Benign Tumors: Chorangiosis

  • Kurt Benirschke
  • Peter Kaufmann

Abstract

With rare exceptions, vascular tumors are the only benign tumors of the placenta. Tumors designated chorioangiomas, chorangiomas, fibroangiomyxomas, fibromas, and the many other names that have been applied in the past are essentially similar, relatively common neoplasms of the placenta. Three large reviews have been published that bring together most of the literature. DeCosta et al. (1956) found about 250 case reports and listed all the synonyms applied previously. They also made reference to the frequency of hydramnios and associated fetal angiomas. Fox (1967), who also reviewed the often-confusing nomenclature, indicated that Clarke described the first such tumor in 1798. Since then, the review by Siddall (1924) encompassed 130 cases, that by Marchetti (1939) comprised 209 cases, and Fox traced another 127 cases. Fox accounted for 344 published cases and gave incidence figures of 1 in 9,000 to 1 in 50,000 placentas. When careful study of placentas is undertaken, the real prevalence may be as high as 1 in 100 pregnancies, according to some authors, although in our experience this number is excessive. Wallenburg (1971) provided 13 new cases and summarized publications between 1939 and 1970. His reported incidence in consecutively collected placentas was 1 in 117. These authors provided an extensive literature documentation that would be redundant to repeat. Soma et al. (1991) found that the tumor existed in 0.2% of placentas in Japanese women but was more common (2.5–7.6%) in the high-altitude population of Nepal. This figure is similar to the higher frequency of chorioangioma observed in placentas of women living at altitude by Reshetnikova et al. (1996). We have seen chorioangiomas associated with chronic vascular thrombi and elevated nucleated red blood cells (NRBCs) in the fetal circulation. Thus, an hypoxic stimulus is inferred to lead to excessive villous capillary proliferative stimulation. While still speculative, such angiogenesis may well be regulated by such vascular growth factors as demon-strated to occur in the placenta by Jackson et al. (1994). A more detailed consideration of the placental villous adaptation to hypoxia can be found in the contribution by Kaufmann et al. (1993).

Keywords

Benign Tumor Arteriovenous Fistula Hypobaric Hypoxia Placenta Previa Fetal Circulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adducci, J.E.: Chorioangioma of the placenta: causing fetal distress. Minn. Med. 58: 820–821, 1975.PubMedGoogle Scholar
  2. Ali, K.Z.M.: Stereological study of the effect of altitude on the trophoblast cell populations of human term placental villi. Placenta 18: 447–450, 1997.PubMedCrossRefGoogle Scholar
  3. Altshuler, G.: Chorangiosis: an important placental sign of neonatal morbidity and mortality. Arch. Pathol. Lab. Med. 108: 71–74, 1984.PubMedGoogle Scholar
  4. Arodi, J., Auslender, R., Atad, J. and Abramovici, H.: Case report: giant chorioangioma of the placenta. Acta Obstet. Gynecol. Scand. 64: 91–92, 1985.CrossRefGoogle Scholar
  5. Asadourian, L.A. and Taylor, H.B.: Clinical significance of placental hemangiomas. Obstet. Gynecol. 31: 551–555, 1968.PubMedGoogle Scholar
  6. Barry, F.E., McCoy, C.P. and Callahan, WP.: Hemangioma of the umbilical cord. Am. J. Obstet. Gynecol. 62: 675–680, 1951.PubMedGoogle Scholar
  7. Battaglia, F.C. and Woolever, C.A.: Fetal and neonatal complications associated with recurrent chorioangiomas. Pediatrics 41: 62–66, 1968.PubMedGoogle Scholar
