Articles

Radiofrequency thermal ablation of giant placental chorioangioma complicated with fetal hydrops: a case report and successful outcome

Abstract Objectives Chorioangiomas are the most frequently occurring type of benign tumour of the placenta. However, large chorioangiomas greater than 4 cm are rare and can be more frequently associated with serious complications such as: polyhydramnios, hydrops fetalis, fetal anaemia, intrauterine growth restriction, preterm birth, and an increased risk of perinatal mortality. Importantly timely prenatal diagnosis with close surveillance alongside potential intrauterine intervention can prove impactful on pregnancy outcome and fetal survival. Case presentation We present a case of a 36-year-old female referred to our tertiary fetal medicine unit at 28 weeks’ gestation with a large chorioangioma measuring 9.4×8.8×5.5 cm and ultrasonographic evidence of severe fetal anaemia and fetal hydrops. The patient underwent an intrauterine transfusion and in utero surgical therapy with radiofrequency ablation (RFA). Immediately following the procedure, the fetus sustained a period of bradycardia, followed by asystole. Delivery was expedited via emergency caesarean section. Careful planning and rapid delivery after fetal intervention within the most appropriate surgical setting mitigated risks for the baby and resulted in a positive outcome. The baby was discharged from the neonatal unit on day 84 of life. Conclusions Large placental chorioangiomas are a rare occurrence, however, when associated with fetal complications present a high incidence of adverse perinatal outcomes. In utero interventions require careful planning and surgical expertise to ensure improved fetal and neonatal outcomes. To the best of our knowledge this case is the first recorded instance of a successful postnatal outcome following RFA for a large placental chorioangioma, whereby the fetus was complicated by fetal hydrops.

Management of large placental chorioangioma: two-port laser approach for fetal intervention.

There is a paucity of literature providing evidence-based guidelines for the management of large placental chorioangioma (≥ 4 cm in diameter). The objectives of this study were to compare outcomes between patients managed expectantly and those undergoing in-utero intervention and to describe the different in-utero techniques used for cessation of blood flow to the tumor and the associated outcome. This was a retrospective cohort study of 34 patients referred for the management of large placental chorioangioma in a single center between January 2011 and December 2022, who were managed expectantly or underwent in-utero intervention. In-utero intervention was performed when the fetus developed any signs of impending compromise, including high combined cardiac output (CCO), worsening polyhydramnios or abnormal fetal Doppler velocimetry findings. Interventions included radiofrequency ablation (RFA), interstitial laser ablation (ILA) and single-port or two-port fetoscopic laser photocoagulation (FLP). Treatment selection was dependent on the proximity of the tumor to the umbilical cord insertion (UCI) and placental location. The two-port technique was performed in patients with a chorioangioma with large feeding vessels (≥ 3 mm) located in the posterior placenta, in which one port was used for occlusion using bipolar forceps and the other port was used for laser photocoagulation of the feeding vessels downstream. The single-port technique was used for chorioangioma with small feeding vessels (< 3 mm) located in the posterior placenta. ILA or RFA was performed in cases with an anterior placenta. Supportive treatments, including amnioreduction and intrauterine transfusion (IUT), were performed for worsening polyhydramnios and suspected fetal anemia based on middle cerebral artery Doppler flow studies, respectively. Comparative statistical analysis between cases undergoing expectant management vs in-utero intervention was performed. Descriptive details were provided for patients who underwent in-utero intervention. Thirty-four cases of large chorioangioma were evaluated, of which 25 (73.5%) were managed expectantly and nine (26.5%) underwent intervention. The frequency of polyhydramnios was significantly higher in the intervention group compared with the expectant-management group (66.7% vs 8.0%, P < 0.001). The live-birth rate among expectantly managed cases with large chorioangioma was significantly higher compared with that in cases that underwent in-utero intervention (96.0% vs 62.5%, P = 0.01). In the intervention group, preoperative CCO was elevated in all cases with available information and preoperative hydrops was present in 33.3% (3/9) of cases. One patient experienced fetal demise following IUT prior to planned FLP. Among the remaining eight patients, four underwent two-port FLP, two underwent single-port FLP, one underwent ILA and one underwent both ILA and RFA. All three cases in which hydrops was present at the time of intervention resulted in fetal demise. In-utero interventions aimed at cessation of blood flow in the feeding vessels are a therapeutic option for the management of cases with large chorioangioma. The two-port percutaneous technique appears to improve the efficiency of FLP when a large chorioangioma with large feeding vessels is located in the posterior placenta. We propose that in-utero interventions for large chorioangioma should be initiated prior to the development of fetal hydrops. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Neonatal non-immune hydrops due to large placental chorioangioma -a treatable cause of hydrops

