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Lucrezia DC, Claudio F, Anna C, Miriam T, Laura G, Alessandro L, Andrei F, Sara B, Marcella P, Nadia DM, Italo D. A case of radiotherapy during pregnancy for oropharyngeal cancer: long term pediatric outcome evaluation and literature review. Pract Radiat Oncol 2024:S1879-8500(24)00202-9. [PMID: 39182646 DOI: 10.1016/j.prro.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/14/2024] [Accepted: 06/05/2024] [Indexed: 08/27/2024]
Abstract
Oropharyngeal cancer (OphC) is extremely rare during pregnancy, although its incidence is expected to increase in the years to come. Any delay of treatment can heavily affect cancer control and survival. Information regarding radiotherapy during pregnancy and long-term pediatric outcome is lacking. In this article, we discuss a case of OphC in a pregnant woman, treated with surgery and radiotherapy, offering also an update review with respect to the limited current evidences of the feasibility and clinical results of radiotherapy during pregnancy. A 39-year-old pregnant woman (through assisted fertilization) with locally advanced OphC underwent surgery and subsequent radiotherapy. A special fetal shielding device and a modified planning optimization strategy were used to reduce the dose to the fetus as much as possible. Phantom and in-vivo dosimetry were performed to estimate the dose to the fetus and the related risks, according to ICRP90. Thanks to the actions taken, the mean dose to the fetus was estimated to be around 50 mSv. A healthy baby was born at 33 weeks of gestation + 6 days. After ten-year follow-up, the patient is in complete remission and her 16-year old daughter is healthy with good school performances. Adjuvant radiotherapy in OphC during pregnancy may be optimized to reduce the dose to the fetus and the measures taken represents a realistic option to ensure mother and baby health.
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Affiliation(s)
| | - Fiorino Claudio
- Medical Physics Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Anna
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Torrisi Miriam
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giannini Laura
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Loria Alessandro
- Medical Physics Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fodor Andrei
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Broggi Sara
- Medical Physics Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pasetti Marcella
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Dell'Oca Italo
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
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Milosevic B, Likic Ladjevic I, Dotlic J, Beleslin A, Mihaljevic O, Pilic I, Kesic V, Gojnic M, Stefanovic A, Stefanovic K. Cancer during pregnancy: Twenty-two years of experience from a tertiary referral center. Acta Obstet Gynecol Scand 2024; 103:716-728. [PMID: 38216215 PMCID: PMC10993340 DOI: 10.1111/aogs.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Cancer complicating pregnancy is a rare but potentially life-threatening condition for both the mother and her child. The aim of the present study was to assess the outcomes for mothers and children after pregnancy complicated by malignancy and to investigate which parameters are important for their 1-year survival. MATERIAL AND METHODS The study included 84 pregnant women diagnosed with malignant tumors during pregnancy from 2001 to 2022. The pregnancy course and outcome, as well as parameters that could influence the survival and condition of the mother and child were evaluated. Mothers and children were followed up for 1 year after delivery to assess their condition/complications and overall survival. RESULTS Most malignancies were gynecological (31%) or hematological (23.8%) and were diagnosed and surgically treated in the second trimester. Most children (69%) showed adequate growth and development throughout pregnancy but were delivered before term (53.6%) to allow mothers to receive therapy. Adjuvant therapy during pregnancy mostly caused a transitory deterioration of the child's condition, while surgery did not significantly impact the pregnancy course. Deliveries, on average, occurred during the 33.01 ± 6.16 gestational week (range: 20-40) and mostly by cesarean section (76.2%). For mothers, the pregnancy survival rate was 95.2% and survival after 1 year was 87.5%. However, 37.5% of women were still ill and required additional therapy 1 year postpartum. The pregnancy survival rate for children was 94%, whereas the 1-year survival rate was 76.2%. Most children had a favorable condition (alive, adequately growing and developing, and without complications) at birth (81%) as well as at the 1-year follow-up (63.7%). Regression analysis identified the following predictors of favorable 1-year maternal condition: applying therapy during pregnancy, no progression of the malignancy during pregnancy, and delivery at a later gestational week. Predictors of favorable 1-year condition of children were lower histopathological grade of malignancy, surgery as therapy for malignancy, obtaining higher birthweight, and delivery by cesarean section. CONCLUSIONS If the malignancy is not progressing, pregnancy should be continued as long as possible for the child to obtain adequate birthweight. Both surgery and chemotherapy were safe therapeutic choices, as most pregnancies continued successfully after therapy.