  8. Benirschke, K.: Placenta pathology questions to the perinatologist. J. Perinatol. 14: 371–375, 1994a.PubMedGoogle Scholar
  9. Benirschke, K.: Obstetrically important lesions of the umbilical cord. J. Reprod. Med. 39: 262–272, 1994b.PubMedGoogle Scholar
  10. Benson, P.F. and Joseph, M.C.: Cardiomegaly in a newborn due to placental chorioangioma. Br. Med. J. 1: 102–105, 1961.PubMedCrossRefGoogle Scholar
  11. Burrows, S., Gaines, J.L. and Hughes, F.J.: Giant chorioangioma. Am. J. Obstet. Gynecol. 115: 579–580, 1973.PubMedGoogle Scholar
  12. Caldwell, C., Purohit, D.M., Levkoff, A.H., Garvin, A.J., Williamson, H.O. and Horger, E.O., III: Chorangiosis of the placenta with persistent transitional circulation. Am. J. Obstet. Gynecol. 127: 435–436, 1977.PubMedGoogle Scholar
  13. Cary, W.H.: Report of a well-authenticated case of sarcoma of the placenta. Am. J. Obstet. 69: 658–664, 1914.Google Scholar
  14. Cash, J.B. and Powell, D.E.: Placental chorioangioma: presentation of a case with electron-microscopic and immunochemical studies. Am. J. Surg. Pathol. 4: 87–92, 1980.PubMedGoogle Scholar
  15. Castaldo, F, Guariglia, L., Lanzone, A., Marana, R. and Plotti, G.: Tumori non trofoblastici della placenta. I: Tumori primitivi. Recenti Prog. Med. 70: 445–456, 1981.CrossRefGoogle Scholar
  16. Chan, K.W. and Leung, C.Y.: Recurrent multiple chorangiomas and intrauterine death. Pathology 20: 77–78, 1988.PubMedCrossRefGoogle Scholar
  17. Chazotte, C., Girz, B., Koenigsberg, M. and Cohen, W.R.: Spontaneous infarction of placental chorioangioma and associated regression of hydrops fetalis. Am. J. Obstet. Gynecol. 163: 1180–1181, 1990.PubMedGoogle Scholar
  18. Chen, K.T.K., Ma, C.K. and Kassel, S.H.: Hepatocellular adenoma of the placenta. Am. J. Surg. Pathol. 10: 436–440, 1986.PubMedCrossRefGoogle Scholar
  19. Cohen, M.I. and Sinclair, J.C.: Neonatal death from congestive heart failure associated with large cutaneous cavernous hemangioma. Pediatrics 32: 924–925, 1963.PubMedGoogle Scholar
  20. Cooper, A.G. and Bolande, R.P.: Multiple hemangiomas in an infant with cardiac hypertrophy: postmortem angiographie demonstration of the arteriovenous fistulae. Pediatrics 35: 27–35, 1965.PubMedGoogle Scholar
  21. Corcoran, C.J. and Murphy, E.C.: Rare bovine placental tumour—a case report. Vet. Rec. 77: 1234–1235, 1965.PubMedCrossRefGoogle Scholar
  22. Cox, J.N. and Chavrier, F.: Heterotopic adrenocortical tissue within a placenta. Placenta 1: 131–133, 1980.PubMedCrossRefGoogle Scholar
  23. Daniel, S.J. and Cassady, G.: Non-immunologic hydrops fetalis associated with a large hemangioendothelioma. Pediatrics 42: 829–833, 1968.Google Scholar
  24. Dao, A.H., Rogers, C.W. and Wong, S.W.: Chorioangioma of the placenta: report of 2 cases with ultrasound study in 1. Obstet. Gynecol. 57: 46S–49S, 1981.PubMedGoogle Scholar
  25. DeCosta, E.J., Gerbie, A.B., Andresen, R.H. and Gallanis, T.C.: Placental tumors: hemangiomas. With special reference to an associated clinical syndrome. Obstet. Gynecol. 7: 249–259, 1956.Google Scholar
  26. Dorman, S.L. and Cardwell, M.S.: Ballantyne syndrome caused by a large placental chorioangioma. Am. J. Obstet. Gynecol. 173: 1632–1633, 1995.PubMedCrossRefGoogle Scholar
  27. Doss, B.J., Vicari, J., Jacques, S.M. and Qureshi, F.: Placental involvement in congenital hepatoblastoma. Pediatr. Dev. Pathol. 1: 538–542, 1998.PubMedCrossRefGoogle Scholar
