Esophageal carcinoma during pregnancy: a case report

A case report of metastatic esophageal squamous cell carcinoma during pregnancy

Esophageal cancer is extremely rare in pregnant women, accounting for only 0.07%-0.1% of all malignant neoplasms in pregnancy. It is rapidly progressive in nature and requires timely intervention. Our literature search yielded six case reports of esophageal cancers in pregnancy thus far. We herein report the case of a 30-year-old female, presenting at 32 weeks of gestation with complaints of hoarseness, dysphagia, and weight loss. The biopsy taken from within the esophagus, using an endoscope during an upper endoscopy procedure confirmed the diagnosis of squamous cell carcinoma of esophagus and Positron emission tomography-computed tomography revealed metastasis to parathyroid region. She was confirmed with metastatic squamous cell cancer positive for cytokeratin 5/6 and cytokeratin P40 immunohistochemistry. The Positron emission tomography-computed tomography of the chest showed a large hypermetabolic soft tissue mass in the mid-esophagus with significant proximal dilation. The head-and-neck computed tomography scan represented a necrotic nodal mass in the neck and circumferential mural thickening involving the mid-esophagus resulting in the proximal dilation confirming the primary tumor site. Two weeks after the delivery, the patient started a chemotherapy regimen consisting of nine cycles of Carboplatin and Paclitaxel. Postchemotherapeutic computed tomography showed remonstration of lesion in the thyroid gland and middle part of the esophagus. Thus, in pregnant patients with new onset hoarseness, dysphagia, or substantial weight loss, clinicians should keep esophageal cancer as part of their differentials. A thorough history, detailed physical examination, and imaging should be performed to determine esophageal cancer, as it can advance swiftly and has a poor prognosis if left untreated.

Transhiatal esophagectomy for distal esophageal cancer during pregnancy: A rare and challenging case report

INTRODUCTION

Esophageal cancer during pregnancy is extremely very rare. The diagnosis of esophageal cancer during pregnancy is not easy because of overlapping clinical presentation of the disease and pregnancy related symptoms. The management of esophageal cancer during pregnancy is also very challenging. This is because of the absence of standard treatment guidelines and all treatment options have significant risk both on the mother and fetus.

CASE PRESENTATION

We present a 35 years old multipara women presented with difficulty of swallowing solid meal initially and later both to solid and liquid diet of 3 months duration and significant weight loss of same duration at gestational age of 27 weeks whom successfully treated with trans hiatal esophagectomy and discharged from the hospital uneventfully.

DISCUSSION

Proper patient evaluation and high index of suspicion is very important in order to detect esophageal at its early stage. Multidisciplinary and individualized patient approach should be advised to manage esophageal cancer during pregnancy as there is no standard treatment guideline. For resectable esophageal cancer during pregnancy, esophagectomy can be a treatment option as free margin tumor resection with lymph node clearance is the only curative treatment option for esophageal cancer.

CONCLUSION

Esophagectomy can be one of the option of treatment for pregnant women diagnosed with resectable esophageal cancer without causing major risk both on the patient and pregnancy.

A Case of Recurrent Esophageal Cancer Treated with Concurrent Chemoradiation Therapy in Pregnancy

Esophageal cancer rarely coincides with pregnancy, and only five cases have been reported thus far. The management of esophageal cancer during pregnancy is extremely challenging due to its aggressive nature. We herein report a case of recurrent esophageal cancer in pregnancy. A 41-year-old multigravida with a history of esophageal squamous cell cancer treated with esophagectomy and perioperative chemotherapy was diagnosed with local recurrent carcinoma of the residual esophagus at 16 weeks of gestation. The patient strongly desired to continue the pregnancy, and concurrent chemoradiation therapy (CRT) consisting of 50.4 Gy of radiation, cisplatin, and 5-fluorouracil was carried out from 19 weeks of gestation. CRT was dramatically effective, and the recurrent lesion disappeared. At 38 weeks of gestation, she underwent cesarean section and delivered a healthy female baby. Both maternal and fetal courses were satisfactory, and the patient has been free of disease for 12 months. This is the first case of recurrent esophageal cancer in pregnancy in which CRT was completed without reducing treatment intensity and led to a complete response. Nevertheless, little is known regarding the safety and possible adverse effects of CRT on the fetus. Therefore, deliberate selection of patients and long-term follow-up of the child are necessary.

A Case of Metastatic Esophageal Carcinoma in a Pregnant Woman with Radiologic Findings

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.

Resection of esophageal carcinoma during pregnancy

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.

A prospective randomized trial comparing the clinical and endocrinological outcome with rosiglitazone versus laparoscopic ovarian drilling in patients with polycystic ovarian disease resistant to ovulation induction with clomiphene citrate

OBJECTIVES

Rosiglitazone, an insulin sensitizing agent is used currently in women with clomiphene citrate (CC) resistant polycystic ovarian syndrome (PCOS). Our study proposed to compare the efficacy of rosiglitazone and CC with laparoscopic ovarian drilling (LOD) and CC in terms of biochemical effects, ovulation rate and pregnancy rate in patients of PCOS resistant to CC.

METHODS

This prospective randomised trial included 43 patients of PCOS resistant to CC. Twenty-two women were assigned to the rosiglitazone (4 mg twice daily) and CC group and other 21 patients underwent unilateral LOD and then received CC and multivitamins. The treatment continued for six cycles in both the groups. The biochemical response, ovulation rate and pregnancy rate over a follow up period of 6 months were compared.

RESULTS

Treatment with rosiglitazone and CC or LOD and CC resulted in increased ovulation (80.8 vs. 81.5%) and pregnancy (50 vs. 42.8%), respectively. There was no statistical difference between the two groups in terms of biochemical response, ovulation rate and pregnancy rate.

CONCLUSION

To avoid the risk of adverse effects of LOD preference may be given to the use of rosiglitazone and CC therapy in patients of PCOS resistant to CC.

Esophageal cancer associated with pregnancy

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.