Karimi Mohadeseh, Sajjadi Hakimeh S
Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Int J Surg Case Rep. 2025 Jan;126:110252. doi: 10.1016/j.ijscr.2024.110252. Epub 2024 Sep 7.
Chorioangioma is benign, non-trophoblastic vascular neoplasms of the placenta with an estimated incidence of 1 %. It originates from placental blood vessels. Giant chorioangiomas, larger than 4 cm in diameter, are rare with an incidence ranging between 1/3500 and 1/9000 pregnancies. Giant chorioangiomas easily detected by prenatal ultrasound and are associated with a series of pregnancy and fetal complications.
A 34-year-old multigravida woman, with twin pregnancy presented with notation of reduced fetal movement. On sonographic examination, first fetus was Intrauterine Growth Restriction (IUGR), stage 1 and the second fetus was small-for gestational age and a well-defined, hypoechoic lesion with increased vascularity measuring 5.8 × 4.7 × 2.5 cm on the fetal surface of the placenta was seen. However, at 35 + 3 weeks, the patient presented with pain in the lower abdomen. Maternal vital signs were within normal ranges. On Physician team discussion, cesarean section was performed. Two female neonates weighing 2260 g and 2400 g were delivered, with normal APGAR scores and physical examinations. And physical examination. The placenta was sent to pathology laboratory. In histopathology numerous proliferative blood vessels was found that confirm with immunohistochemical analysis. Finally, the patient was diagnosed with placental chorioangioma.
Placental chorioangioma is a rare anomaly in villous capillary development, with uncertain pathogenesis. It is often linked to twin pregnancies, gestational diabetes, maternal hypertension, and female fetal sex. Prenatal sonographic scans are valuable for its identification, revealing a hypoechoic, highly vascular mass confirmed via Doppler ultrasound. In contrast, chorangiocarcinoma, a malignant placental tumor, comprises chorioangioma and proliferating trophoblast cells with distinct histological features. Close monitoring and sonographic evaluations are vital during pregnancy when managing chorioangioma, especially giant ones, known to cause various fetal and pregnancy complications. The decision-making process for delivery in cases of giant chorioangioma should consider fetal complications and gestational age. While some interventions like laser ablation are available, the challenging nature of the patient's response may warrant conservative management in certain instances.
We report a rare case of giant placental chorioangioma in a 34-year-old twin pregnant patient. Chorioangioma benign vascular neoplasms of the placenta may cause pregnancy and fetal complications.
绒毛膜血管瘤是胎盘的良性、非滋养层血管肿瘤，估计发病率为1%。它起源于胎盘血管。直径大于4厘米的巨大绒毛膜血管瘤很少见，发病率在1/3500至1/9000次妊娠之间。巨大绒毛膜血管瘤很容易通过产前超声检测到，并与一系列妊娠和胎儿并发症相关。
一名34岁的多胎妊娠女性，怀有双胞胎，出现胎动减少。超声检查显示，第一个胎儿为1期宫内生长受限（IUGR），第二个胎儿为小于胎龄儿，在胎盘胎儿表面可见一个边界清晰、低回声且血管增多的病变，大小为5.8×4.7×2.5厘米。然而，在孕35+3周时，患者出现下腹部疼痛。产妇生命体征在正常范围内。经医生团队讨论后，进行了剖宫产。分娩出两名女婴，体重分别为2260克和2400克，阿氏评分和体格检查均正常。胎盘被送去病理实验室。组织病理学检查发现大量增生血管，免疫组化分析予以证实。最终患者被诊断为胎盘绒毛膜血管瘤。
胎盘绒毛膜血管瘤是绒毛毛细血管发育中的罕见异常，发病机制尚不清楚。它常与双胎妊娠、妊娠期糖尿病、母亲高血压和女性胎儿性别有关。产前超声扫描对其识别很有价值，可显示低回声、高血管性肿块，经多普勒超声证实。相比之下，绒毛膜癌是一种恶性胎盘肿瘤，由绒毛膜血管瘤和具有独特组织学特征的增生滋养层细胞组成。在管理绒毛膜血管瘤，尤其是巨大绒毛膜血管瘤时，孕期密切监测和超声评估至关重要，因为已知其会导致各种胎儿和妊娠并发症。巨大绒毛膜血管瘤病例的分娩决策过程应考虑胎儿并发症和孕周。虽然有激光消融等一些干预措施，但在某些情况下，患者反应的挑战性可能需要保守治疗。
我们报告了一例34岁双胎妊娠患者的罕见巨大胎盘绒毛膜血管瘤病例。胎盘绒毛膜血管瘤这种良性血管肿瘤可能导致妊娠和胎儿并发症。
