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Chorioangioma and toxemia of pregnancy
COMMUNICATIONS IN BRIEF
Chorioangioma pregnancy* H.
and
ALEXANDER
toxemia
HEGGTVEIT,
ROBERTO
DE
ANDREAS
J,
M.D.
CARVALHO, NUYENS,
features of the placenta were compatible with its age. Case 2. A 17-year-old white girl, gravida ii, para i, was admitted near term in a semicomatose condition with a blood pressure of 14O/IOO mm. Hg and +f++ albuminuria. The day prior to entry, her blood pressure had been 180/120 mm. Hg. She was treated with magnesium sulfate, went into labor, and was spontaneously delivered of a stillborn female infant weighing 5 pounds, 3 ounces. The baby exhibited no external abnormalities; an autopsy was not performed. Following mild transitory visual and memory loss, the patient recovered completely. The placenta weighed 415 grams. Cut sections near one margin disclosed multiple, discrete and confluent, reddish brown nodules varying from 0.2 to 1.5 cm. in diameter (Fig. 2). These were irregularly distributed throughout the full thickness of the placenta over an area of 4 by 7 cm. Microscopically, the nodules were composed of anastomosing networks of capillary-like blood vessels separated by small amounts of loose mesenchymal stroma. The angiomatous nodules were covered by layers of trophoblast. Adjacent placental tissue manifested intervillous thrombosis and infarction consistent with its degree of maturation.
of
M.D. M.D.
Departments of Pathology, and Obstetrics and Gynecology, Ottawa General Hospital and University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada Chorioangioma,
while
encountered
rarely,
is the
most common placental tumor. About one third of the cases are associated with hydramnios, prematurity, antepartum or postpartum hemorrhage, uterine atony, dystocia, stillbirth, or major congenital anomalies. This report documents two examples of placental angioma associated with toxemia of pregnancy, a relationship which, to our knowledge, has not previously been emphasized. Case 1. A 2%year-old white woman developed hypertension and albuminuria during the latter part of the first pregnancy. Her blood pressure ranged from 130/90 to 160/100 mm. Hg and the urine contained + to +++ albumin. Peripheral edema was absent and the total weight gain was 14 pounds. Labor was induced at 38 weeks’ gestation and she was delivered of a normal 4 pound, 6 ounce, female infant. The postpartum course was uneventful. The 670 gram placenta contained a single, ovoid nodule, the size of a walnut, beneath the fetal surface (Fig. 1). Histologically, the nodule consisted of an interlacing meshwork of vascular spaces of various sizes, supported by variable amounts of fibrous connective tissue stroma. The edge of the angiomatous tissue was layered by trophoblast and surrounded by a peripheral sinus. External to this was a fibrous capsule carrying the nutrient vessels (Fig. 1). Otherwise the histologic
*Supported Foundation
in (Ko.
part i-3).
by a grant
from
the
Ontario
The incidence and pathologic aspects of chorioangioma have been considered in a previous report from this department.1 Although most lesions of this type occur singly and are situated on the fetal aspect of the placenta, they may be multiple and more widespread as in Case 2. Siddall? in a review of 131 cases of chorioangioma lists two instances from the older literature which were associated with eclampsia. We have been unable to find any other recorded examples of toxemia of pregnancy in conjunction with chorioangioma. The specific relationship, if any, of placental hemangioma to the pre-eclamptic or eclamptic state is obscure, and the association in these cases may simply be fortuitous. A chorioangioma acts as an arteriovenous fistula; fetal blood shunted through it returns unoxygenated to the fetus. The resultant anoxemia stimulates fetal excre-
Heart
291
292
Communications
Fig. 1. Case chorioangioma
1. Low-power (Trichrome
in brief
photomicrograph stain; x3).
of solitary
placental
has not been determined on the basis of these cases. Two examples of chorioangioma of the placenta associated with toxemia of pregnancy are described.
The
authors
wish
to Dr. Bruce Horner placenta and clinical
to express
their
appreciation
of Shawville, Quebec, data in Case 2.
for
the
REFERENCES
1. Karnauchow, P. N. : Obst. & Gynec. 9: 317, 1957. 2. Siddall, R. S.: A111. J. OBST. $ GYNEC. 8: 430, 554, 1924.
Multiple areas of endometriosis of the ectocervix and vagina
Fig. 2. Case 2. Gross photograph faces of placenta through area tosis.
of two cut surof chorioan,gioma-
tion of catabolic waste products, creasing amniotic osmotic pressure, dramnios.* Whether this mechanism, some substance elaborated by the lated in any way to the development
which by ininduces hyor possibly lesions, is reof toxemia,
P.
V.
DILTS,
R.
R.
GREENE,
JR.,
M.D., M.D.,
Department of Obstetrics Chicago Wesley Memorial Northwestern Uniuersity Chicago, Illinois
M.S. M.S.
and Gynecology, Hos@tal and Medical School,
This gravida ii, para ii, white married female, aged 29, was delivered of a 9 pound, 3 ounce, living male by primary cesarean section for ccphalopelvic disproportion in 1956. The adnexa were examined and found to be normal.
