Placental Chorioangioma Information

Above. Chorioangioma. Color Doppler. The CA (chorioangioma) is demonstrated. The tumor measures 5 cm. and the placenta is demonstrated separately with a “feeder vessel” arising from the placenta.

Fetal Chorioangioma Information Helpful for Diagnostics

Page Links: Definition, Pathology, Risk Factors, Etiology, Prenatal Outcome, Neonatal Outcome, Treatment, References

Chorioangiomas are benign vascular tumors of the placenta. Larger lesions can be seen on ultrasound, and color Doppler can define their size and extent. Larger tumors can be associated with fetal morbidity, as the tumors act as peripheral arteriovenous shunts and cause high output cardiac failure. Lesions can be clinically associated with changes in amniotic fluid volume, fetal anemia, and fetal growth. Various strategies have been proposed for prenatal treatment.

Definition and Incidence of Infant Chorioangioma

Definition and Incidence of Infant Chorioangioma

Chorioangioma (CA) is the most common benign, vascular, non-trophoblastic tumor of the placenta. [1] The incidence is .05 to 1.3% of placentas. [1]

Pathology of Infant Chorioangioma

High-Risk Placental Chorioangioma Pathologyincidental findings on pathologic examination of the placenta

Chorioangiomas most often are small (<0.5 cm.), incidental findings on pathologic examination of the placenta. When larger, these lesions can be seen with ultrasound and may have significant clinical consequences. CAs may be nodular or multinodular and are located on the chorionic plate, protruding toward the fetus. Histologically, these lesions show nonspecific findings of trophoblastic hyperplasia similar to partial moles. [2]

rare forms of vascular placental tumors

Other rare forms of vascular placental tumors include chorangiosis (CH) and chorangiomatosis (CM). These are villous capillary (VC) lesions that may also be related to hypoxemia, and each of these rarer forms of vascular tumors may have specific clinical associations. [2] Chorangiosis has a relatively high association with stillbirth [3] and occurs with a different gestational age distribution compared to other placental vascular lesions. [4]

Risk Factors

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Risk factors include a linear increase with maternal age, hypertension, diabetes, and female gender. [5]

Etiology

Increased growth factor expression may play a part in chorioangioma formation. [6] Others report potential angiogenic precursors, which might play a role in tumor formation. [7] Genes that lie in certain DNA regions may be a part of the pathogenesis of chorioangioma. [8]

Prenatal Outcome of Fetal Chorioangioma

Larger chorioangiomas can result in poor fetal outcome

Larger chorioangiomas can result in poor fetal outcome. In the angiomatous type of chorioangioma, the tumor within the vascular bed acts as an arteriovenous shunt that can induce hemodynamic changes in the fetus [9], resulting in high output cardiac failure and fetal hydrops.  A second mechanism is through a functional empty space due to the tumor.

As a result of these mechanisms, fetal adverse events can occur. Complications include: polyhydramnios, preterm birth, fetal growth restriction, anemia, fetal congested heart failure, non-immune fetal hydrops, and an increase in perinatal mortality. [9] Microangiopathic thrombocytopenia may also result.

Poor outcome is reported in over 50% of the cases. In 9 cases of chorioangioma detected in singletons, 5 were associated with pregnancy complications; of the 5 all had abnormalities of amniotic fluid volume; 2 were associated with growth restriction, and 1 with non-immune hydrops. In addition, 44% delivered before 35 weeks. [10]

Chorioangioma’s Neonatal Outcome

Chorioangioma's Neonatal Outcomepresence of chorioangioma in the placenta results in neonatal consequences

The presence of chorioangioma in the placenta results in neonatal consequences similar to those seen antenatally. Newborns can present with severe anemia, thrombocytopenia, heart failure and growth restriction. Cerebral embolism has been reported with diffuse chorioangiomas that occurred before birth but resulted in neonatal neurological compromise. [11]

In addition, placental vascular tumors can occur simultaneously with infantile hemangiomas. [12] Chorioangioma is also reported in association with multiple diffuse cutaneous and liver angiomatosis. [13] Others have described multiple diffuse resolving neonatal hemangiomatosis after a pregnancy complicated by placental chorioangioma. These vascular tumors that occur in the placenta and in the neonate may share a common histopathology. [12]

Treatment of Fetal Chorioangioma

Treatment of Fetal Chorioangioma

A number of potential treatment options for chorioangioma have been reported. These include: fetal transfusion, fetoscopic devascularization, embolization, and injection with absolute alcohol. [14]

1. Fetal alcohol ablation of a feeding vessel was performed successfully in a patient with a large chorioangioma accompanied with polyhydramnios and fetal hydrops, although delivery occurred at 32 weeks. [15] Another report of alcohol injection resulted in a 28 week delivery. [16]

2. Laser directed at the feeding vessel and interstitial laser is reported with variable success in a small number of patients. [17], [18], [19]

3. Indomethacin to treat associated polyhydramnios was thought to be successful in delaying delivery for 3 weeks. [20]

4. Finally, peak systolic velocity measurements of the middle cerebral artery define anemia and guide fetal transfusion therapy. [21]

References


 

    1
  1. Abstract: PMID: 15022059

    2
  2. Abstract: PMID: 10987255

    3
  3. Abstract: PMID: 16208478

    4
  4. Abstract: PMID: 14989498

    5
  5. Abstract: PMID: 12747233

    6
  6. Abstract: PMID: 12747234

    7
  7. Abstract: PMID: 12852866

    8
  8. Abstract: PMID: 17203486

    9
  9. Abstract: PMID: 12364888

    10
  10. Abstract: PMID: 14672481

    11
  11. Abstract: PMID: 16737029

    12
  12. Abstract: PMID: 17937433

    13
  13. Abstract: PMID: 14663833

    14
  14. Abstract: PMID: 15085884

    15
  15. Abstract: PMID: 12078971

    16
  16. Abstract: PMID: 17228160

    17
  17. Abstract: PMID: 19156708

    18
  18. Abstract: PMID: 14607052

    19
  19. Abstract: PMID: 15736199

    20
  20. Abstract: PMID: 11776505

    21
  21. Abstract: PMID: 16969001