Placental Anomalies in Children with Infantile Hemangioma

Abstract

Evaluation of the placenta provides some important insights into pathophysiologic changes that take place during the prenatal and intrapartum process. We investigated the pathogenic significance of placental features and their relationship to the development of infantile hemangioma in order to obtain a better understanding of its cause. Placental specimens were reviewed from 26 singleton pregnancies of women whose offspring weighed less than 1500 g. A group of 13 neonates who developed infantile hemangioma in the immediate neonate period were compared with 13 healthy preterm infants of comparable postconception age who had no infantile hemangioma. Pathologic placental changes were analyzed in both groups. Gross lesions with disturbance of the utero-placental circulation were found in all placentas from children who developed infantile hemangioma, including massive retroplacental hematoma in two infants, extensive ischemic infarction in seven, and large dilatated vascular communications, severe vasculitis, chorioamnionitis and funiculitis in four. Placental features included percentages greater than 25% of avascular villi, platelet and fibrin aggregates, and multifocal disease involving more than one histologic section. Examination of 13 placentas of low-birth-weight infants without infantile hemangioma only showed abnormal placentation in one and isolated villous dismaturity in two. The higher ratio of placental pathologic findings in patients with infantile hemangioma suggests that reduced placental oxygen diffusive conductance contributes to fetal hypoxic stress and that hypoxic/ischemic changes in the placenta could be related to infantile hemangioma development via vascular endothelial growth factor and placental growth factor expression, among others, within the villious vessels and throphoblasts.

Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies

“…subsequently performed transcriptome clustering analysis of placenta as well as vascular tumours, and found that microarray expression profiles of IHs and placental tissue shared remarkable similarities, supporting a possible relationship. López Gutiérrez et al . evaluated placentas from 26 infants weighing < 1500 g, half of whom had IHs.…”

Pre‐eclampsia and risk of infantile haemangioma

“…Nonetheless, there is histological evidence to support an association between pre‐eclampsia and infantile haemangioma. Anomalous placentas and infantile haemangiomas both have altered angiogenic profiles . Early‐onset pre‐eclampsia involves imbalance in pro‐ and antiangiogenic biomarkers with an underperfused placenta, possibly secondary to hypoxia .…”

“…The aetiology of infantile haemangiomas is poorly understood. Placental disorders including pre‐eclampsia are potentially novel risk factors for infantile haemangioma in addition to preterm birth and low birthweight . Only two prospective studies have examined placental disorders and infantile haemangioma with a control group, but small sample sizes precluded analysis of pre‐eclampsia specifically, or the role of different variants of pre‐eclampsia.…”

A Potential Role for Notch Signaling in the Pathogenesis and Regulation of Hemangiomas

“…49 Histologic examination of placentas from premature births also revealed histologic anomalies, notably areas of infarctions. 50 There have also been reports that infants whose mothers underwent chorionic villous sampling had higher incidences of having hemangiomas. 51 Finally, Barnes et al 52 showed that HemECs share similar molecular profile with placental ECs.…”