The term non-immunologic hydrops fetalis (NIHF) defines an edematous fetus with fluid collections in some usually two or all serous cavities that does not have erythroblastosis fetalis from isoimmunization. Ballantyne described the first case of non-immune hydrops. In 1943 Dr Edith Potter published the first description of NIHF. Hydrops Fetalis is considered as a prenatal form of cardiac failure. Hydrops may present as a stiffness of one limb due to edema (present case) to severe generalized anasarca with bilateral pleural effusion. Usually non-immune hydrops associated with severe morbidity and mortality. NIHF not only caused by fatal fetal causes like Chromosomal, alpha thalassemia, infections and cardiac causes but also caused by placental causes like twin to twin transfusion syndrome and placental tumours like placental chorioangioma, among these last entity usually have good prognosis if we managed properly in utero or at the time of delivery and early postnatal days. Some cases of non-immune hydrops amenable to treatment and will have better prognosis like chylothorax, CCAM, Supra Ventricular Tachycardia (SVT), bladder obstruction and hydrothorax.

Large placental chorioangioma: a potential effective in-utero treatment modality for radio frequency ablation

Abstract Background Placenta chorioangiomas are common benign placental tumours. While microscopic chorioangiomas are frequent, macroscopic chorioangiomas of more than 5 cm are rare and often associated with fetal complications such as high output cardiac failure, fetal anaemia and stillbirth. Close monitoring and in-utero treatment are sometimes necessary to prevent adverse pregnancy outcome. Case presentation We present two cases of large placenta chorioangiomas with one case requiring surgical therapy with radiofrequency ablation (RFA) of tumour vessels, which resulted in a successful outcome of a live birth at term. Conclusion We conclude that RFA is an effective alternative treatment modality to fetoscopic laser therapy in utero for cases at risk of fetal cardiac failure and intrauterine demise in the presence of large chorioangiomas.

Placental Chorioangioma with Nonimmune Hydrops Fetalis.

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.

Intrauterine fetal death caused by large placental chorioangioma and hypercoiled umbilical cord: A case report

Intrauterine fetal death caused by large placental chorioangioma and hypercoiled umbilical cord: A case report

EP21.20: Prenatal diagnosis and management of anemia in a large placental chorioangioma

EP21.20: Prenatal diagnosis and management of anemia in a large placental chorioangioma

Large placental chorioangioma, cause for gross polyhydramnios; experience of two cases and review of literature

Placental chorioangioma is a benign vascular tumor most frequently diagnosed by sonographic and Doppler evaluation. Although it is not uncommon (1% incidence) cases which measure more than 4 cm in diameter are rare. Large chorioangioma can be associated with pregnancy complications. These include hydrops fetalis, growth restriction, fetal or neonatal demise, polyhydramnios and preterm birth. We report here 2 cases of large placental chorioangioma resulting in polyhydramnios, intrauterine growth restriction and preterm birth. Both the tumors were more than 5 cm and on ultrasound were seen as a hypoechoic lesion in continuation with upper pole of placenta projecting into the amniotic cavity .Gross examination showed a globular mass arising from the fetal surface of placenta and in both the cases histopathological examination was suggestive of placental chorioangioma along with areas of calcification. The maternal outcome was good but one of the babies died due to very low birth weight.

