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Kantarovich D, Archer S, Khoshnam N, Al-Haddad E, Moncaleano D, Demian S, Jacob AM, Shehata BM. Increased Incidence of Villitis in Placentas Exposed to Chemotherapy During Pregnancy: Is There a Correlation? Pediatr Dev Pathol 2019; 22:540-545. [PMID: 31167598 DOI: 10.1177/1093526619853179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We have identified 9 pregnant patients who were diagnosed with malignancy and initiated chemotherapy during their second trimester (cervical cancer [n = 3], leukemia [n = 3], breast cancer [n = 2], and Hodgkin's lymphoma [n = 1]). Five of the patients' placentas were small for gestational age (SGA). Pathologic examination revealed inflammatory changes in 4 of the placentas: 2 from the SGA placentas and 2 from non-SGA placentas. Examination revealed 3 placentas with villitis of unknown etiology (VUE) and 1 with intervillositis; all were negative for bacterial and viral cultures and by immunohistochemical (IHC) stains. In the VUE cases, IHC stains showed positivity of CD25+/FOXP3+ with focal positivity and CD3 and CD4 IHC were focally to strongly positive. Literature suggests that the use of chemotherapy during pregnancy can be detrimental to both the mother and the fetus; however, there has been limited focus on the effects of chemotherapy on the placenta. We suggest that the inflammatory process noted in the placentas is due to chemotherapy-induced toxic effects.
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Affiliation(s)
- Diana Kantarovich
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Sydney Archer
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Nasim Khoshnam
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Eman Al-Haddad
- Department of Pathology, Children's Hospital of Michigan, Detroit, Michigan
| | - Daniela Moncaleano
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Sherry Demian
- Department of Pathology, Children's Hospital of Michigan, Detroit, Michigan
| | - Angela M Jacob
- Department of Pathology, Children's Hospital of Michigan, Detroit, Michigan
| | - Bahig M Shehata
- Department of Pathology, Children's Hospital of Michigan, Detroit, Michigan
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Disseminated carcinomatosis of the bone marrow from gastric cancer during pregnancy. Clin J Gastroenterol 2019; 12:447-452. [PMID: 30915672 DOI: 10.1007/s12328-019-00963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
Gastric cancer during pregnancy is extremely rare and difficult to diagnose at early stages because of its nature. Furthermore, it is often difficult to determine the appropriate treatment strategy considering both the patient's condition and the effect of the treatment on the fetus. We present a case of a 34-year-old woman with gastric cancer who was 22 weeks pregnant and had multiple liver and bone metastases at the time of diagnosis. The disease progressed to disseminated carcinomatosis of the bone marrow, in which cancer invades and spreads diffusely to the bone marrow and then presents disseminated intravascular coagulation. Fortunately, the selected systematic chemotherapy dramatically reduced the severity of the patient's cancer and she could deliver her baby successfully. There are few reports of disseminated carcinomatosis of the bone marrow from gastric cancer during pregnancy. Even in such an oncological emergency, prompt chemotherapy saved the mother's life and enabled safe delivery of the fetus.
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Samiee-rad F, Zangivand AA. The coexistence of ovarian dysgerminoma and normal intra-uterine pregnancy presented with acute abdominal pain. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s00580-017-2592-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hummeida ME, Hamad K, Gadir AFA, Ali AA. Ovarian Cancer During Pregnancy: A Case Report and Literature Review. Clin Pract 2015; 5:727. [PMID: 26236450 PMCID: PMC4500872 DOI: 10.4081/cp.2015.727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/12/2015] [Accepted: 03/11/2015] [Indexed: 11/23/2022] Open
Abstract
Ovarian cancer during pregnancy is a rare event. Little is known about the treatment of this condition due to lack of prospective randomized trials and cohort studies. In this paper the authors reported a rare case of small cells ovarian cancer, diagnosed at 16 weeks of gestation, treated with conservative surgery at 18 weeks and chemotherapy. At week 38, the patient underwent caesarean section and delivered a healthy baby girl. Staging surgery was then carried out followed by adjuvant chemotherapy. Thus the findings from this case concluded that prognosis and quality of the patient’s life should be a priority, chemotherapy during the second trimester seems to be safe however, potential risks of this interventions still has to be considered.
