Placental mesenchymal dysplasia, a case of intrauterine sudden death of fetus with rupture of cirsoid periumbilical chorionic vessels

Abstract

We report a 32-year-old woman (1-gravid, 1-para) with a vesicular lesion in her uterus that was pointed out on ultrasound at 8 weeks' gestation. Amniocentesis at 15 weeks' gestation showed a normal female karyotype, 46XX. As the pregnancy advanced, the mole-like lesion became relatively reduced. Throughout gestation, the maternal human chorionic gonadotropin level was normal, but the serum alpha fetoprotein level rose as her pregnancy progressed. Her fetus did not exhibit any remarkable anomalies. The patient visited our hospital complaining of a diminished feeling of fetal movements at 36 weeks 5 days' gestation, and intrauterine fetal death (IUFD) was confirmed. She delivered a 2336-g female without any definite anomalies. A pathological examination led to a diagnosis of placental mesenchymal dysplasia, and androgenetic/biparental mosaicism in the placenta was identified using p57kip2 immunohistochemical staining. And it also revealed that the rupture of the cirsoid chorionic vessels had led to IUFD.

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

“…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]. …”

Placental Mesenchymal Dysplasia

“…In addition, subchorionic hemorrhage may mimic PMD, owing to the cystic spaces seen on ultrasonography. [10][11][12][13][14][15] In conclusion, PMD is a relatively rare entity that needs to be distinguished from molar pregnancy to clinically prevent unnecessary termination of the pregnancy. 9 If PMD is suspected after antenatal ultrasonography and genetic testing, it is imperative that affected patients be followed up as patients with high-risk pregnancies owing to the association with growth restriction, stillbirth, and other chromosomal abnormalities.…”

Placental Mesenchymal Dysplasia, a Rare Cause of Non Molar Placental Hydrops: A Case Report

“…11 Molar pregnancies always exhibit elevated hCG levels, while in one series of PMD by Nayeri et al 2 38% of the cases showed elevated hCG level. In the present case hCG level was mildly elevated.…”

“…1 The exact incidence of PMD is unknown, some of the studies show the incidence to be 0.02%. 2 PMD is characterized by enlarged placenta with dilated, fluid filled vesicles. Prenatal ultrasonography reveals an enlarged, thickened placenta with cystic spaces in the sub chorionic zone.…”

“…The only maternal complication was hypertension which developed in 9% of cases. 2 The diagnosis of PMD is only affirmed after pathological evaluation of placenta. Grossly, it is characterised by placentomegaly, dilated or even aneurysmal chorionic vessels and enlarged hydropic or cystic villi.…”