Placental Chorangioma Research Articles

Whole exome sequencing of placental chorangioma

IntroductionPlacental chorangioma is a benign non-trophoblastic vascular proliferation of the placental chorion favored to represent hamartoma-like or hyperplastic capillary lesions. As the exact pathophysiology has not been established, we investigated the molecular characteristics of placental chorangiomas using exploratory whole exome sequencing. MethodsThree cases were retrospectively selected and whole exome sequencing was performed on macrodissected lesions. DNA extraction, DNA quantification, library preparation and sequencing were performed with IDT xGen™ Exome Hybridization Panel v2 for library capture. Sequencing data was analyzed with an in-house bioinformatics pipeline for single-nucleotide variants and insertions/deletions. ResultsAll neonates were delivered at term and had birth weights ranging from 11th-35th percentile for gestational age. All mothers presented with hypertensive disorder during pregnancy. Chorangiomas ranged from 0.7 cm to 5.1 cm and were well-circumscribed near the fetal surface. Case 1 showed a background of chorangiosis and acute subchorionitis, while case 2 had foci of chronic lymphocytic villitis. Whole exome sequencing did not reveal any significant pathologic variants. DiscussionsThe absence of molecular alteration in placental chorangioma is likely indicative of the reactive/non-neoplastic nature of this lesion. The presence of compromised blood flow in the form of hypertensive disorders in our cases may be one of its underlying pathophysiologic mechanisms.

A case of placental multiple giant chorangioma leading to neonatal death from fetal hydrops

Abstract Objectives Although placental chorangiomas are often asymptomatic, larger tumors (>4–5 cm) can cause various perinatal complications, including polyhydramnios, preterm birth, fetal anemia, fetal hydrops, and intrauterine fetal death. Symptomatic placental chorangiomas are often diagnosed prenatally on ultrasonography as a mass on the fetal side of the placenta. Case presentation A 37-year-old pregnant woman underwent emergency cesarean delivery at 34 weeks’ gestation due to rapidly progressive fetal hydrops leading to fetal dysfunction, resulting in neonatal death. Placental pathology indicated multiple placental giant chorangiomas that occupied 40% of the placenta. Because of the disk shape of the placenta, prenatal diagnosis by ultrasonography was difficult. Conclusions Some placental chorangiomas are difficult to diagnose and lead to fetal hydrops and poor prognosis, even if ultrasonography does not show an obvious mass in the placenta.

Two Giant Placental Chorangiomas Discovered at 34 week’s Gestation: A Case Report

Abstract Introduction/Objective Chorangioma is a benign vascular tumor of the placenta, likely hamartoma, occurring in 1% of all examined placentas and arising from the primitive chorionic mesenchyme. The clinical significance is related to the size of the tumor. Most chorangiomas are small and asymptomatic; however, those larger than 4 cm are associated with intrauterine growth restriction (IUGR), polyhydramnios, preterm delivery, arteriovenous shunting, hydrops, and fetal thrombocytopenia. Methods/Case Report Herein, we present a case report of a placenta with two chorangiomas that are prenatally detected in a 25-year-old G2P1 female patient by ultrasound which showed a placental mass and mild polyhydramnios. The patient also developed hypertension and preeclampsia so she was referred for early induction of labor. The patient was elected for caesarian section and the placenta was delivered at 35 weeks of gestation. Grossly, two tan soft well-circumscribed lobulated placental masses were identified and measured 9.5 x 9.1 x 3.3 cm and 5.5 x 4.5 x 1.9 cm, respectively. The two masses were joined together by a thick blood vessel. The larger 9.5 cm mass was connected to the placental disc at the umbilical cord insertion site and is associated with blood vessel thrombosis. Microscopically the mass showed proliferation of capillary-sized vessels with surrounding stroma consistent with chorangioma. Clinical, radiological, and microscopic profiles support the diagnosis of placental chorangioma. Results (if a Case Study enter NA) N/A Conclusion To our knowledge, this is the first case report of two giant placental chorangiomas connected together by a thick blood vessel. Although both are giant (more than 4 cm), early diagnosis and timely intervention led to good maternal and neonatal outcomes aided with neonatal intensive care unit management.

