Placenta

• Premature infant delivered at 31 weeks gestational age with hydrops and multifocal intestinal stenosis (Indian J Pathol Microbiol 2006;49:600)
• Premature male infant delivered at 32 weeks gestation with placentomegaly, cardiomegaly and microangiopathic hemolytic anemia and thrombocytopenia (Fetal Pediatr Pathol 2017;36:457)
• Newborn with multifocal chorangiomatosis with disseminated intravascular coagulopathy, hydrops and massive umbilical vein thrombosis (J Matern Fetal Neonatal Med 2022;35:4009)

Contributed by Shahrazad Saab, M.D.

Which of the following describes the lesion shown above?

1. A capillary proliferation localized to a group of contiguous primary stem villi
2. A localized capillary proliferation which when > 3 cm can result in polyhydramnios and intrauterine growth restriction
3. Enlarged villi with irregular contours, increased stroma, trophoblast inclusions and irregularly distributed arterioles, venules and capillaries
4. Foci of excessive capillary proliferation present at the edges of stem and intermediate villi that can be associated with advanced maternal age, preterm birth and multiparty
5. Multifocal or diffuse increase in villous diameter with increased stromal cellularity and the presence of nonperipheral villous capillaries

D. Foci of excessive capillary proliferation present at the edges of stem and intermediate villi that can be associated with advanced maternal age, preterm birth and multiparty. Answer A is incorrect because it describes localized chorangiomatosis (wandering chorangioma). Answer B is incorrect since it describes a giant chorangioma, which has a high prevalence of poor fetal outcomes related to polyhydramnios, intrauterine growth restriction, cardiomegaly, high output heart failure and fetal hydrops. Answer C is incorrect because it describes dysmorphic villi. Answer E is incorrect because it describes immature villi.

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Reference: Chorangiomatosis

Which of the following is true about multifocal chorangiomatosis?

1. Can be categorized as patchy or extensive
2. Can be seen in placentas of mothers living at high altitudes
3. Localized, nodular capillary proliferation
4. Placentas are enlarged with segmentally abnormal proximal villi showing stromal overgrowth and vascular abnormalities affecting small and large villous vessels

A. Can be categorized as patchy or extensive. Answer B is incorrect because it describes chorangiosis. Answer D is incorrect because it describes placental mesenchymal dysplasia. Answer C is incorrect because it describes chorangioma.

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Reference: Chorangiomatosis