A Large Placental Chorioangioma without an Adverse Perinatal Effect

Chorioangiomas are the most common benign tumors of placenta with reported prevalence of approximately 0.5% -1%. Large tumors are rare but those exceeding 5 cm in diameter may be associated with adverse effects on both mother and fetus. The larger the size of the tumor the more is the chance of developing complications. However, it is not necessary that complications would always ensue. Here, we present a case with a large asymptomatic placental chorioangioma that was found incidentally at term and led to a successful outcome. Despite the large size, it was not associated with the maternal or fetal complications expected with a chorioangioma of that size.

Severe Anemia and Thrombocytopenia in a Premature Associated with a Large Placental Chorioangioma

Chorioangioma is a tumor of vascular placental origin, the most frequent among primary placental non-trophoblastic tumors; however, it is found in about 1% of placental pathology case studies. Most of the chorioangiomas found are small, asymptomatic lesions that are only found postnatally after careful slicing of the placenta [1]. Larger tumors, particularly those measuring more than 4 cm, are rarely seen in obstetric practice but are clinically significant. In this case report, we will show you the premature with large chorioangioma and we will tell the treatment we take to cure the baby successfully.

Placental chorioangioma presenting prenatal hemolytic anemia and consumption coagulopathy: a case report

AbstractLarge placental chorioangioma is a rare but serious complication of pregnancy. To our knowledge, this case is the first reported diagnosis of consumption coagulopathy in a fetus using fetal blood sampling (FBS) during pregnancy complicated by placental chorioangioma. A 25-year-old woman, primigravida, was referred to our hospital at 29 weeks of gestation for placental chorioangioma. At 34+1 gestation, polyhydramnios and hyperdynamic circulation were observed in the fetus. FBS demonstrated microangiopathic hemolytic anemia and the presence of consumption coagulopathy. Cesarean section was performed at 34+4 gestation because fetal maturation was expected. A female infant weighing 2158 g was born, with Apgar scores of 6 and 8 at 1 and 5 min, respectively. Neonatal blood sampling results were similar to those of FBS. The infant was treated for hyperdynamic cardiac function, hemolytic anemia, and consumption coagulopathy on mechanical ventilation in the neonatal intensive care unit and recovered fully. When fetal anemia is suspected in a case of large placental chorioangioma, the possibility of developing consumption coagulopathy during the fetal period should be considered.

Color Doppler score: a new approach for monitoring a large placental chorioangioma.

We employed color Doppler score as an innovative approach for the prenatal diagnosis and monitoring of a large placental chorioangioma case diagnosed at 26 weeks and the subjective semiquantitative assessment of the vascularization. The blood flow was assessed by a color Doppler score based on the intensity of the color signal with the following value ranges: (1) no flow, (2) minimal flow, (3) moderate flow, and (4) high vascular flow. Weekly examinations were programmed. Initially, a color Doppler score 3 was assigned, remaining unchanged at the following two exams and decreasing to Score 2 in the following 2 exams and to Score 1 thereafter. The ultrasonographic scan showed an increase of the mass size at the second and third exams and was followed by an arrest of the growth persisting for the rest of the pregnancy. Some hyperechogenic spots inside the mass appeared at the end. Expectant management was opted for, and the delivery was at 39, 2 weeks and maternal and fetal outcomes were favourable. The color Doppler score employed for assessment of vascularization in successive examinations proved to be an important tool for the prediction of the chorioangioma involution, and this new approach of monitoring allowed effective surveillance and successful tailored management.

English

Polyhydramnios is a common problem during pregnancy but massive hydramnios is relatively rare especially that due to placental tumour. This case report presents a case of large placental chorioangioma with massive polyhydramnios leading to preterm labour.

Placental Tumour : What Could it be ? = ماذا يمكن أن يكون ؟

Placental tumours include placental chorioangiomas, teratomas, haemangiomas, and haematomas. Placental chorioangiomas are benign vascular tumours and are the most common placental tumours, with a prevalence of 1%. Large placental chorioangiomas are rare and may lead to pregnancy complications and poor perinatal outcomes. These complications include fetal anaemia, hydrops fetalis, fetal growth restriction, polyhydramnios, and preterm delivery. We report a case of a large placental chorioangioma, the antenatal management and the maternal and fetal outcomes.

