Non-trophoblastic tumours of the placenta

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

Non-Trophoblastic Tumours of the Placenta: Pathophysiology, Diagnosis and Management Le Vance J, Gurney L, Hodgetts Morton V. Non-trophoblastic tumours of the placenta: pathophysiology, diagnosis and management. TOG 2025;27:91– 103. doi:10.1111/tog.12970

~1% 1 in 3500–9000 8.2% PLACENTAS WITH CHORIOANGIOMA BIRTHS WITH ‘GIANT’ (>4CM) CHORIOANGIOMA IUFD RISK, EXPECTANT CHORIOANGIOMA (MICROSCOPIC) (95%CI 3.8–15.0%)

DO N' T-M IS S FA C TS

  1. Chorioangioma: ~1% of placentas; ‘giant’ (>4cm) in 1 in 3500–9000 births – complications mainly with tumours >4cm

  2. Severe fetal anaemia = MCA PSV >1.50 MoM; polyhydramnios is the commonest complication (14–28%)

  3. Avascular appearance on colour Doppler does NOT exclude chorioangioma diagnosis

  4. Expectant IUFD risk 8.2% vs 23.6% after in-utero intervention (higher-risk cases selected for intervention)

  5. All in-utero chorioangioma intervention should occur in a specialist fetal medicine centre with MDT/patient consensus

  6. PMD vs GTD: βhCG usually normal in PMD; karyotype PMD = 46,XX/XY, partial mole = triploid – avoid erroneous termination

  7. Teratoma vs fetus acardius amorphus: look for a rudimentary umbilical cord and axial skeletal organisation (present only in amorphus)

  8. Placental metastasis carries 81% maternal mortality; melanoma, lung and gastric cancer are the commonest primaries

TUMOUR COMPARISON AT A GLANCE

Chorioangioma – commonest, most complications if >4cm

Teratoma, leiomyoma, hepatocellular adenoma – rare, usually incidental/benign course PMD – 1/3 FGR, 1/3 IUFD risk, mimics GTD

ABBREVIATION KEY

PMD — placental mesenchymal dysplasia HELLP — haemolysis, elevated liver enzymes, low platelets

GTD — gestational trophoblastic disease MDT — multidisciplinary team

FGR — fetal growth restriction EMCS/ELCS — emergency/elective caesarean section

IUFD — intrauterine fetal death NVD — normal vaginal delivery

MCA PSV — middle cerebral artery peak systolic velocity TOP — termination of pregnancy

MoM — multiples of the median 3D — three-dimensional

AFP — alpha fetoprotein MRI — magnetic resonance imaging

βhCG — beta human chorionic gonadotropin SSFSE — single-shot fast spin-echo sequence

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — management. TOG 2025;27:91–103. doi:10.1111/tog.12970

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