Incidental Finding of Multiple Placental Chorangioma Associated with Foetal Growth Restriction (FGR)

Incidental Finding of Multiple Placental Chorangioma Associated with Foetal Growth Restriction (FGR)

Case Series: Seventeen Year Institutional Review of Placental Chorangiomas

Abstract Introduction/Objective Chorangioma is a rare tumor occurring in less than 0.5 - 1% of all pregnancies. Small chorangiomas (< 4cm) are mostly asymptomatic and incidental. Large chorangiomas (> 4 cm) may be associated with various fetal complications and complicated pregnancies. The aim of our study is to assess the ultrasound detection rate of these lesions. Methods A retrospective study of chorangioma cases seen at Vidant Medical Center between 2003 to 2019 was conducted. Size of the lesion, detection on prenatal imaging, gestational weeks at delivery, maternal age and pregnancy related fetal and maternal complications were analyzed. Results A total of 25761 placentas were examined from 2003 to 2019 in Vidant Medical Center. Out of these only thirty-nine cases (0.15%) of chorangioma were found. 41% of these women were above 30 years of age. 36 patients were non-Hispanic. 92.3 % (36 cases) of these lesions were less than 4cm and 7.6 %(3 cases) were above 4 cm, with only one recent case of 7.0 cm in greatest dimension. 92% of the total patients presented with complicated pregnancies. Preeclampsia, preterm delivery, gestational hypertension and intrauterine growth retardation were among the most common complications observed. 3 patients presented with oligohydramnios. Interestingly, none of the lesions were detected on prenatal ultrasound. Conclusion Large chorangiomas(>4 cm) are rare but are known to be associated with adverse fetal outcomes. Our seventeen year institutional review shows the largest chorangioma to be 7 cm in greatest dimension. Regular ultrasound monitoring is required to pick up these benign lesions early and prevent adverse outcomes. A retrospective review is needed to determine why the lesions in our study were not detected radiographically.

Corioangioma placentario gigante: a propósito del primer caso sometido a fetoscopia y fotocoagulación láser en el Perú

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.

Successful Pregnancy Outcome in a Case of Large Placental Chorangioma in an Elderly Primigravida

Successful Pregnancy Outcome in a Case of Large Placental Chorangioma in an Elderly Primigravida

Exploring the association between chorangioma and infantile haemangioma in singleton and multiple pregnancies: a case–control study in a Swedish tertiary centre

ObjectivesPlacenta or placental chorangioma could be the origin site of infantile haemangioma since they share various histochemical and genetic characteristics with placental vascular tissue. The aim of the current study...

Sonographic Evaluation of a Large Placental Chorangioma

Placental chorangioma is a rare, benign tumor of the placenta. Chorangiomas are typically small, are asymptomatic, and pose no threat to pregnancy. However, in extreme cases, large placental chorangiomas can cause maternal and fetal complications associated with poor outcomes and fetal demise. Prenatal sonography is an accurate method for diagnosing these benign tumors based on grayscale imaging and color Doppler assessment of intratumoral vascularity. Early diagnosis is critical in predicting the potential for subsequent maternal and fetal complications, planning sonographic surveillance, treating maternal symptoms, and delivery planning. This case study discusses the diagnosis and management of a large placental chorangioma in an otherwise uncomplicated pregnancy.