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Affiliation(s)
- Branislav Milosevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Ivana Likic Ladjevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Jelena Dotlic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandra Beleslin
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Olga Mihaljevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Igor Pilic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Vesna Kesic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Miroslava Gojnic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandar Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Katarina Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
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Huang X, Zhang C, Zhu J, Li Y, Tang J. Influence of cancer in pregnancy on obstetric and neonatal outcomes: an observational retrospective cohort study. J Gynecol Oncol 2024; 35:35.e74. [PMID: 38522950 DOI: 10.3802/jgo.2024.35.e74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/18/2023] [Accepted: 02/11/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE The study aimed to review the oncological characteristics and treatment of pregnancy-associated cancers and analyze the obstetric and neonatal outcomes to provide evidence-based recommendations for reproductive function preservation, oncological treatment, and obstetric management. METHODS We conducted an observational retrospective cohort study among pregnant patients with cancer in 7 Chinese tertiary A hospitals from 2003 to 2021. We conducted multiple logistic regression to determine the influence of various factors on preterm birth and small-for-gestational-age infants, log-binomial regression to analyze temporal changes, and χ² tests to explore the effects of cancer type/treatment. RESULTS Of 204 women, 17% terminated their pregnancies; 59% received pre-delivery treatment. Every 6 years, the rates of pregnancy termination (relative risk [RR]=0.48; 95% confidence interval [CI]=0.35-0.67) and iatrogenic preterm births (RR=0.73; 95% CI=0.54-0.98) reduced, and that of pre-delivery treatment increased, mainly due to increased rates of surgery (RR=1.87; 95% CI=1.31-2.67). Maternal systemic diseases were related to small-for-gestational-age infants (odds ratio [OR]=12.02; 95% CI=1.82-79.43). Chemotherapy with taxanes plus platinum-based agents was related to adverse obstetric outcomes (OR=1.87; 95% CI=1.42-2.46; p<0.05). Thyroid (OR=0.36; 95% CI=0.22-0.57) and ovarian cancer (OR=0.70; 95% CI=0.50-0.98) were associated with fewer cesarean sections. Thyroid cancer was associated with fetal growth restriction (OR=5.21; 95% CI=1.21-22.55). CONCLUSION Rates of pregnancy termination in cancer declined. Taxane plus platinum-based chemotherapy was associated with adverse obstetric outcomes. Cancer type influenced outcomes. TRIAL REGISTRATION Chinese Clinical Trial Register Identifier: ChiCTR2100044292.
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Affiliation(s)
- Xuan Huang
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Chen Zhang
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Jialei Zhu
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Yueyan Li
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing Tang
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China.
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Yin T, Li X, Li Y, Zang X, Liu L, Du M. Macrophage plasticity and function in cancer and pregnancy. Front Immunol 2024; 14:1333549. [PMID: 38274812 PMCID: PMC10808357 DOI: 10.3389/fimmu.2023.1333549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
As the soil of life, the composition and shaping process of the immune microenvironment of the uterus is worth exploring. Macrophages, indispensable constituents of the innate immune system, are essential mediators of inflammation and tissue remodeling as well. Recent insights into the heterogeneity of macrophage subpopulations have renewed interest in their functional diversity in both physiological and pathological settings. Macrophages display remarkable plasticity and switch from one phenotype to another. Intrinsic plasticity enables tissue macrophages to perform a variety of functions in response to changing tissue contexts, such as cancer and pregnancy. The remarkable diversity and plasticity make macrophages particularly intriguing cells given their dichotomous role in either attacking or protecting tumors and semi-allogeneic fetuses, which of both are characterized functionally by immunomodulation and neovascularization. Here, we reviewed and compared novel perspectives on macrophage biology of these two settings, including origin, phenotype, differentiation, and essential roles in corresponding microenvironments, as informed by recent studies on the heterogeneity of macrophage identity and function, as well as their mechanisms that might offer opportunities for new therapeutic strategies on malignancy and pregnancy complications.
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Affiliation(s)
- Tingxuan Yin
- Lab of Reproduction Immunology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Xinyi Li
- Lab of Reproduction Immunology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Yanhong Li
- Lab of Reproduction Immunology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Xingxing Zang
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Lu Liu
- Lab of Reproduction Immunology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
| | - Meirong Du
- Lab of Reproduction Immunology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University Shanghai Medical College, Shanghai, China
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Koutras A, Ntounis T, Fasoulakis Z, Papalios T, Pittokopitou S, Prokopakis I, Syllaios A, Valsamaki A, Chionis A, Symeonidis P, Samara AA, Pagkalos A, Pergialiotis V, Theodora M, Antsaklis P, Daskalakis G, Kontomanolis EN. Cancer Treatment and Immunotherapy during Pregnancy. Pharmaceutics 2022; 14:pharmaceutics14102080. [PMID: 36297515 PMCID: PMC9611953 DOI: 10.3390/pharmaceutics14102080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background/aim: Immunotherapy has, in recent years, witnessed an expansion in its indications for the treatment of cancer. Coupled with the fact that, nowadays, even more women choose to postpone parenthood, thus increasing their chances of having some kind of malignancy during pregnancy, more and more women are eligible for receiving immunotherapy during this period of their lives. The cases of cancer diagnosed during pregnancy is an ever-increasing trend nowadays. Materials and methods: The oncologists and clinicians treating women often face a range of ethical and therapeutic dilemmas due to the particularity of the patient’s conditions. The primary concern is the protection of the mother, firstly, and then the fetus (through adjustments to the various treatment regimens) if possible. Results and conclusions: Oncological drugs, radiation therapy, surgery, or a combination of all the above methods are selected, depending on the case. In this project, we studied the oncology drugs used for various types of gestational cancer, their appropriateness and timing, as well as their possible effects on the parent and embryo upon their administration. Various studies have shown that the administration of oncological drugs should be postponed until at least after the first trimester of pregnancy.
