Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 95-97  

Utility of reticulin stain in the diagnosis of a completely infarcted chorangioma


1 Department of Pathology, Kasturba Medical College, Manipal University, Mangalore, India
2 Department of Pathology, MS Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Web Publication22-Dec-2015

Correspondence Address:
Pooja K Suresh
Department of Pathology, Kasturba Medical College, Mangalore, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.167965

Rights and Permissions
  Abstract 

This report highlights the utility of the reticulin stain in a completely infarcted chorangioma that facilitated the diagnosis. The patient had normal spontaneous delivery with good neonatal outcome in spite of the large size of the chorangioma and the presence of hydramnios in the antenatal period which may perhaps be due to the complete infarction of the tumor.

Keywords: Chorangioma, infarction, reticulin stain


How to cite this article:
Sahu KK, Rau A, Suresh PK. Utility of reticulin stain in the diagnosis of a completely infarcted chorangioma . Med J DY Patil Univ 2016;9:95-7

How to cite this URL:
Sahu KK, Rau A, Suresh PK. Utility of reticulin stain in the diagnosis of a completely infarcted chorangioma . Med J DY Patil Univ [serial online] 2016 [cited 2020 Aug 9];9:95-7. Available from: http://www.mjdrdypu.org/text.asp?2016/9/1/95/167965


  Introduction Top


Chorangioma is a primary benign tumor of the placenta with predominantly vascular involvement. [1] Nowadays, chorangiomas have been referred to as a hamartoma-like, or a hyperplastic capillary lesion, rather than a true neoplasm. [2] It is the most frequent nontrophoblastic tumor of the placenta. The exact incidence is unknown; however, it is reported as 0.5-1% of all the microscopically examined placentas, and it accounts with clinical evidence of approximately 1:3500-9000 births. The tumor is not associated with maternal or fetal complications unless the size is more than 5 cm, or it is present near the umbilical cord insertion. Large chorangiomas may complicate pregnancy with hydramnios, postpartum bleeding, and delay in the intrauterine growth or congestive cardiac failure in the newborn. [3],[4] Here, we present a case of large completely infracted chorangioma without fetal complications. In spite of complete infarction of the chorangioma, a definitive diagnosis could be offered with the help of reticulin stain.


  Case Report Top


A 27-year-old full-term pregnant lady with gravida 3 para 2 living 2 came to the hospital for delivery. Ultrasonography at 36 weeks of gestation showed a normally growing fetus with a hyperechoic mass measuring 7 cm × 4 cm at the upper pole of the placenta and an increased liquor volume (polyhydramnios). The patient had spontaneous normal delivery without any maternal or fetal complications. A normal full term female baby of 2.75 kg weight and normal Apgar score was delivered. Placenta was expelled after 10 min and was sent for histopathological examination.

Macroscopically, placenta with the umbilical cord measured 17 cm × 14 cm × 4 cm and the umbilical cord measured 16 cm in length. Maternal surface of the placenta showed a well-circumscribed mass measuring 7 × 5 cm ×2 cm at the margin with gray outer surface. Cut surface was homogenous, yellowish white in color. There were two more, whitish areas in different places of the placenta.

Microscopic examination showed normal histology of the umbilical cord. Both the whitish areas showed infracted placental tissue. The mass showed completely infracted tumor composed of ghost cells forming small and large capillaries [Figure 1]a] with a peripheral rim of decidual tissue. Based on the site and the ultrasound findings, a diagnosis of infracted chorangioma was considered. As the tumor was completely infracted, reticulin stain was requested, in order to highlight the architectural pattern of the tumor. Reticulin stain showed loose lattice of reticulin fibers with no clear demarcation between the capillary basement membrane and the surrounding stroma [Figure 1]b] in contrast to the normal area that showed outlines of chorionic villi [Figure 1]c], thereby confirming the diagnosis of chorangioma.
Figure 1: (a) Infarcted tumor composed of ghost cells forming small and large spaces appearing as capillaries (H and E, ×400). (b) Loose lattice of reticulin fibers with no clear demarcation between capillary basement membrane and surrounding stroma (Reticulin stain, ×400). (c) Outlines of normal chorionic villi (Reticulin stain, ×400)

Click here to view


Both the mother and the baby were healthy and were discharged after 1-week of delivery.


  Discussion Top


Chorangiomas are a benign angioma arising from chorionic tissue. [4] They are usually solitary but occasionally multiple; the apparent recorded number being 25 discrete tumors. [5] Chorangiomas when small are of little consequence. However, multiple and large ones which are >5 cm can cause complications such as hydrops fetalis, preeclampsia, premature labor, fetomaternal transfusion, and increased maternal levels of alpha-fetoprotein in the serum. [6] Development of polyhydramnios is clearly related to the size of the chorangioma, for there have been no convincing reports of polyhydramnios complicating chorangiomas measuring <5 cm of diameter. It can induce antepartum bleeding either due to retroplacental hemorrhage or rupture of the vascular pedicle of a pedunculated tumor. [5] Unfavorable effects of chorangioma on the fetus are often noted like intrauterine death, prematurity, neonatal death, neonatal anemias, hydrops fetalis, and occasionally neonatal thrombocytopenia. [4],[5],[6]

