Chorioangioma

Chorioangioma is a benign tumor of placenta. It is seen in approximately 0.5 to 1% pregnancies.[1] It is mostly diagnosed ultrasonically in the second trimester of pregnancy. Large chorioangiomas are known to cause complications in pregnancy, while the smaller ones are asymptomatic.

Chorioangioma
Other namesPlacental hemangioma

Presentation

Complications

Large or multiple chorioangiomas may lead to complications. The complications are polyhydramnios, preterm labour, hemolytic anemia, fetal cardiomegaly, fetal thrombocytopenia, intrauterine growth retardation, preeclampsia, abruption of placenta and congenital anomalies.[1][2]

Pathogenesis

The origin of chorioangioma is from primitive chorionic mesenchyme. It develops when the blood vessels and stroma undergo rapid proliferation independent of the surrounding tissue. Based on histological features, chorioangioma is classified by Marchetti[3] into three types:[4]

  • Cellular type : This type is immature and contains mostly cellular elements packed compactly.
  • Angiomatous (vascular) type : This is the most common type of choriocarcinoma. It is distinguished by the presence of numerous small blood vessels.
  • Degenerative type : This is the mature type with degenerative changes.

Each type is believed to represent a phase of tumor development. Chorioangioma has no malignant potential.

Diagnosis

Most chorioangiomas are asymptomatic. They are generally picked up in second trimester scan. Chorioangioma is seen as a hypo- or hyperechoic circumscribed mass that is distinct from the placenta at gray-scale US examination. Large lesions may contain fibrous septa. It is seen protruding into the amniotic cavity near the insertion of the cord. Doppler examination shows anechoic cystic areas, with pulsatile flow in spectral analysis. Some chorioangiomas may be solid masses, and may not be identifiable in gray-scale imaging. Therefore, the investigation of choice is Colour Doppler, which also distinguishes it from placental hematoma.[4]

Management

Expectant management is recommended for chorioangioma as majority of them are asymptomatic. Large tumors are monitored with ultrasonogram every 1–2 weeks. In case of maternal or foetal complications, possible interventions are serial foetal transfusions, fetoscopic laser coagulation of vessels supplying the tumor, endoscopic surgical devascularization and chemosclerosis using absolute alcohol.[4]

Prognosis

Large chorioangiomas with decreased echogenicity, decreased tumor volume and decreased blood flow in colour doppler images are may undergo spontaneous infarction. When chorioangiomas have deceased blood flow, fetal hemodynamics and clinical outcome are found to be improved.[5]

Epidemiology

It is the most common tumor of the placenta. Chorioangiomas over the size of 5 cm in diameter are rare, and occur at a rate of 1:3500 to 1:16,000 births.[6] Smaller chorioangiomas are more frequent, with an incidence of 14‑139:10,000 births.[7] However, many small chorioangiomas may not be sonologically visible and hence go unreported. In a clinical study, more than half of all tumors were discovered only by histological techniques.[2]

History

Chorioangioma was first described by Clarke in 1798.

References
  1. U, Ruman; TS, Chowdhury (July 2012). "Placental chorioangioma : A case report" (PDF). Birdem Medical Journal. 2 (2): 113–115. doi:10.3329/birdem.v2i2.12326. Retrieved 9 December 2016.
  2. Kodandapani, Sreelakshmi (2012). "Chorioangioma of Placenta: A Rare Placental Cause for Adverse Fetal Outcome". Case Reports in Obstetrics and Gynecology. 2: 913878. doi:10.1155/2012/913878. PMC 3384918. PMID 22754703.
  3. AA, Marchetti (1939). "A consideration of certain types of benign tumors of the placenta". Surgical Gynaecology and Obstetrics: 733–743.
  4. Kirkpatrik, Aaron; Podberesky, Daniel (21 March 2007). "Placental chorioangioma". Radiographics. 27 (4): 1187–1190. doi:10.1148/rg.274065207. PMID 17620474.
  5. K, Kanenishi; T, Hata (2004). "Three-dimensional sonographic features of placental abnormalities". Gynaecological and Obstetric Investigations. 2: 61–65.
  6. UI, Esen; SU, Orife (1997). "Placental chorioangioma: a case report and literature review". British Journal of Clinical Practice. 3 (51): 181–182.
  7. H, Fox (1967). "Vascular tumors of the placenta". Obstetrical & Gynecological Survey. 22 (5): 697–711. doi:10.1097/00006254-196710000-00001. PMID 4863447.
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