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Chellan D, Senthamizhselvan K, Nair A, Mohan P, Ramkumar G, Badhe B. Skull Base Metastasis and Krukenberg Tumor in a Pregnant Woman: An Unusual Presentation of Metastatic Gastric Cancer. ACG Case Rep J 2024; 11:e01283. [PMID: 38333720 PMCID: PMC10852361 DOI: 10.14309/crj.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Gastric cancer is an infrequent cause of vomiting during pregnancy. It is often diagnosed at an advanced stage due to late presentation by patients, mistaking it for gestational symptoms. We report a 24-year-old pregnant woman with gastric cancer with skull base metastasis and Krukenberg tumor on initial diagnosis. She underwent medical termination of pregnancy and best supportive care before dying of her illness.
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Affiliation(s)
- Deepak Chellan
- Department of Medical Gastroenterology, JIPMER, Puducherry, India
| | | | - Ahalya Nair
- Department of Nuclear Medicine, JIPMER, Puducherry, India
| | - Pazhanivel Mohan
- Department of Medical Gastroenterology, JIPMER, Puducherry, India
| | - G. Ramkumar
- Department of Radiodiagnosis, JIPMER, Puducherry, India
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Eckel F, Carlin G, Mayer S, Polterauer S, Chalubinski K. Krukenberg Progression of Gastric Carcinoma in Pregnancy: Is Early Diagnosis Possible? Case Report and Review of the Literature. J Clin Med 2023; 12:5397. [PMID: 37629439 PMCID: PMC10455580 DOI: 10.3390/jcm12165397] [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: 05/09/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Krukenberg tumors are metastatic tumors of the ovaries, associated with poor outcomes. Most commonly, these tumors are of gastric origin. The diagnosis of Krukenberg tumors in pregnant patients is extremely rare and poses specific difficulties for clinicians. We report a case of a pregnant woman presenting with an unknown abdominal tumor. Through the use of magnetic resonance imaging, multiple differential diagnoses were proposed, including a malignant ovarian tumor. A cesarean section and explorative laparotomy were conducted, revealing Krukenberg metastases of a gastric tumor, discovered during intraoperative gastroscopy. Tumor resection with concomitant chemotherapy was conducted. The main aim of this paper was to evaluate whether earlier diagnosis seems possible in such cases. A thorough literature review was conducted, unfortunately revealing no reliable method for early detection. Furthermore, no consensus regarding diagnostics or therapy exists to date. Thus, more research should be conducted regarding this rare condition to offer recommendations regarding early detection, diagnostics, and therapeutic approaches.
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Affiliation(s)
- Fanny Eckel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Greta Carlin
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Stefanie Mayer
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Kinga Chalubinski
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
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Imaging of Metastatic Disease to the Ovary/Adnexa. Magn Reson Imaging Clin N Am 2022; 31:93-107. [DOI: 10.1016/j.mric.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Importance Adnexal masses are identified in approximately 0.05% to 2.4% of pregnancies, and more recent data note a higher incidence due to widespread use of antenatal ultrasound. Whereas most adnexal masses are benign, approximately 1% to 6% are malignant. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians. Objective The aim of this study was to review imaging modalities for evaluating adnexal masses in pregnancy and imaging characteristics that differentiate benign and malignant masses, examine various types of adnexal masses, and understand complications of and explore management options for adnexal masses in pregnancy. Evidence Acquisition This was a literature review using primarily PubMed and Google Scholar. Results Ultrasound can distinguish between simple-appearing benign ovarian cysts and masses with more complex features that can be associated with malignancy. Radiologic information can help guide physicians toward recommending conservative management with observation or surgical removal during pregnancy to facilitate diagnosis and treatment. The risks of expectant management of an adnexal mass during pregnancy include rupture, torsion, need for emergent surgery, labor obstruction, and progression of malignancy. Historically, surgical removal was performed more routinely to avoid such complications in pregnancy; however, increasing knowledge has directed management toward conservative measures for benign masses. Surgical removal of adnexal masses is increasingly performed via minimally invasive techniques including laparoscopy and robotic surgery due to a decreased risk of surgical complications compared with laparotomy. Conclusions and Relevance Adnexal masses are increasingly identified in pregnancy because of the use of antenatal ultrasound. Clear and specific guidelines exist to help differentiate between benign and malignant masses. This is important for management as benign masses can usually be conservatively managed, whereas malignant masses require excision for diagnosis and treatment. A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.