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Abstract
OBJECTIVES Systematically review the literature assessing outcomes of acute myeloid leukemia (AML) treatment during pregnancy. DATA SOURCES A Pubmed literature search (January 1969 to June 2014) for articles written about AML and pregnancy, and bibliographies/citations of previously published reviews. STUDY SELECTION AND DATA EXTRACTION Articles written in the English language that administered active AML chemotherapy during pregnancy were included. DATA SYNTHESIS Eighty-five fetuses were exposed to chemotherapy from 83 mothers: 8 mothers began induction chemotherapy in the first trimester, 61 mothers in the second trimester, and 14 mothers in the third trimester. Chemotherapy resulted in more fetal deaths and spontaneous abortions during the first trimester (37.5%) compared with the second (9.7%) and third trimesters (0%). All cases included cytarabine; 47 fetuses were exposed to daunorubicin and 8 fetuses to idarubicin. The percentages of fetal defects and death for cytarabine and daunorubicin combinations were 8.5% and 6.4%, respectively. With cytarabine and idarubicin combinations, the percentages of fetal defects and death were 28.6% and 12.5%, respectively. Complete remission (CR) rates were 100%, 81%, and 67% in the first, second, and third trimesters. CONCLUSIONS Treatment during the second and third trimesters resulted in fewer fetal complications than the first trimester. However, delaying AML treatment may adversely affect the mother's outcomes. In the reported cases, induction during pregnancy resulted in CR rates comparable to that in nonpregnant patients. The choice of anthracycline is still unclear, but the decision should be made with careful consideration, weighing the outcomes for the mother and fetus.
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Sagan D, Semczuk A, Lampka E. Combination chemotherapy for Hodgkin's lymphoma during pregnancy: Favorable outcome for mother and child. J Obstet Gynaecol Res 2010; 36:882-6. [DOI: 10.1111/j.1447-0756.2010.01249.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Evseenko D, Paxton JW, Keelan JA. Active transport across the human placenta: impact on drug efficacy and toxicity. Expert Opin Drug Metab Toxicol 2009; 2:51-69. [PMID: 16863468 DOI: 10.1517/17425255.2.1.51] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The human placenta expresses a large number of transport proteins. The ATP-binding cassette (ABC) family of active efflux pumps, predominantly localised to the maternal-facing syncytial membrane of placental microvilli, comprise the major placental drug efflux transporters. A variety of other transporters are also expressed in the placenta that can facilitate xenobiotic transfer in both the maternal and fetal directions. Many drugs administered in pregnancy are ABC transporter substrates, and many are either teratogenic or fetotoxic. The in vitro, in vivo and clinical evidence reviewed in this article argues that active efflux of drugs by placental transporters helps to maintain its barrier function, reducing the incidence of adverse fetal effects. ABC transporter polymorphisms may explain the wide variability observed in fetal drug concentrations, incidence of teratogenesis or drug failure in pregnancies exposed to therapeutic agents. Although our understanding of the molecular mechanics and dynamics of placental drug transfer is advancing, much work is needed to fully appreciate the significance of placental drug transporters in the face of increasing drug administration in pregnancy.
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Affiliation(s)
- Denis Evseenko
- University of Auckland, Liggins Institute, Faculty of Medical and Health Science, Auckland, New Zealand
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Warraich Q, Smith N. Herceptin therapy in pregnancy: Continuation of pregnancy in the presence of anhydramnios. J OBSTET GYNAECOL 2009; 29:147-8. [DOI: 10.1080/01443610802643774] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- J Palmer
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, UK.
