1
|
Clinicopathological characteristics, survival outcome and prognostic factors of very young gastric cancer. Clin Exp Med 2022; 23:437-445. [PMID: 35451668 DOI: 10.1007/s10238-022-00822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/16/2022] [Indexed: 12/24/2022]
Abstract
To explore the clinicopathological characteristics, survival outcomes, and prognosis of very young gastric cancer (GC). From January 1, 2011 to January 1, 2021, GC patients under 30 years old treated in three tertiary hospitals were enrolled. Clinicopathological characteristics were summarized, prognostic factors and survival outcomes including overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) were retrospectively analyzed. One hundred patients were finally included, with a median age of 23 years.73 (73.0%) were female. Most patients had initial symptoms of abdominal pain (66.0%). The most common tumor locations were gastric antrum (38.0%) and gastric body (37.0%). The main histological types were diffuse (81.0%) and poorly differentiated (91.0%). Most patients presented with stage III-IV disease (82.0%) at diagnosis and the common sites of metastasis were ovary (39.5%) and peritoneum (27.6%). The mOS of the whole group was 23.3 months (95% CI 17.2-29.4). Moreover, the mOS of patients at stage I-II was not reached. The mOS of patients at stage III and stage IV was 40.6 months (95% CI 10.2-70.9) and 10.3 months (95% CI 8.9-11.6), respectively. The mDFS of stage I-III patients was 28.5 months (95% CI 14.7-42.3), and the mPFS of the metastatic patients was 4.5 months (95% CI 4.0-5.0). TNM stage (P = 0.005) and radical surgery (P = 0.001) were independent prognostic factors of overall survival. The very young GC were predominantly female, diffuse type, and advanced diagnosis. TNM stage and radical surgery were independent prognosis factors for overall survival.
Collapse
|
2
|
Marbun VMG, Putranto AS. Diagnosis and management of gastric cancer in pregnancy-An evidence-based case report. Int J Surg Case Rep 2020; 75:338-344. [PMID: 32980705 PMCID: PMC7522585 DOI: 10.1016/j.ijscr.2020.09.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gastric cancer in pregnancy is a very rare case with an incidence of 0.016% and is mostly detected in a locally advanced or advanced stage due to misinterpretation of non-specific signs and symptoms. Management of gastric cancer in pregnancy should emphasize mother and fetal survival. Currently, there is no diagnostic and management guidance for gastric cancer in pregnancy. The purpose of this study is to ascertain how to diagnose and manage gastric cancer in pregnancy. METHODS This study is an evidence-based case report performed in Digestive Division of Department of Surgery in Cipto Mangunkusumo hospital in September-October 2017. Literature search on databases such as Cochrane, PubMed, ScienceDirect, and Scholar Google used keywords like "gastric cancer" AND "pregnant" OR "pregnancy" with inclusion criteria which are systematic review, randomized-clinical trial (RCT), cohort study, case report, or case series, performed in human and published in the last 10 years in English language. Critical appraisal is done according to Oxford Centre For Evidence-Based Medicine 2011. This work is reported in line with the SCARE criteria. RESULTS There are 9 case-report studies and 1 case-control study. Radiology examination includes endoscopy, MRI, and CT scan. Management is given according to cancer stage which is; surgery, surgery with adjuvant therapy, and palliative chemotherapy. CONCLUSION Radiology examinations with a lower risk of adverse effects are endoscopy and MRI. CT scan may be performed when the benefits exceed the risk. Surgery and chemoradiation have the lowest rate of adverse effects when done in the second and third trimester.
Collapse
Affiliation(s)
- Vania Myralda Giamour Marbun
- Digestive Division of General Surgery Department, Faculty of Medicine, Universitas Indonesia, General Surgery Department, Cipto Mangunkusumo Hospital, Jalan Diponegoro #71, Senen, Central Jakarta, Indonesia.
| | - Agi Satria Putranto
- Digestive Division of General Surgery Department, Faculty of Medicine, Universitas Indonesia, General Surgery Department, Cipto Mangunkusumo Hospital, Jalan Diponegoro #71, Senen, Central Jakarta, Indonesia.
| |
Collapse
|
3
|
Patan S, Benzar T, Sanford G, Kavanaugh M. Advanced metastatic gastric adenocarcinoma identified within the placenta: a case report with literature review. J Gastrointest Oncol 2020; 11:127-132. [PMID: 32175115 DOI: 10.21037/jgo.2019.09.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We present an extremely rare case of a multiparous women age 32 in her 35th week of gestation who was admitted to our hospital for evaluation of back pain and was incidentally found to have metastatic gastric adenocarcinoma, diagnosed from a routine placental specimen. The coexistence of gastric carcinoma with pregnancy is a rare event, accounting for 0.026% to 0.1% of all pregnancies. To the best of our knowledge, the world literature contains only eight known cases of metastatic gastric cancer to the placenta-the present case is the ninth. An uncommon finding, in this case, was the extensive spread of cancer to bone marrow and leptomeninges.
