Placenta

Non-trophoblastic neoplasms

Chorangioma



Topic Completed: 21 July 2021

Minor changes: 26 July 2021

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PubMed Search: Chorangioma [title] placenta

Baris Boyraz, M.D., Ph.D.
Drucilla J. Roberts, M.D.
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Cite this page: Boyraz B, Roberts D. Chorangioma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/placentachorangioma.html. Accessed October 23rd, 2021.
Definition / general
  • Well demarcated placental mass composed of capillaries, stromal cells and surrounding trophoblast arising in a stem villus
Essential features
  • Well circumscribed nodule(s) formed by proliferation of capillaries in a stem villus
  • Most are asymptomatic and microscopic
  • When large (> 4 cm), can cause fetal hemodynamic complications
Terminology
  • Placental hemangioma
  • Fibroangiomyxoma
ICD coding
  • ICD-10: 043.89 - other placental disorders
Epidemiology
  • Most common in multiple gestation pregnancies or pregnancies complicated by preeclampsia
  • Most common placental tumor (in 0.5 - 1% of all placentas) (Fetal Pediatr Pathol 2010;29:199)
Sites
  • Placenta
Pathophysiology
  • Likely a hamartoma but may be a reactive process due to hypoxia
Etiology
Clinical features
  • Most are small, incidental and asymptomatic
  • Large (> 4 cm) chorangiomas are associated with intrauterine growth restriction (IUGR), polyhydramnios, preterm delivery, arteriovenous shunting (and fetal cardiomegaly or heart failure), hydrops, fetal thrombocytopenia and maternal mirror syndrome (J Perinat Med 2014;42:273, Indian Pediatr 1996;33:520)
Diagnosis
  • Most are incidental and microscopic, rarely evident grossly as masses at the chorionic plate
  • If large enough, diagnosis can be made antenatally by imaging
Radiology description
  • Well circumscribed hypoechoic mass(es) by ultrasound imaging, vascular by color Doppler imaging or MRI
Radiology images

Contributed by Bryann Bromley, M.D.
Transabdominal ultrasound

Transabdominal ultrasound

Color Doppler

Color Doppler

Prognostic factors
  • Most small chorangiomas have no clinical relevance
  • Large chorangiomas (> 4 cm) may be associated with perinatal morbidity and even mortality due to hemodynamic stresses on the fetus (see Clinical features)
Case reports
Treatment
  • Careful monitoring for the development of hydrops if large
  • Symptomatic treatment (intrauterine transfusions, amniodrainage)
  • Interventions in rare cases (alcohol injection, microcoil embolization, endoscopic laser coagulation and interstitial laser therapy)
  • Reference: Fetal Pediatr Pathol 2010;29:199
Gross description
  • Single or multiple well circumscribed spherical / oval masses if large enough to be grossly identifiable
  • Subchorionic or marginal
  • Red-brown, fleshy
  • Firm and tan-brown, if infarcted
  • Range: 1 - 10 cm; most < 4 cm
  • Reference: Fetal Pediatr Pathol 2010;29:199
Gross images

Contributed by Baris Boyraz, M.D., Ph.D. and Drucilla J. Roberts, M.D.
Typical chorangioma

Typical chorangioma

Infarcted large chorangioma

Infarcted large chorangioma

Large chorangioma

Large chorangioma

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Baris Boyraz, M.D., Ph.D. and Drucilla J. Roberts, M.D.
Well circumscribed mass

Well circumscribed mass

Capillary proliferation and surrounding stroma

Capillary proliferation and surrounding stroma

Cellular chorangioma

Cellular chorangioma

Trophoblast hyperplasia

Trophoblast hyperplasia

Positive stains
Molecular / cytogenetics description
Sample pathology report
  • Placenta, term vaginal delivery:
    • Mature placenta (530 g, ~50th percentile for 40 weeks gestational age); patchy villous edema; chorangioma (2 cm) (see comment)
    • Comment: These are benign, usually incidental, placental masses, likely hamartomas, of no clinical significance when < 4 cm, as is this one. Some have noted an association with infantile hemangiomas; clinical correlation is necessary.
Differential diagnosis
Board review style question #1

Which of the following is the most likely diagnosis of this well circumscribed placental mass near the chorionic plate?

  1. Chorangioma
  2. Inflammatory myofibroblastic tumor
  3. Intervillous thrombus
  4. Leiomyoma
  5. Placental infarct
Board review style answer #1
A. Chorangioma. Chorangiomas are likely hamartomas of the placental stem villi forming vascular masses nearly always peripheral and adjacent to the chorionic plate. They are well demarcated, firm masses when grossly identifiable and most are incidental and microscopic. Leiomyomas from the uterus can be adherent to the basal plate of the placenta and are extremely rare masses, extraneous to the placental parenchyma. Placental infarcts are typically firm and gritty triangular or rectangular masses at the maternal floor (not the chorionic plate). Intervillous thrombi are laminated irregularly shaped red or white soft masses anywhere in the placenta. Placental associated inflammatory myofibroblastic tumors are also unusual extrinsic masses that can be attached to the placenta basal plate or membranes.

Comment Here

Reference: Chorangioma
Board review style question #2
What are complications associated with chorangioma?

  1. Fetal and maternal hydrops
  2. Malignant transformation
  3. Maternal visceral hemangiomas
  4. Obstructed labor and delivery
Board review style answer #2
A. Fetal and maternal hydrops. Vascular steal and heart failure due to fetal perfusion of a large chorangioma can lead to fetal hydrops. Maternal mirror syndrome is a rare but serious complication of hydrops fetalis. Malignant transformation does not occur in chorangiomas; if malignancy occurs, the diagnosis is likely an intraplacental choriocarcinoma, which can have associated hypervascular villi. Visceral hemangiomas in the mother are not associated with chorangiomas but fetal / neonatal hemangiomas of the skin have been reported. Chorangiomas rarely reach a size which could complicate delivery.

Comment Here

Reference: Chorangioma
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