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Witzel I, Müller V, Harps E, Janicke F, deWit M. Trastuzumab in pregnancy associated with poor fetal outcome. Ann Oncol 2008; 19:191-2. [DOI: 10.1093/annonc/mdm542] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To report a case of both successful maternal treatment outcome and normal fetal outcome in a patient who was diagnosed with Burkitt's lymphoma (BL) and aggressively treated with 6 different chemotherapy agents during the second and third trimesters of pregnancy. CASE SUMMARY A 21-year-old white woman was diagnosed with stage II BL of the head and neck at 26 weeks' gestation. She was treated with 2 cycles of systemic intensive polychemotherapy, including cyclophosphamide, vincristine, doxorubicin, cytarabine, etoposide, ifosfamide, mesna, and intrathecal cytarabine with growth factor support during the second and third trimesters. She delivered a healthy, premature boy 6 weeks after diagnosis. At a follow-up 1 year after diagnosis, the patient remained disease-free and the baby remained healthy. DISCUSSION The prognosis of BL depends on the stage at diagnosis, as well as treatment aggressiveness. Previous reports indicate that most patients diagnosed with BL during pregnancy received either no treatment or only one chemotherapy agent, and the majority ultimately died of rapidly progressive diseases. The fetal outcomes seem to depend primarily on the time of exposure to chemotherapy and/or radiation, doses, specific chemotherapy agent given, and frequency of treatment during pregnancy. Limited retrospective data suggest that chemotherapy given after the first trimester is relatively safe and does not adversely affect the short- and long-term fetal outcomes. CONCLUSIONS Treatment of BL during pregnancy can be very challenging because an aggressive approach is the main key to maximize the patient's long-term disease-free survival. However, the health of the unborn child should also be a concern when choosing treatment. This case demonstrates that combination chemotherapy given after the first trimester did not result in any congenital malformations or acute adverse effects in the fetus. Long-term follow-up of the child remains necessary to evaluate possible long-term complications.
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Affiliation(s)
- Masha S H Lam
- Hematology/Oncology, Shands at the University of Florida, FL, USA.
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Boubred F, Vendemmia M, Garcia-Meric P, Buffat C, Millet V, Simeoni U. Effects of maternally administered drugs on the fetal and neonatal kidney. Drug Saf 2006; 29:397-419. [PMID: 16689556 DOI: 10.2165/00002018-200629050-00004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The number of pregnant women and women of childbearing age who are receiving drugs is increasing. A variety of drugs are prescribed for either complications of pregnancy or maternal diseases that existed prior to the pregnancy. Such drugs cross the placental barrier, enter the fetal circulation and potentially alter fetal development, particularly the development of the kidneys. Increased incidences of intrauterine growth retardation and adverse renal effects have been reported. The fetus and the newborn infant may thus experience renal failure, varying from transient oligohydramnios to severe neonatal renal insufficiency leading to death. Such adverse effects may particularly occur when fetuses are exposed to NSAIDs, ACE inhibitors and specific angiotensin II receptor type 1 antagonists. In addition to functional adverse effects, in utero exposure to drugs may affect renal structure itself and produce renal congenital abnormalities, including cystic dysplasia, tubular dysgenesis, ischaemic damage and a reduced nephron number. Experimental studies raise the question of potential long-term adverse effects, including renal dysfunction and arterial hypertension in adulthood. Although neonatal data for many drugs are reassuring, such findings stress the importance of long-term follow-up of infants exposed in utero to certain drugs that have been administered to the mother.
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Affiliation(s)
- Farid Boubred
- Faculté de Médecine, Université de la Méditerrannée and Assistance Publique Hôpitaux de Marseille, Hôpital de la Conception, Service de Néonatologie, Marseille, France
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Potluri V, Lewis D, Burton GV. Chemotherapy with Taxanes in Breast Cancer During Pregnancy: Case Report and Review of the Literature. Clin Breast Cancer 2006; 7:167-70. [PMID: 16800979 DOI: 10.3816/cbc.2006.n.029] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two patients with breast cancer received docetaxel-containing chemotherapy as adjuvant or neoadjuvant therapy during pregnancy. The first pregnant patient began neoadjuvant therapy with doxorubicin/cyclophosphamide at 14 weeks of gestation. After 4 cycles of doxorubicin/cyclophosphamide and surgery, she received adjuvant docetaxel for 4 cycles. The second patient began neoadjuvant therapy with doxorubicin/docetaxel at 14 weeks of gestation and received 6 cycles. The fetus of the first patient had hydrocephalus on ultrasound at 17 weeks of gestation (before docetaxel therapy) that persisted on serial follow-up ultrasounds and spontaneously regressed over several months after delivery. No fetal malformations were detected in the second fetus. These 2 cases add to the existing data on the use of taxanes during pregnancy. Although the data are limited with case reports, pregnant patients with cancer can be treated with chemotherapy including taxanes during the second and third trimesters without significant risks to the fetus. Taxanes should not be excluded, if indicated, in pregnant patients with cancer.
