Placental Chorangiocarcinoma a Specific Histological Pattern of Uncertain Incidence and Clinical Impact: Systematic Review of the Literature

Giant placental chorioangioma: A rare case report

INTRODUCTION AND IMPORTANCE

Chorioangioma is benign, non-trophoblastic vascular neoplasms of the placenta with an estimated incidence of 1 %. It originates from placental blood vessels. Giant chorioangiomas, larger than 4 cm in diameter, are rare with an incidence ranging between 1/3500 and 1/9000 pregnancies. Giant chorioangiomas easily detected by prenatal ultrasound and are associated with a series of pregnancy and fetal complications.

CASE PRESENTATION

A 34-year-old multigravida woman, with twin pregnancy presented with notation of reduced fetal movement. On sonographic examination, first fetus was Intrauterine Growth Restriction (IUGR), stage 1 and the second fetus was small-for gestational age and a well-defined, hypoechoic lesion with increased vascularity measuring 5.8 × 4.7 × 2.5 cm on the fetal surface of the placenta was seen. However, at 35 + 3 weeks, the patient presented with pain in the lower abdomen. Maternal vital signs were within normal ranges. On Physician team discussion, cesarean section was performed. Two female neonates weighing 2260 g and 2400 g were delivered, with normal APGAR scores and physical examinations. And physical examination. The placenta was sent to pathology laboratory. In histopathology numerous proliferative blood vessels was found that confirm with immunohistochemical analysis. Finally, the patient was diagnosed with placental chorioangioma.

DISCUSSION

Placental chorioangioma is a rare anomaly in villous capillary development, with uncertain pathogenesis. It is often linked to twin pregnancies, gestational diabetes, maternal hypertension, and female fetal sex. Prenatal sonographic scans are valuable for its identification, revealing a hypoechoic, highly vascular mass confirmed via Doppler ultrasound. In contrast, chorangiocarcinoma, a malignant placental tumor, comprises chorioangioma and proliferating trophoblast cells with distinct histological features. Close monitoring and sonographic evaluations are vital during pregnancy when managing chorioangioma, especially giant ones, known to cause various fetal and pregnancy complications. The decision-making process for delivery in cases of giant chorioangioma should consider fetal complications and gestational age. While some interventions like laser ablation are available, the challenging nature of the patient's response may warrant conservative management in certain instances.

CONCLUSION

We report a rare case of giant placental chorioangioma in a 34-year-old twin pregnant patient. Chorioangioma benign vascular neoplasms of the placenta may cause pregnancy and fetal complications.

A case series of chorioangiomas in placentas with clinical indication for histological examination

Chorioangiomas are benign angiomas arising from chorionic tissue and they are the most common non-trophoblastic tumors of the placenta, as they are observed in 1% of all placentas examined. Most chorioangiomas are small and asymptomatic, often undetected during a prenatal ultrasound, and their clinical significance is still unknown. Large chorioangiomas, measuring more than 4-5 cm in diameter, can usually be detected prenatally by gray-scale or color Doppler sonography, and may be associated with maternal or fetal complications, such as preeclampsia, maternal mirror syndrome, preterm delivery, nonimmune fetal hydrops, fetal growth restriction and fetal demise. We herein describe the clinical-pathological features of a monocentric series of 30 placental chorioangiomas and discuss their clinical-pathological features and possible molecular mechanisms underlying their development.

Long-term outcome and fertility results of intraplacental choriocarcinoma: a retrospective study of 14 patients and literature review

BACKGROUNDS

Intraplacental choriocarcinoma (IC) is an extremely rare subtype of gestational choriocarcinoma. The long-term follow-up and reproductive outcomes of IC patients remain unclear. Here, we report a series of 14 cases and conduct a literature review to assess the fertility and recurrence results of this rare disease.

RESULTS

Fourteen patients with pathologically confirmed IC treated in Peking Union Medical College Hospital between January 2002 and July 2022 were included in this study. Half of them had metastatic IC and were treated by chemotherapy with or without surgery. Only 1 patient had chemoresistant disease, but she achieved complete remission after immunotherapy. The median follow-up time was 45.5 months (range 4-192), and no recurrence occurred. One metastatic IC patient who achieved remission after chemotherapy had a full-term delivery. Among the 5 patients with fertility demands, 3 abandoned their pursuit of pregnancy because of "fear and worry about choriocarcinoma recurrence". We reviewed a total of 89 cases of IC in English and Chinese literature from 1963 to 2022, and only 5 cases with subsequent pregnancy were reported, all of them were nonmetastatic IC cases.

CONCLUSIONS

IC is sensitive to chemotherapy and has good long-term remission and a low recurrence rate. Patients with metastatic or nonmetastatic IC can have good pregnancy results after treatment. Doctors should pay more attention to the psychology of these patients.

CLINICAL TRIAL REGISTRATION

N/A.

Intraplacental Gestational Neoplasms: A Review of Clinically Relevant Diagnostically Challenging Lesions

CONTEXT.—

Case studies reporting intraplacental choriocarcinoma (IPC) and intraplacental "chorangiocarcinoma" have recently increased, with IPC also represented in molecular analyses of gestational trophoblastic neoplasms.

OBJECTIVE.—

To provide an overview of 2 intraplacental neoplastic lesions that can have a significant impact on both mother and fetus/infant, focusing on diagnostic characteristics, and ancillary and molecular tools that support diagnosis, determine prognosis, and further elucidate the nature of these lesions.

DATA SOURCES.—

Data were compiled from a PubMed literature review that included diagnostic and additional keywords within the scope of study for gestational choriocarcinoma in general. Illustrative cases were retrieved from the pathology archives at Michigan Medicine, including the consultation files of the author.

CONCLUSIONS.—

Intraplacental gestational tumors exist along the spectrum of benign (chorangioma) to aggressive malignant (choriocarcinoma) neoplasms with a high potential for metastasis. Although most gestational choriocarcinomas follow complete hydatidiform mole, 20% to 25% occur in association with normal intrauterine gestations, including rare cases in which they are detected within the placenta (IPC). IPCs range from asymptomatic to widely metastatic, with metastases possible even when only microscopic IPCs are present. A second, even less common lesion, variably called "chorangiocarcinoma" and chorangioma with atypical trophoblast proliferation, is also reviewed. The incidence of these lesions is likely to be underestimated. Heightened suspicion and more liberal placental sampling, particularly when specific clinical features are present, may result in higher detection. Enhanced detection to provide the earliest intervention for both mother and infant may improve prognosis, particularly for asymptomatic disease that may later present with metastasis.

Maternal and fetal outcomes of intraplacental choriocarcinoma complicated by fetomaternal hemorrhage: a systematic review

INTRODUCTION

Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH.

MATERIALS AND METHODS

We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched.

RESULTS

The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described.

DISCUSSION

The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis.