Hemangioma of the umbilical cord: A case report on a rare entity

Abstract

Several hundred cases of placental hemangiomas have been reported in the literature. However, the umbilical cord is extremely uncommon as a site of occurrence. We present a case of postnatal discovery of giant hemangioma of the umbilical cord (HUM) in a Coronavirus Disease 2019 (COVID 19) positive mother. To our knowledge, this is the first reported case of HUM synchronous to a maternal infection with COVID 19. We aim, through this case and a review of the literature, to study the clinicopathological characteristics of this singular entity. Our patient, a 37‐year‐old woman, presented to the Department Of Obstetrics And Gynecology for respiratory distress and loss of fetal movements. Ultrasound examination concluded to intrauterine fetal desmise. After stabilization of the patient, a cesarean section was performed. A macerated fetus was extracted. Placenta showed a giant mass attached to the cord. It was submitted for pathological examination. Gross examination showed that the umbilical cord was inserted eccentrically with a fusiform dilation. Near its placental end, three cohesive solid angiomatous nodules were noted. Microscopic examination revealed lobules of dilated blood‐filled capillaries set in a myxoid stroma. The diagnosis of HUM have been established. HUM arise from endothelial cells of the umbilical vessels. Their etiology, physio‐pathology and pathways of tumorigenesis are not yet well defined. Further studies are needed to explore the pathways of tumorigenesis and to determin the implication of COVID‐19 in HUM.

Umbilical cord hemangioma and pseudocyst with favorable fetal outcome

“…They are clearly demarcated from surrounding stroma. These nodules vary in dimensions, ranging from 0.2 to 7 cm in largest dimension, and if associated with edema may measure up to 18 cm 1–3,9 . A hypercoiled umbilical cord was noted with a multinodular mass at the insertion site.…”

“…4,8 Even though rare, umbilical cord neoplasms are predominantly hemangiomas and less commonly teratomas. 1,2 Hemangiomas arise from endothelial cells, especially of the umbilical arteries, and have an undefined pathophysiology. 9 In a unique occurrence, Thayer et al recently documented an umbilical cord hemangioma occurring synchronously with maternal COVID-19 infection with adverse fetal outcome.…”

“…9 In a unique occurrence, Thayer et al recently documented an umbilical cord hemangioma occurring synchronously with maternal COVID-19 infection with adverse fetal outcome. 1 Hemangiomas may present as fusiform swellings of the cord comprising of an angiomatous nodule, surrounded by edema of the Wharton's jelly with myxoid cystic degeneration. They are clearly demarcated from surrounding stroma.…”

Umbilical Cord Hemangioma and Pseudocyst With Favorable Fetal Outcome

“…Even though rare, umbilical cord neoplasms are predominantly hemangiomas and less commonly teratomas 1,2 . Hemangiomas arise from endothelial cells especially of the umbilical arteries and have an undefined pathophysiology 9 .…”

“…They are clearly demarcated from surrounding stroma. These nodules vary in dimensions, ranging from 0.2 to 7 cm in largest dimension, and if associated with edema may measure up to 18 cm [1][2][3]9 . A hyper-coiled umbilical cord was noted with a multi-nodular mass at the insertion site.…”