Case Report: Pregnancy with concomitant chorangioma and placental vascular malformation with mesenchymal hyperplasia

Abstract

We present two pregnancies associated with normal live births and the unusual concomitance of chorangioma and placental vascular malformation with mesenchymal hyperplasia. The enlarged placenta had the characteristic findings of chorangioma, dilated and varicose chorionic vessels and multiple vesicle-like villi containing hyaluronic acid. The vesicle-like villi showed diploid cellular DNA contents. Molecular genetic analysis using the polymerase chain reaction amplification of polymorphic microsatellite markers confirmed genetic identity among the chorangioma, the vesicle-like villi and the fetus. Both pregnancies were complicated by polyhydramnios, pre-term labour and prematurity. One neonate suffered from anaemia and thrombocytopenia. Another neonate suffered from haemangiomatosis. Our cases demonstrate that concomitant chorangioma and placental mesenchymal hyperplasia are genetically identical to the fetus and can coexist with a normal viable fetus. Since haemangiomas, chorangiomas, chorionic vessels and villi mesenchymal cells are all derived from the mesoderm, a combination of fetal haemangiomas, placental vascular malformation, chorangiomas and placental mesenchymal hyperplasia may represent a mixed form of congenital malformation of the mesoderm.

Placental Mesenchymal Dysplasia: Chronological Observation of Placental Images during Gestation and Review of the Literature

“…Of the 110 cases reviewed, 16 (14.5%) were associated with BWS [2,3,4,5,6,7,8,9,10], 33 (30.0%) had evidence of fetal growth restriction [4,11,12,13,14,15,16,17,18,19,20,21,22,23,24,41,46,48] as in the current case, and 28 (25.5%) ended in intrauterine fetal death [4,6,7,8,12,13,15,16,17,18,25,26,45,47]. There is a female preponderance in cases of PMD; of the infant data reviewed, there were 78 females and 19 males.…”

“…All articles without an abstract or with unavailable full text were excluded. We identified 49 articles including 110 cases of PMD [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49]. …”

Displasia mesenquimal placentaria

“…Varios autores han preferido usar el término hiperplasia mesenquimal placentaria, en lugar de displasia (5,11,13,14) . La verdadera incidencia de DMP se desconoce, porque previamente ha sido informada bajo una variedad de nombres, como 'placentomegalia con hydrops masivo de las vellosidades placentarias' y 'molas pseudoparciales' (15,16) .…”

“…Las comunicaciones previas indicaron constitución genética biparental normal (11,14) . Sin embargo, recientemente, Cohen y col. (26) describieron 3 casos con aneuplodías: una trisomía 13 con translocación balanceada entre los cromosomas 1 y 13, un síndrome de Klinefelter (47,XXY) y una triplodia (69,XXX; un caso previamente informado por Paradinas y col. (16) ).…”

“…Una de las principales características de esta anomalía es la presencia de vasos vellosos troncales aneurismales, los cuales, en cortes histológicos de 4-5 µm, pueden ser confundidos con otras alteraciones vasculares, como corioangioma, corioangiosis o corioangiomatosis, originadas en la misma región de la placa coriónica. La dificultad para el diagnóstico histopatológico se incrementa cuando estas últimas alteraciones se presentan simultáneamente con la hiperplasia mesenquimal, como ocurre en casos muy raros (11) , en los cuales la microscopia electrónica de barrido aclara el panorama.…”