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Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies. Cancers (Basel) 2024; 16:1341. [PMID: 38611019 PMCID: PMC11011172 DOI: 10.3390/cancers16071341] [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: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.
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Affiliation(s)
- Jennifer Le Guévelou
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Radiation Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75005 Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, 75005 Paris, France
| | - Enora Laas
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
- Université de Paris, 75006 Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, 75005 Paris, France
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Yu X, Qie M, Huang L, Hou M. Successful pregnancy in a female with embryonal rhabdomyosarcoma of the cervix who received biopsy and chemotherapy alone without recurrence after 16 years: a case report and literature review. BMC Womens Health 2023; 23:466. [PMID: 37658404 PMCID: PMC10474710 DOI: 10.1186/s12905-023-02623-6] [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: 07/01/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Embryonal rhabdomyosarcoma (ERMS) of the uterine cervix is rare, but the population affected is mostly underage females. The scope of surgery has now evolved from extensive to limited, and organ-preserving surgery combined with chemotherapy is recommended to preserve the patient's fertility. However, reports of birth outcomes are rare. CASE A minor woman with cervical ERMS who underwent only an outpatient biopsy of the lesion had no residual lesion on subsequent multipoint cervical biopsy and refused radical surgery or cervical conization, after which the patient received a nonclassical regimen of chemotherapy. The patient stopped the chemotherapy on her own, but the patient conceived spontaneously 16 years later with a good pregnancy outcome and no recurrence. CONCLUSIONS This case suggests that preservation of reproductive function is often feasible in immature women with cervical ERMS, and the prognosis is usually good as long as the primary tumour can be surgically removed and the lesion is free of residual disease. We also look forward to reports of subsequent growth and pregnancy outcomes in other children with reproductive tract RMS. In cervical ERMS, accurate evaluation of the disease and development of an individualized treatment plan are crucial, and the protection of reproductive function and psychological well-being deserves special attention.
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Affiliation(s)
- Xiuzhang Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Number 17, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Mingrong Qie
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Number 17, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Liyan Huang
- Department of Pathology, West China Second University Hospital, Sichuan University, Number 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Minmin Hou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Number 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Number 17, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.
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Meng L, Zhang Q, Han Q, Sun X, Liu Y, Huang X. Embryonic cervical rhabdomyosarcoma complicated with uterine inversion with cerebral venous sinus thrombosis as the first symptom: a case report and literature review. J Int Med Res 2021; 49:3000605211031776. [PMID: 34369193 PMCID: PMC8358511 DOI: 10.1177/03000605211031776] [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] [Indexed: 12/29/2022] Open
Abstract
The probability of rhabdomyosarcoma occurring in the cervix is less than 0.5% and may be associated with a pathogenic dicer 1, ribonuclease III (DICER1) gene variation. Tumour-induced hypercoagulability and high levels of cancer antigen (CA) 125 are risk factors for cerebral venous sinus thrombosis (CVST). In addition, although nonpuerperal uterine inversion is very rare and is usually caused by leiomyomas from the uterus, large cervical masses can also be the cause. This case report describes a 24-year-old woman with uterine inversion caused by an embryonic cervical rhabdomyosarcoma that presented with CVST as her first symptom. The patient underwent laparoscopic total uterus and bilateral salpingectomy, during which the uterus was found to be completely inverted. Postoperative pathology confirmed embryonic cervical rhabdomyosarcoma. The patient quickly developed lung and para-aortic lymph node metastases. Two months later, the patient died of complications. When coagulation indices in patients with tumours are abnormal, especially when the levels of D-dimer and CA125 increase, it is recommended that anticoagulant therapy is administered in a timely manner to prevent the occurrence of CVST. Furthermore, for large cervical tumours, physicians should also be alert to the occurrence of uterine inversion.
