CLINICAL HISTORY
A 33-year-old primigravida woman
with a past medical history of thyroidectomy, presented to the
outpatient gynecology clinic during the gestational age of 33 weeks,
complaining of reduced fetal movements. Physical examination revealed a
uterine fundal height of 29 cm appropriate for the gestational age.
Ultrasonography showed a single live fetus of 32-33 weeks in breech
presentation and an anterior fundal placenta. A well-defined
heterogeneous and hypoechoic space-occupying lesion measuring 8.3 x 4.9
cm noted in the placenta bulging into amniotic cavity at the site of
umbilical cord insertion was interpreted as consistent with a
chorioangioma (Figure 1A & 1B). Neither fetal cardiomegaly nor early
signs of hydrops fetalis were noted. Non stress tests revealed no sign
of fetal distress. Spontaneous labor commenced at 34 weeks of gestation
and she delivered a live male baby with a breech presentation via a
cesarean delivery with an Apgar score of 9 in the first minute and 10 in
the fifth minute. The newborn weighed 2.7 kg and did not show any signs
of anemia (Hb : 19 g/dl) or distress. The placenta was sent to the
pathology department for histological examination. Grossly, the
delivered placenta measured 16×15×3 cm and weighed 835 g. There was a
well-defined lobular mass on the fetal surface measuring 8×4.9 cm and
located near the insertion of the umbilical cord (Figure 1 C). The
length of the umbilical cord was 40 cm. On serial sections, the cut
surface of the mass was solid whitish with few reddish and micro cystic
areas (Figure 1 D). The rest of the placenta, membranes, and umbilical
cord were unremarkable. The placenta was intact and complete, and the
outer surface of the mass was congested with prominent vascular
markings. Microscopic examination of the placental mass showed a
well-demarcated lesion composed of numerous capillary sized vascular
channels set in a fibroid matrix. Sections from the umbilical cord were
unremarkable. The histology results, therefore, confirmed the diagnosis
of a chorioangioma of capillary type (Figures 2A, 2B, 2C).
Immunohistochemical study showed strong positive immunostaining of
endothelial cells for CD 34 (Figure 2D). The infant did not have anemia
and hypoproteinemia and there was no evidence of hydrops fetalis at
birth. The mother and her baby were discharged on the fifth day
post-delivery after the newborn was found to be normal on subsequent
examinations.