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Affiliation(s)
- Vinaya Potluri
- Department of Medicine, Louisiana State University Health Sciences Center Shreveport, 71130, USA
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Dy Echo AV, Soriano-Estrella AS. Gestational trophoblastic tumor in pregnancy: a case report and review of the literature. Int J Gynecol Cancer 2006; 16:875-81. [PMID: 16681776 DOI: 10.1111/j.1525-1438.2006.00556.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A case of gestational trophoblastic tumor (GTT) concurrent with an intrauterine pregnancy is reported in a 21-year-old gravida 2 para 0 (0010) who presented with dyspnea, orthopnea, headache, and blurring of vision at 33 weeks age of gestation. She had a history of hydatidiform mole for which curettage was done. Chest radiograph showed pulmonary metastases, with pleural effusion on both lungs. Serum beta subunit of human chorionic gonadotropin was abnormally elevated for age of gestation. Due to worsening maternal pulmonary condition, the patient underwent primary, low segment cesarean section and was subsequently started on multidrug chemotherapy. This is the first reported case of GTT in pregnancy in the Philippines in which both the mother and the infant survived. Several hypotheses regarding its origin, its diagnosis, and its management and prognosis are presented. This case report emphasizes the importance of early diagnosis and treatment to improve the prognosis of both the mother and the infant.
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Affiliation(s)
- A V Dy Echo
- Department of Obstetrics and Gynecology, Philippine General Hospital, Manila, Philippines.
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Abstract
Chemotherapy may be indicated for the treatment of cancer during pregnancy. The decision to use chemotherapy significantly impacts the pregnancy, and in turn the pregnancy may affect the treatment options available to patients with cancer. This review provides information about the effects of chemotherapeutic agents in pregnancy, taking into account both the mother and the fetus. For convenience, the agents are divided into categories based upon class and mechanism of action. These include alkylating agents, antimetabolites, nucleoside analogs, topoisomerase I inhibitors, topisomerase II inhibitors, vinca alkaloids, taxanes, and biologics such as signaling and growth factor blocking agents.
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Affiliation(s)
- Kimberly K Leslie
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, 2211 Lomas Boulevard NE, Albuquerque NM 87131-0001, USA.
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Abstract
Hematologic malignancies complicating pregnancy are uncommon, but a delay in diagnosis or treatment can mean the difference between life and death. It is the responsibility of the obstetrician, nurse-midwife, or nurse practitioner to maintain a high index of suspicion when patients present with unexplained lymphadenopathy or protracted constitutional symptoms. Management of these patients requires a multifaceted team from the oncology, pediatrics, and obstetrics services. With most hematologic cancers now requiring multiagent chemotherapy for optimal survival, the patient, her family, and her physicians are often faced with what seems to be a Faustian dilemma. Most infants exposed in utero to multiagent chemotherapy, however, seem to suffer no long-term detrimental consequences.
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Affiliation(s)
- Timothy J Hurley
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico Health Science Center, 2211 Lomas Boulevard, Albuquerque, NM 87131, USA.
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Abstract
A human fetus is most susceptible to teratogenic agents during the first trimester of pregnancy. Cyclophosphamide and doxorubicin are pregnancy category D agents; however, potential benefits may warrant treatment with these agents during pregnancy under special circumstances. During her first trimester of pregnancy, a 37-year-old Caucasian woman was diagnosed with stage IIB infiltrating ductal carcinoma in situ (breast cancer) that was estrogen and progesterone receptor negative and human epidermal growth factor receptor-2 positive. The patient was treated with doxorubicin and cyclophosphamide in the second and third trimesters and delivered a premature baby boy at 31 weeks' gestation. The neonate was intubated on delivery because of respiratory distress and failure; however, no physical anomalies were observed. He had neutropenia and anemia, quite possibly as a result of his mother's chemotherapy 1 week before delivery. He was prophylactically treated for sepsis, but all cultures were negative. The infant grew and developed normally during his first year of life and remained in good health. An objective causality assessment revealed that it was probable that the infant's adverse events (prematurity, neutropenia, and anemia) were related to his mother's doxorubicin and cyclophosphamide therapy; however, these were the only adverse events potentially linked to in utero exposure to chemotherapy during the second and third trimesters. Due to the special considerations of both mother and infant, optimal treatment for patients with pregnancy-associated breast cancer requires the expert opinion of a multidisciplinary care team.