  28. Drut, R., Drut, R.M. and Toulouse, J.C.: Hepatic hemangioendotheliomas, placental chorioangiomas, and dysmorphic kidneys in Beckwith-Wiedemann syndrome. Pediatr. Pathol. 12: 197–203, 1992.PubMedCrossRefGoogle Scholar
  29. Dunn, R.I.S.: Haemangioma of the placenta (chorio-angioma). J. Obstet. Gynaecol. Br. Emp. 66: 51–57, 1959.PubMedCrossRefGoogle Scholar
  30. Earn, A.A. and Penner, D.W.: Five cases of chorioangioma. J. Obstet. Gynaecol. Br. Emp. 57: 442–444, 1950.PubMedCrossRefGoogle Scholar
  31. Eldar-Geva, T., Hochner-Celnikier, D., Ariel, I., Ron, M. and Yagel, S.: Fetal high output cardiac failure and acute hydramnios caused by large placental chorioangioma: case report. Br. J. Obstet. Gynaecol. 95: 1200–1203, 1988.PubMedCrossRefGoogle Scholar
  32. Fox, H.: Vascular tumors of the placenta. Obstet. Gynecol. Surv. 22: 697–711, 1967.PubMedCrossRefGoogle Scholar
  33. Fox, H.: Pathology of the Placenta. Saunders, London, 1978. Froehlich, L.A. and Housler, M.: Neonatal thrombocytopenia and chorangioma. J. Pediatr. 78: 516–519, 1971.Google Scholar
  34. Froehlich, L.A., Fujikura, T. and Fisher, R: Chorioangiomas and their clinical implications. Obstet. Gynecol. 37: 51–59, 1971.PubMedGoogle Scholar
  35. Greene, E.E. and Iams, J.D.: Chorioangioma: a case presentation. Am. J. Obstet. Gynecol. 148: 1146–1148, 1984.PubMedGoogle Scholar
  36. Heggtveit, H.A., de Carvalho, R. and Nuyens, A.J.: Chorioangioma and toxemia of pregnancy. Am. J. Obstet. Gynecol. 91: 291–292, 1965.PubMedGoogle Scholar
  37. Hirata, G.I., Masaki, D.I., O’Toole, M., Medearis, A.L. and Platt, L.D.: Color flow mapping and Doppler velocimetry in the diagnosis and management of a placental chorioangioma associated with nonimmune fetal hydrops. Obstet. Gynecol. 81: 850–852, 1993.PubMedGoogle Scholar
  38. Hsieh, C.-C. and Soong, Y.-K: Infarction of placental chorioangioma and associated regression of hydrops fetalis. Am. J. Obstet. Gynecol. 166: 1306, 1992.PubMedGoogle Scholar
  39. Hörmann, G.: Zur Systematik einer Pathologie der menschlichen Plazenta. Arch. Gynäkol. 191: 297–344, 1958.PubMedCrossRefGoogle Scholar
  40. Imakita, M., Yutani, C., Ishibashi-Ueda, H., Murakami, M. and Chiba, Y.: A case of hydrops fetalis due to placental chorioangioma. Acta Pathol. Jpn. 38: 941–945, 1988.Google Scholar
  41. Jackson, M.R., Mayhew, T.M. and Haas, J.D.: Morphometric studies on villi in human term placentae and the effects of altitude, ethnic grouping and sex of newborn. Placenta 8: 487–495, 1987.PubMedCrossRefGoogle Scholar
  42. Jackson, M.R., Carney, E.W., Lye, S.J. and Knox Ritchie, J.W.: Localization of two angiogenic growth factors (PDECGF and VEGF) in human placentae throughout gestation. Placenta 15: 341–353, 1994.PubMedCrossRefGoogle Scholar
  43. Jauniaux, E., Zucker, M., Meuris, S., Verherst, A., Wilkin, P. and Hustin, J.: Chorangiocarcinoma: an unusual tumour of the placenta: the missing link? Placenta 9: 607–613, 1988.PubMedCrossRefGoogle Scholar
  44. Kaufmann, R, Kohnen, G. and Kosanke, G.: Wechselwirkungen zwischen Plazentamorphologie und fetaler Sauerstoffversorgung. Gynäkologe 26: 16–23, 1993.PubMedGoogle Scholar
  45. Keenan, W.J. and Altshuler, G.: Massive pulmonary hemorrhage in a neonate. J. Pediatr. 86: 466–471, 1975.PubMedCrossRefGoogle Scholar
  46. Khalifa, M.A., Gersell, D.J., Hansen, C.H. and Lage, J.M.: Hepatic (hepatocellular) adenoma of the placenta: a study of four cases. Int. J. Gynecol. Pathol. 17: 241–244, 1998.PubMedCrossRefGoogle Scholar
  47. Kim, C.K., Benirschke, K. and Connolly, K.S.: Chorangioma of the placenta: chromosomal and electron microscopic studies. Obstet. Gynecol. 37: 372–376, 1971.PubMedGoogle Scholar
