Skip to main content
SpringerLink
Log in

Multimodality imaging of placental masses: a pictorial review

  • Pictorial Essay
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Placental masses are uncommonly identified at the time of obstetric ultrasound evaluation. Understanding the pathologies presenting as placental masses is key for providing a differential diagnosis and guiding subsequent management, which may include additional imaging with magnetic resonance (MR) imaging. Potential benign entities include chorioangiomas and teratomas. Larger chorioangiomas can cause fetal cardiovascular issues from volume overload. Placental mesenchymal dysplasia has an association with fetal anomalies and detailed fetal evaluation should be performed when it is suspected. Identifying other cystic masses such as partial and complete moles is crucial to prevent erroneous pregnancy termination. This review addresses normal imaging appearance of the placenta on ultrasound and MR imaging and describes various trophoblastic and nontrophoblastic placental masses. Potential placental mass mimics including uterine contractions and thrombo-hematomas are also presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Elsayes KM, Trout AT, Friedkin AM, et al. (2009) Imaging of the placenta: a multimodality pictorial review. Radiographics 29(5):1371–1391. doi:10.1148/rg.295085242

    Article  PubMed  Google Scholar 

  2. Masselli G, Gualdi G (2013) MR imaging of the placenta: what a radiologist should know. Abdom Imaging 38(3):573–587. doi:10.1007/s00261-012-9929-8

    Article  PubMed  Google Scholar 

  3. Wallenburg HC (1939) Chorioangioma of the placenta. Thirteen new cases and a review of the literature from 1939 to 1970 with special reference to the clinical complications. Obstet Gynecol Surv 26(6):411–425

    Article  Google Scholar 

  4. Zalel Y, Weisz B, Gamzu R, et al. (2002) Chorioangiomas of the placenta: sonographic and Doppler flow characteristics. J Ultrasound Med 21(8):909–913

    PubMed  Google Scholar 

  5. Fan M, Mootabar H (2014) A rare giant placental chorioangioma with favorable outcome: a case report and review of the literature. J Clin Ultrasound . doi:10.1002/jcu.22187

    PubMed  Google Scholar 

  6. Achiron R (1992) Chorioangioma with hydrops in twins. Fetus 2(1):1–3

    Google Scholar 

  7. Eldar-Geva T, Hochner-Celnikier D, Ariel I, Ron M, Yagel S (1988) Fetal high output cardiac failure and acute hydramnios caused by large placental chorioangioma. Case report. Br J Obstet Gynaecol 95(11):1200–1203

    Article  CAS  PubMed  Google Scholar 

  8. Kung FT, Chen WJ, Hsu PH, et al. (1997) Large chorioangioma: antenatal color-flow Doppler ultrasonic imaging and its correlation with postpartum pathology. Experience of two cases. Acta Obstet Gynecol Scand 76(3):277–279

    Article  CAS  PubMed  Google Scholar 

  9. Nicolini U, Zuliani G, Caravelli E, et al. (1999) Alcohol injection: a new method of treating placental chorioangiomas. Lancet 353(9165):1674–1675. doi:10.1016/S0140-6736(99)00781-3

    Article  CAS  PubMed  Google Scholar 

  10. Lau TK, Yu SC, Leung TY, et al. (2005) Prenatal embolisation of a large chorioangioma using enbucrilate. BJOG 112(7):1002–1004. doi:10.1111/j.1471-0528.2005.00567.x

    Article  PubMed  Google Scholar 

  11. Bermudez C, Luengas O, Perez-Wulff J, et al. (2007) Management of a placental chorioangioma with endoscopic devascularization and intrauterine transfusions. Ultrasound Obstet Gynecol 29(1):97–98. doi:10.1002/uog.3903

    Article  CAS  PubMed  Google Scholar 

  12. Taori K, Patil P, Attarde V, Singh A, Rangankar V (2008) Chorioangioma of placenta: sonographic features. J Clin Ultrasound 36(2):113–115. doi:10.1002/jcu.20366