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Affiliation(s)
- Antonios Koutras
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-694567622
| | - Thomas Ntounis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Theodoros Papalios
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Savia Pittokopitou
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Ioannis Prokopakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Athanasios Syllaios
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma Str. 17, 11527 Athens, Greece
| | - Asimina Valsamaki
- Department of Internal Medicine, Koutlimbaneio and Triantafylleio General Hospital of Larissa, Tsakalof Str. 1, 41221 Larisa, Greece
| | - Athanasios Chionis
- Department of Obstetrics and Gynecology, Laikon General Hospital of Athens, Agiou Thoma Str. 17, 11527 Athens, Greece
| | - Panagiotis Symeonidis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis–Makris, 68100 Alexandroupolis, Greece
| | - Athina A. Samara
- Department of Embryology, University General Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
| | - Athanasios Pagkalos
- Department of Obstetrics and Gynecology, General Hospital of Xanthi, Neapoli, 67100 Xanthi, Greece
| | - Vasilios Pergialiotis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Marianna Theodora
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Panos Antsaklis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Emmanuel N. Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis–Makris, 68100 Alexandroupolis, Greece
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Miller D, Livingston JA, Park Y, Posey K, Godbole S, Skubitz K, Robinson SI, Agulnik M, Davis LE, Van Tine BA, Hirbe AC, Parkes A. Pregnancy outcomes related to the treatment of sarcomas with anthracyclines and/or ifosfamide during pregnancy. Cancer Med 2022; 11:3471-3478. [PMID: 35343652 PMCID: PMC9487868 DOI: 10.1002/cam4.4707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/14/2022] [Accepted: 03/13/2022] [Indexed: 11/12/2022] Open
Abstract
Background Sarcomas are rare diagnoses but are seen with relative frequency in adolescents and young adults and thus can present in pregnancy. We sought to study the administration of anthracyclines and/or ifosfamide in pregnancy‐associated sarcomas. Patients and Methods We conducted a multi‐institutional retrospective study, identifying sarcoma patients who received anthracyclines and/or ifosfamide during pregnancy. Chart review identified variables related to demographics, cancer diagnosis, therapies, and outcome of the patient and fetus. Wilcoxon rank‐sum test compared two independent samples. Results We identified 13 patients at seven institutions with sarcoma who received anthracyclines and/or ifosfamide during pregnancy, including four bone sarcomas and nine soft tissue sarcomas diagnosed at a mean gestational age of 16.7 ± 5.9 weeks. Only nine patients had live births (9/13, 69.2%), with mean gestational age of 30.8 ± 3.8 weeks at delivery. The four patients with pregnancy loss all received both doxorubicin and ifosfamide, with chemotherapy initiated at 15.5 weeks as compared with 21.3 weeks for those patients with live births (p = 0.016). Conclusion In this multi‐institutional study of sarcoma chemotherapy regimens administered during pregnancy, we found a high rate of fetal demise that was seen only in patients receiving both doxorubicin and ifosfamide and statistically more likely with chemotherapy initiation earlier in the second trimester. While limited by a small sample size, our study represents the largest study of sarcoma patients that received anthracyclines and/or ifosfamide in pregnancy thus far reported and supports development of an international registry to study concerns raised by our study.
