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Gastrointestinal malignancies in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1709-1723. [PMID: 36607401 DOI: 10.1007/s00261-022-03788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023]
Abstract
Gastrointestinal malignancies, though uncommon in pregnancy, present several unique challenges with regards to diagnosis, staging, and treatment. Imaging the pregnant patient with a suspected or confirmed GI malignancy requires modifications to the radiologic modality of choice and protocol in order to minimize harm to the fetus, ensure accuracy in diagnosis and staging and guide treatment decisions. In this review article, we discuss the imaging approach to the pregnant patient with GI cancer, including safe radiologic modalities and modifications to imaging protocols. We also review the most common GI cancers encountered in pregnancy, including colorectal, pancreatic, gastric, and small bowel tumors, with emphasis to imaging findings, staging, and treatment considerations.
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Incidental diagnosis of a pancreatic adenocarcinoma in a woman affected by gestational diabetes mellitus: case report and literature review. Am J Obstet Gynecol MFM 2021; 3:100471. [PMID: 34454160 DOI: 10.1016/j.ajogmf.2021.100471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 12/17/2022]
Abstract
Pancreatic cancer is rarely diagnosed during pregnancy; it usually manifests with symptoms such as epigastric pain, vomiting, weight loss, and jaundice, rarely mimicking the hemolysis, elevated liver enzymes, and low platelet count syndrome. It has been postulated that there exists a correlation between the diagnosis of gestational diabetes mellitus and the occurrence of pancreatic cancer later in life. We conducted an expert literature review of the 31 available documented pancreatic cancer cases that were diagnosed during pregnancy. We also report pancreatic adenocarcinoma incidentally suspected in an asymptomatic woman affected by gestational diabetes mellitus; the woman was undergoing a fetal growth scan.
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Joshi U, Upadhaya SR, Agrawal V, Rana A. Pancreatic Tumors Complicating Pregnancy: A Concern for Fetomaternal Well Being. Int Med Case Rep J 2020; 13:255-259. [PMID: 32765121 PMCID: PMC7367919 DOI: 10.2147/imcrj.s263298] [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: 05/19/2020] [Accepted: 06/20/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hemoperitoneum resulting from the rupture of pancreatic tumors is a rare condition, especially during pregnancy. CASE PRESENTATION We report a case of a 21-year-old gravida 2, para 1, at 25+5 weeks of gestation, who presented to the hospital with severe epigastric pain and decreased fetal movement. Ultrasonography showed intrauterine fetal death, a retroperitoneal mass in the epigastric region, and hemoperitoneum. Computed tomography scan revealed a heterogeneously enhancing pancreatic mass suggestive of pancreatic neoplasm. However, the late diagnosis and the delay in treatment resulted in a deterioration of maternal status with eventual mortality. CONCLUSION Diagnostic difficulties occur because of the rarity of the condition and vague clinical presentations. In case of a pregnancy complicated by hemoperitoneum, prompt effort to stop the intraperitoneal bleeding is imperative.
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Affiliation(s)
- Utsav Joshi
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Correspondence: Utsav Joshi Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, PO Box 1524, Kathmandu, NepalTel +977 98 4972 6254Fax +977 1 4423771 Email
| | - Sandesh Raj Upadhaya
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Vishakha Agrawal
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ashma Rana
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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AlQattan AS, Alkuwaiti FA, Alghusnah ES, Bojal SA, Alqahtani MS. Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature. Int J Surg Case Rep 2019; 61:38-43. [PMID: 31306902 PMCID: PMC6626975 DOI: 10.1016/j.ijscr.2019.06.044] [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: 04/01/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Ampullary adenocarcinoma is a rare entity during pregnancy. It accounts for 0.5% of all gastrointestinal malignancies. The best treatment modality for resectable tumors with the best reported outcome is surgical resection in the form of pancreaticoduodenectomy (Whipple procedure). In this case report, we discuss the challenges in the management of ampullary adenocarcinoma in a pregnant patient. CASE PRESENTATION We report a case of 22 years old pregnant women who presented with vague abdominal pain and jaundice at the 28th week of gestation. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture around the ampulla and distal common bile duct (CBD). The CBD was stented and a biopsy was taken. Histopathology revealed: an invasive adenocarcinoma. The patient was managed by elective pancreaticoduodenectomy after induction of vaginal delivery at the 34th week of gestation. CONCLUSION Diagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother & fetus in case of early stage disease.
