Placental Mesenchymal Dysplasia with Hepatic Mesenchymal Hamartoma: A Case Report and Literature Review

Abstract

Placental mesenchymal dysplasia (PMD) is characterized by placentomegaly and grapelike vesicles resembling a partial molar pregnancy and in most cases, a phenotypically normal fetus. Hepatic mesenchymal hamartoma (HMH) is a benign hamartomatous proliferation of mesenchymal liver tissue. PMD has been associated with HMH. Although rare, in combination, it is known to carry a poorer prognosis than in fetuses without structural abnormalities. There are only a few reported cases of PMD and associated HMH with varying management strategies and outcomes, precluding ascertainment of the most appropriate treatment plan. We present a case of PMD with associated cystic HMH resulting in fetal death. We also reviewed the published literature on this issue and explored possible management strategies to prevent adverse fetal and neonatal outcomes.

Prospective risk of stillbirth in women with placental mesenchymal dysplasia

“…The search term ‘placental mesenchymal dysplasia’ yielded a list of 88 published reports. Of these, 50 were included in the present analysis because information was available regarding individual data on PMD pregnancies with GW ≥ 24 in the English language . In addition, a further 13 reports that appeared in the reference lists of pertinent reports were also included in our analysis.…”

Late diagnosis of hepatic mesenchymal hamartoma and placental mesenchymal dysplasia

“…1 Other fetal anatomical conditions can often co-exist with PMD including Hepatic Mesenchymal Hamartomas (HMH), with up to a dozen cases reported in the literature. 2 The striking feature is the morphological similarity of the oedematous, myxoid changes seen in both the placenta and liver with these two conditions. 2 The striking feature is the morphological similarity of the oedematous, myxoid changes seen in both the placenta and liver with these two conditions.…”

“…1 HMH is a rare, benign, proliferative lesion of mesenchymal tissue of the liver, with the majority being diagnosed in infants below the age of 2 years. 2 The striking feature is the morphological similarity of the oedematous, myxoid changes seen in both the placenta and liver with these two conditions. While the aetiology is poorly understood, the increased incidence of HMH with PMD does suggest a possible common developmental mechanism.…”

“…2,5 While there is no consensus on how to manage these cases antenatally, it can be agreed that heightened surveillance with serial growth scans and fetal wellbeing assessments, is required in the perinatal period to reduce fetal morbidity and mortality. However, it does appear that the co-occurrence of PMD and HMH is associated with worse outcomes than if these conditions were to occur individually and could potentially result in prematurity, hydrops, IUGR and fetal demise.…”

“…However, it does appear that the co-occurrence of PMD and HMH is associated with worse outcomes than if these conditions were to occur individually and could potentially result in prematurity, hydrops, IUGR and fetal demise. 2,5 While there is no consensus on how to manage these cases antenatally, it can be agreed that heightened surveillance with serial growth scans and fetal wellbeing assessments, is required in the perinatal period to reduce fetal morbidity and mortality. There may also be a role for consideration of early delivery and ultrasound guided percutaneous decompression of the HMH if other concerning features such as rapid enlargement with associated mass effect, hydrops, or growth abnormalities are also present.…”