Antenatal embolization of a large placental chorioangioma: a case report

IntroductionA chorioangioma is the most common benign tumor of the placenta. The majority of pregnancies with chorioangiomas are asymptomatic. Pregnancies with large chorioangiomas are associated with maternal and fetal complications, such as growth restriction, cardiomegaly, congestive heart failure, fetal anemia, thrombocytopenia, nonimmune hydrops and intrauterine fetal death. There are several modalities of treatment published to date with various results. Our case was the third such case report published on the successful treatment with antenatal embolization of the feeding vessel of the chorioangioma. To the best of our knowledge, there have been no published cases about antenatal treatment of placental chorioangiomas in Saudi Arabia, or any other Gulf state.Case presentationWe describe the case of a 28-year-old Arab woman diagnosed at 22 weeks of gestation with a chorioangioma. A glue material - enbucrilate (Histoacryl) - was used for embolization of the feeding vessel. Intrauterine fetal blood transfusions were performed twice, as a treatment for fetal anemia. The fetus developed heart failure at 30 weeks of gestation. A Cesarean section was performed and the outcome was a live baby with right ventricular hypertrophy. The baby was admitted to our neonatal intensive care unit and discharged at 42 days following birth in a stable condition,with follow-up with our cardiology team.ConclusionIn this case, we found that intrauterine embolization of the feeding vessel of a chorioangioma with Histoacryl was a valid treatment option that carried a small risk considering the good pregnancy outcome.

Combined Approach in a Large Placental Chorioangioma Case with Intratumoral Alcohol Injection, Cordocentesis, IU Transfusion, and Amnioreduction

Large placental chorioangiomas (LPCs) are rare complications of pregnancy and these tumors are associated with increased risk of pregnancy complications. We presented a LPC case at 25th week of gestation, complicated by polyhydramnios and preterm labor in which intratumoral alcohol injection was performed succesfully. Cordocentesis, fetal intrauterine transfusion, and amnioreduction were performed at the same session, as a combined approach. The safety of the procedure was shown by the lack of alcohol in the fetal cord blood sample. Intratumoral alcohol injection is a reliable and effective treatment modality in the management of LPCs and may be combined with other invasive procedures.

High‐output cardiac failure in a fetus with thanatophoric dysplasia associated with large placental chorioangioma: Case report

Placental chorioangioma is an angioma arising from chorionic tissue. Fetal thanatophoric dysplasia is a lethal skeletal dysplasia due to mutation of fibroblast growth factor receptor 3 gene. These two conditions are rare and their coexistence in a given fetus is even rarer. We present a case of a fetus with thanatophoric dysplasia having high-output cardiac failure due to a large placental chorioangioma.

Endoscopic laser coagulation following amnioreduction for the management of a large placental chorioangioma

Endoscopic laser coagulation following amnioreduction for the management of a large placental chorioangioma

Giant placental chorioangioma: natural history and pregnancy outcome

Giant placental chorioangiomas are associated with a high prevalence of pregnancy complications and a poor perinatal outcome. The aim of the study was to evaluate the natural history, intrauterine treatment and outcome of pregnancies complicated by giant placental chorioangioma. This was a retrospective study of 19 cases of giant placental chorioangioma, in which the natural history, intrauterine treatment and outcome of pregnancy were evaluated. Eighteen of the 19 cases were associated with a wide variety of fetal complications, including polyhydramnios, growth restriction, hyperdynamic circulation, cardiomegaly, anemia and non-immune hydrops. Two-thirds of the cases developed complications that required either elective delivery for fetal growth restriction (n = 6) or intervention for cardiovascular effects (n = 7). Fetal therapy, when required, was tailored to the particular complication and resulted in a successful pregnancy in all cases. The presence of large placental chorioangioma is associated with the development of fetal growth restriction and hyperdynamic state in a significant number of cases. This series elucidates some of the putative underlying mechanisms for these complications, and reports on a safe and effective treatment modality, percutaneous ultrasound-guided interstitial laser therapy.

P18.17: Coagulation of feeding vessels with bipolar cautery in a large placental chorioangioma: case report

P18.17: Coagulation of feeding vessels with bipolar cautery in a large placental chorioangioma: case report