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Affiliation(s)
| | | | | | - Shoukat Ahmad Bojal
- Department of General Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Aynιoglu Ö, Ergin RN, Çakιroglu Y, Çalιşkan E. Pregnancy with Concomitant Pancreatic Cancer. Proc AMIA Symp 2017. [DOI: 10.1080/08998280.2017.11929617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
We present a rare case of metastatic pancreatic adenocarcinoma diagnosed antepartum. A high index of suspicion must be maintained to diagnose pancreatic cancer during pregnancy. We recommend a thorough history and physical and aggressive pursuit of sensitive imaging in patients with persistent symptoms. If pancreatic adenocarcinoma is diagnosed, a multidisciplinary approach that focuses on patient goals should be undertaken. The effect of pregnancy on tumor growth rates is unknown.
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Şahin Aker S, Katlan DC, Yüce T, Söylemez F. Placental, hepatic, and supraclavicular lymph node metastasis in pancreatic adenocarcinoma during pregnancy: A case report. Turk J Obstet Gynecol 2016; 13:161-163. [PMID: 28913114 PMCID: PMC5558309 DOI: 10.4274/tjod.39327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/20/2016] [Indexed: 12/27/2022] Open
Abstract
The occurrence of coexisting cancer in pregnant women is not a common phenomenon. It complicates approximately 1 in 1000 to 1500 pregnancies. We present a multiparous woman aged 27 years in her 28th week of pregnancy who was admitted to our clinic with right upper quadrant pain and was finally revealed to have multiple metastatic pancreatic adenocarcinoma. To the best of our knowledge, this is the first documented case of pancreatic adenocarcinoma to metastasize both to the placenta and multiple maternal sites (liver, supraclavicular, para-aortic lymph nodes) in a pregnant patient. Unpredictable metastases to the placenta may be encountered and may even lead to definitive diagnosis, as in our case. Therefore, the placenta in any patient with known malignancy should be sent for pathologic evaluation.
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Affiliation(s)
- Seda Şahin Aker
- Dr. Sami Ulus Maternity and Children's Health Training and Research Hospital, Clinic of Gynecology and Obstetrics, Ankara, Turkey
| | - Doruk Cevdi Katlan
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Tuncay Yüce
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Feride Söylemez
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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Søreide JA, Greve OJ, Gudlaugsson E. Adult pancreatic hemangioma in pregnancy--concerns and considerations of a rare case. BMC Surg 2015; 15:119. [PMID: 26518354 PMCID: PMC4628376 DOI: 10.1186/s12893-015-0106-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/19/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pancreatic tumors in pregnancy are rare but clinically challenging. Careful diagnostic workup, including appropriate imaging examinations, should be performed to evaluate surgery indications and timing . In the present case a diagnosis of an adult pancreatic hemangioma was made. We were not able to identify a similar case in the very sparse literature on this rare disease. CASE PRESENTATION A 30-year-old woman at 12 weeks of gestation was diagnosed with a large pancreatic tumor having a cystic pattern based on imaging. Although the preoperative diagnosis was uncertain, patient preference and clinical symptoms and signs suggested surgery. Open distal pancreatic resection including splenectomy was performed, and complete resection of the large cystic tumor was successfully achieved, with no postoperative complications. Although a solid pseudopapillary epithelial neoplasm (SPEN) was suspected, specimen morphology, including immunohistochemistry, supported the diagnosis of an adult benign pancreatic hemangioma. CONCLUSION Although mucinous cystic neoplasm (MCN) and adenocarcinoma are the most common pancreatic tumors during pregnancy, various other malignant and benign lesions can be encountered. This report adds to the very small number of pancreatic hemangiomas reported in the literature and involves the first patient diagnosed with this rare condition during pregnancy. Careful clinical considerations regarding diagnostic workup and treatments are required to ensure that mother and child receive the best possible care.