Chorioangioma pregnancy* H.
and
ALEXANDER
toxemia
HEGGTVEIT,
ROBERTO
DE
ANDREAS
J,
M.D.
CARVALHO, NUYENS,
features of the placenta were compatible with its age. Case 2. A 17-year-old white girl, gravida ii, para i, was admitted near term in a semicomatose condition with a blood pressure of 14O/IOO mm. Hg and +f++ albuminuria. The day prior to entry, her blood pressure had been 180/120 mm. Hg. She was treated with magnesium sulfate, went into labor, and was spontaneously delivered of a stillborn female infant weighing 5 pounds, 3 ounces. The baby exhibited no external abnormalities; an autopsy was not performed. Following mild transitory visual and memory loss, the patient recovered completely. The placenta weighed 415 grams. Cut sections near one margin disclosed multiple, discrete and confluent, reddish brown nodules varying from 0.2 to 1.5 cm. in diameter (Fig. 2). These were irregularly distributed throughout the full thickness of the placenta over an area of 4 by 7 cm. Microscopically, the nodules were composed of anastomosing networks of capillary-like blood vessels separated by small amounts of loose mesenchymal stroma. The angiomatous nodules were covered by layers of trophoblast. Adjacent placental tissue manifested intervillous thrombosis and infarction consistent with its degree of maturation.
of
M.D. M.D.
Departments of Pathology, and Obstetrics and Gynecology, Ottawa General Hospital and University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada Chorioangioma,
while
encountered
rarely,
is the
most common placental tumor. About one third of the cases are associated with hydramnios, prematurity, antepartum or postpartum hemorrhage, uterine atony, dystocia, stillbirth, or major congenital anomalies. This report documents two examples of placental angioma associated with toxemia of pregnancy, a relationship which, to our knowledge, has not previously been emphasized. Case 1. A 2%year-old white woman developed hypertension and albuminuria during the latter part of the first pregnancy. Her blood pressure ranged from 130/90 to 160/100 mm. Hg and the urine contained + to +++ albumin. Peripheral edema was absent and the total weight gain was 14 pounds. Labor was induced at 38 weeks’ gestation and she was delivered of a normal 4 pound, 6 ounce, female infant. The postpartum course was uneventful. The 670 gram placenta contained a single, ovoid nodule, the size of a walnut, beneath the fetal surface (Fig. 1). Histologically, the nodule consisted of an interlacing meshwork of vascular spaces of various sizes, supported by variable amounts of fibrous connective tissue stroma. The edge of the angiomatous tissue was layered by trophoblast and surrounded by a peripheral sinus. External to this was a fibrous capsule carrying the nutrient vessels (Fig. 1). Otherwise the histologic
*Supported Foundation
in (Ko.
part i-3).
by a grant
from
the
Ontario
The incidence and pathologic aspects of chorioangioma have been considered in a previous report from this department.1 Although most lesions of this type occur singly and are situated on the fetal aspect of the placenta, they may be multiple and more widespread as in Case 2. Siddall? in a review of 131 cases of chorioangioma lists two instances from the older literature which were associated with eclampsia. We have been unable to find any other recorded examples of toxemia of pregnancy in conjunction with chorioangioma. The specific relationship, if any, of placental hemangioma to the pre-eclamptic or eclamptic state is obscure, and the association in these cases may simply be fortuitous. A chorioangioma acts as an arteriovenous fistula; fetal blood shunted through it returns unoxygenated to the fetus. The resultant anoxemia stimulates fetal excre-
Heart
291
292
Communications
Fig. 1. Case chorioangioma
1. Low-power (Trichrome
in brief
photomicrograph stain; x3).
of solitary
placental
has not been determined on the basis of these cases. Two examples of chorioangioma of the placenta associated with toxemia of pregnancy are described.
The
authors
wish
to Dr. Bruce Horner placenta and clinical
to express
their
appreciation
of Shawville, Quebec, data in Case 2.
for
the
REFERENCES
1. Karnauchow, P. N. : Obst. & Gynec. 9: 317, 1957. 2. Siddall, R. S.: A111. J. OBST. $ GYNEC. 8: 430, 554, 1924.
Multiple areas of endometriosis of the ectocervix and vagina
Fig. 2. Case 2. Gross photograph faces of placenta through area tosis.
of two cut surof chorioan,gioma-
tion of catabolic waste products, creasing amniotic osmotic pressure, dramnios.* Whether this mechanism, some substance elaborated by the lated in any way to the development
which by ininduces hyor possibly lesions, is reof toxemia,
P.
V.
DILTS,
R.
R.
GREENE,
JR.,
M.D., M.D.,
Department of Obstetrics Chicago Wesley Memorial Northwestern Uniuersity Chicago, Illinois
M.S. M.S.
and Gynecology, Hos@tal and Medical School,
This gravida ii, para ii, white married female, aged 29, was delivered of a 9 pound, 3 ounce, living male by primary cesarean section for ccphalopelvic disproportion in 1956. The adnexa were examined and found to be normal.