  48. King, C.R. and Lovrien, E.W.: Chorioangioma of the placenta and intrauterine growth failure. J. Pediatr. 93: 1027–1028, 1978.PubMedCrossRefGoogle Scholar
  49. Kirkbride, C.A., Bicknell, E.J. and Robl, M.G.: Hemangioma of a bovine fetus with a chorioangioma of the placenta. Vet. Pathol. 10: 238–240, 1073.CrossRefGoogle Scholar
  50. Klaften, E.: Chorionhaemangioma placentae. Z. Geburtshilfe Gynäkol. 95: 426–437, 1929.Google Scholar
  51. Knoth, M., Rygaard, J. and Hesseldahl, H.: Chorioangioma with hydramnios and intra-uterine fetal death. Acta Obstet. Gynecol. Scand. 55: 279–281, 1976.CrossRefGoogle Scholar
  52. Kosanke, G., Kadyrov, M., Korr, H. and Kaufmann, R: Maternal anemia results in increased proliferation in human placental villi. Trophoblast Res. 11: 339–357, 1998.Google Scholar
  53. Kühnel, R: Placental chorangioma. Acta Obstet. Gynecol. Scand. 13: 143–194, 1933.CrossRefGoogle Scholar
  54. Leblanc, A. and Carrier, C.: Chorio-angiome placentaire, angiomes cutanes et cholestase néonatale. Arch. Fr. Pédiatr. 36: 484 486, 1979.Google Scholar
  55. Limaye, N.S. and Tchabo, J.-G.: Asymptomatic thrombocytopenia associated with chorioangioma of placenta. Am. J. Obstet. Gynecol. 161: 76–77, 1989.PubMedGoogle Scholar
  56. Linder, D. and Gartler, S.M.: Glucose-6-phosphate dehydrogenase mosaicism: utilization as a cell marker in the study of leiomyomas. Science 150: 67–69, 1965.PubMedCrossRefGoogle Scholar
  57. Lopez, H.B.B. and Kristoffersen, S.E.: Chorioangioma of the placenta. Gynecol. Obstet. Invest. 28: 108–110, 1989.PubMedCrossRefGoogle Scholar
  58. Ludighausen, M.V. and Sahiri, I.: Chorangiome der Plazenten als Ursache wiederholter Totgeburten. Geburtsh. Frauenheilkd. 43: 233–235, 1983.CrossRefGoogle Scholar
  59. Mahmood, K.: Small chorioangiomas and small-for-gestational age baby. Am. J. Obstet. Gynecol. 127: 440–442, 1977.PubMedGoogle Scholar
  60. Majlessi, H.F., Wagner, K.M. and Brooks, J.J.: Atypical cellular chorangioma of the placenta. Int. J. Gynecol. Pathol. 1: 403–408, 1983.PubMedCrossRefGoogle Scholar
  61. Mandelbaum, B., Ross, M. and Riddle, C.B.: Hemangioma of the placenta associated with fetal anemia and edema: report of a case. Obstet. Gynecol. 34: 335–338, 1969.PubMedGoogle Scholar
  62. Marchetti, A.A.: A consideration of certain types of benign tumors of the placenta. Surg. Gynecol. Obstet. 68: 733–743, 1939.Google Scholar
  63. Mclnroy, R.A. and Kelsey, H.A.: Chorio-angioma (haemangioma of placenta) associated with acute hydramnios J. Pathol. Bacteriol. 68: 519–523, 1954.CrossRefGoogle Scholar
  64. von Meyenburg, H.: Über Hämangiomatosis diffusa placentae. Beitr. Pathol. Anat. Allg. Pathol. 70: 510–512, 1922.Google Scholar
  65. Müller, G. and Rieckert, H.: Beitrag zur Frage der Placentarinsuffizienz an Hand eines diffusen Chorangioms. Arch. Gynäkol. 204: 78–88, 1967.PubMedCrossRefGoogle Scholar
  66. Murray, D.E., Meyerowitz, B.R. and Hutter, J.J.: Congenital arteriovenous fistula causing congestive heart failure in the newborn. J.A.M.A. 209: 770–771, 1969.PubMedCrossRefGoogle Scholar
  67. Mutema, G. and Stanek, J.: Numerical criteria for the diagnosis of placental chorangiosis using CD34 immunostaining (abstract). Placenta 19:A-39,1998.Google Scholar
  68. Nuutinen, E.W., Puistola, U., Herva, R. and Koivisto, M.: Two cases of large placental chorioangioma with fetal and neonatal complications. Eur. J. Obstet. Gynecol. Reprod. Biol. 29: 315–320, 1988.PubMedCrossRefGoogle Scholar
