Placental Chorioangioma Research Articles

Increased Intrauterine Transfusion Blood Volume Needed to Correct Fetal Anemia due to Placental Chorioangioma

Introduction: To compare the blood volume transfused for fetal anemia in cases of placental chorioangioma versus red blood cell (RBC) alloimmunization in patients matched for gestational age (GA) and hydrops. Methods: Study patients had intrauterine transfusions and were obtained from 3 sources: group (1) placental chorioangioma patients treated at our center (2016–2023); group (2) placental chorioangioma patients reported in the medical literature; and group (3) RBC alloimmunization patients treated for fetal anemia at our center (2016–2023) matched (2:1) to patients in groups 1 and 2 by GA at procedure and presence of hydrops. The expected volume (cc) of transfusion was calculated for all patients based on a formula commonly used for fetal anemia in cases of RBC alloimmunization that includes the GA at procedure, pre-transfusion hemoglobin, donor hemoglobin, and target hemoglobin. The ratio of the volume actually transfused to the expected volume was calculated for each group and for groups 1 and 2 combined; comparisons were made using nonparametric testing. Results: By group, the patients studied included: (1) 7 treated chorioangioma patients, (2) 8 chorioangioma patients described in the literature, and (3) 30 matched RBC alloimmunization patients. The median (range) GA at procedure for groups 1, 2, and 3 was 29.6 (22.7–32.7), 27.0 (24.0–30.0), 28.4 (22.7–34.3) weeks. The median pre-procedure hemoglobin for each group was 8.5 (5.8–12.5), 6.7 (5.6–12.0), and 5.3 (2.2–10.7) g/dL, and the median post-procedure hemoglobin for each group was 12.9 (11.5–14.0), 12.7 (9.6–14.7), and 13.6 (8.0–15.7) g/dL. The median (range) ratio of the actual to the expected volume transfused for each group was 2.50 (1.79–8.33), 1.64 (1.11–3.85), and 1.10 (0.69–1.86) (p < 0.001). When groups 1 and 2 were combined, the median ratio was 1.89 (1.11–8.33), which remained statistically significant when compared to group 3 (p < 0.001). Conclusion: Intrauterine transfusion for fetal anemia in cases of large placental chorioangiomas appeared to require nearly twice the blood volume that was normally anticipated for cases of RBC alloimmunization, although the actual amount transfused varied widely.

Exploring the Prospects of Antenatal Microcoil Embolization of Giant Placental Chorioangioma: Case Report and Review of Literature

AbstractGiant placental chorioangiomas, which measure more than 4 cm, are associated with adverse maternal, fetal, and neonatal outcomes, with an estimated perinatal mortality of 30 to 40%. Early diagnosis, close prenatal surveillance, intrauterine intervention, and timely delivery would play a vital role in improving pregnancy outcomes. Using conventional treatment options like amniodrainage to reduce intrauterine pressure and intrauterine blood transfusion to correct fetal anemia fails to tackle the underlying pathophysiology. Interventions aimed at devascularizing the tumor, such as injection of alcohol or surgical glue, use of bipolar cautery, placement of vascular clips, interstitial laser, and radiofrequency ablation, have had mixed results due to their invasive nature and associated complications. In this case report, we discuss a minimally invasive, percutaneous, extraamniotic method of focal occlusion accomplished by microcoil embolization of the feeding vessel. The combination of slow blood flow and endothelial vessel damage due to the presence of coils stimulates thrombogenic mechanisms, contributing to the formation of a clot and leading to the cessation of blood flow to the chorioangioma, thereby treating the primary pathology.

Clinicopathological characteristics of placental chorioangioma: A clinicopathological study of 30 cases.