The universal feature of chorangioma is an excessive proliferation of endothelial cells. Chorangiomas have increased consistency compared to adjacent tissues. They tend to be single, rounded, and reddish brown in color with preferred localization on the fetal side of the placental disk. There are three histological sub types of chorangioma namely angiomatous, cellular, and degenerative. Angiomatous type is the most insidious and the most common one. [1],[7] Fifty-five percent of chorangiomas are localized subchorially. [8] In our case, the chorangioma was of degenerative type due to complete infarction and had a good neonatal outcome with full term normal delivery. Occasionally, even the giant chorangioma can be asymptomatic or regress spontaneously due to thrombosis or tumor degeneration and giving a good neonatal outcome. [9],[10] Since the tumor in this case was completely infarcted, it was difficult to identify the lesion. Reticulin stain highlighted the pattern of chorangioma similar to the finding observed by Ogino and Redline [11] as infarction is a structured necrosis where the architecture of the tissue is maintained despite the death of its constituent cells. [12]

The differential diagnosis of chorangioma includes chorangiomatosis and chorangiosis. Placenta diffusely infiltrated by hemangiomatous tissue is called as chorangiomatosis. [5] According to Ogino and Redline, the chorangioma is similar to the localized form of chorangoimatosis in all ways. [11] Chorangiosis is a poorly defined term to describe an increased number of capillaries in an otherwise normal villi called as increased number of capillaries profile per villous profile. [13] The criterion for diagnosis is 10 or more villi in 10 fields, viewed under a ×10 objective, containing 10 or more fetal villi. [7] Chorangiosis was differentiated from chorangioma by reticulin stain in which each capillary had its own distinct basement membrane whereas in chorangioma capillaries are surrounded by loose bundles of reticulin fibers that are merged with the surrounding stroma. [11]


  Conclusion Top


Our case is unique in two ways. First, the neonatal outcome was very good in spite of the presence of giant chorangioma and polyhydramnios which may be due to the complete infarction of the tumor. Second, the reticulin stain helped for the definitive histopathological diagnosis of the lesion. Reticulin stain may, therefore, be useful in the characterization of a fully infracted lesion. In the newer generation of immunohistochemistry and other ancillary methods, the old histochemical staining method should also be tried since it is very economical to the patient, and it also aids in the diagnosis.

 
  References Top

1.
Rech F, Salernitano D, Patella A. Placental chorioangioma. Minerva Ginecol 2002;54:417-33.  Back to cited text no. 1
    
2.
Amer HZ, Heller DS. Chorangioma and related vascular lesions of the placenta - a review. Fetal Pediatr Pathol 2010;29:199-206.  Back to cited text no. 2
    
3.
García-Flores J, Vega-Malagón G, Vega-Malagón JA, Galván-Aguilera A, Salmón-Vélez F. Giant chorioangioma: Presentation of a case. Rev Med Inst Mex Seguro Soc 2005;43:503-6.  Back to cited text no. 3
    
4.
Fox H. Non-trophoblastic tumour of the placenta. In: Fox H, Wells M, editors. Haines and Taylor Obstetrical and Gynecological Pathology. 5 th ed. Edinburgh: Churchill Livingstone; 2003. p. 1449-63.  Back to cited text no. 4
    
5.
Kuhnel P. Placental chorioangioma. Acta Obstet Gynecol Scand 1933;13:143-5.  Back to cited text no. 5
    
6.
Dorman SL, Cardwell MS. Ballantyne syndrome caused by a large placental chorioangioma. Am J Obstet Gynecol 1995;173:1632-3.  Back to cited text no. 6
    
7.
Greene EE, Iams JD. Chorioangioma: A case presentation. Am J Obstet Gynecol 1984;148:1146-8.  Back to cited text no. 7
[PUBMED]    
8.
Guschmann M, Henrich W, Entezami M, Dudenhausen JW. Chorioangioma - New insights into a well-known problem. I. Results of a clinical and morphological study of 136 cases. J Perinat Med 2003;31:163-9.  Back to cited text no. 8
    
9.
Esen UI, Orife SU, Pollard K. Placental chorioangioma: A case report and literature review. Br J Clin Pract 1997;51:181-2.  Back to cited text no. 9
    
10.
Chazotte C, Girz B, Koenigsberg M, Cohen WR. Spontaneous infarction of placental chorioangioma and associated regression of hydrops fetalis. Am J Obstet Gynecol 1990;163:1180-1.  Back to cited text no. 10
    
11.
Ogino S, Redline RW. Villous capillary lesions of the placenta: Distinctions between chorangioma, chorangiomatosis, and chorangiosis. Hum Pathol 2000;31:945-54.  Back to cited text no. 11
    
12.
Walter JB, Talbot IC, editors. Cell response to injury. In: Walter and Israel General Pathology. 7 th ed. Edinburgh: Churchill Livingstone; 1996. p. 87-101.  Back to cited text no. 12
    
13.
Reshetnikova OS, Burton GJ, Milovanov AP, Fokin EI. Increased incidence of placental chorioangioma in high-altitude pregnancies: Hypobaric hypoxia as a possible etiologic factor. Am J Obstet Gynecol 1996;174:557-61.  Back to cited text no. 13
    


    Figures

  [Figure 1]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed1148    
    Printed17    
    Emailed0    
    PDF Downloaded147    
    Comments [Add]    

Recommend this journal