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PLACENTAL CHORIOANGIOMA -A CAUSE OF HYDROPS FOETALIS ANDINTRAUTERINE FOETAL DEATH
Kusum D Jashnani**, Jigna B Doshi*, Jyoti D Rege**
*Lecturer; **Registrar; ***Associate Professor, Department of Surgery, BYL Nair Charitable Hospital, Mumbai.
Chorioangioma of the placenta, commonest benign growth, if of large size or multiple are usually accompanied by complications affecting the mother and developing foetus and might be responsible for maternal toxaemia, prematurity, hydrops foetalis and intrauterine foetal death (IUFD).INTRODUCTION
Chorioangioma of the placenta was originally described by Clarke in 1798.[1] This constitutes the commonest benign growth of the placenta, and yet it is rarely encountered because placental tumours are generally quite infrequent. As the name indicates, it is a haemangioma of placenta, usually arising from chorion. We report a case of multiple placental chorioangiomas which were responsible for hydrops foetalis and IUFD.
CASE REPORT
Twenty year old female with nine months of amenorrhoea complained of absent foetal movements since last eight days. On per abdominal examination, the uterus was full term with vertex presentation but foetal heart sounds were not heard. USG revealed a single intrauterine gestation with no cardiac activity, and with hydrops foetalis and ascites. Thus a clinical diagnosis of intrauterine foetal death was made. The patient underwent labour following pitocin drip and placenta was sent for histopathological examination. There were no congenital anomalies in the female child except for features of hydrops foetails.
Pathological Examination
Gross examination of placenta showed multiple well circumscribed round-to-oval lesions, red in colour and firm in consistency on cut surface. Larger two were 2.5 cm in diameter and the others were 0.5 to 1.0 cm in diameter as seen in Fig. 1.
Microscopic examination from these lesions showed a tumour mass composed of capillary and cavernous sized blood vessels (Fig. 2). Surrounding parenchyma showed chorionic villi which were larger in size, more cellular, with vessels in the centre of the core indicating delay in villous maturity. Thus a final diagnosis was multiple placental chorioangiomas leading to hydrops foetalis and IUFD.
DISCUSSION
Incidence of placental chorioangioma is 1%. It can be extraplacental attached to the foetal surface of placenta as a bulging protuberant mass or can be small intraplacental lesion.[2]
Vast majority of placental chorioangiomas are of no clinical importance. A proportion of them, of large size or multiple are usually accompanied by a variety of complications affecting the mother, the developing foetus or the neonate.[3],[4] Foetal demise is due to lack of oxygenation due to shunting of blood through the tumour, thus allowing it to bypass the functioning placental tissue. Hydrops foetalis with chorioangioma of the placenta[5],[6] could be because of the compression of the umbilical vessels by the tumour, increased secretion of foetal metabolites through the tumour or transudation of fluid from the tumour.
Polyhydramnios, prematurity and maternal toxanaemia are other complications of the chorioangioma whereas anaemia, thrombocytopenia or congestive cardiac failure[7] may be seen in a neonate. Placental chorioangioma can often grossly be confused with infarct or intervillous thrombus.[8]
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REFERENCES1.Clarke J. Account of a tumour found in the substance of the human placenta. Phil Trans R Soc 1798; 88 : 361.
2.Fox. Pathology of the placenta. Non trophoblastic tumours of the placenta. WB Sauders Company Ltd. London - Philadelphia Toronto. 1978; 13 : 343-67.
3.Asadourian LA, Taylor HB. Clinical significance of placental hemangiomas. Obstet Gynecol 1968; 31 : 551-5.
4.Leonidas JC, Beaty EC, Hall RT. Chorangioma of the placenta : a cause of cardiomegaly and heart failure in the newborn. Am J Roent Rad Ther and Nuc Med 1975; 23 : 703-7.
5.Sweet L, Robertson NRC. Hydrops fetalis with chorioangioma of the placenta. J of Pediatrics 1973; 82 : 91-4.
6.Sieracki JC, Panke TW, Horvat BL, et al. Chorioangiomas. Obstet Gynecol 1975; 46 : 155-9.
7.Wallenburg HCS. Chorioangioma of the placenta : thirteen new cases and a review of the literature from 1939 to 1970 with special reference to clinical complications. Obstet and Gynec Survey 1971; 26 : 411-25.
8.Kaplan C, Lowell D, Salafia C. Structural changes associated with abnormal function in the maternal / fetal / placental unit in the second and third trimesters. Arch Pathol Lab Med 1991; 115 : 709-16.
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