Iranian Journal of Pathology

Placental Mesenchymal Dysplasia Associated with Severe Intrauterine Growth Restriction: A Case Report

Document Type : Case Reports

Authors

Arshia Yazdani 1
Mohammad Ranaee 1
Sara Babazadeh 1
Fatemeh Shafizadeh 2

1 Department of Pathology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran

2 Department of Obstetrics and Gynecology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran

https://doi.org/10.30699/ijp.2023.548113.2828
Abstract
Placental mesenchymal dysplasia (PMD) is an uncommon placental lesion, which may mimic molar pregnancy at gross and microscopic examination. PMD can be associated with fetal growth restriction, Beckwith-Wiedemann syndrome, intrauterine fetal death, and preterm delivery. Nonetheless, it may also be associated with a normal appearing fetus.
Objective: We aimed to emphasize that clinicians, radiologists, and pathologists should be aware of PMD as one of the etiologies of intrauterine growth restriction (IUGR).
We presented the case of a 27-year-old gravida 1, para 1 woman who was admitted to Ayatollah Rouhani hospital, in Babol, Iran, at 30 weeks of gestation due to severe IUGR and fetal tachycardia. Ultrasound examination showed uteroplacental insufficiency and increased resistive index (RI) of umbilical artery. At last, a normal female fetus (1320 g) with no definitive anomalies was delivered by cesarean section. Pathological examination revealed cystically dilated stem villi with peripherally located thick-walled muscular stem vessels, and also stromal fibroblasts overgrowth in some stem villi. None of the examined sections revealed trophoblastic proliferation or stromal trophoblastic inclusion. The findings confirmed the diagnosis of PMD.
Careful radiological and pathological examination should be performed in the case of IUGR for ruling out the rare placental abnormalities, including PMD.

Keywords

Fetal growth retardation
Placenta
Placental disease
Vascular disease

Subjects

  1. Marusik C, Frykholm C, Ericson K, Wikstrom J, Axelsson O. Diagnosis of placental mesenchymal dysplasia with magnetic resonance imaging. Ultrasound Obstet Gynecol. 2017;49(3):410-2. [DOI:10.1002/uog.15930] [PMID]
  2. Toscano MP, Schultz R. Placental mesenchymal dysplasia: case report with gross and histological findings. Autops Case Rep. 2014;4(4):51-6. [DOI:10.4322/acr.2014.039] [PMID] [PMCID]
  3. Moscoso G, Jauniaux E, Hustin J. Placental vascular anomaly with diffuse mesenchymal stei villuos hyperplasia: a new clinico-pathological entity? Patho Res Pract. 1991;187(2-3):324-8. [DOI:10.1016/S0344-0338(11)80791-0] [PMID]
  4. Doroftei B, Neculai-Valeanu S, Simionescu G, Grab D, Plopa N, Anton E, et al. A case report of placental mesenchymal dysplasia: A rare case of a genetically normal fetus with severe intrauterine growth restriction. Medicine. 2019;98(8):e14554. [DOI:10.1097/MD.0000000000014554] [PMID] [PMCID]
  5. Eren Karanis MI, Zamani AG. Localized Placental Mesenchymal Dysplasia in Monochorionic Diamniotic Twin Placenta with Beckwith-Wiedemann Syndrome. Fetal Pediatr Pathol. 2022;41(4):657-64. [DOI:10.1080/15513815.2020.1865492] [PMID]
  6. Pham T, Steele J, Stayboldt C, Chan L, Benirschke K. Placental mesenchymal dysplasia is associated with high rates of intrauterine growth restriction and fetal demise: a report of 11 new cases and a review of the literature. Am J Clin Pathol. 2006;126(1):67-78. [DOI:10.1309/RV45HRD53YQ2YFTP] [PMID]
  7. Oliveira RC, Ferraz Z, Cerdeira C, Pina R. Placental Mesenchymal Dysplasia with Fetal Mosaicism-A Case Report. Clin Case Rep Int. 2017;1009.
  8. Kong Y, Zhang Y, Tang H, Chen X. Case series of placental mesenchymal dysplasia with live birth. Int J Clin Exp Med. 2020;6(1):1-4. [DOI:10.11648/j.ijcems.20200601.11]
  9. Pal S, Bose K, Ch Mondal P, Chakrabarti S, Sikder M. Placental Mesenchymal Dysplasia With Normal Fetus: A Rare Case Report. Iran J Pathol. 2017;12(3):307-10. [DOI:10.30699/ijp.2017.25856] [PMID] [PMCID]
  10. Guenot C, Kingdom J, De Rham M, Osterheld M, Keating S, Vial Y, et al. Placental mesenchymal dysplasia: an underdiagnosed placental pathology with various clinical outcomes. Euro J Obstet Gynecol Reprod Biol. 2019;234:155-64. [DOI:10.1016/j.ejogrb.2019.01.014] [PMID]
  11. Li H, Li L, Tang X, Yang F, Yang KX. Placental mesenchymal dysplasia: a case of a normal-appearing fetus with intrauterine growth restriction. Int J Clin Exp Pathol. 2014;7(8):5302-7.
  12. Umazume T, Kataoka S, Kamamuta K, Tanuma F, Sumie A, Shirogane T, et al. Placental mesenchymal dysplasia, a case of intrauterine sudden death of fetus with rupture of cirsoid periumbilical chorionic vessels. Diagn Pathol. 2011;6(1):38. [DOI:10.1186/1746-1596-6-38] [PMID] [PMCID]
  13. Sun Y, Zheng J, Jiang Z, Zhang L, Ding S, Liu X. Placental mesenchymal dysplasia in a normal female infant: a rare case report with follow-up. Int J Clin Exp Pathol. 2020;13(5):896.
  14. Luewan S, Chaksuwat P, Pongsuvareeyakul T, Tongsong T. Prenatal sonographic findings and management of placental mesenchymal dysplasia. Clin Exp Obstet Gynecol. 2021;48(2):439-43. [DOI:10.31083/j.ceog.2021.02.2194]
  15. Woo GW, Rocha FG, Gaspar-Oishi M, Bartholomew ML, Thompson KS. Placental mesenchymal dysplasia. Am J Obstet Gynecol. 2011;205(6):e3-5. [DOI:10.1016/j.ajog.2011.08.019] [PMID]
  16. Rosner-Tenerowicz A, Pomorski M, Fuchs T, Sliwa J, Zimmer-Stelmach A, Bek W, et al. Placental mesenchymal dysplasia and hepatic cyst. Ginekol Pol. 2020;91(12):779-80. [DOI:10.5603/GP.a2020.0129] [PMID]
  17. Kodera C, Aoki S, Ohba T, Higashimoto K, Mikami Y, Fukunaga M, et al. Clinical manifestations of placental mesenchymal dysplasia in Japan: A multicenter case series. J Obstet Gynaecol Res. 2021;47(3):1118-25. [DOI:10.1111/jog.14647] [PMID].
Iranian Journal of Pathology
Volume 18, Issue 2
Spring 2023
Pages 221-224

  • Receive Date 22 February 2022
  • Revise Date 29 May 2022
  • Accept Date 17 March 2023

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