PRENATAL DIAGNOSIS OF PLACENTAL TUMOR BY ULTRASOUND by Sangarappilai Asokan, MD; Krishna Chadalavada, MD; Rashmikant Gardi, MD and Vasantha Sastry, MD

ABSTRACT A case of placental chorioangioma is reported. To our knowledge, this is the first case diagnosed prenatally by ultrasonography. The complications of chorioangiomas include hydramnios, antepartum hemorrhage and premature labor, fetal demise, low birth weight and toxemia. CASE REPORT

A 29 year old female was admitteg with a diagnosis of intrauterine fetal demise. The pregnancy was greater than 32 weeks’ duration at the time of admission. The fetal heart sounds were not heard on examination. Ultrasonography revealed a single fetus. The fetal heartbeats could not be detected on the time motion mode. The placenta was located posteriorly, extending to the fundus. A 5 cm lesion with a complex echo pattern with cystic and solid areas was identified on the fetal surface of the placenta near the uterine fundus (Fig. 1). A placental tumor, most probably chorioangioma, was diagnosed. Hydramnios was also detected. Labor was induced with intraamniotic prostaglandin injection. Gross examination of the placenta revealed a placental tumor. Pathological examination confirmed the presence of a chorioangioma (Fig. 2). The stillborn child did not show any congenital abnormalities at autopsy. DISCUSSION

Placental tumors, apart from hydatidiform mole and chorioepithelioma, are thought t o be extremely uncommon (2). Chorioangioma is the most common benign placental tumor, with an incidence of one in 72 pregnancies. From the Division of Nuclear Medicine/Ultrasound, Christ Hospital, Oak Lawn, Illinois and the Departments of Radiology and Ob Gynecology, Cook County Hospital, Chicago, Illinois. For reprints contact: Sangarappilai Asokan, MD, Division of Nuclear Medicine/Ultrasound. Christ Hospital, 4 4 4 0 W. 95th Street, Oak Lawn, Illinois 60453. 180

FIGURE 1. Placental t u m o r (arrow) i s seen on the fetal surface of the placenta. Hydramnios ( A ) i s also noted.

Complications of placental tumors are varied ( 3 ) . Hydramnios can occur and can lead to premature labor. Large chorioangiomas, 4 to 5 cm, are associated with hydramnios in about 30% of cases. Antepartum hemorrhage can occur in 15 to 20% of the cases. This may be due t o premature separation of the placenta secondary to retroplacental bleeding from the tumor or rupture of the vascular pedicle of the tumor. Premature labor, which occurs in 10% of cases, is either due to hydramnios or anteparturn hemorrhage. Intrauterine death was reported several’ times. Death is mostly due to unrelated abnormalities of pregnancy, but could occasionally be secondary to a large tumor as a result of blood being shunted into the tumor at the expense of the fetus. I

Slightly higher incidence of preeclamptic toxemia has been observed. Large tumors together with hydramnios could impede the normal growth and development of the fetus.

2

JCU. Vol. 6 . 143-214 (1978). 0 1978, John Wiley and Sons, Inc., 0091-2751/78/0006-0180 $01.00.

REFERENCES

1. Sieracki JC, Panke TW, Horvat BL et al: Chorioangiomas: Obstet Gynecol 45:155,1975.

2. Fox H: Haemangiomata of placenta: J Clin Path (1966) 19,133.

FIGURE 2. Specimen showing placental t u m o r (arrow) on fetal surface.

V O L U M E 6. N U M B E R 3

3. DeCosta J E , Gerbie MD, Anderson RH e t al: Placental Tumors, hemangiomas: Obstet Gynecol 7:249,1956.

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