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Abstract
PMD (Placental Mesenchymal Dysplasia) is a rare, benign cystic lesion of the placental stroma generally categorized by placentomegaly and enlargement of chorionic villi. It is significantly associated with severe intrauterine growth restriction and intrauterine fetal demise. We present a case of a 31-year-old gravida 2 para 1 with previous intrauterine fetal death at 28 weeks with no fetal movements. Post-fetal expulsion, the placenta was sent for histopathology, which reported placental mesenchymal dysplasia. It is imperative to do a careful examination of the placenta and exclude rare cases of placental pathologies. PMD is associated with severe IUGR with fetal demise.
PMD is a rare, benign, cystic disorder of the placenta. It is often misdiagnosed as a partial hydatidiform mole.[1] However, placental mesenchymal dysplasia is diploid in nature with normal trophoblast, while partial hydatidiform mole is triploid in nature with trophoblastic hyperplasia.
The incidence of PMD is 0.02% in pregnancies.[2] PMD is associated with severe fetal growth restriction or fetal demise.[3] In few reported cases of PMD, there is a correlation to a pathogenic heterozygous variant in one of the genes. Hence, genetic counselling is important for future pregnancy care.
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References
- Parveen Z, Tongson-Ignacio JE, Frasier CR, et al. Placental mesenchymal dysplasia. Arch Pathol Lab Med 2007;131:131–7. DOI: https://doi.org/10.5858/2007-131-131-PMD
- Arizawa M, Nakayama M. Suspected involvement of the X chromosome in placental mesenchymal dsyplasia. Congenit Anom 2002;42:309–17.
- Pham T, Steele J, Stayboldt C, et al. 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;126:67–78. DOI: https://doi.org/10.1309/RV45-HRD5-3YQ2-YFTP
- Gavanier D, Allias F, Huissoud C, et al. Ultrasound findings and clinical outcomes in 23 cases of placental mesenchymal dysplasia. J Repr Med 2017;62:366-75.
- Rosner-Tenerowicz A, Pomorski M, Fuchs T, et al. Placental mesenchymal dysplasia and hepatic cyst. Ginekol Polska 2020;91:779–80. DOI: https://doi.org/10.5603/GP.a2020.0129
- Lazebnik N. Placental mesenchymal dysplasia; current understanding of the sonographic, histologic, and molecular findings of a rare and challenging disorder. J Gynecol Womens Health 2020;18:1-10. DOI: https://doi.org/10.19080/JGWH.2020.18.555989
- Cubal A, Carvalho J, Faria B, et al. Placental mesenchymal dysplasia. Acta Obstet Ginecol Port 2015;9:235–40.
- Psarris A, Sindos M, Kourtis P, et al. Placental mesenchymal dysplasia: ultrasound characteristics and diagnostic pitfalls. Ultrasound Int Open 2020;6:E2–3. DOI: https://doi.org/10.1055/a-1180-9571
- Rohilla M, Siwatch S, Jain V, et al. Placentomegaly and placental mesenchymal dysplasia. BMJ Case Rep 2012;2012. DOI: https://doi.org/10.1136/bcr-2012-007777
- Colpaert RM, Ramseyer AM, Luu T, et al. Diagnosis and management of placental mesenchymal disease. A review of the literature. Obstet Gynecol Surv 2019;74:611-22.
- Højberg KE, Aagaard J, Henriques U, et al. Placental vascular malformation with mesenchymal hyperplasia and a localized chorioangioma: a rarity simulating partial mole. Pathol-Res Pr 1994;190:808–13. DOI: https://doi.org/10.1016/S0344-0338(11)80429-2
- Jauniaux E, Nicolaides K, Hustin J. Perinatal features associated with placental mesenchymal dysplasia. Placenta 1997;18:701-6. DOI: https://doi.org/10.1016/S0143-4004(97)90012-6
- Arizawa M, Nakayama M. Suspected involvement of the X chromosome in placental mesenchymal dysplasia. Congenit Anom 2002;42:309–17. DOI: https://doi.org/10.1111/j.1741-4520.2002.tb00897.x
- Gheysen W, Strybol D, Moerman P, et al. Discordance for placental mesenchymal dysplasia in a monochorionic diamniotic twin pregnancy: a case report. Clin Case Rep 2018;6:1557–60. DOI: https://doi.org/10.1002/ccr3.1662
References
Parveen Z, Tongson-Ignacio JE, Frasier CR, et al. Placental mesenchymal dysplasia. Arch Pathol Lab Med 2007;131:131–7. DOI: https://doi.org/10.5858/2007-131-131-PMD
Arizawa M, Nakayama M. Suspected involvement of the X chromosome in placental mesenchymal dsyplasia. Congenit Anom 2002;42:309–17.
Pham T, Steele J, Stayboldt C, et al. 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;126:67–78. DOI: https://doi.org/10.1309/RV45-HRD5-3YQ2-YFTP
Gavanier D, Allias F, Huissoud C, et al. Ultrasound findings and clinical outcomes in 23 cases of placental mesenchymal dysplasia. J Repr Med 2017;62:366-75.
Rosner-Tenerowicz A, Pomorski M, Fuchs T, et al. Placental mesenchymal dysplasia and hepatic cyst. Ginekol Polska 2020;91:779–80. DOI: https://doi.org/10.5603/GP.a2020.0129
Lazebnik N. Placental mesenchymal dysplasia; current understanding of the sonographic, histologic, and molecular findings of a rare and challenging disorder. J Gynecol Womens Health 2020;18:1-10. DOI: https://doi.org/10.19080/JGWH.2020.18.555989
Cubal A, Carvalho J, Faria B, et al. Placental mesenchymal dysplasia. Acta Obstet Ginecol Port 2015;9:235–40.
Psarris A, Sindos M, Kourtis P, et al. Placental mesenchymal dysplasia: ultrasound characteristics and diagnostic pitfalls. Ultrasound Int Open 2020;6:E2–3. DOI: https://doi.org/10.1055/a-1180-9571
Rohilla M, Siwatch S, Jain V, et al. Placentomegaly and placental mesenchymal dysplasia. BMJ Case Rep 2012;2012. DOI: https://doi.org/10.1136/bcr-2012-007777
Colpaert RM, Ramseyer AM, Luu T, et al. Diagnosis and management of placental mesenchymal disease. A review of the literature. Obstet Gynecol Surv 2019;74:611-22.
Højberg KE, Aagaard J, Henriques U, et al. Placental vascular malformation with mesenchymal hyperplasia and a localized chorioangioma: a rarity simulating partial mole. Pathol-Res Pr 1994;190:808–13. DOI: https://doi.org/10.1016/S0344-0338(11)80429-2
Jauniaux E, Nicolaides K, Hustin J. Perinatal features associated with placental mesenchymal dysplasia. Placenta 1997;18:701-6. DOI: https://doi.org/10.1016/S0143-4004(97)90012-6
Arizawa M, Nakayama M. Suspected involvement of the X chromosome in placental mesenchymal dysplasia. Congenit Anom 2002;42:309–17. DOI: https://doi.org/10.1111/j.1741-4520.2002.tb00897.x
Gheysen W, Strybol D, Moerman P, et al. Discordance for placental mesenchymal dysplasia in a monochorionic diamniotic twin pregnancy: a case report. Clin Case Rep 2018;6:1557–60. DOI: https://doi.org/10.1002/ccr3.1662