Collapse
Affiliation(s)
- Shajadi Patan
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Taras Benzar
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Gabrielle Sanford
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Mindie Kavanaugh
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| |
Collapse
|
4
|
Niknam R, Haghighat S, Mokhtari M. The pregnancy-associated gastric cancer: a case report and review of the literature. J OBSTET GYNAECOL 2020; 41:308-309. [PMID: 31955632 DOI: 10.1080/01443615.2019.1694880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Shirin Haghighat
- Hematology and Medical Oncology Department, Shiraz University of Medical Science, Shiraz, Iran
| | - Maral Mokhtari
- Pathology Department, Faghihi Hospital, Shiraz University of Medical Science, Shiraz, Iran
| |
Collapse
|
5
|
Disseminated carcinomatosis of the bone marrow from gastric cancer during pregnancy. Clin J Gastroenterol 2019; 12:447-452. [PMID: 30915672 DOI: 10.1007/s12328-019-00963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
Gastric cancer during pregnancy is extremely rare and difficult to diagnose at early stages because of its nature. Furthermore, it is often difficult to determine the appropriate treatment strategy considering both the patient's condition and the effect of the treatment on the fetus. We present a case of a 34-year-old woman with gastric cancer who was 22 weeks pregnant and had multiple liver and bone metastases at the time of diagnosis. The disease progressed to disseminated carcinomatosis of the bone marrow, in which cancer invades and spreads diffusely to the bone marrow and then presents disseminated intravascular coagulation. Fortunately, the selected systematic chemotherapy dramatically reduced the severity of the patient's cancer and she could deliver her baby successfully. There are few reports of disseminated carcinomatosis of the bone marrow from gastric cancer during pregnancy. Even in such an oncological emergency, prompt chemotherapy saved the mother's life and enabled safe delivery of the fetus.
Collapse
|
6
|
Hussain N, Selvakumari N, Afadapa F, Amu O. Pregnancy and gastric cancer: diagnostic and treatment dilemma. BMJ Case Rep 2018; 2018:bcr-2017-222963. [PMID: 29936442 PMCID: PMC6021030 DOI: 10.1136/bcr-2017-222963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/03/2022] Open
Abstract
Gastric cancer in pregnancy is an extremely rare entity. The incidence of gastric cancer is more in elderly patients and higher in the male population. Gastric cancer symptoms can be nausea, vomiting and epigastric discomfort which is similar to early pregnancy symptoms. This leads to a misinterpretation and delay in the diagnosis during pregnancy. Gastric cancer in pregnancy is associated with poor prognosis because of its delayed diagnosis at an advance stage. We present our patient here, with this rare clinical diagnosis and with no suspicion in a young healthy woman.
Collapse
Affiliation(s)
- Nawar Hussain
- Obstetrics and Gynaecology, Royal Oldham Hospital, Greater Manchester, UK
| | | | - Frances Afadapa
- Women & Children’s Division, Royal Oldham Hospital, Greater Manchester, UK
| | - Olubusola Amu
- Women & Children’s Division, Royal Oldham Hospital, Greater Manchester, UK
| |
Collapse
|
7
|
Bozkurt M, Antonoff M, Jaramillo S, Sagebiel T, Murphy MB. Gastroesophageal Cancer During Pregnancy: a Case Report and Review of the Literature. J Gastrointest Cancer 2018; 50:634-640. [PMID: 29577180 DOI: 10.1007/s12029-018-0093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mustafa Bozkurt
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Sylvia Jaramillo
- Department of Hematology-Oncology, Texas Oncology, Austin, TX, 78758, USA
| | - Tara Sagebiel
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mariela B Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA. .,Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| |
Collapse
|
8
|
Song MJ, Park YS, Song HJ, Park SJ, Ahn JY, Choi KD, Lee GH, Jung HY, Yook JH, Kim BS. Prognosis of Pregnancy-Associated Gastric Cancer: An Age-, Sex-, and Stage-Matched Case-Control Study. Gut Liver 2017; 10:731-8. [PMID: 27114414 PMCID: PMC5003196 DOI: 10.5009/gnl15323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/01/2015] [Accepted: 11/20/2015] [Indexed: 01/26/2023] Open
Abstract
Background/Aims Pregnancy-associated gastric cancer is a rare condition. This case-control study was performed to identify the clinicopathological features and prognostic factors of pregnancy-associated gastric cancer. Methods All consecutive patients who presented to our tertiary referral hospital with pregnancy-associated gastric cancer from 1991 to 2012 were identified. Two age-, sex-, and stage-matched controls for each case were also identified from the records. Clinicopathological, gynecological, and oncological outcomes were recorded. Immunohistochemical staining was performed for estrogen receptor, progesterone receptor, epidermal growth factor receptor, human epidermal growth factor receptor, and E-cadherin. Fluorescence in situ hybridization was performed for fibroblast growth factor receptor 2. Results The median overall survival rates of the pregnancy-associated gastric cancer and control groups were 7.0 months and 15.0 months, respectively (p=0.189). Poor prognostic factors included advanced stage and tumor location in the corpus or the entire stomach but not pregnancy status or loss of E-cadherin. Pregnancy-associated gastric cancer was associated with a longer time from diagnosis to treatment (21 days vs 7 days, p=0.021). The two groups did not differ in the expression of the receptors or E-cadherin. Conclusions The dismal prognosis of pregnancy-associated gastric cancer may related to the tumor stage and location rather than to pregnancy itself.
Collapse
Affiliation(s)
- Min Jeong Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Jeong Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hwan Yook
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Sik Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Pacheco S, Norero E, Canales C, Martínez JM, Herrera ME, Muñoz C, Jarufe N. The Rare and Challenging Presentation of Gastric Cancer during Pregnancy: A Report of Three Cases. J Gastric Cancer 2016; 16:271-276. [PMID: 28053815 PMCID: PMC5206319 DOI: 10.5230/jgc.2016.16.4.271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/29/2016] [Accepted: 11/10/2016] [Indexed: 12/20/2022] Open
Abstract
Pregnancy-associated gastric cancer is extremely rare. In many cases, it is diagnosed at an advanced stage because the symptoms during pregnancy are generally overlooked. We report three cases of gastric cancer during pregnancy with various outcomes. The first case included a patient with stage IV gastric cancer who received palliative chemotherapy. This patient had a preterm birth and died 7 months after diagnosis. The second case received neoadjuvant chemotherapy during pregnancy and a total gastrectomy was performed after delivery. She then received adjuvant chemoradiotherapy. This patient developed pulmonary metastasis and died of recurrence 41 months after surgery. In the third case, a distal subtotal gastrectomy was performed at week 14 of pregnancy, with no complications. The patient received adjuvant chemoradiotherapy. She is currently without recurrence 14 months after surgery. In patients with pregnancy-associated gastric cancer, treatment decisions are predominantly influenced by clinical stage and gestational age at diagnosis.