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Affiliation(s)
- Devon Miller
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Yeonhee Park
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Sonia Godbole
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Keith Skubitz
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Lara E Davis
- Oregon Health & Science University, Portland, Oregon, USA
| | - Brian A Van Tine
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Angela C Hirbe
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Amanda Parkes
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Li J, Ju J, Zhao Q, Liu W, Yuan Y, Liu Q, Zhou L, Han Y, Yuan W, Huang Y, Xie Y, Li Z, Chen J, Huang S, Chen R, Li W, Tan M, Wang D, Zhou S, Zhang J, Zeng F, Yu N, Su F, Chen M, Ge Y, Huang Y, Jin X. Effective Identification of Maternal Malignancies in Pregnancies Undergoing Noninvasive Prenatal Testing. Front Genet 2022; 13:802865. [PMID: 35265103 PMCID: PMC8900746 DOI: 10.3389/fgene.2022.802865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background: The existence of maternal malignancy may cause false-positive results or failed tests of NIPT. Though recent studies have shown multiple chromosomal aneuploidies (MCA) are associated with malignancy, there is still no effective solution to identify maternal cancer patients from pregnant women with MCA results using NIPT. We aimed to develop a new method to effectively detect maternal cancer in pregnant women with MCA results using NIPT and a random forest classifier to identify the tissue origin of common maternal cancer types. Methods: For examination, 496 participants with MCA results via NIPT were enrolled from January 2016 to June 2019 at BGI. Cancer and non-cancer participants were confirmed through the clinical follow-up. The cohort comprising 42 maternal cancer cases and 294 non-cancer cases enrolled from January 2016 to December 2017 was utilized to develop a method named mean of the top five chromosome z scores (MTOP5Zscores). The remaining 160 participants enrolled from January 2018 to June 2019 were used to validate the performance of MTOP5Zscores. We established a random forest model to classify three common cancer types using normalized Pearson correlation coefficient (NPCC) values, z scores of 22 chromosomes, and seven plasma tumor markers (PTMs) as predictor variables. Results: 62 maternal cancer cases were confirmed with breast cancer, liver cancer, and lymphoma, the most common cancer types. MTOP5Zscores showed a sensitivity of 85% (95% confidence interval (CI), 62.11–96.79%) and specificity of 80% (95% CI, 72.41–88.28%) in the detection of maternal cancer among pregnant women with MCA results. The sensitivity of the classifier was 93.33, 66.67, and 50%, while specificity was 66.67, 90, and 97.06%, and positive predictive value (PPV) was 60.87, 72.73, and 80% for the prediction of breast cancer, liver cancer, and lymphoma, respectively. Conclusion: This study presents a solution to identify maternal cancer patients from pregnant women with MCA results using NIPT, indicating it as a value-added application of NIPT in the detection of maternal malignancies in addition to screening for fetal aneuploidies with no extra cost.
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Affiliation(s)
- Jia Li
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
- Hebei Industrial Technology Research Institute of Genomics in Maternal & Child Health, Shijiazhuang BGI Genomics Co., Ltd., Shijiazhuang, China
| | - Jia Ju
- BGI-Shenzhen, Shenzhen, China
- BGI Education Center, University of Chinese Academy of Sciences, Shenzhen, China
| | - Qiang Zhao
- Department of Obstetrics and Gynecology, Jiangmen Central Hospital, Jiangmen, China
- Reproductive Medicine Center, Jiangmen Central Hospital, Jiangmen, China
| | - Weiqiang Liu
- Central Lab, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | | | - Qiang Liu
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Lijun Zhou
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Yuan Han
- BGI-Wuhan, BGI-Shenzhen, Wuhan, China
| | - Wen Yuan
- BGI-Wuhan, BGI-Shenzhen, Wuhan, China
| | - Yonghua Huang
- Department of Obstetrics and Gynecology, Jiangmen Central Hospital, Jiangmen, China
| | - Yingjun Xie
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhihua Li
- Department of Prenatal Diagnosis and Fetal Medical, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jingsi Chen
- Department of Prenatal Diagnosis and Fetal Medical, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuyu Huang
- The Department of Obstetrics, Foshan First People’s Hospital, Foshan, China
| | - Rufang Chen
- The Department of Obstetrics, Foshan First People’s Hospital, Foshan, China
| | - Wei Li
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Meihua Tan
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
- BGI Education Center, University of Chinese Academy of Sciences, Shenzhen, China
| | - Danchen Wang
- School of Basic Medicine, Qingdao University, Qingdao, China
| | - Si Zhou
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
- Hebei Industrial Technology Research Institute of Genomics in Maternal & Child Health, Shijiazhuang BGI Genomics Co., Ltd., Shijiazhuang, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Jian Zhang
- Department of Prenatal Diagnosis Center, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, Fujian province, China
| | | | - Nan Yu
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | | | - Min Chen
- Department of Prenatal Diagnosis and Fetal Medical, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Xin Jin, ; Min Chen, ; Yunsheng Ge, ; Yanming Huang,
| | - Yunsheng Ge
- Department of Prenatal Diagnosis Center, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, Fujian province, China
- *Correspondence: Xin Jin, ; Min Chen, ; Yunsheng Ge, ; Yanming Huang,
| | - Yanming Huang
- Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, Guangdong province, China
- *Correspondence: Xin Jin, ; Min Chen, ; Yunsheng Ge, ; Yanming Huang,
| | - Xin Jin
- BGI-Shenzhen, Shenzhen, China
- School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Xin Jin, ; Min Chen, ; Yunsheng Ge, ; Yanming Huang,
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Bouab M, Elazzouzi E, El Miski F, Jalal M, Lamrissi A, Fichtali K, Bouhya S, Beliamime I, Khouaja A, Karkouri M. Rare association of the ovarian adenocarcinoma with pregnancy: A case report. Ann Med Surg (Lond) 2022; 75:103350. [PMID: 35198187 PMCID: PMC8850659 DOI: 10.1016/j.amsu.2022.103350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 12/03/2022] Open
Abstract
The association of ovarian malignancy with pregnancy is rare; accounting for 3–6% of ovarian masses of which malignant germ cell tumors represent the type most frequently associated with pregnancy, whereas the incidence of epithelial ovarian cancer is only 1/12,000 to 1/50,000 of pregnancies. The diagnosis and management of ovarian cancer in pregnancy remain poorly codified because of the rarity of cases and the limited data available on this pathology. We report here the case of a 45-year-old woman with a large ovarian mucinous adenocarcinoma diagnosed during pregnancy, identified by ultrasound and magnetic resonance imaging. The patient was treated by surgical resection followed by adjuvant chemotherapy with carboplatin and paclitaxel with a follow-up of 36 months, she is in complete remission. The association of ovarian malignancy with pregnancy is rare. The timing of delivery in patients with ovarian cancer again depends on stage and gestational age. The therapeutic approach should focus on a multidisciplinary team integrating gynecologic oncology, perinatology, and neonatology services.