    Article  PubMed  Google Scholar 

  13. Jauniaux E, Ogle R (2000) Color Doppler imaging in the diagnosis and management of chorioangiomas. Ultrasound Obstet Gynecol 15(6):463–467. doi:10.1046/j.1469-0705.2000.00127.x

    Article  CAS  PubMed  Google Scholar 

  14. Eom HM, Kim YN, Choi BH, et al. (2016) Chorioamniotic membrane separation caused by the seromucinous collection from a placental chorioangioma. Obstet Gynecol Sci 59(3):233–237. doi:10.5468/ogs.2016.59.3.233

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kawamotoa S, Ogawa F, Tanaka J, Ban S, Heshiki A (2000) Chorioangioma: antenatal diagnosis with fast MR imaging. Magn Reson Imaging 18(7):911–914

    Article  CAS  PubMed  Google Scholar 

  16. Weinreb JC, Brown CE, Lowe TW, Cohen JM, Erdman WA (1986) Pelvic masses in pregnant patients: MR and US imaging. Radiology 159(3):717–724. doi:10.1148/radiology.159.3.3517956

    Article  CAS  PubMed  Google Scholar 

  17. Shimojo H, Itoh N, Shigematsu H, Yamazaki T (1996) Mature teratoma of the placenta. Pathol Int 46(5):372–375

    Article  CAS  PubMed  Google Scholar 

  18. Ahmed N, Kale V, Thakkar H, Hanchate V, Dhargalkar P (2004) Sonographic diagnosis of placental teratoma. J Clin Ultrasound 32(2):98–101. doi:10.1002/jcu.10231

    Article  PubMed  Google Scholar 

  19. Prashanth A, Lavanya R, Girisha KM, Mundkur A (2012) Placental teratoma presenting as a lobulated mass behind the neck of fetus: a Case Report. Case Rep Obstet Gynecol . doi:10.1155/2012/857230

    PubMed  PubMed Central  Google Scholar 

  20. Moscoso G, Jauniaux E, Hustin J (1991) Placental vascular anomaly with diffuse mesenchymal stem villous hyperplasia. A new clinico-pathological entity? Pathol Res Pract 187(2–3):324–328

    Article  CAS  PubMed  Google Scholar 

  21. Paradinas FJ, Sebire NJ, Fisher RA, et al. (2001) Pseudo-partial moles: placental stem vessel hydrops and the association with Beckwith–Wiedemann syndrome and complete moles. Histopathology 39(5):447–454

    Article  CAS  PubMed  Google Scholar 

  22. Kinoshita T, Fukaya S, Yasuda Y, Itoh M (2007) Placental mesenchymal dysplasia. J Obstet Gynaecol Res 33(1):83–86. doi:10.1111/j.1447-0756.2007.00480.x

    Article  PubMed  Google Scholar 

  23. Starikov R, Goldman R, Dizon DS, Kostadinov S, Carr S (2011) Placental mesenchymal dysplasia presenting as a twin gestation with complete molar pregnancy. Obstet Gynecol 118(2 Pt 2):445–449. doi:10.1097/AOG.0b013e3182161828

    Article  PubMed  Google Scholar 

  24. Mulch AD, Stallings SP, Salafia CM (2006) Elevated maternal serum alpha-fetoprotein, umbilical vein varix, and mesenchymal dysplasia: are they related? Prenat Diagn 26(8):659–661. doi:10.1002/pd.1436

    Article  PubMed  Google Scholar 

  25. Matsui H, Iitsuka Y, Yamazawa K, et al. (2003) Placental mesenchymal dysplasia initially diagnosed as partial mole. Pathol Int 53(11):810–813

    Article  PubMed  Google Scholar 

  26. Cohen MC, Roper EC, Sebire NJ, Stanek J, Anumba DO (2005) Placental mesenchymal dysplasia associated with fetal aneuploidy. Prenat Diagn 25(3):187–192. doi:10.1002/pd.1103