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Affiliation(s)
- Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, N-4068, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Ole Jakob Greve
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway.
| | - Einar Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway.
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Labarca-Acosta M, Reyna-Villasmil E, Aragón-Charris J, Santos-Bolívar J. [Pancreatic adenocarcinoma during pregnancy]. Cir Esp 2015; 93:479-81. [PMID: 24120255 DOI: 10.1016/j.ciresp.2013.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/20/2013] [Accepted: 04/23/2013] [Indexed: 12/01/2022]
Affiliation(s)
- María Labarca-Acosta
- Servicio de Obstetricia y Ginecología, Maternidad Dr. Nerio Belloso, Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia, Venezuela
| | - Eduardo Reyna-Villasmil
- Servicio de Obstetricia y Ginecología, Maternidad Dr. Nerio Belloso, Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia, Venezuela.
| | - Jhoan Aragón-Charris
- Servicio de Obstetricia y Ginecología, Maternidad Dr. Nerio Belloso, Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia, Venezuela
| | - Joel Santos-Bolívar
- Servicio de Obstetricia y Ginecología, Maternidad Dr. Nerio Belloso, Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia, Venezuela
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Lui MW, Lai CWS, Ong CYT. Metastatic pancreatic adenocarcinoma presented as back pain in pregnancy: case report and review of literature. J Matern Fetal Neonatal Med 2015; 29:1421-4. [PMID: 26067261 DOI: 10.3109/14767058.2015.1049942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To report a case of pancreatic adenocarcinoma complicating pregnancy with a review of literature. METHODS A literature search of all English articles on pancreatic adenocarcinoma in pregnancy till December 2014. RESULTS A 35-year-old patient presented at 22 weeks of gestation for back pain and weight loss. Subsequent she was confirmed to have metastatic pancreatic adenocarcinoma. There were in total eleven case reports identified. Abdominal pain and back pain were the presenting symptoms in 75% and 33.3% of patients respectively. CONCLUSIONS Pancreatic adecnocarcinoma is a rare cancer in pregnancy. A high index of suspicion is required in case of atypical symptoms.
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Affiliation(s)
- Man-Wa Lui
- a Department of Obstetrics and Gynecology , Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Carman Wing Sze Lai
- a Department of Obstetrics and Gynecology , Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Charas Yeu-Theng Ong
- a Department of Obstetrics and Gynecology , Queen Mary Hospital, The University of Hong Kong , Hong Kong
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Al-Ibrahim A, Parrish J, Dunn E, Swallow C, Maxwell C. Pregnancy and maternal outcomes in women with prior or current gastrointestinal malignancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:34-41. [PMID: 24444285 DOI: 10.1016/s1701-2163(15)30681-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To review the fetal and maternal outcomes of women with a diagnosis of gastrointestinal (GI) cancer before or during pregnancy. METHODS We conducted a retrospective cohort study of pregnant women referred to a single tertiary care centre with a current or previous diagnosis of GI malignancy. Maternal, obstetric, and infant data were recorded. RESULTS We identified 18 pregnancies in 13 women. Nine women were found to have a GI malignancy during pregnancy (group 1). There was an indirect maternal death in this group in a woman with advanced gastric adenocarcinoma. Nine unique pregnancies occurred in eight women with diagnosis and management of GI malignancies before their pregnancies (group 2). CONCLUSION GI malignancies are difficult to diagnose and manage during pregnancy and are usually advanced at the time of diagnosis. Surgery can be performed during pregnancy if necessary, with chemotherapy and radiotherapy usually deferred to the postpartum period. Women who have had a prior GI malignancy have special circumstances related to the type of surgery performed and previous exposure to chemotherapy. These patients may benefit from a multidisciplinary team effort to optimize their care.
