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Year : 2010  |  Volume : 53  |  Issue : 2  |  Page : 378-379
Placental teratoma: A diagnostic dilemma with fetus acardius amorphous


1 Department of Pathology, Kasturba Medical College, Manipal, India
2 Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal, India

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Date of Web Publication12-Jun-2010
 

How to cite this article:
Kudva R, Monappa V, Rai L. Placental teratoma: A diagnostic dilemma with fetus acardius amorphous. Indian J Pathol Microbiol 2010;53:378-9

How to cite this URL:
Kudva R, Monappa V, Rai L. Placental teratoma: A diagnostic dilemma with fetus acardius amorphous. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Sep 22];53:378-9. Available from: http://www.ijpmonline.org/text.asp?2010/53/2/378/64293


Sir,

Primary non-trophoblastic tumors of the placenta are rare, the most common being chorangioma, having an incidence of about 1%. Placental teratomas are extremely rare, with less than 30 cases reported in the world literature. [1],[2] A 25-year-old female Gravida-2 Para-1 Living-1, at 36+ weeks gestational age was referred to our institute with a provisional diagnosis of polyhydramnios with fetal encephalocoele. Ultrasound (USG) scan revealed a singleton fetus with an echogenic mass close to the fetal head. Patient was taken up for elective cesarean section, with delivery of healthy female baby weighing 2.1 kg, with a normal Apgar score. Placenta weighed 250g and measured 15 x 12 x 4 cm; cut section was unremarkable. A trilobed mass measuring 5.5 x 5 x 3 cm and weighing 50g was attached to its margin by a pedicle. Cut section was solid, gelatinous and yellow with focal gritty and cystic areas [Figure 1] and [Figure 2]. Microscopically, placenta showed third trimester villi with hypoxic changes. Umbilical cord was normal. Mass attached to the placental membrane was lined by epidermis with attached adnexae. Deeper portion showed lobules of mature adipose tissue, stromal myxoid change, thick-walled blood vessels, lymphocyte aggregates, calcification and islands of cartilage and smooth muscle bundles [Figure 3]. Section from pedicle revealed two vascular channels (1 artery and 1 vein) covered only by fetal membranes without Wharton's jelly. Based on these observations, a final diagnosis of placental teratoma was made. The first case of placental teratoma was reported by Morville [2] in 1925. Various theories have been put forward regarding the histogenesis of this tumor, of which the 'Germ cell theory' has been most widely accepted. According to this theory, in the early stages of embryogenesis, the primitive gut evaginates into the umbilical cord, during which time primordial germ cells from the primitive gut migrate through the gut wall and are deposited in the connective tissue of the cord and eventually pass into connective tissue between amnion and fetal surface of placenta. [3],[4] These tumors range in size from 2 to 11 cm and usually lie between the placental membranes. They could also be attached to the placental membrane by a vascular pedicle as seen in this case. Prenatal recognition of placental teratoma is prognostically important because, unlike other placental tumors, it is benign, with no adverse effects on the fetus. However, the case reported by Fujikara, [2] showed multiple congenital anomalies. It can be diagnosed on prenatal USG on the basis of presence of tissue of varied echogenicity, such as calcification, fat and fluid. [5] Nevertheless, knowledge of this entity and clinicoradiological suspicion is of prime importance. In our case, it was erroneously considered to be encephalocoele; the varied echogenicity and its close approximation to the fetal head contributing to this delusion. The diagnostic challenge faced by pathologists is to differentiate placental teratomas from fetus acardius amorphous. Histopathologic evaluation - lack of umbilical cord, absence of large feeding vessels and totally disorganized skeletal development with lack of cranial and caudal ends and lack of axial development can validate the diagnosis. However, it still remains unresolved whether it is a true neoplasm or an extreme form of fetus acardius. Negative family history of twin gestation, USG findings of singleton gestation early in pregnancy and the awareness of this entity and its radiological features may prove very useful in arriving at the diagnosis. Scrutiny of the genetic sex and molecular alterations may provide further insight to the ongoing dilemma.

 
   References Top

1.Fox H, Sebire NJ. In: Pathology of placenta. MPP series. 3 rd ed. China: Elsevier; 2007. p. 412-4.  Back to cited text no. 1      
2.Anuradha K, Sindha T, Revadi PS, Pramod RM. A case report of placental teratoma: An unusual primary non-trophoblastic tumor of placenta. Indian J Pathol Microbiol 2005;48:223-4.  Back to cited text no. 2      
3.Joseph TJ, Vogt PJ. Placental teratomas. Obstet Gynecol 1973;41:574-8.  Back to cited text no. 3  [PUBMED]    
4.Gillet N, Hustin J, Magritte JP, Givron O, Longueville. Placental teratoma: differential diagnosis with acardiac fetus. J Gynecol Obstet Biol Reprod 2001;30:789-92.   Back to cited text no. 4      
5.Ahmed N, Kale V, Thakkar H, Hanchate V, Dhargalkar P. Sonographic diagnosis of placental teratoma. J Clin Ultrasound 2004;32:98-101.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Vidya Monappa
Department of Pathology, Basic Science Building, KMC, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.64293

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  [Figure 1], [Figure 2], [Figure 3]

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