1
|
Sharma A, Gupta T, Rathore R, Chakraborty O. Placental mesenchymal disease masquerading as molar pregnancy with a favourable maternal and fetal outcome. BMJ Case Rep 2024; 17:e258296. [PMID: 38724211 PMCID: PMC11085982 DOI: 10.1136/bcr-2023-258296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Placental mesenchymal dysplasia (PMD) is an exceptionally rare placental anomaly characterised by placentomegaly and grape-like vesicles resembling partial mole on ultrasonography, yet it can coexist with a viable fetus. We present the case of a primigravida who presented at 22 weeks gestation with a suspected partial mole but with a normally growing fetus. The differential diagnoses considered included placental mesenchymal disease, partial mole and twin pregnancy with molar pregnancy. With normal beta HCG levels and prenatal invasive testing reports, a probable diagnosis of PMD was made, and after thorough counselling, the decision was made to continue the pregnancy. The pregnancy progressed until 37 weeks, culminating in the uneventful delivery of a 2.4 kg healthy male infant. Histopathology confirmed PMD. Early recognition and management of PMD pose significant challenges, given its rarity. Prenatal identification of PMD during both early and late gestation could avert unnecessary termination of pregnancy.
Collapse
Affiliation(s)
- Aparna Sharma
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanisha Gupta
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchi Rathore
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Oishika Chakraborty
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Soejima H, Hara S, Ohba T, Higashimoto K. Placental Mesenchymal Dysplasia and Beckwith-Wiedemann Syndrome. Cancers (Basel) 2022; 14. [PMID: 36428656 DOI: 10.3390/cancers14225563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Placental mesenchymal dysplasia (PMD) is characterized by placentomegaly, aneurysmally dilated chorionic plate vessels, thrombosis of the dilated vessels, and large grapelike vesicles, and is often mistaken for partial or complete hydatidiform mole with a coexisting normal fetus. Androgenetic/biparental mosaicism (ABM) has been found in many PMD cases. Beckwith-Wiedemann syndrome (BWS) is an imprinting disorder with complex and diverse phenotypes and an increased risk of developing embryonal tumors. There are five major causative alterations: loss of methylation of imprinting control region 2 (KCNQ1OT1:TSS-DMR) (ICR2-LOM), gain of methylation at ICR1 (H19/IGF2:IG-DMR) (ICR1-GOM), paternal uniparental disomy of 11 (pUPD11), loss-of-function variants of the CDKN1C gene, and paternal duplication of 11p15. Additional minor alterations include genetic variants within ICR1, paternal uniparental diploidy/biparental diploidy mosaicism (PUDM, also called ABM), and genetic variants of KCNQ1. ABM (PUDM) is found in both conditions, and approximately 20% of fetuses from PMD cases are BWS and vice versa, suggesting a molecular link. PMD and BWS share some molecular characteristics in some cases, but not in others. These findings raise questions concerning the timing of the occurrence of the molecularly abnormal cells during the postfertilization period and the effects of these abnormalities on cell fates after implantation.
Collapse
|
3
|
Aoki S, Higashimoto K, Hidaka H, Ohtsuka Y, Aoki S, Mishima H, Yoshiura KI, Nakabayashi K, Hata K, Yatsuki H, Hara S, Ohba T, Katabuchi H, Soejima H. Aberrant hypomethylation at imprinted differentially methylated regions is involved in biparental placental mesenchymal dysplasia. Clin Epigenetics 2022; 14:64. [PMID: 35581658 PMCID: PMC9115938 DOI: 10.1186/s13148-022-01280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placental mesenchymal dysplasia (PMD) is a morphological abnormality resembling partial hydatidiform moles. It is often associated with androgenetic/biparental mosaicism (ABM) and complicated by Beckwith-Wiedemann syndrome (BWS), an imprinting disorder. These phenomena suggest an association between PMD and aberrant genomic imprinting, particularly of CDKN1C and IGF2. The existence of another type of PMD containing the biparental genome has been reported. However, the frequency and etiology of biparental PMD are not yet fully understood. RESULTS We examined 44 placental specimens from 26 patients with PMD: 19 of these were macroscopically normal and 25 exhibited macroscopic PMD. Genotyping by DNA microarray or short tandem repeat analysis revealed that approximately 35% of the macroscopic PMD specimens could be classified as biparental, while the remainder were ABM. We performed a DNA methylation analysis using bisulfite pyrosequencing of 15 placenta-specific imprinted differentially methylated regions (DMRs) and 36 ubiquitous imprinted DMRs. As expected, most DMRs in the macroscopic PMD specimens with ABM exhibited the paternal epigenotype. Importantly, the biparental macroscopic PMD specimens exhibited frequent aberrant hypomethylation at seven of the placenta-specific DMRs. Allelic expression analysis using single-nucleotide polymorphisms revealed that five imprinted genes associated with these aberrantly hypomethylated DMRs were biallelically expressed. Frequent aberrant hypomethylation was observed at five ubiquitous DMRs, including GRB10 but not ICR2 or ICR1, which regulate the expression of CDKN1C and IGF2, respectively. Whole-exome sequencing performed on four biparental macroscopic PMD specimens did not reveal any pathological genetic abnormalities. Clinical and molecular analyses of babies born from pregnancies with PMD revealed four cases with BWS, each exhibiting different molecular characteristics, and those between BWS and PMD specimens were not always the same. CONCLUSION These data clarify the prevalence of biparental PMD and ABM-PMD and strongly implicate hypomethylation of DMRs in the pathogenesis of biparental PMD, particularly placenta-specific DMRs and the ubiquitous GRB10, but not ICR2 or ICR1. Aberrant hypomethylation of DMRs was partial, indicating that it occurs after fertilization. PMD is an imprinting disorder, and it may be a missing link between imprinting disorders and placental disorders incompatible with life, such as complete hydatidiform moles and partial hydatidiform moles.