    Article  PubMed  Google Scholar 

  27. Pham T, Steele J, Stayboldt C, Chan L, Benirschke K (2006) 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 126(1):67–78. doi:10.1309/RV45-HRD5-3YQ2-YFTP

    Article  PubMed  Google Scholar 

  28. Francis B, Hallam L, Kecskes Z, et al. (2007) Placental mesenchymal dysplasia associated with hepatic mesenchymal hamartoma in the newborn. Pediatr Dev Pathol 10(1):50–54. doi:10.2350/06-03-0066.1

    Article  PubMed  Google Scholar 

  29. Vaisbuch E, Romero R, Kusanovic JP, et al. (2009) Three-dimensional sonography of placental mesenchymal dysplasia and its differential diagnosis. J Ultrasound Med 28(3):359–368

    PubMed  PubMed Central  Google Scholar 

  30. Kuwata T, Takahashi H, Matsubara S (2014) ‘Stained-glass’ sign for placental mesenchymal dysplasia. Ultrasound Obstet Gynecol 43(3):355. doi:10.1002/uog.13230

    Article  CAS  PubMed  Google Scholar 

  31. Jauniaux E, Nicolaides KH, Hustin J (1997) Perinatal features associated with placental mesenchymal dysplasia. Placenta 18(8):701–706

    Article  CAS  PubMed  Google Scholar 

  32. Marusik C, Frykholm C, Ericson K, Wikstrom J, Axelsson O (2016) Diagnosis of Placental Mesenchymal Dysplasia with a focus on magnetic resonance imaging (MRI). Ultrasound Obstet Gynecol . doi:10.1002/uog.15930

    PubMed  Google Scholar 

  33. Himoto Y, Kido A, Minamiguchi S, et al. (2014) Prenatal differential diagnosis of complete hydatidiform mole with a twin live fetus and placental mesenchymal dysplasia by magnetic resonance imaging. J Obstet Gynaecol Res 40(7):1894–1900. doi:10.1111/jog.12441

    Article  PubMed  Google Scholar 

  34. Eltorky M, Khare VK, Osborne P, Shanklin DR (1995) Placental metastasis from maternal carcinoma. A report of three cases. J Reprod Med 40(5):399–403

    CAS  PubMed  Google Scholar 

  35. Ferreira CM, Maceira JM, Coelho JM (1998) Melanoma and pregnancy with placental metastases. Report of a case. Am J Dermatopathol 20(4):403–407

    Article  CAS  PubMed  Google Scholar 

  36. Kume A, Morikawa T, Ogawa M, et al. (2014) Congenital neuroblastoma with placental involvement. Int J Clin Exp Pathol 7(11):8198–8204

    PubMed  PubMed Central  Google Scholar 

  37. Lurain JR (2010) Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol 203(6):531–539. doi:10.1016/j.ajog.2010.06.073

    Article  PubMed  Google Scholar 

  38. Aso K, Tsukimori K, Yumoto Y, et al. (2009) Prenatal findings in a case of massive fetomaternal hemorrhage associated with intraplacental choriocarcinoma. Fetal Diagn Therapy 25(1):158–162. doi:10.1159/000209201

    Article  Google Scholar 

  39. Liu J, Guo L (2006) Intraplacental choriocarcinoma in a term placenta with both maternal and infantile metastases: a case report and review of the literature. Gynecol Oncol 103(3):1147–1151. doi:10.1016/j.ygyno.2006.08.007

    Article  PubMed  Google Scholar 

  40. Jiao L, Ghorani E, Sebire NJ, Seckl MJ (2016) Intraplacental choriocarcinoma: systematic review and management guidance. Gynecol Oncol 141(3):624–631. doi:10.1016/j.ygyno.2016.03.026

