Successful Management of Giant Placental Chorangioma by Microcoil Embolization

Abstract

Optimal prenatal management of giant placental chorangioma (also known as chorioangioma, angiomyxoma, fibroangiomyxoma, or fibroma) has yet to be determined. Interventions intended to devascularize the tumor such as interstitial laser, bipolar coagulation, fetoscopic laser photocoagulation, and chemical embolization have met mixed results. We report a minimally invasive, extra-amniotic approach, technically similar to cordocentesis, of microcoil embolization of the feeding vessel. These percutaneously placed microcoils initiate clot formation at the site of insertion and are unable to migrate through the tumor, thereby minimizing fetal harm by downstream embolic phenomena. Intervention at 26 and 22 weeks resulted in intraoperative fetal loss in the former and vaginal delivery at term of a healthy neonate in the latter. Preoperative, intraoperative, and placental findings are highlighted. The ease and safety of this procedure may alter the risk–benefit equation toward earlier intervention with potentially better clinical outcomes.

Keywords

chorangioma - chorioangioma - coil embolization - fetal therapy

• References

• 1 Fan M, Skupski DW. Placental chorioangioma: literature review. J Perinat Med 2014; 42 (03) 273-279
• 2 Wu Z, Hu W. Clinical analysis of 26 patients with histologically proven placental chorioangiomas. Eur J Obstet Gynecol Reprod Biol 2016; 199: 156-163
• 3 Sepulveda W, Alcalde JL, Schnapp C, Bravo M. Perinatal outcome after prenatal diagnosis of placental chorioangioma. Obstet Gynecol 2003; 102 (5 Pt 1): 1028-1033
• 4 Hosseinzadeh P, Shamshirsaz AA, Javadian P. , et al. Prenatal therapy of large placental chorioangiomas: case report and review of the literature. AJP Rep 2015; 5 (02) e196-e202
• 5 Papaioannou GK, Evangelinakis N, Kourtis P, Konstantinidou A, Papantoniou N. Giant chorioangioma treated with interstitial laser coagulation. Ultrasound Obstet Gynecol 2017
• 6 Jones K, Tierney K, Grubbs BH, Pruetz JD, Detterich J, Chmait RH. Fetoscopic laser photocoagulation of feeding vessels to a large placental chorioangioma following fetal deterioration after amnioreduction. Fetal Diagn Ther 2012; 31 (03) 191-195
• 7 Lim FY, Coleman A, Polzin W. , et al. Giant chorioangiomas: perinatal outcomes and techniques in fetoscopic devascularization. Fetal Diagn Ther 2015; 37 (01) 18-23
• 8 Nicolini U, Zuliani G, Caravelli E, Fogliani R, Poblete A, Roberts A. Alcohol injection: a new method of treating placental chorioangiomas. Lancet 1999; 353 (9165): 1674-1675
• 9 Cheng YK, Yu SC, So PL, Leung TY. Ultrasound-guided percutaneous embolisation of placental chorioangioma using cyanoacrylate. Fetal Diagn Ther 2017; 41 (01) 76-79
• 10 Voon HY, Amin R, Kok JL, Tan KS. Call for caution: neonatal portal vein thrombosis following enbucrilate embolization of placental chorioangioma. Fetal Diagn Ther 2018; 43 (01) 77-80
• 11 Lau TK, Leung TY, Yu SC, To KF, Leung TN. Prenatal treatment of chorioangioma by microcoil embolisation. BJOG 2003; 110 (01) 70-73
• 12 Luks FI, Johnson A, Polzin WJ. ; North American Fetal Therapy Network. Innovation in maternal-fetal therapy: a position statement from the North American Fetal Therapy Network. Obstet Gynecol 2015; 125 (03) 649-652