Large placental hemangioma diagnosed by ultrasonography-a case report

We present a case of large placental hemangioma comprising more than half of the organ and not causing feto-maternal complications. It appeared after 29 weeks of gestation. At 29 weeks an ultrasonography disclosed a normal placenta. At 35 weeks of gestation it measured 60 x 57 mm and appeared as a well delineated hypoechoic image. Delivery took place at 38 weeks by cesarean section and the child was normal.


P lacental hemangiomas (chorioangiomas)
occur in about 1% of placentas, but the majority of these tumors measure less than one centimeter and are not observed at inspection of the organ (3).
Large tumors are rare and may cause various clinical complications in the mother and fetus/newborn.Fetal cardiomegaly, congestive heart failure and hydropsy have been attributed to shunting of blood through the hemangioma.
Address for correspondence: Achilea Lisboa Bittencourt Hospital Prof. Edgard Santos -Univers.Federal da Bahia Servir;o de Anatomia Patol6gica Rua Joao das Botas sin, Canela SalvadorlBA -Brasil -CEP 40110-160 Other fetal complications associated with tumors, larger than 5 cm, are fetal growth retardation, anemia, thrombocytopenia, disseminated intravascular coagulation and hemangiomas in other fetal areas.These large tumors are generally accompanied by hydramnios, pre-eclampsia and premature delivery (2).
Hemangiomas in other tissues of the body are characterized by a very slow' growth and lack of capsulation.However, in the placenta, these tumors are capsulated and grow faster.In this paper, a case of a large placental hemangioma diagnosed by ultrasonography (US) that caused no disturbances in the mother and fetus is discussed.Ultrasonographically, the fetus presented normal biometrical parameters for the gestational age without cardiomegaly or hepatomegaly.Delivery took place at 38 weeks of gestation by cesarean section and was uneventful.

CASE REPORT
The male child was born weighing 3.420 g.Echocardiography and abdominal US of the newborn did not disclose cardiac or hepatic alterations and a hematological evaluation was normal.
The placenta weighed 500g and measured 18 x 13 cm.A large tumor measuring 6 x 6 cm bulged on the surface.It was subchorionic and presented a fleshy and red cut surface, well delineated by a thin capsule (Fig. 2).The umbilical cord was normal.Microscopically, the tumor consisted of small vessels within a myxedematous stroma (Fig. 3).It was delineated by a fibrous capsule and exhibited the aspect of a capillary hemangioma.The placental villi were normal for the gestational age, although they presented more capi Ilaries than is normally observed (chorioangiosis).
According to Philippe (5), placental hemangiomas generally appear after 30 weeks gestation.However, there are two reports of chorionangiomas diagnosed at 22 and 25 weeks by ultrasonography (1,4).In the present case, the tumor appeared after 29 weeks of gestation and showed a rapid growth, reaching .60 x 57 mm in less than six FIGURE 2 -Cut surface of the tumor showing a large and tumor surrounded by a thin capsule.weeks.' gestation, a routine ultasonography (US) yielded normal results.In the her first pregnancy she had provoked abortion.Her second pregnancy, three years ago, resulted in a term vaginal deli very of a healthy child.The course of the present pregnancy was uneventful until the 29th week, when she began to present uterine contractions.At this time, the US was normal.
She was recommended to rest and was treated with betamimetics (Brycanil).The tumor was subchorionic, close to the umbilical cord, and comprised more than half ofthe placental parenchyma.In spite of this, the chi ld was born without complications.
It was submitted to an echocardiograph ic study and to an abdominal ultrasonography in order to"search for cardiac enlargement and abdominal tumors, respectively, but no abnormalities were observed.In addition, no hemangiomas were seen in the newborn's skin.Probably, the chorioangiosis observed in the placental villi resulted from a compensatory mechanism because of the reduction of the functional parenchyma.
The present case is unusual because the very large placental hemangioma did not cause abnormalities in the conceptus, and the pregnancy was uneventful.
The ultrasonographic and placental examinations indicated a rapid growth of the hemangioma.

A
28-year-old woman, 03 PI, began to have prenatal care at eight weeks of gestation.In the 17th week of CHAGAS, K.; BITTENCOURT, A.; SANTANA, A.M.; TEIXEIRA, V. -Large placental hemangioma diagnosed by ultraspnography -when a 60 x 57 mm subchorionic lesion was visualized in an anterior placenta.It consisted of a well delineated hypoechoic image with a small echogenic round a.rea (Fig.I).The echographic diagnosis was hemangioma.

FIGURE 1 -FIGURE 3 -
FIGURE 1 -Ultrasonography shows a well-delineated hypoechoic image with a small echogenic round area at the left.