Breus’ mole/chorangiosis/chorangioma of the placenta: a dilemma with a rare fetal outcome report


  • Nitika Sobti Department of Obstetrics and Gynecology, Max Health Care, Gurugram, Haryana, India
  • Ankita Chandna Department of Obstetrics and Gynecology, Max Super Specialty Hospital, Shalimar Bagh, New Delhi, India
  • Bhawna Narula Department of Pathology, Max Super Specialty Hospital, Shalimar Bagh, New Delhi, India



Breus’ mole, Chorioangioma, Chorangiosis, Perinatal outcomes, Placenta


Massive Subchorionic Thrombohematoma (MST) is a rare condition in which there is a massive collection of blood between the placental membranes and uterine wall separating the villous chorionic plate from villous chorion. It is relatively rare and is poorly understood. Many theories have been proposed to explain the etiology of Breus mole; some suggest it is a fetal haemorrhage, while others claim it has a maternal-origin thrombosis of placental vessels. A 30-year-old healthy Indian pregnant woman was presented at Max Hospital, Shalimar Bagh Delhi, India, during her second pregnancy with a complaint of fever. On routine level-2 ultrasonography (USG) done at 18.6 weeks of gestation showed thick placenta. No fetal tumours or any other anomalies were noted on that scan which was followed by a detailed scan which confirmed a solitary mass arising from fetal side 103x64x82 mm S/O chorioangioma. Serial growth and doppler USG were conducted to monitor placental function, tumor characteristics and future anatomy. The subject received steroids to enhance fetal lungs maturation at Week 30, iron/calcium supplements, Ecosprin tablets, and progesterone support. At 32.5 weeks, the subject developed deranged sugars followed by gestational hypertension at 34.1 weeks. Ultrasonography also showed fetal growth restriction with large chorioangioma. The subject underwent a successful elective caesarean section at 34.4 weeks. On placental examination, 10 cm large mass encasing ¾ of the placenta was identified as a large subchorionic hematoma/chorioangioma (800 g). This study concludes that early identification of a large chorangioma aids in consequent fetal surveillance, management of maternal symptoms, and delivery planning discussions even if the pathological diagnosis turns out to be Breus’ mole with underlying chorangiosis postnatally.


Gupta R, Nigam S, Arora P, Khurana N, Batra S, Mandal AK. Clinico-pathological profile of 12 cases of chorangiosis. Arch Gynecol Obstet. 2006;274(1):50-3.

Srinivasan AP, Omprakash BO, Lavanya K, Subbulakshmi Murugesan P, Kandaswamy S. A prospective study of villous capillary lesions in complicated pregnancies. J Pregnancy. 2014;2014:193925.

Fung TY, To KF, Sahota DS, Chan LW, Leung TY, Lau TK. Massive subchorionic thrombohematoma: a series of 10 cases. Acta Obstet Gynecol Scand. 2010;89(10):1357-61.

Alanjari A, Wright E, Keating S, Ryan G, Kingdom J. Prenatal diagnosis, clinical outcomes, and associated pathology in pregnancies complicated by massive subchorionic thrombohematoma (Breus' mole). Prenat Diagn. 2013;33(10):973-8.

Altshuler G. Chorangiosis. An important placental sign of neonatal morbidity and mortality. Arch Pathol Lab Med. 1984;108(1):71-4.

Agale SV, Dongaonkar DD. Chorangiosis of placenta. Bombay Hosp J. 2009;51(2):251-2.

Ingale YP, Buch AC, Ulhas PN, Kumar H. Incidental detection of chorangioma with chorangiosis of placenta: A rare case report. Med J DY Patil Vidyapeeth. 2019;12(2):174-176.

Ogawa M, Nagao D, Mori K, Sato M, Sato A, Shimizu D. Elastography for differentiation of subchorionic hematoma and placenta previa. Ultrasound Obstet Gynecol. 2012;39(1):112-4.

Kojima K, Suzuki Y, Makino A, Murakami I, Suzumori K. A case of massive subchorionic thrombohematoma diagnosed by ultrasonography and magnetic resonance imaging. Fetal Diagn Ther. 2001;16(1):57-60.

Linduska N, Dekan S, Messerschmidt A, Kasprian G, Brugger PC, Chalubinski K. Placental pathologies in fetal MRI with pathohistological correlation. Placenta. 2009;30(6):555-9.

Kim DT, Riddell DC, Welch JP, Scott H, Fraser RB, Wright JR Jr. Association between Breus' mole and partial hydatidiform mole: chance or can hydropic villi precipitate placental massive subchorionic thrombosis? Pediatr Pathol Mol Med. 2002;21(5):451-9.

Fisteag-Kiprono L, Foster K, McKenna D, Baptista M. Antenatal sonographic diagnosis of massive subchorionic hematoma: a case report. J Reprod Med. 2005;50(3):219-21.

Heller DS, Rush D, Baergen RN. Subchorionic hematoma associated with thrombophilia: report of three cases. Pediatr Dev Pathol. 2003;6(3):261-4.

Aparna M, Archana J, Vidula G. Chorangiosis of placenta. Report of two cases. Panacea Journal of Medical Sciences. 2014;4(2):50-1.

FoxHarold, Sebire NJ. Abnormalities of villous vessels in pathology of placenta edited by Heather McCormick, Third edition. 2007;165-166.

Kingdom JC, Audette MC, Hobson SR, Windrim RC, Morgen E. A placenta clinic approach to the diagnosis and management of fetal growth restriction. Am J Obstet Gynecol. 2018;218(2S):S803-S817.

Benirschke K. Abortions and moles. Monogr Pathol. 1981:23-48.






Case Reports