  69. Philippe, E., Muller, G., Dehalleux, J.-M., Lefakis, P. and Gandar, R.: Le chorio-angiome et ses complications foetomaternelles. Rev. Fr. Gynécol. 64: 335–341, 1969.Google Scholar
  70. Reiner, L. and Fries, E.: Chorangioma associated with arterio- venous aneurysm. Am. J. Obstet. Gynecol. 93: 58–64, 1965.PubMedGoogle Scholar
  71. Reshetnikova, O.S., Burton, G.J. and Milovanov, A.P.: Hypoxia at altitude and villous vascularisation in the mature human placenta (abstract). Placenta 14: A62, 1993.CrossRefGoogle Scholar
  72. Reshetnikova, O.S., Burton, G.J. and Milovanov, A.P.: Effects of hypobaric hypoxia on the fetoplacental unit: the morphometric diffusing capacity of the villous membrane at high altitude. Am. J. Obstet. Gynecol. 171: 1560–1565, 1994.PubMedGoogle Scholar
  73. Reshetnikova, O.S., Burton, G.J. and Milovanov, A.P.: Increased incidence of placental chorioangioma in high-altitude pregnancies: hypobaric hypoxia as a possible etiological factor. Am. J. Obstet. Gynecol. 174: 557–561, 1996.PubMedCrossRefGoogle Scholar
  74. Santamaria, M., Benirschke, K., Carpenter, PM., Baldwin, V.J. and Pritchard, J.A.: Transplacental hemorrhage associated with placental neoplasms. Pediatr. Pathol. 7: 601–615, 1987.PubMedCrossRefGoogle Scholar
  75. Schulz-Hetzel, I.: Über das Chorioangiom. Arch. Gynäkol. 225: 131–146, 1978.PubMedCrossRefGoogle Scholar
  76. Sen, D.K.: Placental hypertrophy associated with chorangioma. Am. J. Obstet. Gynecol. 107: 652–654, 1970.PubMedGoogle Scholar
  77. Siddall, R.S.: Chorioangiofibroma (chorioangioma). Am. J. Obstet. Gynecol. 8:430–456, 554–568, 1924.Google Scholar
  78. Sieracki, J.C., Panke, T.W., Horvat, B.L., Perrin, E.V. and Nanda, B.: Chorioangiomas. Obstet. Gynecol. 46: 155–159, 1975.PubMedGoogle Scholar
  79. Soma, H., Satoh, M., Higashi, S., Ogura, H., Horikiri, H. and Hata, T.: Ultrastructure of choriocarcinoma. J. Clin. Electron Microsc. 24: 5–6, 1991.Google Scholar
  80. Stiller, A.G. and Skafish, P.R.: Placental chorangioma: a rare cause of fetomaternal transfusion with maternal hemolysis and fetal distress. Obstet. Gynecol. 67: 296–298, 1986.PubMedCrossRefGoogle Scholar
  81. Sulman, F.G. and Sulman, E.: Increased gonadotrophin production in a case of detachment of placenta due to placental haemangioma. J. Obstet. Gynaecol. Br. Emp. 56: 1033–1034, 1949.PubMedCrossRefGoogle Scholar
  82. Sweet, L., Reid, W.D. and Robertson, N.R.C.: Hydrops fetalis in association with chorioangioma of the placenta. J. Pediatr. 82: 91–94, 1973.PubMedCrossRefGoogle Scholar
  83. Wallenburg, H.C.S.: Chorioangioma of the placenta: thirteen new cases and a review of the literature from 1939–1970 with special reference to the clinical complications. Obstet. Gynecol. Surv. 26: 411–425, 1971.PubMedCrossRefGoogle Scholar
  84. Williams, J.T.: Angioma of the placenta: with pathological report and microphotography by Dr. Frank B. Mallory. Surg. Gynecol. Obstet. 32: 523–526, 1921.Google Scholar
  85. Wurster, D.H., Hoefnagel, D., Benirschke, K. and Allen, F.H.: Placental chorangiomata and mental deficiency in a child with 2/15 translocation; 46XX; t(2q-; 15q+). Cytogenetics 8: 389–399, 1969.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Kurt Benirschke
    • 1
  • Peter Kaufmann
    • 2
  1. 1.University Medical CenterUniversity of California, San DiegoSan DiegoUSA
  2. 2.Institut für Anatomie der Medizinischen FakultätRheinisch-Westfälische Technische Hochschule AachenAachenGermany

Personalised recommendations