Large Placental Chorangioma with an Unusual Uneventful Course

Background: Placental chorangioma is a rare benign placental lesion associated with a multitude of fetomaternal or neonatal complications. Though it is the most common benign condition of the placenta, a chorangioma measuring >5 cm is very rare and leads to various clinically significant consequences. Case: This article presents the case of a 34-year-old multiparous woman, with no significant medical or obstetric history and with an unremarkable clinical status, who was diagnosed with a chorangioma (≈ 12 cm) at 32 weeks of pregnancy by ultrasonography and kept for observation for the rest of the gestation. A few weeks later, she had premature labor and delivered a male child uneventfully via a normal vaginal delivery. The delivered placenta had a well-defined lobular mass on the fetal surface, measuring 12 cm in its greatest diameter and located near the insertion of the umbilical cord. The placenta was intact and complete, and the outer surface of the mass was congested with prominent vascular markings. Results: On microscopy, multiple sections from the mass were examined showing numerous dilated vascular channels surrounded by placental stroma and pools of blood seen in few cavernous spaces. Sections from the umbilical cord were unremarkable. The histology results, therefore, confirmed the diagnosis of a chorangioma. Conclusions: Despite the clinically significant size of the chorangioma, prematurity was the only complication seen in this case. Still, these lesions should be viewed with caution, as location and vascularity are now increasingly identified as crucial factors in prognosis. Therefore, careful examination of the placenta, timely antenatal diagnosis, and early intervention should be given due emphasis, so that associated morbidity and mortality to both the fetus and the mother can be prevented. (J GYNECOL SURG 33:30)

Histopathologic findings in multicentric placental chorangioma with trophoblastic proliferation in a sheep

Histopathologic findings in multicentric placental chorangioma with trophoblastic proliferation in a sheep

Clinical Outcome in Singleton and Multiple Pregnancies with Placental Chorangioma.

IntroductionChorangiomas (CAs) are the most common non-trophoblastic tumor-like-lesions of the placenta. Although the clinical significance of small CAs is unknown, the large lesions are often associated with maternal and fetal complications. The aim of our study was to assess the maternal clinical characteristics and neonatal outcome in singleton and multiple pregnancies with placental CA.Materials and MethodsAmong 15742 selected placentas 170 CAs were diagnosed. Pregnancy and neonatal outcomes were analyzed in singleton (n = 121) and multiple (n = 49) pregnancy groups including 121 and 100 neonates, respectively.ResultsThe frequency of APGAR score <7 at 5 minutes (p = 0,012), abnormal pulsatility index (p = 0,034), and abnormal blood flow class (p = 0,011) were significantly higher in neonates from singleton compared to multiple pregnancies. Significantly smaller CAs in singleton pregnancies were related to small for gestational age neonates (p = 0,00040) and neonates admitted to the neonatal care unit (p = 0,028). In singleton pregnancies, significantly smaller CAs were associated to maternal preeclampsia (p = 0,039) and larger CAs to multiparity (p = 0,005) and smoking (p = 0,001) groups. The frequency of preeclampsia was high in both singleton and multiple pregnancy groups (41,32% vs 26,53%, respectively), however, the difference did not reach the level of statistical significance.DiscussionA high incidence of preeclampsia in cohort of placental CA might lead to a possible recognition of CAs as potential morphologic indicator of placental hypoxia.ConclusionA more favorable pregnancy outcome in multiple gestations compared to the singleton gestations with CAs might reflect an adaptive mechanism for increased demand of oxygen and associated placental tissue hypoxia in this group.

Chorangioma Placentae: A Rare Entity

Background: A chorangioma, a nontrophoblastic tumor, is a primary benign neoplasm of the placenta. It is found on the fetal surface of the placenta or in the placental parenchyma. Chorangiomas can have various histopathologic presentations, ranging from vascular to cellular, and can undergo degenerative changes. They can be diagnosed prenatally with ultrasound, color Doppler imaging, and magnetic resonance imaging. Case: A large placental chorangioma with secondary changes was found in a 32-year-old primigravida female who was referred to the Postgraduate Institute of Medical Sciences, in Rohtak, Haryana, India, at 36 weeks of gestation, with polyhydramnios and intrauterine growth restriction. Results: The patient herself delivered a placenta and deceased fetus without surgical intervention. The patient responded well after treatment. Conclusions: Chorangioma must be differentiated from other villous capillary lesions, namely, chorangiomatosis and chorangiosis. Most chorangiomas are small and possess no clinical significance. On the contrary, clinically significant chorangiomas, greater than 5 cm or multiple, may be associated with pregnancy complications. (J GYNECOL SURG 31:26)

PFM.55 Antenatal diagnosis of placental chorangioma: implications for clinical management

IntroductionChorangiomas (placental haemangiomas) are rarely diagnosed antenatally but have been associated with cardiac failure and poor outcome. The aim of this study was to review cases of antenatally diagnosed placental...