Collapse
Affiliation(s)
- Saori Aoki
- Division of Molecular Genetics and Epigenetics, Department of Biomolecular Sciences, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Ken Higashimoto
- Division of Molecular Genetics and Epigenetics, Department of Biomolecular Sciences, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.
| | - Hidenori Hidaka
- Division of Molecular Genetics and Epigenetics, Department of Biomolecular Sciences, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Yasufumi Ohtsuka
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Shigehisa Aoki
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Hiroyuki Mishima
- Department of Human Genetics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| | - Koh-Ichiro Yoshiura
- Department of Human Genetics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan
| | - Hitomi Yatsuki
- Division of Molecular Genetics and Epigenetics, Department of Biomolecular Sciences, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Satoshi Hara
- Division of Molecular Genetics and Epigenetics, Department of Biomolecular Sciences, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Takashi Ohba
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Hidenobu Soejima
- Division of Molecular Genetics and Epigenetics, Department of Biomolecular Sciences, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.
| |
Collapse
|
4
|
Mehedintu C, Frincu F, Ionescu O, Cirstoiu MM, Sajin M, Olinca M, Bratila E, Petca A, Carp-veliscu A. A Challenging Diagnosis: Placental Mesenchymal Dysplasia—Literature Review and Case Report. Diagnostics (Basel) 2022; 12:293. [PMID: 35204384 PMCID: PMC8871501 DOI: 10.3390/diagnostics12020293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
We describe a 22-year-old woman (2-gravid) case who was referred to our clinic at 18 weeks of gestation for a placenta with vesicular lesions discovered on prenatal examination routine. An ultrasound exam at 31 weeks of gestation showed numerous vesicular lesions, which gradually augmented as the pregnancy advanced. A live normal-appearing fetus was confirmed by intrauterine growth restriction (IUGR). The maternal serum β-human chorionic gonadotropin level remained in normal ranges. At some point, a multidisciplinary medical consensus considered the termination of the pregnancy, but the patient refused to comply. At 33 weeks of gestation, preterm premature rupture of membranes (pPROM) occurred, and she spontaneously delivered a 1600 g healthy female baby with a good long-term outcome. Placental mesenchymal dysplasia (PMD) was retrospectively diagnosed after confronting the data from ultrasound, chorionic villus sampling (CVS), amniocentesis, pathological examination, and immunohistochemical stain. The lack of sufficient reports of PMD determines doctors to be cautious and reserved, approaching these cases more radically than necessary. We reviewed this disease and searched for all cases of PMD associated with healthy, live newborns.
Collapse
|
5
|
Doroftei B, Neculai-Valeanu S, Simionescu G, Grab D, Plopa N, Anton E, Maftei R. A case report of placental mesenchymal dysplasia: A rare case of a genetically normal fetus with severe intrauterine growth restriction. Medicine (Baltimore) 2019; 98:e14554. [PMID: 30813167 PMCID: PMC6408077 DOI: 10.1097/md.0000000000014554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE We report a rare case of a pregnant woman with placental mesenchymal dysplasia (PMD) and intrauterine growth restriction (IUGR) with a genetically normal fetus. PATIENT CONCERNS A 42-year-old woman Gravida I, Para I with pre-existent uncontrolled hypertension and uterine polyfibromatosis present at 30 weeks of gestation for diminished fetal activity during the last 2 days. DIAGNOSIS Placental mesenchymal dysplasia associated with intrauterine growth restriction, hypertension, and uterine polyfibromatosis. INTERVENTION A live male infant was delivered by emergency caesarean section. OUTCOMES The infant, weighing 700 g, died 4 days after birth due to a massive intracerebral hemorrhage. LESSONS A careful examination should be done at every ultrasound in case of a fetus with IUGR to exclude some rare cases of placental pathologies. PMD can be a rare cause of IUGR with a genetically normal fetus.
