Hemangiomas of the umbilical cord

Four cases of umbilical cord hemangioma are presented and analyzed with all previously reported cases. Umbilical cord hemangiomas consist of an angiomatous nodule containing and encompassed by edema and myxomatous degeneration of Wharton's jelly, often cystic. The angiomatous nodules range from 0.2 to 7 cm in largest dimension, whereas the associated edema may measure up to 15 cm. The tumors tend to occur at the placental end of the cord and presumably arise from one or more of the major umbilical vessels. The angiomatous nodules tend to be sharply demarcated from the surrounding stroma and are invariably cytologically benign. Although cord hemangiomas are strongly associated with fetal morbidity and mortality, a causal relationship has not been definitely established. There is no apparent association between cord hemangiomas and maternal age, race, or gravidity nor does one sex predominate. Unlike placental hemangiomas, cord hemangiomas are not associated with maternal hydramnios. Ultrastructural differences between umbilical cord and placental amnion explain both this differing clinical effect as well as the presence of marked edema and myxomatous degeneration of Wharton's jelly in cord tumors. Speculation concerning an underlying congenital predisposition to vascular neoplasm in these infants is presented.