• Altshuler criteria: More than 10 capillaries in at least 10 terminal villi in 10 or more noninfarcted areas in at least 3 low power fields of the placenta (Arch Pathol Lab Med 1984;108:71); normal villi rarely have > 5 capillaries/villous
• Capillary hyperplasia is due to chronic placental hypoperfusion or low grade tissue hypoxemia (Gynecol Obstet Invest 2012;73:141)
• May be seen in pre-eclampsia, diabetes mellitus, placentomegaly, high altitudes, drugs and urinary tract infections
• Associated with neonatal morbidity / mortality

• More than 10 capillaries in more than 10 terminal villi in at least 10 different noninfarcted areas in 3 low power fields of the placenta
• Capillaries have distinct basement membranes but are not surrounded by a continuous layer of pericytes or associated with stromal fibrosis
• May be associated with other features of villous dysmaturity, chorangioma, amnion nodosum, chronic villitis and fetal thrombotic vasculopathy (FTV)
• Must distinguish from congestion (vessels appear prominent but are normal in number) and tissue ischemia (has shrunken devitalized villi)

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• Chorangioma: nodular lesion composed entirely of capillary vascular channels with surrounding trophoblasts; analogous to hemangiomas occurring elsewhere
• Chorangiomatosis: heterogeneous and less well defined lesion with intermediate features between chorangioma and chorangiosis
  • Hyperplastic capillaries surround larger vessels in central cores of stem villi
  • Increased number of perivascular bundles of reticulin fibers and pericytes
  • Smooth mucle actin positive in pericytes
• Congestion: prominent capillaries in the villi but there is no numerical increase in the number of capillaries

Which of the following is true?

1. Chorangiosis is also known as hemangioma of the placenta.
2. Chorangiosis is always seen in women with diabetes mellitus, while chorangiomatosis is always seen in women with pre-eclampsia.
3. In chorangiosis, each capillary shows a distinct basement membrane but there is no increase in perivascular pericytes or reticulin bundles.
4. All of the above.

C. In chorangiosis each capillary shows a distinct basement membrane but there is no increase in perivascular pericytes or reticulin bundles. Answer A is false because chorangioma, not chorangiosis, is known as hemangioma of the placenta. B is false because diabetes mellitus is associated with, but not always seen with chorangiosis.

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