Collapse
Affiliation(s)
- Sergio Pacheco
- Digestive Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile.; Digestive Surgery Unit, Hospital Dr. Eduardo Pereira, Universidad de Valparaíso, Valparaíso, Chile
| | - Enrique Norero
- Digestive Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile.; Esophagogastric Surgery Unit, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Claudio Canales
- Digestive Surgery Unit, Hospital Dr. Eduardo Pereira, Universidad de Valparaíso, Valparaíso, Chile
| | - José Miguel Martínez
- Digestive Surgery Unit, Hospital Dr. Eduardo Pereira, Universidad de Valparaíso, Valparaíso, Chile
| | | | - Carolina Muñoz
- Esophagogastric Surgery Unit, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Nicolás Jarufe
- Digestive Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
10
|
Microangiopathic Hemolytic Anemia Due to Malignancy in Pregnancy. Obstet Gynecol 2016; 128:1437-1440. [PMID: 27824770 DOI: 10.1097/aog.0000000000001675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microangiopathic disorders during pregnancy remain a diagnostic challenge because these conditions often imitate more common obstetric diseases. CASE A 31-year-old multigravid woman delivered at term with a postpartum course complicated by laboratory indices consistent with hemolysis, elevated liver enzymes, and low platelet count syndrome. After clinical recovery, she was readmitted 2 weeks after delivery with presumptive pyelonephritis. Persistent hemolysis and worsening thrombocytopenia suggested a diagnosis of thrombotic microangiopathy, which did not respond to plasma exchange. Directed bone biopsy revealed metastatic signet ring cell adenocarcinoma. CONCLUSION Microangiopathic hemolytic anemia is rarely the initial clinical manifestation of malignancy. Given the similar features of several common obstetric complications, additional diagnostic measures may be necessary to refine the diagnosis in cases unresponsive to standard obstetric management.
Collapse
|
11
|
Akdemir Z, Karaman E, Arslan H, Çalli I, Akdeniz H. A Case of Metastatic Esophageal Carcinoma in a Pregnant Woman with Radiologic Findings. J Clin Diagn Res 2016; 10:TD08-9. [PMID: 26894146 DOI: 10.7860/jcdr/2016/16551.7073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/03/2015] [Indexed: 12/21/2022]
Abstract
The incidence of all malignant tumours during pregnancy is extremely rare and esophageal carcinoma ranges from 0.07 to 0.1% of all malignant neoplasms. The physiological changes during pregnancy frequently mask the complaints and symptoms related to the disease. The physical and physiological clinical conditions limit the diagnostic approaches. Therefore, the stage of cancer at the time of diagnosis is usually advanced. The management with cancer surgery and chemotherapy regimens must be modified in pregnant women in order to minimize fetal and maternal risks. Here, we report a very rare case of metastatic esophagus cancer in a 39-year-old woman with 28 weeks of pregnancy and aim to show the ultrasound (USG) and magnetic resonance imaging (MRI) findings with treatment and follow up management.
Collapse
Affiliation(s)
- Zülküf Akdemir
- Medical Doctor, Department of Radiology, Van Training and Research Hospital , Van, Turkey
| | - Erbil Karaman
- Assistant Professor, Department of Obstetric and Gynecology, Yuzuncu Yil University, School of Medicine , Van, Turkey
| | - Harun Arslan
- Assistant Professor, Department of Radiology, Yuzuncu Yil University, School of Medicine , Van, Turkey
| | - Iskan Çalli
- Medical Doctor, Department of General Surgery, Van Training and Research Hospital , Van, Turkey
| | - Hüseyin Akdeniz
- Medical Doctor, Department of Radiology, Van Private Lokman Hekim Hospital , Van, Turkey
| |
Collapse
|
12
|
Bloch MH, Elsarrag RZ, Elsarrag MZ, Salih SM. Challenges of Fertility Sparing Ovarian Surgery Imposed by Krukenberg Tumors in Pregnancy. ACTA ACUST UNITED AC 2015; 2:4. [PMID: 26366440 PMCID: PMC4563814 DOI: 10.23937/2378-3656/1410041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fertility sparing surgery is advocated for reproductive-age women with benign and borderline ovarian tumors. The hormonal milieu of pregnancy may, however, complicate the decision making process. The patient presented in the third trimester with a rapidly growing tumor that was diagnosed as benign steroid cell tumor by intraoperative frozen section. Fertility-sparing surgery with right oophorectomy and partial left oophorectomy was performed. The final pathology examination demonstrated signet cells staining positive for mucin, which is pathognomonic for Krukenberg tumors. Krukenberg cells were overlooked in the frozen section due to the predominance of hormonally active luteinized ovarian stroma cells. This case highlights the challenges associated with fertility sparing surgery in women presenting with ovarian tumors in pregnancy and the limitations of frozen section in providing an accurate diagnosis.
