July 10th, 2020

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Placental Mesenchymal Dysplasia: Key Clinical and Pathology Features to Aid in Differentiation from Molar Pregnancy: A Case Report
Authors:  Cassandra K. Kisby, M.D., Sarah M. Bean, M.D., Jeffrey A. Kuller, M.D., and Eleanor Rhee, M.D.
BACKGROUND: Placental mesenchymal dysplasia (PMD) is a rare placental disorder characterized by placentomegaly. It carries a high incidence of adverse fetal outcomes, and its ultrasound appearance is similar to a partial hydatidiform mole and a complete hydatidiform mole with a normal co-twin. Diagnosis is made through placental pathologic examination following delivery, though prenatal testing and serial ultrasound examinations can suggest PMD over molar pregnancy. There are no consensus guidelines for antenatal and intrapartum management of PMD.

CASE: A 22-year-old woman, gravida 3 para 2002, presented with an enlarged, cystic placenta with a normally grown, viable fetus. Laboratory test results were significant for a normal β-hCG, chest radiograph, and karyotype. The patient was managed with serial growth ultrasound examinations and biophysical profiles. Care was coordinated with a multidisciplinary team. She had a spontaneous vaginal delivery of a viable male infant at 366/7 weeks’ gestation. The workup for Beckwith-Wiedemann syndrome was negative. The diagnosis of PMD was made based on the gross and microscopic pathologic appearance of the placenta.

CONCLUSION: PMD should be on the differential diagnosis when placentomegaly is present on ultrasound. PMD is distinguished from hydatidiform mole based on genetic screening, as well as gross and microscopic examination of the placenta.
Keywords:  Beckwith-Wiedemann syndrome, hydatidiform mole, placenta, placenta diseases, placental mesenchymal dysplasia, pregnancy complications, prenatal diagnosis, prenatal ultrasonography
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