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Affiliation(s)
- Maryem Bouab
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Corresponding author. 1 rue des hôpitaux, Morocco.
| | - Elhassane Elazzouzi
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Fatiha El Miski
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mohamed Jalal
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Amine Lamrissi
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Karima Fichtali
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Said Bouhya
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Imane Beliamime
- Pathology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ayoub Khouaja
- Pathology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mehdi Karkouri
- Pathology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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9
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Ndhlovu E, Deng H, Dai J, Dong X, Liu L, Chen B. Juvenile granulosa cell tumor in pregnancy: case series and literature review. Arch Gynecol Obstet 2021; 305:1299-1310. [PMID: 34694430 DOI: 10.1007/s00404-021-06283-5] [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: 08/12/2020] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pregnancy complicated with juvenile granulosa cell tumor (JGCT) is very rare; thus, the experience on clinical diagnosis and management is limited. CASES Two patients presented with abdominal pain, two were incidentally discovered, one by ultrasonography, and one during a caesarian section. One case received an emergency caesarian section because of tumor rupture at 38th week's gestation, the rest were treated at full term and no abnormalities were detected in the newborns. Three cases received further staging surgery, two of which received postoperative adjuvant chemotherapy. No patient had recurrent disease after a follow-up period spanning from 13 to 57 months. CONCLUSION In the absence of emergency, surgery can be delayed without affecting the fetus. More research is needed to determine the value of chemotherapy in FIGO stage I patients.
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Affiliation(s)
- Elijah Ndhlovu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hui Deng
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiyuan Dong
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lili Liu
- Department of Pathology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
| | - Biao Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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10
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Blundo C, Giroda M, Fusco N, Sajjadi E, Venetis K, Leonardi MC, Vicini E, Despini L, Rossi CF, Runza L, Sfondrini MS, Piciotti R, Di Loreto E, Scarfone G, Guerini-Rocco E, Viale G, Veronesi P, Buonomo B, Peccatori FA, Galimberti VE. Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study. Front Oncol 2021; 11:723693. [PMID: 34504801 PMCID: PMC8421851 DOI: 10.3389/fonc.2021.723693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/04/2021] [Indexed: 01/07/2023] Open
Abstract
Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.
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Affiliation(s)
- Concetta Blundo
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Giroda
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Elham Sajjadi
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M Cristina Leonardi
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa Vicini
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Despini
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia F Rossi
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Letterio Runza
- Division of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria S Sfondrini
- Breast Imaging Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Piciotti
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Scarfone
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Guerini-Rocco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Paolo Veronesi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Buonomo
- Fertility and Procreation Unit, Division of Gynecologic Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Viviana E Galimberti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
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11
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Sipe BH, Običan SG, Henderson-Jackson E, Riddle ND, Makanji R, Gonzalez RJ, Brohl AS. A Case of Retroperitoneal Synovial Sarcoma in Pregnancy Treated with Antepartum Doxorubicin plus Ifosfamide Chemotherapy. Case Rep Oncol Med 2021; 2021:9982171. [PMID: 34336322 PMCID: PMC8313357 DOI: 10.1155/2021/9982171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/18/2021] [Indexed: 12/28/2022] Open
Abstract
We report a case of a 25-year-old pregnant woman diagnosed with a large, unresectable retroperitoneal synovial sarcoma. Successful neoadjuvant treatment with doxorubicin plus ifosfamide prepartum and continuing postpartum resulted in significant disease response allowing for later tumor resection. Following the first prepartum chemotherapy cycle, a decreased amniotic fluid index was noted, representing a potential complication of chemotherapy. Induction of labor was performed at 33 weeks gestation with excellent outcome in the newborn. This case highlights the complex medical decision-making process in the setting of cancer diagnosed during pregnancy, balancing oncologic and obstetric concerns, and to our knowledge is only the second reported case of synovial sarcoma treated with neoadjuvant cytotoxic chemotherapy in the antepartum period.