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Affiliation(s)
- Li Meng
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Qianqian Zhang
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Qingqing Han
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xianghang Sun
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yin Liu
- Department of Obstetrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xianghua Huang
- Department of Gynaecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Ma J, Yu L, Xu F, Yi H, Wei W, Wu P, Wu S, Li H, Ye H, Wang W, Xing H, Fan L. Treatment and clinical outcomes of cervical cancer during pregnancy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:241. [PMID: 31317011 DOI: 10.21037/atm.2019.04.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to investigate clinicopathological factors associated with survival rate and treatment of patients with cervical cancer during pregnancy (CCP). Methods A total of 92 patients diagnosed CCP were retrospectively reviewed. One patient was from Nanfang Hospital of Southern Medical University, 5 patients were from Tongji Hospital, and 86 patients were from case reports in the PubMed database from 1961 to 2019. Patients and tumor characteristics were evaluated. Kaplan-Meier and Cox regression methods were used to analyze the 5-year disease-specific survival (DSS). Results Most patients (73 cases) were stage I according to the 2018 International Federation of Gynecology and Obstetrics (FIGO) standards. Twelve patients (13.04%) terminated pregnancy once diagnosed. These patients were diagnosed at the mean gestational age (GA) of 11±3 weeks, during early pregnancy. For the rest of the patients (80 cases) who continued pregnancy, the mean GA was 35±2 weeks at delivery. There was a significant difference in survival whether the treatment was performed once diagnosed or not. The 5-year DSS was 75% in adenocarcinoma (AC), 68.5% in squamous cell carcinoma (SCC), and 43.7% in the rare subtype. Among the 38 patients who underwent neoadjuvant chemotherapy (NACT), one patient suffered from spontaneous abortion, and one baby experienced acute myeloid leukemia (AML) ex-FAB (French-American-British)-M7 subtype and received bone marrow transplantation. Other delivered newborns showed no abnormality or malformation. Cox multi-factorial analysis demonstrated that tumor size (2 cm) was an independent overall survival predictor for CCP patients (P<0.05). Conclusions Tumor size was an independent prognostic factor of survival in CCP patients. Pregnancy has adverse effects on the prognosis of cervical cancer. Personalized treatment is a priority for CCP patients.
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Affiliation(s)
- Jing Ma
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China.,Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Lan Yu
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, Nanchong Central Hospital, North Sichuan Medical University, Nanchong 637000, China
| | - Hongyan Yi
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wenfei Wei
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Peng Wu
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Sha Wu
- Department of Immunology, School of Basic Medical Sciences, Southern Medical University, Guangdong Provincial Key Laboratory of Proteomics, Guangzhou 510515, China
| | - Hua Li
- Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Hong Ye
- Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Wei Wang
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Hui Xing
- Department of Gynecology and Obstetrics, Xiangyang Hospital, Xiangyang 441000, China
| | - Liangsheng Fan
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
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Gong W, Gao Q, Xu Z, Dai Y. Giant intrascrotal embryonal rhabdomyosarcoma in an adult: a case report and review of the literature. J Med Case Rep 2018; 12:149. [PMID: 29804543 PMCID: PMC5971421 DOI: 10.1186/s13256-018-1607-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/07/2018] [Indexed: 12/03/2022] Open
Abstract
Background Intrascrotal embryonal rhabdomyosarcoma in adults is a rare tumor with high aggression and a poor prognosis. We report our patient’s case and review the relevant literature to improve the understanding of this rare disease. Case presentation A 21-year-old Han Chinese man presented to our hospital with a right intrascrotal mass of 1 year’s duration. His physical examination revealed an enlarged right scrotum containing a huge tender mass measuring about 10 × 7 cm. Ordinary and contrast-enhanced ultrasonography showed a solid mass in the right scrotum, which was suspected to be a malignant tumor. An abdominopelvic computed tomographic scan revealed metastases in the retroperitoneal lymph nodes. The patient was diagnosed with malignant testicular tumor and underwent a right radical orchiectomy by an inguinal approach. Postoperative pathological examination suggested an intrascrotal embryonal rhabdomyosarcoma. Conclusions Intrascrotal embryonal rhabdomyosarcoma is a rare but highly aggressive tumor. Clinical and imaging manifestations of this tumor are nonspecific, so the definitive diagnosis depends on postoperative pathology and immunohistochemistry. Early suspicion, radical orchiectomy, accurate pathologic diagnosis, and adjuvant chemotherapy and/or radiotherapy are the keys to optimal prognosis.
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Affiliation(s)
- Wentao Gong
- Medical School of Nanjing University, Nanjing, 210093, China.,Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Qingqiang Gao
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Zhipeng Xu
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Yutian Dai
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Taghavi K, Sykes P, Innes C, Gibbs D, Hunter L, McBurnie W, Simcock B. Wrong place at the wrong time: A case of cervical embryonal rhabdomyosarcoma in pregnancy. Gynecol Oncol Rep 2015; 12:77-9. [PMID: 26076166 PMCID: PMC4442666 DOI: 10.1016/j.gore.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/12/2015] [Indexed: 12/02/2022] Open
Abstract
First case of NACT in cervical embryonal RMS Second case occurring in pregnancy Histological review outlining diagnostic difficulties
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Affiliation(s)
- Katayoun Taghavi
- Registrar in Obstetrics and Gynecology, Christchurch Women's Hospital, Private Bag 4711, Christchurch 8140, New Zealand
| | - Peter Sykes
- Department of Obstetrics and Gynecogoly, New Zealand
| | - Carrie Innes
- Christchurch Women's Hospital, University of Otago, New Zealand
| | - David Gibbs
- Christchurch Women's Hospital, University of Otago, New Zealand
| | | | - Wendy McBurnie
- Pathology Registrar at Canterbury Health Laboratories, New Zealand
| | - Bryony Simcock
- Christchurch Women's Hospital, University of Otago, New Zealand
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