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Mendoza-Rosado F, Nunez-Isaac O, Espinosa-Marrón A, Lopez-Arjona K, Davila-Martinez F. Krukenberg tumor as an incidental finding in a full-term pregnancy: a case report. J Med Case Rep 2021; 15:304. [PMID: 34049591 PMCID: PMC8164271 DOI: 10.1186/s13256-021-02875-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Krukenberg tumor is a rare metastatic tumor of the ovary with histopathological features known as signet ring cells. It usually develops in women around 45 years of age. However, here we describe an uncommon case in a 38-year-old pregnant woman. We report this case due to our unusual findings, the uncommon presentation in this younger age bracket, its diagnostic challenge, and poor prognosis. Case presentation We describe a unique case of a young Mexican woman with a history of painful vaginal bleeding at 13 weeks of pregnancy and treated for abruptio placentae. In her routine prenatal visit at week 20 of pregnancy, she was found to have a uterine fundus exceeding the expected measure for her gestational age and was referred to the hospital to discard polyhydramnios. Upon admission, a pelvic ultrasound was performed displaying normal findings in a 25-week pregnancy, and also showing bilateral enlarged ovaries with heterogeneous echogenicity. Magnetic resonance imaging revealed a left tumoral lesion with dimensions of 22.1 × 13.6 × 16.3 cm presenting regular lobulated contours with displacement of peripheral structures and mild compression of the bladder, the left ureter, and the inferior vena cava. The lesion was heterogeneous with irregular borders. The patient was scheduled for a cesarean section; during the operation, the abdominal cavity showed bilateral tumors compatible with MRI findings. The ovarian tumors were sent to pathology, and the results showed poorly differentiated mucinous adenocarcinoma (World Health Organization grade III) with extensive signet ring cells, indicative of a Krukenberg tumor. Conclusion This case report describes an uncommon example of a young pregnant woman without identifiable risk factors for gastric cancer who manifested a Krukenberg tumor. This incidental finding suggests that pregnancy obscured the cancer’s clinical appearance. The rapid deterioration in the patient’s condition corresponds to what is described in the literature. The limited information regarding this neoplasm in Mexico and the torpid evolution of the case highlight the importance of conducting additional studies to generate therapeutic interventions aimed at increasing overall survival.
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Affiliation(s)
| | | | - Alan Espinosa-Marrón
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Fernando Davila-Martinez
- Department of Gynecology and Obstetrics, Hospital Regional Ignacio García Téllez, Merida, Mexico
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Wang L, Huang S, Sheng X, Ren C, Wang Q, Yang L, Zhao S, Xu T, Ma X, Guo R, Sun P, Lin Y, Li Y, Wang J, Wang Y. Malignant Ovarian Tumors During Pregnancy: A Multicenter Retrospective Analysis. Cancer Manag Res 2020; 12:10841-10848. [PMID: 33149689 PMCID: PMC7605603 DOI: 10.2147/cmar.s271806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/06/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose The aim of this study was to investigate the clinical characteristics and management of malignant ovarian tumors during pregnancy, as well as the feto-maternal outcomes and analyze the influential factors on the pregnancy outcomes. Patients and Methods Eighty-five patients with ovarian malignancies during pregnancy treated at 12 tertiary hospitals between 2009 and 2019 were analyzed in this study. The clinical features, histopathological characteristics, clinical management, and maternal and perinatal outcomes were retrospectively analyzed. The clinical features and managements were compared between abortion group and live birth group. Results The following diagnoses were made: 41 (48.24%) patients with borderline ovarian tumors, 18 (21.18%) patients with epithelial ovarian cancers, 17 (20.00%) patients with non-epithelial ovarian malignancies and 9 (10.59%) patients with metastatic ovarian tumors. Thirty-six (42.45%) patients underwent conservative surgical treatment. Thirty-four (40.00%) patients opted for fertility-sparing surgery, and fifteen (17.56%) patients received radical surgery. Chemotherapy was administered to 32.94% of the patients. The proportion of ovarian malignancies diagnosed in the first trimester in the abortion group was higher than that in the live birth group (P<0.05). However, tumor diameter, reproductive history, stage and surgical indications showed no significant differences between groups. A total of 67 live babies were recorded in this study, including 19 premature babies and 1 full-term newborn who died of respiratory distress. All of the BOTs were diagnosed with stage I, among whom 38 (92.68%) patients exhibited disease-free survival. Twenty-eight ovarian cancers were in stage I–II and 26 of them had disease-free survival with the longest follow-up time of 10 years. Five of the sixteen patients in advanced stage (stage III–IV) died, four of whom had metastatic tumors. Conclusion Pregnant women with early-stage malignant ovarian tumors appear to have favorable outcomes. Conservative surgery is acceptable for early-stage borderline ovarian tumors during pregnancy. The gestational age of ovarian malignancy detection is key for pregnancy outcomes.
