October 13, 2010

PLAB Question 7

A primigravida has a single episode of vaginal bleeding in her third trimester. All investigations are normal and at term she goes on to have an uneventful normal vaginal delivery of a healthy infant.

Placental examination post-delivery demonstrates a normal sized placenta with a dark-red mass lesion on the fetal surface.

The likely diagnosis is:

a) placental migration
b) uterine myoma
c) Uterine rupture
d) choriocarcinoma
e) chorangioma
f) Vasa previa
g) subplacental abruptio placenta
h) subchorionic abruptio placenta
i) placenta accreta
j) placenta previa

The correct answer is E

This appearance is most typical of a benign neoplasm composed of small vascular channels--essentially a form of hemangioma known as a chorangioma (chorioangioma, placental angioma). These are focal fleshy, dark-red areas on the placenta. These benign hemangiomas occur in 1 percent of placentas.

While small chorioangiomas are usually of no clinical significance, large chorioangiomas are associated with fetal anemia, thrombocytopenia, hydrops, hydramnios, intrauterine growth retardation, prematurity and stillbirth.

The neoplasm's gross appearance can be variable, with a tan to yellow to white to red to brown appearance depending upon vascularity, fibrosis, and hemosiderin deposition. Most chorangiomas are small and of no clinical significance.

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