Large Angiomyxoma of the Umbilical Cord-Uncomplicated Rupture of Tumor Membranes at 32 Weeks of Gestation

Abstract

Background: When a tumor of the umbilical cord is prenatally visualized, it is possible to propose the diagnosis depending on the sonographic appearance of the tumor. Angiomyxoma of the umbilical cord appears as a complex solid-cystic mass that is made of angiomatous component and myxoid stroma. When the tumor is diagnosed, serial ultrasound and doppler examinations are used to monitor the tumor's size and the overall fetal well-being including doppler investigations and fetal growth. Angiomyxomas are not associated with fetal chromosomal pathologies. The cases of intrauterine rupture and fetal death was described in the literature.

Case presentation: A 28 years-old pregnant woman was referred to our clinic for second opinion because of visualized umbilical cord tumor during second trimester ultrasound screening. The tumor gradually increased in size until 34th week of gestation, when the rupture of the cystic component was observed. The fetal doppler studies was normal during the course of pregnancy, we observed decreased AC and decreased estimated fetal weight. At the gestational age of the 37 weeks the labor was induced and heathy male infant was born.

Conclusions: For the first time to our knowledge, we demonstrate the case of uncomplicated rupture of the cystic component of the angiomyxoma that lead to the possibility to manage the pregnancy conservatively without any compromise of the fetus.

Keywords: angiomyxoma; hemangioma; prenatal diagnostic; umbilical cord.

Figure 1

Tumor appearance at 24 + 1 weeks.

Figure 2

(a) Umbilical vessels going through the tumor at 32 + 2 weeks by 3D static HD flow (glass mode) imaging; (b) Tumor appearance at 32 + 2 weeks.

Figure 3

(a) Tumor appearance at 34 + 2 weeks; (b) Growth chart, estimated fetal weight by weeks.

Figure 4

(a) Microscopic appearance of the tumor, CD31 in thin wall of the vessels, ×5; (b) Microscopic appearance of the tumor, CD34 in thin wall of the vessels, ×10; (c) Microscopic appearance of the tumor, small anastomosing vascular structures surrounded by myxoid degeneration, ×5; (d) Microscopic appearance of the tumor, obliterated small vessels in myxoid degeneration, ×10; (e) Macroscopic appearance of the tumor.

Figure 4

(a) Microscopic appearance of the tumor, CD31 in thin wall of the vessels, ×5; (b) Microscopic appearance of the tumor, CD34 in thin wall of the vessels, ×10; (c) Microscopic appearance of the tumor, small anastomosing vascular structures surrounded by myxoid degeneration, ×5; (d) Microscopic appearance of the tumor, obliterated small vessels in myxoid degeneration, ×10; (e) Macroscopic appearance of the tumor.