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Affiliation(s)
- Liya Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
| | - Shenjiao Huang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Centre, Guangzhou 510623, People's Republic of China
| | - Xiujie Sheng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Major Obstetric Diseases of Guangdong Province, Guangzhou 510150, People's Republic of China
| | - Chenchen Ren
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Qiming Wang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Ningbo City, Ningbo 315012, People's Republic of China
| | - Linqing Yang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining 272029, People's Republic of China
| | - Shuping Zhao
- Department of Gynecology, Women and Children's Hospital of Qingdao, Qingdao 266000, People's Republic of China
| | - Tianmin Xu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130000, People's Republic of China
| | - Xiaoxin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated of China Medical University, Shenyang 110004, People's Republic of China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Pengming Sun
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Yang Lin
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130000, People's Republic of China
| | - Yuhong Li
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
| | - Jiandong Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, People's Republic of China
| | - Yudong Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
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Boussios S, Moschetta M, Tatsi K, Tsiouris AK, Pavlidis N. A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives. J Adv Res 2018; 12:1-9. [PMID: 29988841 PMCID: PMC6032492 DOI: 10.1016/j.jare.2018.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/21/2022] Open
Abstract
The management of gestational ovarian cancer can be challenging because of the risk of fetal wastage, and the possibility of treatment-related complications to the fetus; it is based on insufficient data from retrospective studies and case series. Here, a literature review of the diagnostic and surgical approaches to the gestational ovarian cancer has been performed; moreover, data on safety of chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes, have also been reviewed. Up to now, 193 cases of ovarian cancers during pregnancy have been reported in the English literature. Treatment of ovarian malignancies during pregnancy depends on histology, stage, and gestational weeks. When possible, surgical excision is indicated, and fertility-sparing surgery can be offered to stage I epithelial ovarian tumours (EOC), germ cell ovarian, or sex-cord stromal ovarian tumours. Neoadjuvant and/or adjuvant chemotherapy for advanced ovarian tumours is indicated as in non-pregnant women. Administration of chemotherapy after the first trimester, can cause fetal growth restriction, while being seemingly safe. The therapeutic approach of ovarian cancer in pregnancy should be individualized and intended in specialized centers.
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Affiliation(s)
- Stergios Boussios
- Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
- Corresponding author.
| | - Michele Moschetta
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London W1G 6AD, UK
| | - Konstantina Tatsi
- Gynaecology Unit, General Hospital “G. Hatzikosta”, Makrigianni Avenue, 45001 Ioannina, Greece
| | - Alexandros K. Tsiouris
- Department of Biological Applications & Technology, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
| | - Nicholas Pavlidis
- Medical School, University of Cyprus, Old road Lefkosias Lemesou, No. 215/6, 2029 Aglantzia, Nicosia, Cyprus
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Abstract
Meig syndrome is the triad of benign ovarian tumor, ascites, and pleural effusion. Pseudo-Meig syndrome mimics the Meig syndrome triad; however, in pseudo-Meig syndrome, the ovarian tumor usually represents a primary malignancy or metastases. Differentiating Meig from pseudo-Meig syndrome is challenging both clinically and with diagnostic imaging but is important because prognoses for these distinct entities are drastically different. Evidence-based sonographic prediction models are valuable because they can aid in this distinction. Here, we present the first reported case of pseudo-Meig syndrome secondary to large, bilateral Krukenberg tumors of unknown origin, in a gravid 30-year-old woman at 24 weeks' gestation, discovered initially by ultrasound.