The objective is to explore clinicopathological characteristics, diagnosis, differential diagnoses, treatment, and prognoses of placental chorioangioma (PCA). The pathological data of 30 cases of PCA were collected; the color Doppler ultrasound, Down's screening, fetal survival, and pathological characteristics were observed; and the literature was reviewed. Of the 30 patients, the ages ranged from 20 to 38 years, with an average of 29.6 years. Pregnancy comorbidity occurred in 14 patients; intrauterine fetal death occurred in 4; the gross appearance of the tumor: a reddish-brown nodule, slightly round, 0.5-8 cm in diameter, can be seen on the cut surface of the placenta Pregnancy comorbidity occurred in 14 patients and intrauterine fetal death in 4. On sectioning the placenta, tumors grossly appeared as reddish-brown nodules, slightly round and ranging in diameter from 0.5 to 8 cm. Microscopically, the tumor has small, densely packed capillaries with fibrous connective tissue in the stroma. There were 10 cases with high risk of Down's syndrome screening, and the immunophenotype CD34 (+) and Ki-67 proliferation index were less than 10%. PCA is rare and may be misdiagnosed as malignant tumor, which may be related to pregnancy comorbidity and high risk of Down's screening, so improving the understanding of PCA can provide the basis for clinical diagnosis and intervention. PCA is a rare tumor which may be misdiagnosed as a malignancy. It may be related to pregnancy comorbidity and high risk of Down's screening. Improving the understanding of PCA could provide the basis for clinical diagnosis and intervention.

A singleton pregnancy with placental chorioangioma and hydrops fetalis complicated with mirror syndrome and ritodrine-induced side effects: a case report

BackgroundRitodrine hydrochloride is a widely used beta-adrenergic agonist used to stop preterm labor in Taiwan. Many side effects causing maternal morbidity and mortality have been reported. We report a case complicated with ritodrine-induced side effects and mirror syndrome that was associated with placental chorioangioma.Case presentationA 36-year-old singleton pregnant woman at 25 6/7 weeks of gestation, with an undiagnosed placental chorioangioma, underwent tocolysis due to preterm uterine contractions. Her clinical condition deteriorated, attributed to mirror syndrome and adverse events induced by ritodrine. An emergency cesarean section was performed at 27 1/7 weeks of gestation, delivering an infant with generalized subcutaneous edema. A placental tumor measuring 8.5 cm was discovered during the operation, and pathology confirmed chorioangioma. Gradual improvement in her symptoms and laboratory data was observed during the postpartum period. Identifying mirror syndrome and ritodrine-induced side effects poses challenges. Therefore, this case is educational and warrants discussion.ConclusionOur case demonstrates mirror syndrome induced by chorioangioma, which is rare, and ritodrine-induced side effects. The cessation of intravenous ritodrine and delivery are the best methods to treat maternal critical status due to fluid overload.

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.

A Placental Chorioangioma Revealed by Intra-Uterine Growth Retardation

Chorangioma (or chorioangioma) is the most common primary tumor of the human placenta with an incidence of approximately 1%. It is a single or multiple nodular vascular proliferation most often made up of capillary vessels, more rarely larger vessels. The majority of these tumors are small and without any fetal-maternal impact; but when they are large, they can cause fetal complications (intrauterine growth restriction, polyhydramnios, prematurity and neonatal (anemia, thrombocytopenia, etc). We report a case of placental chorioangioma complicated by intrauterine growth retardation in a 23-year-old primigravidae.

Clinical observation of successful pregnancy and delivery of patients with giant placental chorioangioma

Clinical observation of successful pregnancy and delivery of patients with giant placental chorioangioma

Stillbirth and the placenta

Stillbirth affects a large proportion of pregnancies world-wide annually and continues to be a major public health concern. Several causes of stillbirth have been identified and include obstetrical complications, placental abnormalities, fetal malformations, infections, and medical complications in pregnancy. Placental abnormalities such as placental abruption, chorioangioma, vasa previa, and umbilical cord abnormalities have been identified as causes of death for a significant proportion of stillbirths. In the absence of placental abnormalities, the gross and histologic changes in the placenta in stillbirth are found when secondary to other etiologies. Here we describe both gross and histologic changes of the placenta that are associated with stillbirth.

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.

Giant Chorioangioma in a Patient with 36 Weeks of Pregnancy: A Case Report

Abstract Present report relates to a 40-year-old patient with 36 weeks of pregnancy and non-trophoblastic benign placental neoplasm chorioangioma (placental hemangioma). The incidence of chorioangioma has been described as 0.5 to 1.0 % of all pregnancies. Tumors may be &gt;4 cm in diameter; such tumors are called giant tumors. Smaller tumors are generally asymptomatic. However, clinically-significant chorioangioma occur less frequently; incidence varying from 1 in 3500 to 1 in 9000 pregnancies. Giant chorioangiomas are very rare tumors; only a few cases have been reported. Feto-maternal complications like fetal growth retardation, anemia and hydrops may develop in a patient with chorioangioma. Further, fetal loss may be as high as ~ 40 %. Increased incidence of chorioangiomas may occur at high-altitude pregnancies, suggesting role of hypobaric hypoxia in pathogenesis of chorioangioma. Keywords: Well-circumscribed benign placental neoplasm.

