True umbilical cord hemangioma with significant hemodynamic alterations, case report
20 September 2018 (online)
A 35-year-old woman, G4P2, was referred to our hospital after abnormal findings in a routine check-up at 27+2 weeks of gestation. An ultrasound examination revealed polyhydramnios and a highly vascularized, encapsulated neoplasm measuring 77 × 86 mm near the umbilical cord insertion. Admission to the hospital with a rapid growing tumor progression and fetal hemodynamic disturbances. Antenatal steroids were administrated at 28+2 weeks of gestation. Due to rapid tumor growth and sonographic signs of cardiac insufficiency a caesarean section was performed at 30+6 weeks of gestation. A preterm female weighing 1680 g with warning signs of heart failure, cardiomegaly, IRDS, hepatomegaly, and tricuspidal insufficiency was delivered. Mother and baby did well. The child did not require any further surgical interventions. Histologically, the placenta tumor showed mainly thin-walled, variable sized and dilated vascular channels without endothelian atypia or multilayering. The tumor was characterized as a true hemangioma of the umbilical cord.
A review of the literature shows that less than 50 placenta tumor cases have been reported. In our experience the hyperdynamic circulation caused by the rapidly tumor growth triggered hemodynamic compensation that in this case caused cardiomegaly, hepatomegaly and beginning cardiac insufficiency.