Collapse
Affiliation(s)
- Bogdan Doroftei
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr. T. Popa” Iasi
- Clinical Hospital “Cuza Voda” Iasi
- Origyn Fertility Center Iasi
| | | | - Gabriela Simionescu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr. T. Popa” Iasi
- Clinical Hospital “Cuza Voda” Iasi
- Origyn Fertility Center Iasi
| | - Delia Grab
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr. T. Popa” Iasi
- Clinical Hospital “Cuza Voda” Iasi
- Origyn Fertility Center Iasi
| | - Natalia Plopa
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr. T. Popa” Iasi
- Clinical Hospital “Cuza Voda” Iasi
- Origyn Fertility Center Iasi
| | - Emil Anton
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr. T. Popa” Iasi
- Clinical Hospital “Cuza Voda” Iasi
| | - Radu Maftei
- Clinical Hospital “Cuza Voda” Iasi
- Origyn Fertility Center Iasi
- Department of Morphostructural Sciences I, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| |
Collapse
|
6
|
Guenot C, Kingdom J, De Rham M, Osterheld M, Keating S, Vial Y, Van Mieghem T, Jastrow N, Raio L, Spinelli M, Di Meglio L, Chalouhi G, Baud D. Placental mesenchymal dysplasia: An underdiagnosed placental pathology with various clinical outcomes. Eur J Obstet Gynecol Reprod Biol 2019; 234:155-164. [PMID: 30703717 DOI: 10.1016/j.ejogrb.2019.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Placental mesenchymal dysplasia (PMD) is a rare vascular and connective placental anomaly, which is often associated with severe fetal and/or maternal complications. The diversity of presentation of PMD challenges diagnosis and effective pregnancy management. OBJECTIVE We aimed to review cases presenting at 7 tertiary centers worldwide over the last decade and to study the occurrence of obstetric and neonatal complications. STUDY DESIGN Pathology databases from 7 tertiary hospitals were screened for cases of PMD (between 2007-2017). Pregnancy history, outcomes and ultrasound images were then reviewed for each case. RESULTS Twenty-two cases of PMD were identified. Mean gestational age at diagnosis was 23 weeks (16-39 weeks). Prenatal biochemical screening was abnormal in 8 cases (36%). Of the 12 cases that underwent invasive genetic testing, 4 were abnormal. Six patients (27%) developed maternal complications (preeclampsia/gestational hypertension). Fetal growth restriction was identified in 11 cases (50%) and fetal death in 4 (18%). Four (18%) pregnancies were terminated, 9/14 (64%) delivered preterm and only three (14%) progressed normally. Fourteen babies were born alive; 5 (35%) died in the first sixty-one days after birth, 5 (35%) had transient thrombopenia and 1 (7%) had developmental delay at last follow-up. Our series identified four potential new associations with PMD: placental triploidy mosaicism, CHARGE syndrome, fetal pleuropulmonary blastoma and fetal skeletal dysplasia. CONCLUSIONS PMD was substantially under-diagnosed before delivery in this cohort. Sonographers, fetal medicine specialists, obstetricians and pathologists should all suspect PMD in cases of an enlarged placenta and should look for fetal abnormalities. Diagnostic genetic testing should be discussed to exclude partial molar pregnancy. Close pregnancy follow-up is indicated due to the high risk of associated fetal or maternal adverse outcomes.
Collapse
Affiliation(s)
- Cécile Guenot
- Materno-Fetal and Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Lausanne, Switzerland
| | - John Kingdom
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Maud De Rham
- Materno-Fetal and Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Lausanne, Switzerland
| | - Maria Osterheld
- Institute of Pathology, University Hospital Centre, Lausanne, Switzerland
| | - Sarah Keating
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Yvan Vial
- Materno-Fetal and Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Lausanne, Switzerland
| | - Tim Van Mieghem
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada; Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Nicole Jastrow
- Department of Obstetrics and Gynecology, University Hospital, Geneva, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital, Bern, Switzerland
| | - Marialuigia Spinelli
- Department of Obstetrics and Gynecology, University Hospital, Bern, Switzerland; Department of Obstetrics and Gynecology, Private centre "diagnostica ecografica prenatale Aniello Di Meglio srl, Napoli, Italy
| | - Letizia Di Meglio
- Department of Obstetrics and Gynecology, Private centre "diagnostica ecografica prenatale Aniello Di Meglio srl, Napoli, Italy
| | - Gihad Chalouhi
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, Université Paris Sorbonne, Paris, France
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Lausanne, Switzerland.
| |
Collapse
|
7
|
Abstract
BACKGROUND/OBJECTIVES Multifocal infantile hemangiomas (MIHs; previously called neonatal hemangiomatosis) can be associated with extracutaneous hemangiomas. We observed different morphologic types of hemangiomas in children with MIHs and sought to find out whether they are related to the clinical course. METHODS This was a retrospective study of 103 infants with MIHs and a control group of 261 age-matched patients with solitary focal infantile hemangiomas (IHs) seen at an academic pediatric dermatology department between 2004 and 2014. RESULTS Two morphologic subtypes of hemangiomas were identified: miliary focal hemangiomas (MFHs; small, lens shaped) in 58 of 103 MIH patients (56.3%), and classical nonmiliary focal IHs (NMIHs; larger, irregularly shaped) in 17 of 103 patients (16.5%). MIHs featuring both types (mixed type) were observed in 28 of 103 patients (27.2%). MFH lesions were significantly smaller (mean 5.3 mm [range 1-20 mm] vs 22.0 mm [range 2-100 mm]), more numerous (23.4 ± 27.3 [range 5-175] vs 7.4 ± 2.8 [range 5-15] p < 0.001), and occurred up to an older age (6.0 ± 5.8 months [range 0-27 months] vs 3.8 ± 2.6 months [range 0-9 months]) than NMIHs. There was a weakly positive correlation between the number and presence of extracutaneous IHs in children with MFHs. Significantly more children with MIHs were delivered preterm than those with solitary IHs. CONCLUSIONS The number of IHs correlates inversely with their size. MFHs follow a clinical course different from that of classical IHs, are associated with prematurity, and may confer greater risk of extracutaneous hemangiomas. Miliary hemangiomas thus appear to present a separate IH subset requiring special attention.
