Prenatal sonographic findings and management of placental mesenchymal dysplasia

Abstract

Placental mesenchymal dysplasia (PMD) is a rare disorder of the placenta characterized by placentomegaly with di fuse hydropic stem villous, aneurysmally dilated vessels, and lack of trophoblastic proliferation. Case: The prenatal ultrasound of a 34-year-old woman (G1P0) at 33 weeks of gestation showed an enlarged placenta with multiple cystic lesions, heterogeneous echoes with no active blood low, and fetal growth restriction (FGR). The di ferential diagnosis involved partial mole, placental hemorrhage, and PMD. She developed preeclampsia at 38 weeks of gestation and gave birth to a normally formed, growth-restricted baby. The placenta, weighing 785 g, showed scattered cystic vesicles in the parenchyma. The histology shows enlarged edematous stem villi with occasional cistern formation and no area of chorioangioma or features of molar pregnancy. PMD associated fetal growth restriction was diagnosed. Conclusion: PMD has prenatal ultrasound result resembling those of partial mole, placental hemorrhage and chorioangioma, but the fetus is phenotypically normal. Nevertheless, fetal surveillance is essential.

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

“…Placental thickening with multicystic hypoechoic areas: "Swiss-cheese" or "moth-eaten placenta" appearance are classic manifestations diagnosed by ultrasound examination. In color Doppler (stained-glass appearance), different degrees of flow from aneurysmally dilated vessels in some cases of PMD are seen (Figure 3) (14). A B Fig.…”

“…a: Multicystic hypoechoic areas "swisscheese" or "moth-eaten placenta" appearance . b: Different degrees of flow from the aneurysmally dilated vessels (14) The diagnosis of PMD is often suspected in ultrasound evaluation but some laboratory findings such as serum human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP), karyotype analysis, and color Doppler sonography can assist in the diagnosis of PMD (15).…”