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Affiliation(s)
- Bradley H. Sipe
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Sarah G. Običan
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Evita Henderson-Jackson
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Nicole D. Riddle
- Department of Pathology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Ruffolo, Hooper, and AssociatesTampa, Florida, USA
| | - Rikesh Makanji
- Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Ricardo J. Gonzalez
- Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andrew S. Brohl
- Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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12
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Farahmandi S, Elessawy M, Bauerschlag DO, Pecks U, Abdullazade S, Beckmann JH, Heilmann T, Rumpf AL, Maass N, Jansen P, Winkler V. Mucinous Cystic Neoplasm of Pancreas in a Pregnant Woman Presenting with Severe Anemia and Gastric Bleeding: Case Report and Review of the Literature. Healthcare (Basel) 2021; 9:healthcare9050540. [PMID: 34066323 PMCID: PMC8148137 DOI: 10.3390/healthcare9050540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
Mucinous cystic neoplasms of the pancreas are uncommon and especially their occurrence during pregnancy is an extremely rare event which necessitates an individualized and interdisciplinary management. A 33-year old woman was referred to our department during her third trimester of pregnancy (34th week of gestation) with severe anemia and tarry stools. Based on gastroscopic findings, our interdisciplinary team suspected a gastrointestinal stromal tumor and therefore indicated a prompt delivery via cesarean section completed with an oncological resection of the neoplasm. Histological examination subsequently showed a mucinous cystic neoplasm of the pancreas with no evidence of malignancy. To review the prevalence of mucinous cystic neoplasms and to discuss diagnosis and treatment during pregnancy. Moreover, we critically value the indication of preterm delivery and the oncological procedure in the perspective of outcome for mother and infant. A bleeding gastrointestinal tumor during pregnancy represents a life-threatening risk for mother and infant and requires an immediate interdisciplinary treatment. The urgency and radicality of the therapy should be adapted according to individual findings. As our patient's tumor was suspected of having a malignant progression, an extensive surgical intervention was necessary.
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Affiliation(s)
- Susan Farahmandi
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Mohamed Elessawy
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Dirk O. Bauerschlag
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Ulrich Pecks
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Samir Abdullazade
- Department of Pathology, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus U33, 24105 Kiel, Germany;
| | - Jan Henrik Beckmann
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus U33, 24105 Kiel, Germany;
| | - Thorsten Heilmann
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Anna-Lena Rumpf
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Peer Jansen
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Vincent Winkler
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
- Correspondence: ; Tel.: +49-431-500-21401
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13
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Grubman O, Taylor D, Rayapudi M, Brustman L. A case report of a pregnant woman diagnosed with intrahepatic cholangiocarcinoma (ICC) complicated by opioid tolerance. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2019-0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Intrahepatic cholangiocarcinoma (ICC) is a rare form of cancer that has a poor prognosis with a 5-year survival rate for localized disease of approximately 15%.
Case presentation
This is a report of a case of cholangiocarcinoma (CC) diagnosed in pregnancy in a patient with an opioid use disorder. The patient is a 37-year-old G7P2042 who presented at 29 weeks of gestation with acute right upper quadrant pain along with jaundince, and changes to her urine and stool. Her workup revealed CC, a rare diagnosis in pregnancy. Approximately 6 months after the diagnosis of ICC the patient died.
Conclusion
Along with the management of this cancer in pregnancy, this case was further complicated by opioid tolerance and the difficulty in controlling the patient’s pain in pregnancy.
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Affiliation(s)
- Olivia Grubman
- Department of Obstetrics and Gynecology, Mount Sinai West , Icahn School of Medicine at Mount Sinai , New York, NY 10019, USA
| | - Dyese Taylor
- Department of Obstetrics and Gynecology, Mount Sinai West , Mount Sinai, New York, NY , USA
| | - Madhavi Rayapudi
- Department of Gastroenterology, Mount Sinai , New York, NY , USA
| | - Lois Brustman
- Department of Obstetrics and Gynecology, Mount Sinai West , Mount Sinai, New York, NY , USA
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14
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In utero exposure to breast cancer treatment: a population-based perinatal outcome study. Br J Cancer 2019; 121:719-721. [PMID: 31488880 PMCID: PMC6888827 DOI: 10.1038/s41416-019-0563-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/16/2019] [Indexed: 11/21/2022] Open
Abstract
Chemotherapy during a viable pregnancy may be associated with adverse perinatal outcomes. We conducted a prospective cohort study to examine the perinatal outcomes of babies born following in utero exposure to chemotherapy in Australia and New Zealand. Over 18 months we identified 24 births, of >400 g and/or >20-weeks’ gestation, to women diagnosed with breast cancer in the first or second trimesters. Eighteen babies were exposed in utero to chemotherapy. Chemotherapy commenced at a median of 20 weeks gestation, for a mean duration of 10 weeks. Twelve exposed infants were born preterm with 11 by induced labour or pre-labour caesarean section. There were no perinatal deaths or congenital malformations. Our findings show that breast cancer diagnosed during mid-pregnancy is often treated with chemotherapy. Other than induced preterm births, there were no serious adverse perinatal outcomes.