Collapse
Affiliation(s)
- Antonia Reimer
- Department of Pediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Peter H Hoeger
- Department of Pediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| |
Collapse
|
8
|
|
9
|
Ishikawa S, Morikawa M, Yamada T, Akaishi R, Kaneuchi M, Minakami H. Prospective risk of stillbirth in women with placental mesenchymal dysplasia. J Obstet Gynaecol Res 2015; 41:1562-8. [DOI: 10.1111/jog.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/25/2015] [Accepted: 04/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Satoshi Ishikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Mamoru Morikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Takahiro Yamada
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Rina Akaishi
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Masanori Kaneuchi
- Department of Obstetrics and Gynecology; Nagasaki University Graduate School of Medicine; Nagasaki Japan
| | - Hisanori Minakami
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| |
Collapse
|
10
|
Jhun KM, Nassar P, Chen TS, Sardesai S, Chmait RH. Giant chorioangioma treated in utero via laser of feeding vessels with subsequent development of multifocal infantile hemangiomas. Fetal Pediatr Pathol 2015; 34:1-8. [PMID: 24941233 DOI: 10.3109/15513815.2014.925018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We report a case of a giant placental chorioangioma (15.6 cm diameter) complicated by polyhydramnios and severe fetal heart failure. Fetoscopic laser occlusion of a dominant feeding vessel was performed at 29 weeks' gestation and partial devascularization was achieved. In the 33rd week of the pregnancy, the decision was made to preemptively deliver the fetus due to persistent signs of fetal cardiac failure. After birth, the infant developed multifocal infantile hemangiomas with extracutaneous involvement. We posit that the development of infantile hemangiomas may be linked to the presence of the large chorioangioma. Further study is required to ascertain if fetal treatment of the chorioangioma may have been an exacerbating factor.
Collapse
Affiliation(s)
- Katrina M Jhun
- 1Department of Pediatrics, Division of Neonatal Medicine, Los Angeles County + University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | | | | | | |
Collapse
|
11
|
Selmin A, Foltran F, Chiarelli S, Ciullo R, Gregori D. An epidemiological study investigating the relationship between chorangioma and infantile hemangioma. Pathol Res Pract 2014; 210:548-53. [PMID: 24836731 DOI: 10.1016/j.prp.2014.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 04/08/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study aimed to verify whether the infantile hemangioma (IH) incidence in children whose placentas showed a chorangioma is higher than in the general population, thus addressing the hypothesized relationship between chorangioma and IH. METHODS All chorangioma diagnoses by the 1st Service of Pathology, University of Padova in 2004-2010, based on the analysis of placentas sent by the Department of Gynecological Sciences and Human Reproduction (University of Padova), were identified. Demographic, anamnestic and clinical data were collected from the mothers and newborns; mothers and pediatricians were interviewed by telephone within 1 year after birth to verify if any IH appeared. The incidence rates of IH and other adverse events (IUGR, preterm delivery, cesarean section, stillbirth) were compared with national and regional data, when available, or with estimates from the scientific literature. RESULTS Thirty-eight chorangioma diagnoses were found. Of 33 infants born with a placenta affected by chorangioma, 18 infants had IH. The IH incidence recorded in our series (55%) was significantly higher than that recorded in national and regional surveys and in the scientific literature. Similar findings have been observed for the incidence of stillbirth, preterm birth and low birth weight incidence. CONCLUSIONS The IH incidence observed in our series appears to be significantly higher than that recorded among the general population, suggesting that an association between placental chorangioma and IH could exist which should be further verified in prospective studies.
Collapse
Affiliation(s)
- Alessia Selmin
- Department for Women and Neonatal Care, Abano Terme General Hospital, Abano, PD, Italy
| | - Francesca Foltran
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | | | - Rosaria Ciullo
- Department for Mother and Pediatric Care, Obstetrics and Gynecology Clinic, A.O. 2, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
| |
Collapse
|
12
|
Chen CP, Su YN, Lin MH, Wang TY, Chern SR, Kuo YL, Chen YT, Wang W. Detection of altered methylation status at 11p15.5 and 7q32 in placental mesenchymal dysplasia. Taiwan J Obstet Gynecol 2014; 53:68-73. [DOI: 10.1016/j.tjog.2013.10.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/30/2022] Open
|
13
|
Chen CP, Hsu CY, Su YN, Wang TY, Chern SR, Su JW, Wang W. Placental mesenchymal dysplasia associated with antepartum hemorrhage, subchorionic hematoma, and intrauterine growth restriction. Taiwan J Obstet Gynecol 2013; 52:154-6. [PMID: 23548244 DOI: 10.1016/j.tjog.2013.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Chih-Ping Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
| | | | | | | | | | | | | |
Collapse
|
14
|
Qichang W, Wenbo W, Liangkai Z, Hui K, Xiaoqin H, Li S, Yasong X. Pregnancy with concomitant chorioangioma and placental mesenchymal dysplasia: a rare placental abnormality. Case Rep Obstet Gynecol 2013; 2013:591956. [PMID: 23840989 DOI: 10.1155/2013/591956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/07/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Pregnancy with concomitant chorioangioma and placental mesenchymal dysplasia (PMD) coexisting with a normal viable fetus is very rare. The literature was reviewed to explore the incidence and genetic origin of this condition. Case. The case was first identified by prenatal ultrasonography, but the prenatal diagnosis only included chorioangioma. PMD was then confirmed during postnatal evaluation, which included gross and histologic examination of the placenta. The macroscopic and microscopic findings were consistent with concomitant chorioangioma and placental mesenchymal dysplasia during pregnancy. Genetic findings confirmed genetic similarity of the chorioangioma and vesicle-like villi with the fetus. Conclusions. The case represents a rare placental abnormality whose pathogenesis and molecular basis need further research. Detailed histologic and genetic analyses are essential for accurate and differential diagnosis.
