Beneficence toward whom? Ethical decision-making in a maternal-fetal conflict

Dilemmas in a pregnant woman with myelofibrosis secondary to signet ring adenocarcinoma: a case report

Background

We describe the first reported case of myelofibrosis as an extremely rare complication of gastric cancer during pregnancy; the clinical diagnosis and treatment of which is highly challenging due to nonspecific symptoms coupled with the conflicting needs of immediate disease control and continuation of pregnancy.

Case presentation

We report a 36-year-old pregnant woman who presented with cytopenia, fatigue, vomiting, and diarrhea for 20 days on the background of newly diagnosed myelofibrosis secondary to gastric signet ring adenocarcinoma. She accepted palliative care and died several months after the delivery of a healthy newborn.

Conclusion

Signet ring gastric adenocarcinoma is an unusual cause of myelofibrosis during pregnancy. Treatment remains a great challenge as clinicians have to consider the needs of immediate treatment against fetal well-being while taking into account patient preference and fetus rights.

Acute leukemia during pregnancy: a single institutional experience with 17 cases

We reviewed the medical records of 17 consecutive patients with concomitant acute leukemia and pregnancy seen at our institution over a 37-year period. Fifteen cases each were either newly diagnosed or classified as acute myeloid leukemia (AML). Seven diagnoses (41%) occurred in the first, 7 (41%) in the second, and 3 (18%) in the third trimester. In general, nine patients received chemotherapy while pregnant-eight in the second trimester and one in the third. The overall complete remission rate among the 13 patients with newly diagnosed AML was 69%, compared with 86% in those who were pregnant during chemotherapy. Long-term survival was documented in five of the nine complete responders. Three of four patients who elected to delay treatment until after delivery died within days of starting chemotherapy. Unintentional fetal loss occurred in four patients (29%), including two without exposure to chemotherapy. There were no instances of congenital malformation. The results from the current study confirm that pregnancy per se may not affect the outcome of chemotherapy in AML. In addition, it is suggested that treatment delays may compromise maternal outcome without improving pregnancy outcome.