A Rare Case of Chorioangioma / Non Immune Fetal Hydrops

Chorioangioma is a placental hemangioma is a common, non-trophoblastic benign vascular placental tumour of primitive chorionic mesenchyme. The size of the tumour is important. Smaller tumours are clinically insignificant. Giant chorioangioma more than 4 cm has higher risk of maternal and foetal complications. Early diagnosis is done by imaging techniques. Placental lesions detected on sonography necessitate close surveillance of these pregnancies because of the poor outcome ofpregnancy. We present a 32-year primigravida with placental chorioangioma who went in spontaneous labour and delivered a male baby. The baby was referred to higher centre for further evaluation and revealed mild cardiomegaly. The histopathological examination of placenta helped in the diagnosis of placental chorioangioma.

Placental chorioangioma and pregnancy outcome: a ten-year retrospective study in a tertiary referral centre

BackgroundPlacental chorioangioma is a rare disorder in pregnancy. We retrospectively reviewed the perinatal complications and long-term outcomes in pregnancies with placental chorioangioma and evaluated the factors affecting disease prognosis.MethodsWe reviewed pregnant women who delivered at our hospital in the past decade and whose diagnosis of placental chorioangioma was confirmed by pathological diagnosis. Information on maternal demographics, prenatal sonographic findings and perinatal outcomes was obtained by reviewing the medical records. In the latter part of the study, follow-up of children was conducted by phone interview.ResultsIn the 10 years from August 2008 to December 2018, 175 cases(0.17%) were identified as placental chorioangioma histologically and 44(0.04%) of them were large chorioangiomas. Nearly one-third of cases with large chorioangiomas were associated with severe maternal and fetal complications or required prenatal intervention. Although one-fifth of fetuses/newborns complicated with large chorioangiomas were lost perinatally, the long-term prognosis for surviving fetuses was generally good. Further statistical analysis revealed that tumor size and location affect prognosis.ConclusionPlacental chorioangioma may cause an unfavorable perinatal outcome. Regular ultrasound monitoring can provide the tumor characteristics which can be referred to for predicting the tendency of those complications and indicate when intervention may be necessary. It is not clear which factors lead to complications with fetal damage as the main manifestation or polyhydramnios as the main manifestation.

Placentaire chorioangiomen: casusbespreking met massieve foetomaternale bloeding en neonatale sterfte

Placental chorioangiomas associated with massive fetomaternal hemorrhage and neonatal death: a case report Placental chorioangiomas are morphologically aberrant blood vessels similar to hemangiomas, but histologically identical to placental blood vessels of fetal origin. They are usually small and clinically irrelevant. However, when they cover a large part of the placenta, the consequences can be important. Severe fetal complications such as hydrops, high-output failure, anemia, thrombocytopenia and placental abruption are described, all associated with a high fetal and neonatal mortality. The authors present a case of a fetus with pronounced anemia and signs of massive fetomaternal hemorrhage. Histopathological examination of the placenta revealed multiple placental chorioangiomas.

Chorioangioma: a single tertiary care center retrospective study.

Chorioangioma represents a challenge due to the rarity of the condition, paucity of sufficient management guidelines, and controversies regarding the best invasive fetal therapy option; most of the scientific evidence for clinical treatment has been limited to case reports. The aim of this retrospective study was to review the natural antenatal history, maternal and fetal complications, and therapeutic modalities used in pregnancies complicated with placental chorioangioma at a single Center. This retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSH&RC) in Riyadh, Saudi Arabia. Our study population included all pregnancies with ultrasound features of chorioangioma, or histologically confirmed chorioangiomas, between January 2010 and December 2019. Data were collected from the patients' medical records, including the ultrasound reports and histopathology results. All subjects were kept anonymous; case numbers were used as identifiers. Data collected by the investigators were entered into Excel worksheets in an encrypted format. A MEDLINE database was used to retrieve 32 articles for literature review. Over a 10-year period between January 2010 and December 2019, 11 cases of chorioangioma were identified. Ultrasound remains the gold standard for diagnosis and follow-up of the pregnancy. Seven of the 11 cases were detected by ultrasound, allowing proper fetal surveillance and antenatal follow-up. Of the remaining six patients, oneunderwent radiofrequency ablation, two underwent intrauterine transfusion for fetal anemia due to placenta chorioangioma, one had vascular embolization with an adhesive material, and two were managed conservatively until term with ultrasound surveillance. Ultrasound remains the gold standard modality for prenatal diagnosis and follow-up of pregnancies with suspected chorioangiomas. Tumor size and vascularity play a significant role in the development ofmaternal-fetal complications and the success of fetal interventions. To determine the superior modality of fetal intervention mandates more data and research; nevertheless, Fetoscopic Laser Photocoagulation and embolization with adhesive material seem to be a lead choice, with reasonable fetal survival.