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Affiliation(s)
- Ali Al-Ibrahim
- Maternal Disease in Pregnancy Program, Mount Sinai Hospital, University of Toronto, Toronto ON
| | | | - Evelyn Dunn
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Carol Swallow
- Division of General Surgery, Mount Sinai Hospital, University of Toronto, Toronto ON
| | - Cynthia Maxwell
- Maternal Disease in Pregnancy Program, Mount Sinai Hospital, University of Toronto, Toronto ON
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Lubner S, Hall B, Gopal D, Soni A, Hegeman R, Winterle N, Loeffler A, Weber S, Reeder S, Loconte N. A 37 year-old pregnant woman with pancreatic adeno-carcinoma treated with surgery and adjuvant chemotherapy: A case report and literature review. J Gastrointest Oncol 2012; 2:258-61. [PMID: 22811861 DOI: 10.3978/j.issn.2078-6891.2011.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 06/14/2011] [Indexed: 11/14/2022] Open
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Boyd CA, Benarroch-Gampel J, Kilic G, Kruse EJ, Weber SM, Riall TS. Pancreatic neoplasms in pregnancy: diagnosis, complications, and management. J Gastrointest Surg 2012; 16:1064-71. [PMID: 22160782 PMCID: PMC3354643 DOI: 10.1007/s11605-011-1797-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 11/23/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neoplasms of the pancreas during pregnancy are rare, with less than 25 cases of benign and malignant tumors reported in the literature. METHODS We present three unique cases of pancreatic tumors occurring during pregnancy--one mucinous cystic neoplasm and two adenocarcinomas. We review the literature regarding pancreatic neoplasms during pregnancy and discuss the diagnosis, complications, and management of these tumors. RESULTS Magnetic resonance imaging and ultrasound are the imaging modalities of choice in pregnancy. In patients with benign or premalignant tumors, surgical resection may be postponed until the second trimester. In symptomatic patients, or if there is a concern for intrauterine growth restriction, urgent surgical intervention should be performed. With malignant tumors, the benefit of delaying surgery must be balanced with the risk of maternal disease progression. Termination of the pregnancy should be discussed when a malignant tumor is diagnosed during the first trimester. Pancreatic tumors diagnosed during the third trimester may be resected after delivery. If malignant, early delivery of the fetus and subsequent maternal operation can be considered at appropriate fetal maturity. CONCLUSION When these tumors occur during pregnancy, they present a diagnostic and treatment dilemma, with variation in treatment based on gestational age and patient preference.
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Affiliation(s)
| | | | - Gokhan Kilic
- Departments of Surgery and Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Edward J. Kruse
- Department of Surgery, Georgia Health Sciences University, Augusta, GA
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Taylor S. Riall
- Departments of Surgery and Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
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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]
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Abstract
Pregnancy is a physiological condition that affects all organs. Diseases unrelated to pregnancy may present coincidentally during pregnancy or may be exacerbated by pregnancy, and may increase maternal and/or fetal morbidity or mortality. Compared with many other systems, the changes within the biliary tree and pancreas are relatively minimal. However, pregnancy is associated with an increased likelihood of cholelithiasis, which can have significant implications for the parturient.
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Abstract
BACKGROUND Acute, persistent abdominal pain due to ruptured pancreatic carcinoma and perforated stomach is extremely rare during pregnancy. CASE We evaluated a woman at 34 weeks of gestation presenting with uterine contractions. Computed tomography scanning revealed a large retroperitoneal mass, and her blood carbohydrate antigen 19-9 level was elevated. Immediately after an emergency cesarean delivery, pancreatic cancer was detected, and pancreatoduodenectomy was performed. The patient underwent chemotherapy and remains disease-free at 2 years. CONCLUSION Delayed diagnosis and treatment are associated with high morbidity of both neonate and mother in cases of pancreatic cancer during pregnancy. Computed tomography scanning and carbohydrate antigen 19-9 levels are useful for diagnosis, after which radical surgery should be performed immediately in late pregnancy.
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