Chorangiosis placenta with 5-vessel umbilical cord with omphalomesenteric duct remnant: An unusual association

Abstract

Placenta is an organ that is responsible for nourishing and protecting the fetus during pregnancy. Histologic examination of the placenta can yield significant information about pre-uterine and uterine conditions affecting fetal growth. Chorangiosis is defined as the presence of ≥10 terminal villi, each containing ≥10 capillaries per terminal villus in ≥10 low power (×10) fields in at least 3 or more random, non-infarcted cotyledons of the placenta. Chorangiosis is an adaptive response to in-utero hypoxia and its presence signifies better pregnancy outcomes. Abnormalities that lead to multiple cord vessels are rare with the majority of reported cases highlighting four vessels due to a persistent right umbilical vein. We report here a case of chorangiosis of placenta associated with a rare 5-vessel umbilical cord and omphalomesenteric duct remnant. To the best of our knowledge, this is the first case report to document such an association.

Five too many! A Case of Incidentally Detected Five Vessel Umbilical Cord Associated with Placental Chorangiosis

“…Rarely, its association has been demonstrated with UC abnormalities such as true and false knots, long cord, umbilical vein dilatation or thrombosis, nuchal cord, and single umbilical artery. [3] Here, we report a case of chorangiosis of placenta associated with the a rare 5-vessel umbilical cord.…”

“…9, Issue 10, October 2022 pregnancy. Its histopathological examination can reveal significant information about pre-uterine and uterine conditions affecting fetal growth during pregnancy [3]. The UC is flexible cord like structure responsible for maintaining fetal blood circulation during pregnancy.…”

“…One of them proposes that chronic hypoperfusion or tissue hypoxaemia leads to elaboration of vascular endothelial growth factor, platelet-derived growth factor, and transforming growth factor-beta by mesenchymal and trophoblastic cells; while the other hypothesis highlights the role of macrophage-derived tumor necrosis factor-α. Increased intramural pressure due to umbilical vein obstruction is also thought to play a role in the development of chorangiosis in cases associated with cord anomalies, such as long umbilical cord and thrombosis of vessels [3,9] Very sparce literature is available regarding association of supernumery vessels of UC with chorangiosis. Garg et al [3]have presented a case of a five vessel UC associated with chorangiosis, where the mother presented with gestational hypertension with associated oligohydramnios; however, they could not establish a definite correlation as well.…”

“…Increased intramural pressure due to umbilical vein obstruction is also thought to play a role in the development of chorangiosis in cases associated with cord anomalies, such as long umbilical cord and thrombosis of vessels [3,9] Very sparce literature is available regarding association of supernumery vessels of UC with chorangiosis. Garg et al [3]have presented a case of a five vessel UC associated with chorangiosis, where the mother presented with gestational hypertension with associated oligohydramnios; however, they could not establish a definite correlation as well.…”