    Article  CAS  PubMed  Google Scholar 

  41. Unsal MA, Guven S (2012) Complete hydatidiform mole coexisting with a live fetus. Clin Exp Obstet Gynecol 39(2):262–264

    CAS  PubMed  Google Scholar 

  42. Vimercati A, de Gennaro AC, Cobuzzi I, et al. (2013) Two cases of complete hydatidiform mole and coexistent live fetus. J Prenat Med 7(1):1–4

    PubMed  PubMed Central  Google Scholar 

  43. Piura B, Rabinovich A, Hershkovitz R, Maor E, Mazor M (2008) Twin pregnancy with a complete hydatidiform mole and surviving co-existent fetus. Arch Gynecol Obstet 278(4):377–382. doi:10.1007/s00404-008-0591-x

    Article  PubMed  Google Scholar 

  44. Faes T, Pecceu A, Van Calenbergh S, Moerman P (2012) Chorangiocarcinoma of the placenta: a case report and clinical review. Placenta 33(8):658–661. doi:10.1016/j.placenta.2012.04.012

    Article  CAS  PubMed  Google Scholar 

  45. Murtoniemi K, Pirinen E, Kahkonen M, Heiskanen N, Heinonen S (2009) Smooth muscle tumor of the placenta—an entrapped maternal leiomyoma: a case report. J Med Case Rep 3:7302. doi:10.4076/1752-1947-3-7302

    Article  PubMed  PubMed Central  Google Scholar 

  46. Fung TY, To KF, Sahota DS, et al. (2010) Massive subchorionic thrombohematoma: a series of 10 cases. Acta Obstet Gynecol Scand 89(10):1357–1361. doi:10.3109/00016349.2010.512656

    Article  PubMed  Google Scholar 

  47. Alanjari A, Wright E, Keating S, Ryan G, Kingdom J (2013) Prenatal diagnosis, clinical outcomes, and associated pathology in pregnancies complicated by massive subchorionic thrombohematoma (Breus’ mole). Prenat Diagn 33(10):973–978. doi:10.1002/pd.4176

    PubMed  Google Scholar 

  48. Kojima K, Suzuki Y, Makino A, Murakami I, Suzumori K (2001) A case of massive subchorionic thrombohematoma diagnosed by ultrasonography and magnetic resonance imaging. Fetal Diagn Therapy 16(1):57–60. doi:10.1159/000053882

    Article  CAS  Google Scholar 

  49. American College of O, Gynecologists’ Committee on Obstetric P (2016) Committee Opinion No. 656: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol 127(2):e75–e80. doi:10.1097/AOG.0000000000001316

    Article  Google Scholar 

  50. Expert Panel on MRS, Kanal E, Barkovich AJ, et al. (2013) ACR guidance document on MR safe practice. J Magn Reson Imaging 37(3):501–530. doi:10.1002/jmri.24011

    Article  Google Scholar 

  51. Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL (2016) Association between MRI exposure during pregnancy and fetal and childhood outcomes. Jama 316(9):952–961. doi:10.1001/jama.2016.12126

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California San Francisco, 4150 Clement St, Bldg 200, Rm 2A-166, San Francisco, CA, 94121, USA

    Priyanka Jha & Liina Poder

  2. Department of Radiology, Montefiore Medical Center, Bronx, NY, USA

    Viktoriya Paroder

  3. Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Winnie Mar

  4. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jeanne M. Horowtiz

Authors
  1. Priyanka Jha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Viktoriya Paroder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Winnie Mar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeanne M. Horowtiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liina Poder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Priyanka Jha.

Ethics declarations

Conflict of interest

None of the authors have any conflicts of interest to declare.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jha, P., Paroder, V., Mar, W. et al. Multimodality imaging of placental masses: a pictorial review. Abdom Radiol 41, 2435–2444 (2016). https://doi.org/10.1007/s00261-016-0919-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-0919-0

Keywords

Search

Navigation