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15
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Oncological outcome of peripartum colorectal carcinoma-a single-center experience. Int J Colorectal Dis 2019; 34:899-904. [PMID: 30915541 DOI: 10.1007/s00384-019-03278-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to analyze disease presentation, management, and oncological outcomes of patients diagnosed with peripartum colorectal cancer (CRC). METHODS Retrospective cohort study of all consecutive women of childbearing age (18-45 years) between 2002 and 2014 diagnosed with CRC adenocarcinoma at a tertiary academic institution. Patients who experienced pregnancy within 12 months of their diagnosis (peripartum period, group 1) were compared to the remaining patients of the cohort (group 2). Overall survival (OS) was compared between the two groups through Kaplan-Meier estimates. RESULTS Out of 555 consecutive women with a mean age of 37.8 + 6 years, 31 (5.6%) were diagnosed with CRC in the peripartum period. Of these, all patients were symptomatic during pregnancy due to bleeding, abdominal pain, or constipation; however, only 11 CRC (35.5%) were diagnosed during pregnancy, 1 (3.2%) during C section, and the remaining (61.3%) postpartum. TNM stage at presentation was I in 6 patients (19.4%), II in 4 patients (13.9%), III in 8 patients (25.8%), and IV in 13 patients (41.9%). Surgical resection was performed in 23 patients (74.2%): 2 while pregnant, 2 at the time of C section, and the remainder postpartum. Across all stages, OS was 95% at 1 year and 62% at 5 years and did not differ between the two comparative groups (p = 0.16). CONCLUSIONS A suspicious attitude towards cancer-related symptoms during pregnancy is crucial to prevent delayed evaluation for CRC.
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16
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Bines J, Tevaarwerk AJ. Baby steps: Pregnancy outcomes after human epidermal growth factor receptor 2-targeted therapy. Cancer 2018; 125:181-184. [DOI: 10.1002/cncr.31878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Jose Bines
- Division of Oncology; Brazilian National Cancer Institute; Rio de Janeiro Brazil
- Division of Oncology; Sao Vicente Clinic; Rio de Janeiro Brazil
| | - Amye J. Tevaarwerk
- Division of Hematology/Oncology, Department of Medicine; The University of Wisconsin-Madison; Madison Wisconsin
- The University of Wisconsin, Carbone Cancer Center; Madison Wisconsin
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17
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Francis AP, Chang M, Dolin CD, Chervenak J, Cardonick E. Recurrent Cholangiocarcinoma in Pregnancy: A Case Report. AJP Rep 2018; 8:e261-e263. [PMID: 30425881 PMCID: PMC6232044 DOI: 10.1055/s-0038-1675376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/05/2018] [Indexed: 12/13/2022] Open
Abstract
Hepatobiliary malignancies during pregnancy are extremely rare and portend a poor prognosis. There are only seven published cases of cholangiocarcinoma in an obstetrical patient, all are cases of primary cholangiocarcinoma (1-7). Herein, we describe the first case of recurrent cholangiocarcinoma during pregnancy. The patient did not receive chemotherapy during pregnancy and required prolonged hospitalizations for nutritional and intensive medical support. She delivered preterm, at 30 2/7 weeks gestation, after developing pre-eclampsia with severe features. The infant was healthy, with no malformations, and currently exhibits no neurological or behavioral sequelae at 8months of age. We discuss themanagement considerations inherent to this complex clinical scenario including metastatic disease severity, ethical considerations, and palliative care treatment options.
