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Three-Dimensional Sonography of Placental Mesenchymal Dysplasia and Its Differential Diagnosis

Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland/ Detroit, Michigan USA (E.V., R.R., J.P.K., O.E., S.M.-T., F.G., C.J.K., J.-S.K., L.Y., S.S.H.); Departments of Obstetrics and Gynecology (E.V., J.P.K., O.E., S.M.-T., L.Y., S.S.H.) and Pathology (C.J.K., J.-S.K.), Wayne State University School of Medicine, Detroit, Michigan USA; and Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA (R.R.).

Address correspondence to Roberto Romero, MD, Perinatology Research Branch, NICHD/NIH/DHHS, Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4, Detroit, MI 48201, USA., E-mail: prbchiefstaff{at}med.wayne.edu

Objective. Placental mesenchymal dysplasia (PMD) is an uncommon vascular anomaly of the placenta characterized by mesenchymal stem villous hyperplasia. Its main sonographic feature is a thickened placenta with hypoechoic areas, and an accurate sonographic diagnosis is challenging. The aim of this study was to report 2 cases of PMD and discuss the differential diagnosis of its sonographic features. Methods. Cases of placental masses were studied by 2-dimensional (2D), 3-dimensional (3D), and color Doppler imaging. Results. In case 1, a thick placenta with multiple hypoechoic areas was noted at 13 weeks’ gestation. At 19 weeks, the multicystic area, clearly demarcated from a normal-looking placenta, measured 6.5 x 8.5 cm and enlarged gradually. The patient gave birth to a 625-g female neonate after spontaneous labor at almost 26 weeks’ gestation. In case 2, a first sonographic examination at 25 weeks’ gestation revealed a thickened placenta with hypoechoic areas and a fetus with a single umbilical artery and a ventricular septal defect. At 27 weeks, the abnormal area of the placenta measured 14.5 x 7.5 cm. At 32 weeks’ gestation, a caesarean delivery was performed because of a nonreassuring fetal heart tracing, and a 1415-g female neonate was delivered. Both cases were evaluated by 2D, 3D, and color Doppler imaging, and the pathologic features of both placentas were consistent with PMD. Conclusions. Placental mesenchymal dysplasia should be considered in the differential diagnosis of every placental mass, especially in cases of multicystic placental lesion with lack of high-velocity signals inside the lesion, and a normal karyotype.

Key Words: chorioangioma • complete hydatidiform mole and coexistent fetus • Doppler sonography • mesenchymal hyperplasia • pseudo partial mole • sonography

Abbreviations: BWS, Beckwith-Wiedemann syndrome • CMCF, complete mole with a coexistent fetus • FGR, fetal growth restriction • MCA, middle cerebral artery • PMD, placental mesenchymal dysplasia • PSV, peak systolic velocity • 3D, 3-dimensional • 2D, 2-dimensional