Chorioangioma: Causes and Treatments

Chorioangioma is a rare vascular tumour of the placenta that can have significant implications for pregnancy outcomes. Although often benign, its presence can lead to complications that necessitate careful monitoring and management.

They are the most common type of placental tumour, yet they are still relatively rare, occurring in approximately 1% of pregnancies. The tumours are made up of blood vessels and connective tissue and can vary significantly in size. Small chorioangiomas often remain asymptomatic and are incidentally discovered during routine ultrasounds. Larger tumours, however, can lead to complications such as fetal anaemia, polyhydramnios, and preterm birth.

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Causes of Chorioangioma

Genetic and Environmental Factors

While the exact aetiology of chorioangioma remains unclear, several genetic and environmental factors may contribute to its development. Research suggests that genetic abnormalities in the placental tissue could predispose individuals to chorioangioma formation. Environmental factors, such as maternal smoking or exposure to certain chemicals, have also been implicated, although evidence is less conclusive.

Hormonal Influences

Hormonal changes during pregnancy might play a role in the development of chorioangiomas. Elevated levels of certain hormones could potentially stimulate the proliferation of vascular tissue within the placenta, contributing to tumour growth.

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Types of Chorioangioma

Chorioangiomas can be classified based on their size and potential impact on the pregnancy.

Small Chorioangiomas

These are typically less than 5 cm in diameter and asymptomatic. They are often discovered incidentally during routine prenatal ultrasounds and do not typically require intervention.

Large Chorioangiomas

Tumors larger than 5 cm are considered significant and may lead to complications. These tumours require close monitoring and, in some cases, intervention to manage associated risks.

Giant Chorioangiomas

Giant chorioangiomas exceed 10 cm in diameter and are associated with significant complications, including fetal growth restriction, hydrops fetalis, and even intrauterine fetal demise. These cases often necessitate multidisciplinary management.

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Symptoms and Diagnosis of Chorioangioma

Common Symptoms

The symptoms of chorioangioma depend largely on the size of the tumour. Smaller chorioangiomas are usually asymptomatic, while larger ones may present with:

Diagnosis

Chorioangiomas are typically diagnosed through prenatal ultrasound, where they appear as well-circumscribed, hypoechoic lesions within the placenta. Color Doppler imaging can further aid in diagnosis by highlighting the tumour's vascular nature. In some cases, MRI may be used to assess the extent of very large tumours.

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Chorioangioma Prognosis

The prognosis of chorioangioma largely depends on the size and impact of the tumour. Small, asymptomatic chorioangiomas generally have an excellent prognosis and do not affect pregnancy outcomes. Larger tumours, however, can pose significant risks to both the mother and the fetus, necessitating careful monitoring and management throughout the pregnancy.

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Treatment and Management of Chorioangioma

The management of chorioangioma depends on the size of the tumour and the presence of any complications.

Observation and Monitoring

For small, asymptomatic chorioangiomas, regular ultrasound monitoring is typically sufficient. This allows healthcare providers to track the tumour's growth and any potential impact on the fetus.

Interventional Procedures

In cases where the tumour is large and causing complications, interventional procedures may be necessary. These can include:

Delivery Planning

The timing and mode of delivery may be influenced by the presence of a large chorioangioma. In some cases, early delivery may be warranted to prevent further complications. The mode of delivery will depend on the tumour's size, location, and effect on the placental function.

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Chorioangioma Management During Pregnancy

Multidisciplinary Approach

Effective management of chorioangioma often requires a multidisciplinary approach involving obstetricians, neonatologists, and pediatric specialists. This team-based approach ensures comprehensive care and optimal outcomes for both the mother and the fetus.

Patient Education and Support

Educating patients about the condition, its potential complications, and the management strategies is crucial. Providing emotional support and counselling can help patients cope with the stress and uncertainty associated with a chorioangioma diagnosis.