Pancreatic adenocarcinoma in the pregnant patient: case report and review of the literature

Incidental diagnosis of a pancreatic adenocarcinoma in a woman affected by gestational diabetes mellitus: case report and literature review

Pancreatic cancer is rarely diagnosed during pregnancy; it usually manifests with symptoms such as epigastric pain, vomiting, weight loss, and jaundice, rarely mimicking the hemolysis, elevated liver enzymes, and low platelet count syndrome. It has been postulated that there exists a correlation between the diagnosis of gestational diabetes mellitus and the occurrence of pancreatic cancer later in life. We conducted an expert literature review of the 31 available documented pancreatic cancer cases that were diagnosed during pregnancy. We also report pancreatic adenocarcinoma incidentally suspected in an asymptomatic woman affected by gestational diabetes mellitus; the woman was undergoing a fetal growth scan.

Pancreatic Tumors Complicating Pregnancy: A Concern for Fetomaternal Well Being

INTRODUCTION

Hemoperitoneum resulting from the rupture of pancreatic tumors is a rare condition, especially during pregnancy.

CASE PRESENTATION

We report a case of a 21-year-old gravida 2, para 1, at 25+5 weeks of gestation, who presented to the hospital with severe epigastric pain and decreased fetal movement. Ultrasonography showed intrauterine fetal death, a retroperitoneal mass in the epigastric region, and hemoperitoneum. Computed tomography scan revealed a heterogeneously enhancing pancreatic mass suggestive of pancreatic neoplasm. However, the late diagnosis and the delay in treatment resulted in a deterioration of maternal status with eventual mortality.

CONCLUSION

Diagnostic difficulties occur because of the rarity of the condition and vague clinical presentations. In case of a pregnancy complicated by hemoperitoneum, prompt effort to stop the intraperitoneal bleeding is imperative.

Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature

INTRODUCTION

Ampullary adenocarcinoma is a rare entity during pregnancy. It accounts for 0.5% of all gastrointestinal malignancies. The best treatment modality for resectable tumors with the best reported outcome is surgical resection in the form of pancreaticoduodenectomy (Whipple procedure). In this case report, we discuss the challenges in the management of ampullary adenocarcinoma in a pregnant patient.

CASE PRESENTATION

We report a case of 22 years old pregnant women who presented with vague abdominal pain and jaundice at the 28th week of gestation. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture around the ampulla and distal common bile duct (CBD). The CBD was stented and a biopsy was taken. Histopathology revealed: an invasive adenocarcinoma. The patient was managed by elective pancreaticoduodenectomy after induction of vaginal delivery at the 34th week of gestation.

CONCLUSION

Diagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother & fetus in case of early stage disease.

Metastatic Pancreatic Adenocarcinoma During Pregnancy

We present a rare case of metastatic pancreatic adenocarcinoma diagnosed antepartum. A high index of suspicion must be maintained to diagnose pancreatic cancer during pregnancy. We recommend a thorough history and physical and aggressive pursuit of sensitive imaging in patients with persistent symptoms. If pancreatic adenocarcinoma is diagnosed, a multidisciplinary approach that focuses on patient goals should be undertaken. The effect of pregnancy on tumor growth rates is unknown.

Metastatic pancreatic adenocarcinoma presented as back pain in pregnancy: case report and review of literature

OBJECTIVE

To report a case of pancreatic adenocarcinoma complicating pregnancy with a review of literature.

METHODS

A literature search of all English articles on pancreatic adenocarcinoma in pregnancy till December 2014.

RESULTS

A 35-year-old patient presented at 22 weeks of gestation for back pain and weight loss. Subsequent she was confirmed to have metastatic pancreatic adenocarcinoma. There were in total eleven case reports identified. Abdominal pain and back pain were the presenting symptoms in 75% and 33.3% of patients respectively.

CONCLUSIONS

Pancreatic adecnocarcinoma is a rare cancer in pregnancy. A high index of suspicion is required in case of atypical symptoms.

Pancreatic neoplasms in pregnancy: diagnosis, complications, and management

BACKGROUND

Neoplasms of the pancreas during pregnancy are rare, with less than 25 cases of benign and malignant tumors reported in the literature.

METHODS

We present three unique cases of pancreatic tumors occurring during pregnancy--one mucinous cystic neoplasm and two adenocarcinomas. We review the literature regarding pancreatic neoplasms during pregnancy and discuss the diagnosis, complications, and management of these tumors.