An epidemiological study investigating the relationship between chorangioma and infantile hemangioma

ObjectivesThis study aimed to verify whether the infantile hemangioma (IH) incidence in children whose placentas showed a chorangioma is higher than in the general population, thus addressing the hypothesized relationship between chorangioma and IH. MethodsAll chorangioma diagnoses by the 1st Service of Pathology, University of Padova in 2004–2010, based on the analysis of placentas sent by the Department of Gynecological Sciences and Human Reproduction (University of Padova), were identified. Demographic, anamnestic and clinical data were collected from the mothers and newborns; mothers and pediatricians were interviewed by telephone within 1 year after birth to verify if any IH appeared. The incidence rates of IH and other adverse events (IUGR, preterm delivery, cesarean section, stillbirth) were compared with national and regional data, when available, or with estimates from the scientific literature. ResultsThirty-eight chorangioma diagnoses were found. Of 33 infants born with a placenta affected by chorangioma, 18 infants had IH. The IH incidence recorded in our series (55%) was significantly higher than that recorded in national and regional surveys and in the scientific literature. Similar findings have been observed for the incidence of stillbirth, preterm birth and low birth weight incidence. ConclusionsThe IH incidence observed in our series appears to be significantly higher than that recorded among the general population, suggesting that an association between placental chorangioma and IH could exist which should be further verified in prospective studies.

Aberrant methylation of H19‐DMR acquired after implantation was dissimilar in soma versus placenta of patients with Beckwith–Wiedemann syndrome

Gain of methylation (GOM) at the H19-differentially methylated region (H19-DMR) is one of several causative alterations in Beckwith-Wiedemann syndrome (BWS), an imprinting-related disorder. In most patients with epigenetic changes at H19-DMR, the timing of and mechanism mediating GOM is unknown. To clarify this, we analyzed methylation at the imprinting control regions of somatic tissues and the placenta from two unrelated, naturally conceived patients with sporadic BWS. Maternal H19-DMR was abnormally and variably hypermethylated in both patients, indicating epigenetic mosaicism. Aberrant methylation levels were consistently lower in placenta than in blood and skin. Mosaic and discordant methylation strongly suggested that aberrant hypermethylation occurred after implantation, when genome-wide de novo methylation normally occurs. We expect aberrant de novo hypermethylation of H19-DMR happens to a greater extent in embryos than in placentas, as this is normally the case for de novo methylation. In addition, of 16 primary imprinted DMRs analyzed, only H19-DMR was aberrantly methylated, except for NNAT DMR in the placental chorangioma of Patient 2. To our knowledge, these are the first data suggesting when GOM of H19-DMR occurs.

Diffuse neonatal haemangiomatosis with a placental chorangioma

<h3>Introduction</h3> Single haemangiomas are common in neonates. Rarely they present as multiple, widely spread lesions also known as haemangiomatosis. In 50% of these there is visceral involvement, which can affect the liver, GI system and CNS. There are reports of haemangiomatosis being associated placental chorangioma. <h3>Case report</h3> A term male infant, BW 2280 g, was admitted to our neonatal unit with hypoglycaemia and a non-blanching rash. At delivery, a mass was found in the placenta, which was found to be a chorangioma. On admission, he was stable but had polycythaemia, thrombocytopenia and coagulopathy with a prolonged INR, APTR and decreased fibrinogen. He was managed with intravenous Vitamin K, a platelet transfusion and fresh frozen plasma. He remained clinically stable and he received one further dose of IV vitamin K before his thrombocytopenia and coagulopathy completely resolved. An abdominal ultrasound scan was performed to look for visceral involvement. This showed a hepatic haemangioma. <h3>Discussion</h3> Two types of neonatal haemangiomatosis are described. Benign neonatal haemangiomatosis affects the skin only and diffuse neonatal haemangiomatosis affects both the skin and viscera. Our case falls into the second group with both skin and liver involved. The most common sites affected by diffuse haemangiomatosis are the liver, GI system, CNS and lungs. Infants can be ill at birth or present later with high output cardiac failure, GI haemorrhage or CNS compression causing hydrocephalus. Mortality rates of up to 50% is reported.2. Large chorangiomas have an incidence of 1:9000 births and are often associated with antenatal complications and 30% fetal mortality. There is a known link between large chorangiomas and neonatal haemangiomatosis. The mechanisms of this link are still being established. In our case the neonate presented with thrombocytopenia and coagulopathy, which quickly resolved with treatment. This suggests that this was secondary to the placental chorangioma rather than the hepatic haemangioma, which would have caused a more prolonged consumptive coagulopathy.