Collapse
|
15
|
Ventura F, Rutigliani M, Bellini C, Bonsignore A, Fulcheri E. Clinical difficulties and forensic diagnosis: Histopathological pitfalls of villus mesenchymal dysplasia in the third trimester causing foetal death. Forensic Sci Int 2013; 229:e35-41. [DOI: 10.1016/j.forsciint.2013.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
16
|
Nayeri UA, West AB, Grossetta Nardini HK, Copel JA, Sfakianaki AK. Systematic review of sonographic findings of placental mesenchymal dysplasia and subsequent pregnancy outcome. Ultrasound Obstet Gynecol 2013; 41:366-374. [PMID: 23239538 DOI: 10.1002/uog.12359] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe the sonographic features and pregnancy outcomes of placental mesenchymal dysplasia (PMD), an entity often misdiagnosed as molar pregnancy. METHODS We reviewed PMD cases from our institution and performed a systematic review of the existing literature. Inclusion criteria for the review were diagnosis of PMD as defined by placental pathology, description of placental morphology on antenatal ultrasound and reporting of pregnancy outcomes. RESULTS We found three cases of PMD at our institution. Patient 1 had elevated human chorionic gonadotropin (hCG) and an enlarged, hydropic placenta at 13 weeks, suggestive of a molar pregnancy. Patient 2 also had elevated hCG with large, vascular placental lakes on ultrasound suggesting placenta accreta or molar pregnancy. Case 3 involved placentomegaly and fetal anomalies suggestive of Beckwith-Wiedemann syndrome. From the literature review, 61 cases met the inclusion criteria. The most common sonographic features included enlarged (50%) and cystic (80%) placenta with dilated chorionic vessels. Biochemical aneuploidy screening abnormalities were relatively common as were fetal anomalies, Beckwith-Wiedemann syndrome and other genetic abnormalities. Pregnancy complications included intrauterine growth restriction (IUGR; 33%), intrauterine fetal death (IUFD; 13%), and preterm labor (33%). Pregnancies without fetal anomalies, IUGR, IUFD or preterm labor had normal neonatal outcomes despite PMD (9%). CONCLUSIONS The differential diagnosis of PMD includes molar pregnancy and other placental vascular anomalies. PMD is associated with adverse pregnancy outcome, so heightened surveillance with genetic evaluation, serial growth scans and third-trimester assessment of wellbeing should be considered. PMD must be differentiated from gestational trophoblastic disease because management and outcomes differ.
Collapse
Affiliation(s)
- U A Nayeri
- Department of Obstetrics and Gynecology, SUNY Upstate Medical University, Syracuse, NY 13202, USA.
| | | | | | | | | |
Collapse
|
17
|
Ohira S, Ookubo N, Tanaka K, Takatsu A, Kobara H, Kikuchi N, Ohya A, Kanai M, Shiozawa T. Placental Mesenchymal Dysplasia: Chronological Observation of Placental Images during Gestation and Review of the Literature. Gynecol Obstet Invest 2013; 75:217-23. [DOI: 10.1159/000350661] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 03/12/2013] [Indexed: 11/19/2022]
|
18
|
Papoutsis D, Mesogitis S, Antonakou A, Goumalatsos N, Daskalakis G, Papantoniou N, Papaspyrou I, Zirganos N, Antsaklis A. Partial molar pregnancy with a chromosomically and phenotypically normal embryo: presentation of an extremely rare case and review of literature. J Matern Fetal Neonatal Med 2011; 24:1289-93. [PMID: 21410424 DOI: 10.3109/14767058.2011.561892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We present an extremely rare case of partial molar pregnancy with a chromosomically and phenotypically normal embryo and review of the literature. A 31-year-old nulliparous was referred to us at 30 weeks of gestation due to absence of fetal movements and subsequent ultrasound examination revealed intrauterine demise. Prenatal amniocentesis due to raised maternal serum α-fetoprotein had shown a karyotypically normal female embryo and second trimester ultrasound demonstrated no anatomic abnormalities. Upon induction of labor with misoprostol, a phenotypically normal embryo was delivered and the placenta showed intermixed areas of marked hydatidiform villous change and normal parenchyma. Pathologic examination of the placenta confirmed the molar change of placenta. Two are the main theories discussed herein that explain the placental molar changes in singleton pregnancies: confined placental mosaicism (one case reported to date) and placental mesenchymal dysplasia (70 cases reported). Differential diagnosis is based on histopathologic features and genetic analysis of placenta.