Collapse
Affiliation(s)
- Michael H Bloch
- Child Study Center, Department of Psychiatry, Yale University School of Medicine, USA
| | - Ramey Z Elsarrag
- Department of Obstetrics and Gynecology, Divisions of Reproductive Endocrinology and Infertility, University of Wisconsin, USA
| | - Mazin Z Elsarrag
- Department of Obstetrics and Gynecology, Divisions of Reproductive Endocrinology and Infertility, University of Wisconsin, USA
| | - Sana M Salih
- Department of Obstetrics and Gynecology, Divisions of Reproductive Endocrinology and Infertility, University of Wisconsin, USA
| |
Collapse
|
13
|
Şahin M, Kocaman G, Özkan M, Yüksel C, Enön S, Kutlay H. Resection of esophageal carcinoma during pregnancy. Ann Thorac Surg 2015; 99:333-5. [PMID: 25555961 DOI: 10.1016/j.athoracsur.2014.01.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/23/2013] [Accepted: 01/17/2014] [Indexed: 10/24/2022]
Abstract
Esophageal carcinoma diagnosed during pregnancy is a rare occurrence. A 26-year-old pregnant patient was referred to our hospital with dysphagia. A thorough examination showed a tumor in the esophagus. Laparotomy, thoracotomy, and cervical exploration were performed. There are only 2 cases reported in the literature about esophageal carcinoma diagnosed during pregnancy and treated surgically. However, ethical dilemmas arise in managing such situations. Here we report a case of esophageal squamous cell carcinoma diagnosed at 27 weeks of gestation in which surgical resection was performed successfully.
Collapse
Affiliation(s)
- Murat Şahin
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Gökhan Kocaman
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Murat Özkan
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Cabir Yüksel
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serkan Enön
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hakan Kutlay
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
14
|
Deng ZQ, Shu WB, Yang XF, Cao JQ. Gastric cancer associated with pregnancy: A case report. Shijie Huaren Xiaohua Zazhi 2015; 23:530-532. [DOI: 10.11569/wcjd.v23.i3.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent years, the incidence rate of malignant tumors associated with pregnancy has increased gradually due to an increase in childbearing age. This paper reports a rare case of gastric carcinoma during pregnancy. We also discuss and summarize the relationship between pregnancy and the pathogenesis of gastric cancer, medical examinations, diagnosis and treatment of this condition.
Collapse
|
15
|
Nishie H, Mizushima T, Suzuki Y, Fukusada S, Inoue T, Kachi K, Ozeki T, Anbe K, Iwasaki H, Okumura F, Sano H. Chemotherapy treatment of a pregnant woman with progressive gastric cancer. Intern Med 2015; 54:1207-12. [PMID: 25986257 DOI: 10.2169/internalmedicine.54.3973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein describe a rare case of gastric cancer that was treated with chemotherapy during pregnancy. A woman in her thirty's at 23 weeks of gestation was admitted to the hospital with epigastralgia and left cervical lymph node swelling. She had been previously diagnosed with metastatic adenocarcinoma at another hospital. Findings from a CT scan and esophagogastroduodenoscopy revealed progressive gastric cancer, and the pathology indicated poorly differentiated adenocarcinoma. Chemotherapy was administered at 24 weeks of gestation, without the development of severe toxicity. At 32 weeks of gestation, a healthy baby girl (birth weight 1,442 g, Apgar score 7/8) was delivered by caesarean section. The child continued to show no abnormalities at 12 months after delivery.
Collapse
Affiliation(s)
- Hirotada Nishie
- Department of Gastroenterology, Gifu Prefectual Tajimi Hospital, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Co PV, Gupta A, Attar BM, Demetria M. Gastric cancer presenting as a krukenberg tumor at 22 weeks' gestation. J Gastric Cancer 2014; 14:275-8. [PMID: 25580361 PMCID: PMC4286908 DOI: 10.5230/jgc.2014.14.4.275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 11/20/2022] Open
Abstract
Gastric cancer is rare during pregnancy, and often advanced upon presentation. A Krukenberg tumor presents a diagnostic and therapeutic challenge in the pregnant patient. We present a case of a 38-year-old woman at 22 weeks' gestation who presented with worsening epigastric pain, and was found to have a left pelvic mass on ultrasound, which was confirmed by magnetic resonance imaging. She went into active labor and delivered a viable infant via vaginal delivery. An exploratory laparotomy revealed a large mass originating from her left ovary and diffuse thickening of the lesser curvature of the stomach. Frozen section investigation revealed the presence of signet cell adenocarcinoma. Subsequent upper endoscopy showed linitis plastica, while biopsy confirmed the presence of adenocarcinoma. In conclusion, the occurrence of gastric cancer in pregnancy is rare despite extremely common symptoms. The management poses a challenge because of the need for early treatment, and the continuation of the pregnancy.
Collapse
Affiliation(s)
- Paul Vincent Co
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Ashutosh Gupta
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Bashar M Attar
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA. ; Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Melchor Demetria
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| |
Collapse
|
17
|
Jeong B, Shim JY, Kim CJ, Won HS, Lee PR, Kim A. Massive perivillous fibrin deposition in the placenta and uterine metastasis of gastric adenocarcinoma during pregnancy. J Obstet Gynaecol Res 2014; 40:1150-3. [DOI: 10.1111/jog.12292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/05/2013] [Indexed: 01/16/2023]
Affiliation(s)
- Bada Jeong
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| | - Chong Jai Kim
- Department of Pathology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| | - Pil Ryang Lee
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| | - Ahm Kim
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| |
Collapse
|
18
|
Burgazli KM, Mericliler M, Kavukcu E, Erdogan A, Ertan AK. Discovery of asymptomatic Krukenberg tumors diagnosed during caesarean section: therapy with hyperthermic intraperitoneal chemotherapy. Postgrad Med 2013; 125:87-90. [PMID: 23933897 DOI: 10.3810/pgm.2013.07.2681] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of the discovery of asymptomatic Krukenberg tumors in a 37-year-old woman in the 37th week of pregnancy during caesarean section. Subsequent gastroscopy revealed an adenocarcinoma of the stomach as the primary tumor site. The patient was treated with hyperthermic intraperitoneal chemotherapy (HIPEC). Tumor surgery (Partial parietal peritonectomy and partial gastrectomy) and HIPEC treatment were successful, with no complications found during follow-up. Use of HIPEC seems to be a promising option after radical surgery, including its use in patients with gastric tumors that are in advanced stages, and use in patients who have tumors with poor prognoses, such as Krukenberg tumors.