Beckwith–Wiedemann syndrome with placental chorangioma due to H19‐differentially methylated region hypermethylation: A case report

Beckwith-Wiedemann syndrome (BWS) is a common overgrowth syndrome that involves abdominal wall defects, macroglossia, and gigantism. It is sometimes complicated by placental tumor and polyhydramnios. We report a case of BWS, prenatally diagnosed with ultrasonography. A large and well-circumscribed tumor also existed on the fetal surface of the placenta, which was histologically diagnosed as chorangioma after delivery. Polyhydramnios was obvious and the fetal heart enlarged progressively during pregnancy. Because the biophysical profiling score dropped to 4 points at 33 weeks of gestation, we carried out cesarean section. By epigenetic analysis, H19-differentially methylated region hypermethylation was observed in the placental tumor, normal placental tissue, and cord blood mononuclear cells. This is the first report of BWS with placental tumor due to H19-differentially methylated region hypermethylation.

Multifocal Chorangiomatosis

Multifocal chorangiomatosis (MC) is an uncommon villous capillary lesion sharing some features with villous chorangiosis and placental chorangioma. We prospectively identified 53 cases of MC among 5429 consecutively accessioned placentas of >20 weeks gestation over a 10-year period. Two gestational age (GA)-matched controls were selected for each case from the same cohort and a case control analysis of associated clinical and pathologic features was performed. Multifocal chorangiomatosis was seen at all GAs but was most frequent in very preterm placentas (<32 weeks). Avascular villi, villous chorangiosis, and distal villous immaturity were each seen in approximately half of placentas with MC. Other common placental findings included concentric narrowing of fetal villous arterioles, villous edema, and dysmorphic villi. Only one case had an associated placental chorangioma. Maternal factors significantly associated with MC were advanced maternal age, non-African-American ancestry, nonprimigravid status, and >5 previous pregnancies. Infants with placental MC had a significantly increased prevalence of congenital anomalies. Multifocal chorangiomatosis was subcategorized as extensive versus patchy based on the size of the largest focus (> versus < ×2 microscopic field). Fetuses with extensive MC, when compared with patchy MC, were more likely to have congenital anomalies and stillbirth and to be large for GA. Paradoxically, those with patchy MC were more likely to be small for GA. The results of this study suggest that MC may represent an abnormal proliferation of the paravascular capillary net in proximal villi related to fetoplacental developmental anomalies and abnormal fetal blood flow.

Fetal Hydrops Associated with Tumors

Fetuses with tumors associated with hydrops have a high mortality rate. Relatively few survivors have this potentially fatal combination. This study examined the clinical and pathological findings, pathogenesis, and outcomes of fetuses with tumors and hydrops. One hundred and fifty-eight study cases were collected from the literature and from personal files. Only patients where adequate clinical and pathological data were given and the outcome of pregnancy was described were included in the study. Cardiac tumors were the majority found in association with fetal hydrops. Leukemia and extracardiac teratomas were next in frequency followed by hepatic tumors, neuroblastoma, placental, soft tissue, and renal tumors. The main presenting findings along with hydrops were hydramnios, a tumor mass, placentomegaly, and stillbirth. Most tumors were detected in the third trimester of pregnancy. No fetus with the diagnosis of cardiac rhabdomyoma, neuroblastoma, brain tumor, rhabdoid tumor, or histiocytosis associated with hydrops survived. Those patients with placental chorangioma, pericardial teratoma, and hepatic hemangioma had the best outcome. The overall survival rate was low: 30 of 158 (19%).