RESULTS

Magnetic resonance imaging and ultrasound are the imaging modalities of choice in pregnancy. In patients with benign or premalignant tumors, surgical resection may be postponed until the second trimester. In symptomatic patients, or if there is a concern for intrauterine growth restriction, urgent surgical intervention should be performed. With malignant tumors, the benefit of delaying surgery must be balanced with the risk of maternal disease progression. Termination of the pregnancy should be discussed when a malignant tumor is diagnosed during the first trimester. Pancreatic tumors diagnosed during the third trimester may be resected after delivery. If malignant, early delivery of the fetus and subsequent maternal operation can be considered at appropriate fetal maturity.

CONCLUSION

When these tumors occur during pregnancy, they present a diagnostic and treatment dilemma, with variation in treatment based on gestational age and patient preference.

Pancreatic adenocarcinoma in the pregnant patient: a case report and literature review

Pancreatic cancer is the fifth most common cause of cancer-related death in the USA. However, the antepartum diagnosis of pancreatic adenocarcinoma in the pregnant patient is exceedingly rare, with only six cases previously reported in the literature. Optimizing both maternal and fetal health outcomes is particularly challenging when surgical procedures are necessary for staging and/or therapeutic purposes--as these interventions often pose significant risks to both the mother and the developing fetus. In this article, we report a case of pancreatic adenocarcinoma diagnosed during pregnancy and review the literature on the management issues confronted in this unique clinical situation.

Non-functioning, malignant pancreatic neuroendocrine tumour (PNET): a rare entity during pregnancy

INTRODUCTION

Non-functioning pancreatic neuroendocrine tumours (PNET) are extremely rare tumours. To our knowledge, we are the first to report in the literature on two cases of PNET during pregnancy.

PATIENTS

A 32- and a 35-year-old primigravida, both in their second trimester of pregnancy, were referred to our clinic because of a suspicious mass in the pancreas. Both patients had an uneventful medical history and their laboratory test results, including pancreatic hormones, were unremarkable. Both underwent surgical exploration and resection of the pancreatic tumour. One patient with a tumour in the pancreatic tail underwent a distal pancreatectomy and splenectomy, whereas in the other case a pylorus-preserving pancreaticoduodenectomy was performed due to a tumour in the pancreatic head.

RESULTS

One of the patients delivered a healthy infant, which is now at the age of 6 years in excellent health. The other patient is now in her third trimester of pregnancy without any further complications. Histopathological analysis of both tumours showed a strong expression of chromogranin and synaptophysin, thus both were classified as well-differentiated, non-functioning neuroendocrine carcinomas.

CONCLUSIONS

Although PNETs are extremely rare, this entity can be confirmed as another differential diagnosis for suspicious pancreatic mass during pregnancy. In specialized centres, these tumours can be removed without any harmful consequences to the foetus.

An extremely rare cause of acute abdomen in pregnancy: ruptured pancreatic mucinous cystadenocarcinoma

Pancreatic cystadenocarcinoma is an extremely rare neoplasm in pregnancy. To our knowledge, there have been 2 published cases of pancreatic mucinous cystadenocarcinoma (PMC) during pregnancy in the literature; one of which was reported to have ruptured into the abdominal cavity. We present a second case of ruptured PMC resulting in acute abdomen in 36 weeks of pregnancy. Rupture of mucinous cystic neoplasms of pancreas including PMC should be remembered in acute abdomen during pregnancy.

Maternal pancreatic carcinoma metastatic to the placenta: a case report and literature review

In this article, we report a case of maternal pancreatic carcinoma metastatic to the placenta. The baby is alive and well, with no evidence of tumor metastasis at the age of 1 year. We also present a comprehensive review of all maternal cancers with metastasis to the placenta and/or baby published in the English language.

Gastrointestinal, Pancreatic, and Hepatic Cancer During Pregnancy

Pregnancy affects the clinical presentation, evaluation, treatment, and prognosis of patients with gastrointestinal cancer. Pregnant patients may present with advanced gastrointestinal cancer as a result of delayed diagnosis, in part because of difficulty differentiating signs and symptoms of cancer from signs and symptoms of normal pregnancy. The approach to cancer surgery and chemotherapy must be modified in pregnant patients to minimize fetal and maternal risks. Because of these factors, women who develop gastrointestinal cancers during pregnancy seem to have a poor prognosis. This article focuses on cancers of the colon, stomach, pancreas, and liver that occur during pregnancy.