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Affiliation(s)
- Julia R Kerr
- Mountain States Tumor Institute, St. Luke's Regional Medical Center, Boise, Idaho 83712, USA.
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Abstract
BACKGROUND Herceptin (trastuzumab), a new a chemotherapeutic agent, is a monoclonal antibody that blocks the human epidermal growth factor receptor 2 protein. There is no reported experience with use of this agent during pregnancy and possible effects on the fetus. CASE A patient with breast cancer was treated with Herceptin during pregnancy. This treatment was associated with anhydramnios, which resolved slowly after the drug was discontinued. CONCLUSION Although listed as a category B drug, experience with Herceptin in human pregnancy is limited, and it should be used with caution. Investigation of the role of human epidermal growth factor receptor 2 protein in the embryonic kidney may further our understanding of amniotic fluid dynamics.
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Affiliation(s)
- William J Watson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Delatycki MB. A de novo, apparently balanced reciprocal translocation in a child with developmental delay whose mother was being treated with low-dose methotrexate at the time of conception. ACTA ACUST UNITED AC 2005; 73:253-4. [PMID: 15751034 DOI: 10.1002/bdra.20116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Methotrexate is a proven teratogen and its use periconceptually is strongly advised against. Concerns about possible chromosomal effects in the offspring of women treated with this agent have been raised, but they have not been reported. In vivo and in vitro studies have supported this possibility, however. CASE A 32-year-old primigravida was treated with low-dose methotrexate for rheumatoid arthritis from prior to conception until six weeks postconception. Her child was born without congenital malformations but subsequently developed seizures and was diagnosed with developmental delay. He was found to have a de novo, apparently balanced, reciprocal translocation between chromosomes 5 and 20 (46,XY,t(5:20)(q15;p12)). Other investigations failed to reveal another cause for his developmental delay. CONCLUSIONS The possible association between maternal methotrexate exposure and a de novo chromosomal anomaly in an offspring supports the recommendation that women should be advised to cease taking this drug for at least six months prior to conception.
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Affiliation(s)
- Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville 3052, Victoria, Australia.
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Advanced Endodermal Sinus Tumor With Contralateral Dermoid Tumor During Pregnancy: A Case Report and Literature Review. Taiwan J Obstet Gynecol 2004. [DOI: 10.1016/s1028-4559(09)60067-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nakajima W, Ishida A, Takahashi M, Hirayama M, Washino N, Ogawa M, Takahashi S, Okada K. Good outcome for infant of mother treated with chemotherapy for ewing sarcoma at 25 to 30 weeks' gestation. J Pediatr Hematol Oncol 2004; 26:308-11. [PMID: 15111784 DOI: 10.1097/00043426-200405000-00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There have been only three previous reports of women with Ewing sarcoma who received chemotherapy while pregnant. A 17-year-old woman with Ewing sarcoma was treated with a combination of doxorubicin (Adriamycin) and ifosfamide during the 25th to 30th week of gestation, and the baby was delivered at the 32nd week. The baby was developing normally at follow-up at 8 months of age. This case report supports the idea that in this situation, the pregnancy can be continued to await fetal growth, and second-trimester chemotherapy may not have a deleterious effect on the fetus.
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Affiliation(s)
- Wako Nakajima
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan.
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Koivunen DG. Breast cancer and pregnancy. CURRENT SURGERY 2003; 60:3-7. [PMID: 15214307 DOI: 10.1016/s0149-7944(02)00750-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Debra G Koivunen
- Department of Surgery, University of Missouri School of Medicine, Columbia, USA
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:529-44. [PMID: 12426939 DOI: 10.1002/pds.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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