Collapse
Affiliation(s)
- Dimitrios Papoutsis
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Hoeger PH, Maerker JM, Kienast AK, Syed SB, Harper JI. Neonatal haemangiomatosis associated with placental chorioangiomas: report of three cases and review of the literature. Clin Exp Dermatol 2009; 34:e78-80. [DOI: 10.1111/j.1365-2230.2009.03221.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
|
21
|
Vaisbuch E, Romero R, Kusanovic JP, Erez O, Mazaki-Tovi S, Gotsch F, Kim CJ, Kim JS, Yeo L, Hassan SS. Three-dimensional sonography of placental mesenchymal dysplasia and its differential diagnosis. J Ultrasound Med 2009; 28:359-368. [PMID: 19244073 PMCID: PMC2713740 DOI: 10.7863/jum.2009.28.3.359] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Placental mesenchymal dysplasia (PMD) is an uncommon vascular anomaly of the placenta characterized by mesenchymal stem villous hyperplasia. Its main sonographic feature is a thickened placenta with hypoechoic areas, and an accurate sonographic diagnosis is challenging. The aim of this study was to report 2 cases of PMD and discuss the differential diagnosis of its sonographic features. METHODS Cases of placental masses were studied by 2-dimensional (2D), 3-dimensional (3D), and color Doppler imaging. RESULTS In case 1, a thick placenta with multiple hypoechoic areas was noted at 13 weeks' gestation. At 19 weeks, the multicystic area, clearly demarcated from a normal-looking placenta, measured 6.5 x 8.5 cm and enlarged gradually. The patient gave birth to a 625-g female neonate after spontaneous labor at almost 26 weeks' gestation. In case 2, a first sonographic examination at 25 weeks' gestation revealed a thickened placenta with hypoechoic areas and a fetus with a single umbilical artery and a ventricular septal defect. At 27 weeks, the abnormal area of the placenta measured 14.5 x 7.5 cm. At 32 weeks' gestation, a caesarean delivery was performed because of a nonreassuring fetal heart tracing, and a 1415-g female neonate was delivered. Both cases were evaluated by 2D, 3D, and color Doppler imaging, and the pathologic features of both placentas were consistent with PMD. CONCLUSIONS Placental mesenchymal dysplasia should be considered in the differential diagnosis of every placental mass, especially in cases of multicystic placental lesion with lack of high-velocity signals inside the lesion, and a normal karyotype.
Collapse
Affiliation(s)
- Edi Vaisbuch
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Chong Jai Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jung-Sun Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
22
|
Allias F, Lebreton F, Collardeau-Frachon S, Azziza J, Pasquier CJ, Arcin-Thoury F, Patrier S, Devouassoux-Shisheboran M, Patrier S. Immunohistochemical expression of p57 in placental vascular proliferative disorders of preterm and term placentas. Fetal Pediatr Pathol 2009; 28:9-23. [PMID: 19116812 DOI: 10.1080/15513810802545350] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
P57 protein is implicated in some human imprinting disorders such as hydatiform mole and Beckwith-Wiedemann syndrome (BWS), both characterized by mesenchymal and vascular placental abnormalities. We investigated p57 immunohistochemical expression in placental vascular proliferative disorders of preterm and term placentas, including chorangiosis (n = 5), chorangiomatosis (n = 2), chorangiomas (n = 7), umbilical cord angioma (n = 1), and placental mesenchymal dysplasia (PMD) (n = 7). P57 was expressed in decidua, cytotrophoblast, intermediate trophoblast and stromal cells of normal terminal, intermediate and stem villi, umbilical cord, chorangiosis, chorangiomatosis, and chorangiomas. In contrast, there was a loss of p57 expression in stromal cells of dysplastic stem villi in all cases of PMD regardless of whether associated with BWS or not. P57 seems to be involved in the pathogenesis of a subset of placental vascular proliferative disorders in preterm and term placentas, such as PMD. The loss of p57 expression in PMD could be of diagnostic value in helping to distinguish this rare placental lesion from its mimickers.
Collapse
Affiliation(s)
- Fabienne Allias
- Service d'Anatomie et Cytologie Pathologiques, Hopital de la Croix-Rousse, Lyon, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Ang DC, Rodríguez Urrego PA, Prasad V. Placental mesenchymal dysplasia: a potential misdiagnosed entity. Arch Gynecol Obstet 2009; 279:937-9. [DOI: 10.1007/s00404-008-0812-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 09/25/2008] [Indexed: 11/25/2022]
|
24
|
Allias F, Lebreton F, Collardeau-frachon S, Vasiljevic A, Rossignol S, Massardier J, Huissoud C, Devouassoux-shisheboran M. La dysplasie mésenchymateuse du placenta. Ann Pathol 2008; 28:85-94. [DOI: 10.1016/j.annpat.2008.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2008] [Indexed: 11/24/2022]
|
25
|
Soma H, Osawa H, Oguro T, Yoshihama I, Fujita K, Mineo S, Kudo M, Tanaka K, Akita M, Urabe S, Kudo Y. P57kip2 immunohistochemical expression and ultrastructural findings of gestational trophoblastic disease and related disorders. Med Mol Morphol 2007; 40:95-102. [PMID: 17572845 DOI: 10.1007/s00795-007-0362-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
Gestational trophoblastic disease (GTD) is a unique spectrum of diseases ranging from complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), and invasive mole (IM) to choriocarcinoma (CC). Placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT) have been classified as related disorders. Mesenchymal dysplasia (MD) may be misdiagnosed as PHM; however, it is said to have a quite different histogenesis from PHM. P57kip2 is the protein product of a paternally imprinted or maternal gene that inhibits cyclin-dependent kinases (CDK), thus serving to inhibit cell proliferation and to suppress tumor growth. Its lack of expression in trophoblastic disease plays a role in its abnormal proliferation and differentiation. In this study, P57kip2 immunostaining was absent in the trophoblastic layers of CHM and was positive in the trophoblast layer of nonmolar villi and MD. Ultrastructure of complete molar cystic villi showed tree-like branching of microvillous processes and intracytoplasmic lacunae without capillaries in the stroma, whereas MD contained many newly formed blood vessels and collagen. Also, large lacunae with microvilli and polymorphic nuclei of syncytiotrophoblast cells with well-developed organelles were observed in IM. Lung ETT following CHM and normal deliveries showed two types of large mononuclear cells and binuclear cells with abundant organelles and bundles of intermediate-type filaments in the stroma.