Collapse
Affiliation(s)
- Kamil Mehmet Burgazli
- Department of Internal Medicine, Wuppertal Primary Health Care and Research Center, Wuppertal, Germany.
| | | | | | | | | |
Collapse
|
19
|
Berretta M, Di Francia R, Lleshi A, De Paoli P, Li Volti G, Bearz A, Del Pup L, Tirelli U, Michieli M. Antiblastic treatment, for solid tumors, during pregnancy: a crucial decision. Int J Immunopathol Pharmacol 2013; 25:1S-19S. [PMID: 23092516 DOI: 10.1177/03946320120250s201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer is the second leading cause of death during the reproductive years complicating between 0.02 percent and 0.1 percent of pregnancies. The incidence is expected to rise with the increase in age of childbearing. The most common types of pregnancy-associated cancers are: cervical cancer, breast cancer, malignant melanoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma and ovarian cancer. The relatively rare occurrence of pregnancy-associated cancer precludes conducting large, prospective studies to examine diagnostic, management and outcome issues. The treatment of pregnancy-associated cancer is complex since it may be associated with adverse fatal effects. In pregnant patients diagnosed with cancer during the first trimester, treatment with multidrug anti-cancer chemotherapy is associated with an increased risk of congenital malformations, spontaneous abortions or fetal death, and therefore, should follow a strong recommendation for pregnancy termination. Second and third trimester exposure is not associated with teratogenic effect but increases the risk of intrauterine growth retardation and low birth weight. There are no sufficient data regarding the teratogenicity of most cytotoxic drugs. Almost all chemotherapeutic agents were found to be teratogenic in animals and for some drugs only experimental data exist. Moreover, no pharmacokinetic studies have been conducted in pregnant women receiving chemotherapy in order to understand whether pregnant women should be treated with different doses of chemotherapy. This article reviews the available data regarding the different aspects of the treatment of cancer during pregnancy.
Collapse
Affiliation(s)
- M Berretta
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Miller K, Zawislak A, Gannon C, Millar D, Loughrey MB. Maternal gastric adenocarcinoma with placental metastases: what is the fetal risk? Pediatr Dev Pathol 2012; 15:237-9. [PMID: 22339159 DOI: 10.2350/11-08-1074-cr.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The incidence of maternal cancer during pregnancy is low, and metastatic disease involving the placenta is rare. We present a case of rapidly progressive and fatal gastric carcinoma presenting during pregnancy, with spread to the maternal blood space within the placenta but no chorionic villous invasion and no evidence of fetal transmission at the time of delivery or on 12-month follow up. To the best of our knowledge, there have been only 5 previous single case reports of gastric carcinoma metastatic to the placenta. This case highlights the need for clinical vigilance against dismissing gastrointestinal symptoms as pregnancy related and for pathologists to carefully examine the placenta in the setting of maternal malignancy. When placental metastases are present but with no villous invasion, the risk of fetal metastasis may be extremely low, even in the setting of aggressive, terminal malignancy in the mother.
Collapse
Affiliation(s)
- Keith Miller
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland.
| | | | | | | | | |
Collapse
|
21
|
Cancer in pregnancy. Part II: treatment options of breast and other non-gynecological malignancies. Arch Gynecol Obstet 2011; 284:1481-94. [DOI: 10.1007/s00404-011-2059-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/02/2011] [Indexed: 12/17/2022]
|
22
|
Case report: gastric carcinoma diagnosed at the second trimester of pregnancy. Case Rep Obstet Gynecol 2011; 2011:532854. [PMID: 22567511 PMCID: PMC3335580 DOI: 10.1155/2011/532854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 06/29/2011] [Indexed: 11/24/2022] Open
Abstract
We report a rare case of gastric cancer in pregnancy. A 26-year-old woman presented at the 20th week of pregnancy complaining of nausea and vomiting. Although the patient considered the condition to be related with pregnancy and underestimated its importance, her complaints persisted over the following weeks and she was hospitalized for investigation. The diagnostic workup revealed a metastatic gastric cancer. Gastric cancer is very rare in pregnancy, and therefore it may be left out of differential diagnosis by physicians. Diagnosis may be further delayed because of overlapping symptoms occurring during normal pregnancy (nausea, vomiting, and fatigue). All these factors may contribute to a very high mortality of this malignancy during pregnancy.
Collapse
|
23
|
Terzi A, Çoban S, Yıldız F, Aksoy Ş, Toy H, Uzunkoy A. Surgical Treatment of a Gastric Cancer
in a Pregnant Woman without Performing
Abortion. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2010. [DOI: 10.29333/ejgm/82834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Abstract
BACKGROUND Esophageal cancer concomitant with pregnancy is very rare and the prognosis is poor. The main concern in diagnosis is that the clinical presentations of esophageal cancer in pregnant woman are often not considered serious and are misinterpreted as pregnancy-related symptoms. CASE A 29-year-old woman presented at 29 weeks' gestation with dysphagia, weight loss, and a single episode of hematemesis. Esophageal carcinoma was diagnosed on endoscopy, and local spread confirmed by MRI. A Caesarean section was performed at 32 weeks' gestation, and shortly afterwards the patient underwent thoracotomy, but resection of the tumour could not be performed. Palliative treatment was begun and she was discharged from hospital. CONCLUSION Clinicians must be aware and include the probability of esophageal cancer in the differential diagnosis of gastrointestinal symptoms during pregnancy.