Giant Placental Chorioangioma in a Young Patient Causing Adverse Fetal Outcome

Giant Placental Chorioangioma in a Young Patient Causing Adverse Fetal Outcome

Placental chorioangioma with Dysgenesis of corpus callosum: A case report

Placental chorioangioma with Dysgenesis of corpus callosum: A case report

Innovation in fetal surgery: Use of vascular plugs in placental chorioangioma with fetal hydrops

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Placental chorioangioma with an emphasis on rare giant placental chorioangioma and associated maternal and perinatal outcome: Clinicopathological study in a single centre.

Giant placental chorioangiomas (GPC) are exceedingly rare and harbour potential to cause feto-maternal complications with resultant morbidity. A retrospective study using details from Department of Obstetrics & Gynaecology and Pathology is done to study the various clinical and pathological features of placental chorioangiomas with a special emphasis on the rare GPCs and associated complications. Over a period of 16 years, 20 cases were diagnosed as chorioangioma in our institution. 60% of these occurred in primigravida (n=12) and 71% cases carried a female foetus. Only 25% cases were > 30 years. Maternal and foetal complications occurred in 85% and 50% cases. Pre-term labour was the common maternal complication and foetal death/stillbirth was the most common foetal complication. There were 15 cases of GPC, 73% occurred in primigravida (n=11) and 75% of cases carried a female foetus. There were no cases of maternal death or recurrence. Primigravidity was associated with maternal complication in contrast to multigravidity (P = 0.049). Mean age of mothers with maternal complications and those without maternal complications reached statistical significance (P = 0.001). Though histologically all the cases were similar, calcification and infarction were seen exclusively in GPC cases. GPCs are rare and our data adds evidence to use 4cm as an optimum cut-off in the definition. GPCs were associated with a high percentage of primigravidity, female foetus, and poorer outcome of pregnancy. Routine examination of placenta in unexplained foetal/perinatal demise must be stressed to detect microscopic evidence of chorioangioma.

Prenatal diagnosis of placental chorioangioma on ultrasound

Prenatal diagnosis of placental chorioangioma on ultrasound

Ultrasound features of placental chorioangioma detected by SMI technology before and after thrombosis of feeding vessels: analysis of a clinical case

Objective: Placental chorioangioma is the most common non-trophoblastic vascular benign tumor of the placenta, with an estimated incidence of 1% of all pregnancies. Most chorioangiomas are small asymptomatic lesions that are found incidentally only postnatally during histologic examination of the placenta. Voluminous chorioangiomas (&gt;4–5 cm), however, are less common and are more often diagnosed prenatally, through ultrasound imaging. Color Doppler demonstrates either a single blood vessel feeding the lesion or substantial vascularity within the mass. Large tumors have been associated with multiple adverse perinatal outcomes, including fetal growth restriction, preterm birth, polyhydramnios, fetal congestive heart failure, fetal anemia, fetal hydrops and intrauterine death. Case(s): A 35-years-old primigravida woman with uncomplicated pregnancy was referred to the Ultrasound Centre of Obstetric and Gynecologic of Sant’Anna Hospital, Turin, due to a suspect placental mass seen during the ultrasound performed at 32 weeks of gestation. In this case, detailed ultrasound scans with grey scale and Doppler examination were performed (using Aplio 550; Canon Medical Systems Europe BV, Zoetermeer, The Netherlands). We also decided to study the vascularization of the mass with SMI (superb microvascular imaging) technology. In particular, with the use of SMI, it was possible to visualize the vascularization of the mass more completely which was conspicuous at first but disappeared after thrombosis of feeding vessels with favorable pregnancy outcome. Conclusion: SMI is a new vascularity imaging method that can visualize vessels that exhibit slow flow rates. It uses a system to reduce artifacts by greatly reducing interference from tissue movement.