Collapse
Affiliation(s)
- Hiroaki Soma
- Department of Obstetrics & Gynecology, Saitama Medical School, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, 350-0495, and chiba Hokuso Hospital, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Beckwith-Wiedemann syndrome (BWS, OMIM 130650) is characterized by macrosomia, macroglossia, visceromegaly, hemihypertrophy, abdominal wall defects, ear creases/pits, neonatal hypoglycemia, polyhydramnios, placentomegaly, placental mesenchymal dysplasia, cardiac defects, nevus flammeus, hemangiomata, and an increased frequency of embryonal tumors. This article provides an overview of BWS including the genetics, genetic diagnosis, genotype/epigenotype-phenotype correlations, association with assisted reproductive technology, and prenatal diagnosis. Omphalocele is an important sonographic marker for BWS. Prenatal detection of omphalocele, fetal overgrowth, polyhydramnios, increased abdominal circumference, placentomegaly and/or placental mesenchymal dysplasia should alert one to the possibility of BWS and prompt a genetic investigation and counseling for BWS.
Collapse
Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
27
|
Abstract
CONTEXT Placental mesenchymal dysplasia is characterized by placentomegaly and may be mistaken for molar pregnancy both clinically and macroscopically because of the presence of "grapelike vesicles." It may be associated with a completely normal fetus, a fetus with growth restriction, or a fetus with features of Beckwith-Wiedemann syndrome. OBJECTIVE To review the etiology, molecular pathology, gross and microscopic features, clinical presentation, complications, and differential diagnosis of placental mesenchymal dysplasia. DATA SOURCES The PubMed and the Medline databases were systematically searched for articles between 1970 and 2006. The following keywords were used: placental mesenchymal dysplasia, mesenchymal hyperplasia, molar pregnancy, pseudomolar pregnancy, Beckwith-Wiedemann syndrome, and placentomegaly. Relevant references from review articles were also searched. CONCLUSIONS Placental mesenchymal dysplasia should be considered in the differential diagnosis when the ultrasonographic findings show a cystic placenta. Close attention should be paid to fetal morphology for early recognition of fetal complications and to prevent unnecessary termination of pregnancy in cases associated with a normal fetus.
Collapse
Affiliation(s)
- Zahida Parveen
- University of Hawaii Pathology Residency Program, Honolulu, USA.
| | | | | | | | | |
Collapse
|
28
|
Abstract
Placental mesenchymal dysplasia is a very rare disorder in which the placenta is enlarged and contains cystic villi and dilated vasculature. The authors present a new case report of placental mesenchymal dysplasia with severe fetal growth restriction.
Collapse
Affiliation(s)
- Toshihiko Kinoshita
- Department of Obstetrics and Gynecology, Sakura Hospital, School of Medicine, Toho University, Chiba, Japan.
| | | | | | | |
Collapse
|
29
|
Carta M, Maresi E, Giuffrè M, Catalano G, Piro E, Siracusa F, Corsello G. Congenital hepatic mesenchymal hamartoma associated with mesenchymal stem villous hyperplasia of the placenta: case report. J Pediatr Surg 2005; 40:e37-9. [PMID: 15937805 DOI: 10.1016/j.jpedsurg.2005.02.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A newborn with an unusual association of hepatic mesenchymal hamartoma and mesenchymal stem villous hyperplasia of the placenta is presented. At birth, the large hepatic mass caused severe respiratory distress necessitating early surgical intervention. This report on the association of hepatic mesenchymal hamartoma and mesenchymal stem villous hyperplasia of the placenta strongly suggests a common pathogenetic origin of the 2 lesions.
Collapse
Affiliation(s)
- Maurizio Carta
- Dipartimento Materno Infantile, Università di Palermo, 90100 Palermo, Italy.
| | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVES To describe three cases of placental mesenchymal dysplasia (PMD) associated with abnormal karyotype and review the cases reported in the literature. METHODS The cases were retrieved from the files of three different institutions. A search of the English language literature was performed using Medline database. RESULTS Placental abnormalities suggestive of molar changes were seen on the prenatal ultrasound scans. Histologically, the cases had large, hydropic stem villi with myxomatous stroma, cistern formation and 'chorangiomatoid' changes. The placental and fetal karyotypes identified were trisomy 13 (47,XX,t(1:13)(q32;q32)+ 13); Klinefelter syndrome (47,XXY) and triploidy (69,XXX). Including these 3 cases, of 66 reported cases, 51 (78%) were female and 14 (22%) male (ratio 3.6:1); the karyotype was normal in 32/36 (89%) and abnormal in 4/36 (11%); Beckwith-Wiedemann syndrome was confirmed or suspected in 15/66 (23%). Excluding termination of pregnancies, intrauterine death occurred in 18/54 (33%) cases. CONCLUSION Molar ultrasonographic appearances associated with increased maternal serum alpha-fetoprotein but normal, or slightly elevated, levels of ss human Chorionic Gonadotrophin should raise the clinical suspicion of PMD. The diagnosis of this condition should not be disregarded when an abnormal fetus and/or an abnormal karyotype are demonstrated.