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Affiliation(s)
- Antonia P Francis
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Michelle Chang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cara D Dolin
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
| | - Judith Chervenak
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, New Jersey
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18
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Padrão E, Melo C, Fernandes G, Magalhães A. Lung cancer in pregnancy – Report of a case treated with crizotinib. Pulmonology 2018; 24:205-207. [DOI: 10.1016/j.pulmoe.2018.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/26/2018] [Indexed: 12/14/2022] Open
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19
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Shafiee S, Adno A, French B, Johansson C, Frankel A, Williamson JP. Central airway obstruction caused by adenoid cystic carcinoma in pregnancy: a case report and review of the literature. Respirol Case Rep 2018; 6:e00317. [PMID: 29721318 PMCID: PMC5909374 DOI: 10.1002/rcr2.317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022] Open
Abstract
Malignancy complicates one in a thousand pregnancies. The most frequently diagnosed of these are breast, cervical, melanoma, ovarian, and haematological neoplasms. Tumours of respiratory origin are very uncommon during pregnancy. We present a case of tracheal adenoid cystic carcinoma (ACC), a rare type of primary airway tumour, diagnosed in a pregnant woman. To our knowledge, this is the third reported case of tracheal ACC complicating pregnancy. We discuss potential barriers to timely diagnosis of malignancies during pregnancy and consider optimal management strategies, taking into account the potential harm to the mother and foetus in a field with a limited evidence base.
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Affiliation(s)
- Samaneh Shafiee
- Department of Obstetrics and Gynaecology Liverpool Hospital Sydney Australia
| | - Alan Adno
- Department of Obstetrics and Gynaecology Liverpool Hospital Sydney Australia
| | - Bruce French
- Department of Thoracic Surgery Liverpool Hospital Sydney Australia
| | - Cherynne Johansson
- Department of Obstetrics and Gynaecology Liverpool Hospital Sydney Australia
| | - Anthony Frankel
- Department of Respiratory Medicine Bankstown- Lidcome Hospital Sydney Australia
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20
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Framarino-dei-Malatesta M, Sammartino P, Napoli A. Does anthracycline-based chemotherapy in pregnant women with cancer offer safe cardiac and neurodevelopmental outcomes for the developing fetus? BMC Cancer 2017; 17:777. [PMID: 29162041 PMCID: PMC5696726 DOI: 10.1186/s12885-017-3772-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 11/13/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer treatment during pregnancy is a growing problem especially now that women delay childbearing. Systemic treatment of these malignancies during pregnancy centers mainly on the anticancer drugs anthracyclines, widely used in treating hematological and breast cancer during pregnancy and sometimes associated with early and late toxicity for the fetus. Owing to concern about their cardiac and neurodevelopmental toxicity more information is needed on which anthracycline to prefer and whether they can safely guarantee a cardiotoxicity-free outcome in the fetus. DISCUSSION The major research findings underline anthracycline-induced dose-dependent effects, including cardiotoxicity, many avoidable. Partly because the placenta acts mainly as a barrier, research findings indicate low transplacental anthracycline transfer. Anthracycline-induced teratogenicity depends closely on when patients receive chemotherapy. Anthracycline cardiac toxicity may depend on the association with drugs that inhibit or induce placental P-glycoprotein (P-gp). P-gp-induced drug interactions may alter placental P-gp barrier function and subsequently change fetal exposure. Though many anthracyclines have acceptable safety profiles clinical studies suggest giving idarubicin with special caution. Patients and doctors who care for pregnant women should whenever possible avoid prematurity and hence reduce prematurity-induced medical complications at birth and in the long-term. Information is lacking on long-term anthracycline-induced effects. CONCLUSION Pregnant women receiving anthracycline-based chemotherapy should undergo regular, state-of-the-art diagnostic imaging to detect fetal drug-induced cardiac damage early, and allow alternative therapeutic options. Recognizing drug-induced interactions and understanding the most vulnerable fetuses will help in choosing tailored therapy. Future research on placental transport, blood-brain barrier drug passage and pharmacokinetics will improve the way we manage these difficult-to-treat patients and their fetuses.
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Affiliation(s)
| | - Paolo Sammartino
- Department of Surgery “Pietro Valdoni”, University Sapienza Rome, Viale del Policlinico, 155 00161 Rome, Italy
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, University Sapienza Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
- Italian Diabetic and Pregnancy Study Group, Rome, Italy
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Alshahrani AS, Yoo MW. Gastric cancer in pregnancy: is laparoscopic gastrectomy with lymph node dissection feasible and safe? Ann Surg Treat Res 2016; 92:51-53. [PMID: 28090507 PMCID: PMC5234426 DOI: 10.4174/astr.2017.92.1.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 06/20/2016] [Accepted: 08/04/2016] [Indexed: 01/23/2023] Open
Abstract
Gastric cancer with pregnancy is rare and usually presents in late and advanced stage. Standard interventions in diagnosing, staging and treatment of cancer may be harmful for the fetus. The treatment of cancer in pregnancy should not differ significantly from the treatment in nonpregnant women. There have been case reports of open gastrectomy for gastric cancer in pregnancy. We present a case of early gastric cancer in a 37-year-old pregnant woman treated with laparoscopic distal gastrectomy with lymph node dissection with no postoperative complications. Laparoscopic distal gastrectomy with lymph node dissection seems to be feasible and safe in pregnancy for a mother and a fetus.
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Affiliation(s)
- Amer Saeed Alshahrani
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Department of Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Moon-Won Yoo
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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.
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