Collapse
Affiliation(s)
- Iskander Al-Githmi
- Department of Surgery, Division of Cardiothoracic Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| |
Collapse
|
25
|
Yoshida M, Matsuda H, Furuya K. Successful Treatment of Gastric Cancer in Pregnancy. Taiwan J Obstet Gynecol 2009; 48:282-5. [DOI: 10.1016/s1028-4559(09)60305-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
26
|
Esophageal carcinoma during pregnancy: a case report. Arch Gynecol Obstet 2008; 279:401-2. [DOI: 10.1007/s00404-008-0724-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 06/24/2008] [Indexed: 10/21/2022]
|
27
|
Fill S, Taran A, Schulz HU, Kahl S, Kalinski T, Smith B, Costa SD. Sister Mary Joseph’s nodule as the first sign of pregnancy-associated gastric cancer: A case report. World J Gastroenterol 2008; 14:951-3. [PMID: 18240358 PMCID: PMC2687068 DOI: 10.3748/wjg.14.951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sister Mary Joseph’s nodule is an inconspicuous and uncommon clinical sign of advanced malignant disease, especially gastric cancer. Pregnancy-associated gastric cancer is an extremely rare condition and can be difficult to diagnose, due to the absence or misinterpretation of symptoms as pregnancy-related. Diagnostic aids, such as a basic chemistry panel and imaging techniques, may not show any abnormalities. We present a case of a 37-year-old pregnant patient whose umbilical nodule was the first presenting physical sign of gastric cancer, which had metastasized throughout the abdominal and pelvic regions.
Collapse
|
28
|
Pentheroudakis G, Pavlidis N. Gastrointestinal, urologic and lung malignancies during pregnancy. Recent Results Cancer Res 2008; 178:137-164. [PMID: 18080450 DOI: 10.1007/978-3-540-71274-9_13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- G Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, Greece
| | | |
Collapse
|
29
|
Pavlidis N, Pentheroudakis G. Metastatic involvement of placenta and foetus in pregnant women with cancer. Recent Results Cancer Res 2008; 178:183-194. [PMID: 18080453 DOI: 10.1007/978-3-540-71274-9_16] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- N Pavlidis
- Department of Medical Oncology, Medical School, University of Ioannina, Greece
| | | |
Collapse
|
30
|
Pentheroudakis G, Pavlidis N. Cancer and pregnancy: Poena magna, not anymore. Eur J Cancer 2006; 42:126-40. [PMID: 16326099 DOI: 10.1016/j.ejca.2005.10.014] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 10/06/2005] [Indexed: 01/02/2023]
Abstract
Cancer diagnosed during pregnancy constitutes a difficult clinical condition with a devastating impact on the patient's somatic and psychosocial health and possibly on foetal integrity. This circumstance also raises several moral, religious, social and familial dilemmas. In this review we critically present available evidence regarding the incidence, epidemiology and genetics of cancer in pregnant women, its presentation, diagnosis and staging as well as therapeutic management. Issues such as maternal/foetal prognosis, need for termination of pregnancy, risk of foetal health injury and necessity of psychosocial support are reviewed. Recent accumulating evidence suggests that, with appropriate management, poena magna should not be used to define neither cancer nor pregnancy.
Collapse
Affiliation(s)
- George Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, University of Ioannina, 45 110 Ioannina, Greece
| | | |
Collapse
|
31
|
Dunkelberg JC, Barakat J, Deutsch J. Gastrointestinal, Pancreatic, and Hepatic Cancer During Pregnancy. Obstet Gynecol Clin North Am 2005; 32:641-60. [PMID: 16310677 DOI: 10.1016/j.ogc.2005.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jeffrey C Dunkelberg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Ambulatory Care Center-5, 1 University of New Mexico, MSC10-5550, Albuquerque, NM 87131-0001, USA.
| | | | | |
Collapse
|
32
|
Yücesoy G, Büyükgebiz O, Yildiz K, Cakiroğlu Y, Ozkan S, Bodur H. Gastric carcinoma diagnosed at the third trimester: a case report. Arch Gynecol Obstet 2005; 274:47-9. [PMID: 16283407 DOI: 10.1007/s00404-005-0092-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 09/28/2005] [Indexed: 10/25/2022]
Abstract
Gastric carcinoma associated with pregnancy appears to be an extremely rare entity. It is usually diagnosed at advanced stages of the disease and presents a grave prognosis. Since the fatal outcome shows a rapid course within months of diagnosis, prompt gastroduodenal endoscopic examination following early clinical suspicion is mandatory. A case of 29 year-old pregnant woman with 31 weeks of gestation is herein presented. The women was diagnosed as gastric adenocarcinoma while being investigated for intractable nausea, vomiting, and a concomitant epigastric mass. She underwent radical gastric resection and received six cycles of adjuvant chemotherapy following vaginal delivery of a healthy 1950 g fetus. The patient was dead 20 weeks after the surgery due to pulmonary and hepatic metastasis.
Collapse
Affiliation(s)
- Gülseren Yücesoy
- Department of Obstetrics and Gynecology, School of Medicine, University of Kocaeli, Mazhar Osman Sok 10/8, Feneryolu-Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
33
|
Affiliation(s)
- I Ozdemir
- Department of Obstetrics and Gynecology, Duzce Medical School, Abant Izzet Baysal University, Duzce, Turkey.
| | | | | |
Collapse
|
34
|
Khatib F, Shaya M, Samueloff A. Gastric carcinoma with metastasis to the placenta and amniotic fluid: case report and review of the literature. Eur J Obstet Gynecol Reprod Biol 2003; 107:208-9. [PMID: 12648871 DOI: 10.1016/s0301-2115(02)00261-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Faiez Khatib
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Ben-Gurion University of the Negev, Jerusalem, Israel.