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Bansal R, Jain V, Prasad GRV, Kapoor R, Chopra S, Muralidaran C. Successful Feto-maternal Outcome Following Pregnancy in a Patient with Krukenberg Tumor: Case Report and Review of Literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thomassin-Naggara I, Fedida B, Sadowski E, Chevrier MC, Chabbert-Buffet N, Ballester M, Tavolaro S, Darai E. Complex US adnexal masses during pregnancy: Is pelvic MR imaging accurate for characterization? Eur J Radiol 2017; 93:200-208. [PMID: 28668416 DOI: 10.1016/j.ejrad.2017.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To retrospectively evaluate the accuracy of pelvic magnetic resonance (MR) imaging for the characterization of complex sonographic adnexal masses discovered in women during pregnancy. STUDY DESIGN The study population comprised 31 pregnant women (median age: 32 years (range: 19-42); mean gestation age of 16 weeks) referred to our institution for MR imaging for characterization of an adnexal mass discovered incidentally during routine ultrasound (US) for other indications. The population comprised of 31 women, with 36 adnexal lesions (mean size: 103mm [range: 20-290]), of which 27 were benign and 9 were malignant masses. Prospective US and MR reports were reviewed to determine the presence of a benign or malignant lesion. Two radiologists (R1 and R2) blinded to the final outcome, retrospectively evaluated the MR images using the criteria based on the ADNEXMR-SCORE and classified the lesion as benign or malignant. The reference standard was surgical pathology or at least a 1-year imaging follow-up. RESULTS Prospective US and MR imaging correctly identified the diagnosis in 27/36 (75%) (95% confidence interval (CI): 58.9%-86.2%) and in 32/36 (88.9%) (95% CI: 74.6%-95.6%) of lesions, respectively. MR imaging with ADNEXMR-SCORE allowed a correct diagnosis in 32/36 (88.9%) (95% CI: 74.6%-95.6%) of lesions for R1 and in 30/36 (83.3%) (95% CI: 68.1%-92.1%) of lesions for R2. The sensitivities and specificities of MR imaging using the MR ADNEXMR-SCORE were 100% (95% CI: 70.1%-1000%) for both readers and 85.1% (95% CI: 67.5%-94%) and 77.7% (95% CI: 59.2%-89.4%) for R1 and R2, respectively. No malignancy was classified as benign using MR criteria. The reproducibility between the two readers was almost perfect, with a kappa of 0.914. CONCLUSION MR imaging is highly accurate for the characterization of complex adnexal masses incidentally discovered during pregnancy. CLINICAL RELEVANCE MR imaging can accurately characterize adnexal masses in pregnancy and could be useful in opting for expectant management until delivery.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris, France.
| | - Benjamin Fedida
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris, France
| | - Elisabeth Sadowski
- University of Wisconsin, Departments of Radiology, Obstetrics and Gynecology Clinical Science Center, E3/372, 600 Highland Avenue, Madison, WI 53792-3252, United States
| | - Marie-Claude Chevrier
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris, France
| | - Nathalie Chabbert-Buffet
- Sorbonne Universités, UPMC Univ Paris 06, CALG Cancer Associé à La Grossesse, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Gynécologie et Obstetrique, 4 rue de la Chine, 75020 Paris, France
| | - Marcos Ballester
- Sorbonne Universités, UPMC Univ Paris 06, CALG Cancer Associé à La Grossesse, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Gynécologie et Obstetrique, 4 rue de la Chine, 75020 Paris, France
| | - Sebastian Tavolaro
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris, France
| | - Emile Darai
- Sorbonne Universités, UPMC Univ Paris 06, CALG Cancer Associé à La Grossesse, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Gynécologie et Obstetrique, 4 rue de la Chine, 75020 Paris, France
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Montoro García J, Cabellos Olivares M, Cabana Navia A, López Saña J, Rodríguez Fraile JR. Unexpected obstetric haemorrhage. Krukenberg tumour. ACTA ACUST UNITED AC 2017; 64:479-482. [PMID: 28347550 DOI: 10.1016/j.redar.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
Abstract
Obstetric haemorrhage can endanger the lives of mother and foetus. It often occurs unexpectedly without clear predictors. A high degree of suspicion helps to avoid delaying resuscitation measures. We present the case of a ruptured ovarian metastasis that occurred during labour. It caused a massive bleed forcing a caesarean section due to non-reassuring foetal status. This was an unprecedented and undescribed onset of Krukenberg tumour formation. Malignant tumours in pregnancy are rare and difficult to diagnose due to their clinical manifestations which often overlap with those of pregnancy itself (dyspepsia, nausea and bloating). Despite the available therapeutic measures, a delay in diagnosis is a determining factor for long-term prognosis. We review the causes of obstetric bleeding, and underline how rare Krukenberg tumours concomitant to pregnancy are.
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Affiliation(s)
- J Montoro García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - M Cabellos Olivares
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, España
| | - A Cabana Navia
- Servicio de Ginecología y Obstetricia, Hospital Universitario de Guadalajara, Guadalajara, España
| | - J López Saña
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, España
| | - J R Rodríguez Fraile
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Guadalajara, Guadalajara, España
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