Collapse
Affiliation(s)
- Marta C Cohen
- Department of Histopathology, Sheffield Children's Hospital, Western Bank, Sheffield, UK.
| | | | | | | | | |
Collapse
|
31
|
Affiliation(s)
- Yuen F Chan
- Department of Anatomical Pathology, Royal Women's Hospital, Women's and Children's Health Care Network, Melbourne, Australia.
| | | |
Collapse
|
32
|
Abstract
Placental mesenchymal dysplasia is a rare condition of pregnancy that presents as macroscopic features of molar change in the placenta and normal karyotype fetus. These cases are often misdiagnosed as partial mole. We report a new case of mesenchymal dysplasia. A 27-year-old Japanese primigravida delivered an 820 g female baby (46XX karyotype) without congenital anomalies at 27 weeks gestation due to massive bleeding with placenta previa. The placenta had mimicking partial moles, grape-like vesicles and normal villi that diffusely occupied the area on the maternal surface of the placenta. Pathologically, enlarged stem villi contained loose, moderately cellular connective tissue with focal cistern-like formation, and peripherally located vessels. Abnormal trophoblastic proliferation and trophoblastic inclusions were not observed in any of the sections examined. Some villi contained chorioangiomatoid changes. The mother and child were followed up for more than 5 years and showed no sign of trophoblastic disease or Beckwith-Wiedemann syndrome features.
Collapse
Affiliation(s)
- Hideo Matsui
- Department of Obstetrics and Gynecology, Chiba University School of Medicine, Chiba, Japan.
| | | | | | | | | | | | | |
Collapse
|
33
|
Witters I, Van Damme MT, Ramaekers P, Van Assche FA, Fryns JP. Benign multiple diffuse neonatal hemangiomatosis after a pregnancy complicated by polyhydramnios and a placental chorioangioma. Eur J Obstet Gynecol Reprod Biol 2003; 106:83-5. [PMID: 12475589 DOI: 10.1016/s0301-2115(02)00163-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A male newborn with multiple cutaneous hemangiomatosis is described. Pregnancy was complicated by polyhydramnios and a large placental chorioangioma. After an initial outburst of the hemangiomas in the first two weeks of life, spontaneous and almost complete regression occurred before the age of 3 months. The relationship between hemangiomas and placental chorioangioma is briefly discussed.
Collapse
Affiliation(s)
- Ingrid Witters
- Department of Obstetrics and Gynecology, University of Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | | | | | | | | |
Collapse
|
34
|
Abstract
So far, 46 cases of placental mesenchymal dysplasia have been reported worldwide. We encountered 15 cases of placental mesenchymal dysplasia (PMD) including 7 cases delivered in our hospital. The incidence of PMD in our hospital was therefore, 7/30,758 (0.02%). The PMD had a peculiar appearance. In the gross findings, large placenta with intestine-like dilatation of the vessels on the fetal side was reported. Microscopically, cistern-like dilatation of the stem villi, fetal artery thrombosis, and villous hemorrhage were reported. However, we believe most of these findings are secondary rather than the primary of mesenchymal dysplasia. Therefore, we investigated 15 other cases of mesenchymal dysplasia, and found including vascular abnormality of the stem, intermediate and terminal villi in all case of PMD. The abnormality was observed in the vessels of the periphery of the stem villi and their vessel walls were thin and appeared weak. The intermediate villous vessels were unusual, tangled. The terminal villous abnormalities showed chorangiosis and stromal hyperplasia. These findings are mesenchymal dysplasia origin. Moreover, PMD showed female-predominant. 14/15 was female among our cases, We discuss the relationship between mesenchymal dysplasia and the X chromosome in this paper.
Collapse
Affiliation(s)
- Masayoshi Arizawa
- Department of Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
| | | |
Collapse
|
35
|
|
36
|
Kuwabara Y, Shima Y, Araki T, Shin S. Mesenchymal Stem Villous Hyperplasia of the Placenta and Fetal Growth Restriction. Obstet Gynecol 2001; 98:940-943. [DOI: 10.1097/00006250-200111001-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Abstract
A severe case of placental mesenchymal dysplasia occurred in association with intrauterine fetal death (IUFD). The gravida-1, para-1 mother was a 26-year-old Japanese. The first pregnancy was unremarkable and a healthy female infant was delivered. The present pregnancy had been uneventful until 34 weeks of gestation when IUFD was detected. The 1516-g (mean +/- SD, 2050 +/- 387 g) stillborn infant had no external abnormalities and the karyotype was 46,XX. The placenta was markedly enlarged (1050 g; mean +/- SD, 452 +/- 202 g), and approximately 80% was occupied by extraordinary enlarged villous structures with a myxoid appearance. Histologically, the dysplastic villi had myxoid stroma and a decreased number of, occasionally obliterated, fetal vessels. There was no abnormal trophoblastic proliferation. Large-sized fetal vessels in the chorionic plate frequently contained organized thrombi. This is the first case of placental mesenchymal dysplasia, which possibly lead to the IUFD.
Collapse
Affiliation(s)
- M Ohyama
- Division of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan.
| | | | | | | | | | | |
Collapse
|