| | | | | |
Collapse
|
35
|
Abstract
The frequency, symptoms, and complication rate of PUD seem to decrease during pregnancy. Yet clinicians often have to treat dyspepsia or pyrosis of undetermined origin during pregnancy because the frequency of pyrosis significantly increases during pregnancy, and clinicians reluctantly perform EGD during pregnancy for pyrosis to differentiate reliably between GERD and PUD. Dyspepsia or pyrosis during pregnancy is initially treated with dietary and lifestyle modifications. If the symptoms do not remit with these modifications, sucralfate or antacids, preferably magnesium-containing or aluminum-containing antacids, should be administered. Histamine2 receptor antagonists are recommended when symptoms are refractory to antacid or sucralfate therapy. Ranitidine seems to be a relatively safe H2 receptor antagonist. If symptoms continue despite H2 receptor antagonist therapy, the patient should be evaluated for possible EGD or PPI therapy. Pregnant women with hemodynamically significant upper gastrointestinal bleeding or other worrisome clinical findings should undergo EGD. Indications for surgery include ulcer perforation, ongoing active bleeding from an ulcer requiring transfusion of six or more units of packed erythrocytes, gastric outlet obstruction refractory to intense medical therapy, and a malignant gastric ulcer without evident metastases.
Collapse
Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, 760 Broadway Avenue, Brooklyn, NY 11206, USA
| |
Collapse
|
36
|
Okutomi T, Hoshino Y, Amano K, Okamoto H, Hoka S. Intrathecal fentanyl/meperidine combined with low-dose epidural bupivacaine for Cesarean section in a patient with advanced Krukenberg tumors. Acta Anaesthesiol Scand 2002; 46:1272-5. [PMID: 12421201 DOI: 10.1034/j.1399-6576.2002.461016.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This case report demonstrates the anesthetic management of a 41-year-old primiparous parturient with massive ascites due to advanced Krukenberg tumors, undergoing Cesarean section. We chose a combined intrathecal-epidural technique, using intrathecal hypobaric fentanyl and hyperbaric meperidine, and a low dose of epidural bupivacaine in order to avoid hemodynamic instability in this critically ill patient. Surgery was carried out without difficulty under adequate regional anesthesia. The blood pressure was maintained with low doses of phenylephrine and dopamine. Opioid-related complications such as nausea-vomiting, pruritus, drowsiness, and respiratory depression were not observed in this patient. Therefore, intrathecal opioids combined with a low dose of epidural local anesthetics for Cesarean section is suitable for critically ill patients with malignant abdominal tumors, such as a Krukenberg tumor, complicated by massive ascites.
Collapse
Affiliation(s)
- T Okutomi
- Departments of Anesthesiology, Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | | | | | | | | |
Collapse
|
37
|
Cosme A, Ojeda E, Bujanda L, Torrado J, Barrio J. [Krukenberg tumor secondary to gastric carcinoma in a woman in her eighth month of pregnancy]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:63-5. [PMID: 11247291 DOI: 10.1016/s0210-5705(01)78987-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The association of gastric cancer and pregnancy is rare. The cases reported by non-Japanese authors are unusual. Tumors tend to be in advanced stage when diagnosed since the symptoms of gastric cancer are easily presumed to be secondary to those of normal pregnancy. We report the case of a 43-year-old female with gastric carcinoma presenting as a Krukenberg's tumor in the eighth month of gestation. A healthy child was born and after delivery, partial gastrectomy was performed and adjuvant chemotherapy was administered. The patient died 12 months after diagnosis.
Collapse
Affiliation(s)
- A Cosme
- Servicio de Digestivo, Hospital Aránzazu, San Sebastián
| | | | | | | | | |
Collapse
|
38
|
Jaspers VK, Gillessen A, Quakernack K. Gastric cancer in pregnancy: do pregnancy, age or female sex alter the prognosis? Case reports and review. Eur J Obstet Gynecol Reprod Biol 1999; 87:13-22. [PMID: 10579611 DOI: 10.1016/s0301-2115(99)00072-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The coincidence of gastric cancer and pregnancy is a rare event. By literature research of the last three decades only 31 cases from outside Japan were identified including two own patients. The analysis of these and another 61 cases from Japan revealed the same predominance of poorly differentiated diffuse carcinomas with peritoneal and lymphatic metastases as in other young patients (<40 years). The survival rate is not obviously affected by pregnancy, young age or female sex. Experimental and epidemiological data suggest a protective effect of oestrogen against the induction of (intestinal) gastric cancer, while the cancer growth itself seems to be enhanced. Oestrogen receptors (ER) are found in about 22% of gastric cancer cells, especially in the poorly differentiated type. In contrast to target organs like the breast, ER in gastric cancer seem to be a sign of tumour adaptation involving e.g. the pathway of the epidermal growth factor. The results of treatment with anti-oestrogen are controversial in experimental and clinical settings. Due to the very common epigastric complaints early diagnosis of gastric cancer is even more difficult in pregnancy, so that early gastroscopy is advisable in patients on risk. Main effort should be given, however, to primary prevention.
Collapse
Affiliation(s)
- V K Jaspers
- Department of Obstetrics and Gynaecology, Marienhospital Herne, Ruhr-University Bochum, Germany
| | | | | |
Collapse
|
39
|
Hagen A, Becker C, Runkel S, Weitzel HK. Hyperemesis in late pregnancy--should we think of cancer? A case report. Eur J Obstet Gynecol Reprod Biol 1998; 80:273-4. [PMID: 9846683 DOI: 10.1016/s0301-2115(98)00102-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gastric cancer is unusual during pregnancy. The diagnosis may be delayed because specific symptoms are similar to typical pregnancy associated complaints. Our therapeutic management with palliative chemotherapy and later gastrectomy differs from other known cases, where surgical resection has been the treatment of choice. Surgery appears to have no influence on the prognosis of gastric cancer patients with hepatic metastases.
