Rare non‐trophoblastic vascular placental tumor: A diagnostic challenge

Abstract

Key Clinical Message

Pathologists should consider the differential diagnoses of placental chorioangioma, which encompass chorangiosis, chorangiomatosis, chorangiocarcinoma, intervillous thrombus, and placental infarct.

Abstract

Chorioangiomas are rare non‐trophoblastic vascular neoplasms of the placenta, occurring in approximately 1% of pregnancies. Large chorioangiomas (>4 cm) are infrequent and associated with an increased risk of pregnancy complications. There are limited reports in the literature regarding uncomplicated cases of large placental chorioangiomas.

1. CASE DESCRIPTION

A 33‐year‐old woman, gravida 0, para 0, presented to the outpatient gynecology clinic at 33 weeks of gestation, reporting decreased fetal movements. The patient's medical history included hypothyroidism. She had a prepregnancy weight of 60 kg and a height of 163 cm, resulting in a body mass index (BMI) of 22.58. During the physical examination, the uterine fundal height measured 29 cm, which was appropriate for the gestational age. Her blood pressure was recorded as 110/70 mm Hg. Speculum examination revealed no signs of vaginal bleeding or premature rupture of membranes. The cervical length was observed to be shortened, and the cervix was closed. An ultrasound examination conducted at 33 weeks of pregnancy indicated a single fetus in breech presentation, with a heart rate of 152 bpm. No signs of hydrops fetalis or fetal cardiomegaly were detected. Nonstress tests showed no evidence of fetal distress. The placental site was identified as the anterior uterine wall. Notably, a distinct heterogeneous and hypoechoic placental lesion measuring 8.3 × 4.9 cm was observed, protruding into the amniotic cavity at the umbilical cord insertion site. (Figure 1A). The Doppler scan revealed significant vascularity within the placental mass (Figure 1B). At 34 weeks of gestation, the patient experienced spontaneous labor and delivered a male baby weighing 2.7 kg. There were no indications of hydrops fetalis or distress during birth. Further biological tests did not detect anemia (Hb: 19 g/dL) or hypoproteinemia. The placenta was submitted to the pathology department for histological examination. Macroscopically, the delivered placenta measured 16 × 15 × 3 cm and weighed 835 g. On the fetal surface, a distinct lobular mass measuring 8 × 4.9 cm was identified, situated near the insertion point of the umbilical cord. (Figure 2A). The umbilical cord had a length of 40 cm. Sequentially sliced, the cut surface of the mass appeared whitish with some microcystic regions (Figure 2B). Microscopic analysis of the placental mass revealed a clearly delineated lesion consisting of numerous capillary‐sized vascular channels embedded within a fibroid matrix. (Figure 3A,B). Immunohistochemical analysis demonstrated strong positive immunostaining of endothelial cells for CD34. On the fifth day postdelivery, both the mother and her child were discharged, and subsequent examinations of the newborn revealed no abnormalities.

FIGURE 1.

(A) Ultrasonography image displaying a distinct, well‐defined, heterogeneous, and hypoechoic placental lesion measuring 8.3 × 4.9 cm. The lesion is observed protruding into the amniotic cavity at the site of umbilical cord insertion. (B) Color Doppler imaging illustrating a heterogeneous echogenic lobular mass of significant size, measuring approximately 8 × 4.9 cm. Increased blood flow within the tumor is prominently displayed.

FIGURE 2.

(A) Macroscopic view of the placental chorioangioma reveals a distinct lobular mass on the fetal surface, measuring 8 × 4.9 cm and positioned near the umbilical cord insertion site. (B) Upon serial sections, the cut surface of the mass appears solid and whitish, with sporadic reddish and microcystic regions.

FIGURE 3.

(A) Microscopic examination of the placental mass reveals a clearly demarcated lesion consisting of multiple capillary‐sized vascular channels embedded within a fibrous matrix., (hematoxylin and eosin, magnification ×100). (B) Variable‐sized capillaries within a fibrous matrix. Capillaries are lined by endothelial cells devoid of atypia (hematoxylin and eosin, magnification ×400).

What is your diagnosis?

Answer: Placental chorioangioma of capillary type.

2. DISCUSSION

Histologically, chorioangioma is a benign tumor proliferation of vessels accompanying connective tissue and an abundant stromal component. ¹ , ² , ³ The proportion of vascular and stromal components is variable, depending upon the dominant histologic type. The vascular component may include either capillaries or sinusoids. Based on histology, the tumor is classified as capillary, cavernous, endotheliomatous, fibrosing, and fibromatous. In this case, the tumor was of the capillary type. The differential diagnoses for placental chorioangioma encompass chorangiosis, chorangiomatosis, chorangiocarcinoma, intervillous thrombus, and placental infarct.

AUTHOR CONTRIBUTIONS

Faten Limaiem: Formal analysis; methodology; validation; visualization; writing – original draft; writing – review and editing. Anissa Ben Amor: Conceptualization; data curation; formal analysis; investigation; methodology; resources; supervision; validation; visualization; writing – original draft. Khalil Saffar: Conceptualization; data curation; formal analysis; investigation; project administration; resources; supervision; validation; visualization; writing – original draft. Ahmed Halouani: Formal analysis; investigation; methodology; resources; software; supervision; validation; visualization.

FUNDING INFORMATION

We did not receive funding for this article.

CONFLICT OF INTEREST STATEMENT

None declared.

ETHICAL APPROVAL

All procedures performed were in accordance with the ethical standards. The examination was made in accordance with the approved principles.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

Limaiem F, Amor AB, Saffar K, Halouani A. Rare non‐trophoblastic vascular placental tumor: A diagnostic challenge. Clin Case Rep. 2023;11:e7978. doi: 10.1002/ccr3.7978

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.