Collapse
Affiliation(s)
- A Hagen
- Department of Obstetrics and Gynecology, University Hospital Benjamin Franklin, Free University of Berlin, Germany
| | | | | | | |
Collapse
|
40
|
|
41
|
Abstract
The frequency, symptoms, and complication rate of peptic ulcer disease appear to decrease during pregnancy significantly. Clinicians, however, often have to treat dyspepsia or pyrosis of undetermined cause because the frequency of pyrosis increases during pregnancy. Physicians are reluctant to perform esophagogastroduodenoscopy (EGD) during pregnancy for pyrosis to reliably differentiate gastroesophageal reflux from peptic ulcer disease. Dyspepsia or pyrosis during pregnancy first should be treated with dietary and lifestyle changes, together with antacids or sucralfate. When symptoms persist, H2 receptor-antagonists are recommended. If symptoms continue and are severe despite these interventions, the patient should be evaluated for possible EGD or proton pump inhibitor therapy during the second or third trimester.
Collapse
Affiliation(s)
- M S Cappell
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | | |
Collapse
|
42
|
Affiliation(s)
- S S Lo
- Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | | | | |
Collapse
|
43
|
Scharl A, Huber P, Lorenzen J, Göhring UJ. Gastric cancer during early pregnancy. Two case reports. Arch Gynecol Obstet 1996; 258:151-4. [PMID: 8781704 DOI: 10.1007/s004040050117] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Scharl
- Department of Obstetrics and Gynecology, University of Cologne, Germany
| | | | | | | |
Collapse
|
44
|
Tamussino K, Schöll W, Reich O, Winter R. Gastric carcinoma presenting as a Krukenberg tumor in the 24th week of gestation. Eur J Obstet Gynecol Reprod Biol 1995; 62:251-2. [PMID: 8582506 DOI: 10.1016/0301-2115(95)02179-b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- K Tamussino
- Department of Obstetrics and Gynecology, University of Graz, Austria
| | | | | | | |
Collapse
|
45
|
Lau WY, Leung WT, Ho S, Lam SK, Li CY, Johnson PJ, Williams R, Li AK. Hepatocellular carcinoma during pregnancy and its comparison with other pregnancy-associated malignancies. Cancer 1995; 75:2669-76. [PMID: 7743468 DOI: 10.1002/1097-0142(19950601)75:11<2669::aid-cncr2820751105>3.0.co;2-b] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cancer in pregnancy is rare and hepatocellular carcinoma (HCC) in pregnancy even rarer. The impact of pregnancy on the prognosis of patients with different types of cancer remains controversial. Reported cases of HCC in pregnancy are largely isolated and highly scattered. Thus, the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. METHODS A series of five patients with HCC in pregnancy seen at two different centers is reported. A Medlar search for articles between 1957 and 1993 with the key words "Hepatocellular Carcinoma" and "Pregnancy" was conducted. All reported cases were combined and analyzed in terms of race, age, parity, hepatitis B surface antigen status, cirrhosis, serum alpha-fetoprotein (AFP) levels at presentation, history of taking oral contraceptive pills and fetal and maternal outcome. The impact of pregnancy on 12 other malignancies as reported in the medical literature also was reviewed. RESULTS To the authors' knowledge, The five cases reported here constitute the largest series of HCC in pregnancy. A literature search revealed 23 additional cases. Analysis of the 28 cases suggests that the rarity of HCC in pregnancy results from a combination of three factors: the male predominance of HCC, the late age at which the tumor usually presents in women, and decreased fertility in women with advanced cirrhosis (hepatitis is a predisposing factor for HCC development). Long term use of oral contraceptives and high parity enhance the risk. Elevated AFP level is useful for diagnosis. The median survival is shorter than for patients who are not pregnant. There is no significant difference in survival between pregnant and not pregnant women matched by tumor stage, age, and other clinical parameters in most malignancies except in some tumors like lymphoma, thyroid cancer, and nasopharyngeal carcinoma. CONCLUSION Pregnancy has an adverse effect on the prognosis of patients with HCC, lymphoma, thyroid cancer, and nasopharyngeal carcinoma but not of most other malignancies. Measurement of AFP level is recommended for screening HCC in pregnant women at high risk.
Collapse
Affiliation(s)
- W Y Lau
- Joint Hepatocellular Carcinoma Study Group, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Maeta M, Yamashiro H, Oka A, Tsujitani S, Ikeguchi M, Kaibara N. Gastric cancer in the young, with special reference to 14 pregnancy-associated cases: analysis based on 2,325 consecutive cases of gastric cancer. J Surg Oncol 1995; 58:191-5. [PMID: 7898116 DOI: 10.1002/jso.2930580310] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Clinicopathologic features of gastric cancer in young women were analyzed with special reference to pregnancy (P). Among 2,325 consecutive patients, there were 152 young patients under 40 years of age (57 males and 95 females), and 14 P-associated cases were identified. The male-to-female ratio was 1.7:1.0 on the whole, but 1.0:1.7 in the young group with more females predominating as the age of patients decreased. Among characteristics of gastric cancer in the young females, we noted a significantly higher frequency of both Borrmann type 4 cancer and poorly differentiated adenocarcinoma with the scirrhus type of growth and peritoneal metastasis. These characteristics were more pronounced in the P-associated cases. Although we were unable to determine the mechanism for these tendencies, our findings suggest that the development and growth of gastric cancer in young women may be influenced by their natural, biological and hormonal circumstances. The prognosis of the young women with or without associated pregnancy was good after curative surgery. Both early detection of gastric cancer and subsequent potentially curative surgery are the best ways to obtain good survival for young women, as is the case for members of other age and sex groups.
Collapse
Affiliation(s)
- M Maeta
- First Department of Surgery, Tottori University School of Medicine, Yonago, Japan
| | | | | | | | | | | |
Collapse
|