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Constantin A, Constantin R, Achim F, Socea B, Predescu D. Pregnancy and Gastric Cancer: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111909. [PMID: 37296761 DOI: 10.3390/diagnostics13111909] [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: 02/27/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Cases of digestive cancers diagnosed during pregnancy are rare. The increasing prevalence of pregnancy in women aged 30-39 years (and not exceptionally 40-49 years) could explain the frequent co-occurrence of cancers and pregnancy. The diagnosis of digestive cancers in pregnancy is difficult due to the overlap between neoplasm symptomatology and the clinical picture of pregnancy. A paraclinical evaluation may also be difficult depending on the trimester of the pregnancy. Diagnosis is also delayed by practitioners' hesitation to use invasive investigations (imaging, endoscopy, etc.) due to fetal safety concerns. Therefore, digestive cancers are often diagnosed during pregnancy in advanced stages, where complications such as occlusions, perforations, and cachexia have already arisen. In this review, we highlight the epidemiology, clinical aspects, paraclinical evaluation, and particularities of the diagnosis and treatment of gastric cancer during pregnancy.
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Affiliation(s)
- Adrian Constantin
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Roxana Constantin
- Department of Obstetrics and Gynecology, Sanador Hospital, 010991 Bucharest, Romania
| | - Florin Achim
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
- Department of Surgery, Sf. Pantelimon Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Dragos Predescu
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
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2
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Systematic review of fetal and placental metastases among pregnant patients with cancer. Cancer Treat Rev 2022; 104:102356. [DOI: 10.1016/j.ctrv.2022.102356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
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3
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Incidental diagnosis of a pancreatic adenocarcinoma in a woman affected by gestational diabetes mellitus: case report and literature review. Am J Obstet Gynecol MFM 2021; 3:100471. [PMID: 34454160 DOI: 10.1016/j.ajogmf.2021.100471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 12/17/2022]
Abstract
Pancreatic cancer is rarely diagnosed during pregnancy; it usually manifests with symptoms such as epigastric pain, vomiting, weight loss, and jaundice, rarely mimicking the hemolysis, elevated liver enzymes, and low platelet count syndrome. It has been postulated that there exists a correlation between the diagnosis of gestational diabetes mellitus and the occurrence of pancreatic cancer later in life. We conducted an expert literature review of the 31 available documented pancreatic cancer cases that were diagnosed during pregnancy. We also report pancreatic adenocarcinoma incidentally suspected in an asymptomatic woman affected by gestational diabetes mellitus; the woman was undergoing a fetal growth scan.
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4
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Zhou L, Kong Y, Wu J, Li X, Fei Y, Ma J, Wang Y, Mi L. Metabolic Changes in Maternal and Cord Blood in One Case of Pregnancy-Associated Breast Cancer Seen by Fluorescence Lifetime Imaging Microscopy. Diagnostics (Basel) 2021; 11:diagnostics11081494. [PMID: 34441428 PMCID: PMC8392038 DOI: 10.3390/diagnostics11081494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Pregnancy-associated breast cancer (PABC) is a rare disease, which is frequently diagnosed at an advanced stage due to limitations in current diagnostic methods. In this study, fluorescence lifetime imaging microscopy (FLIM) was used to study the metabolic changes by measuring maternal blood and umbilical cord blood via the autofluorescence of coenzymes, reduced nicotinamide adenine dinucleotide (phosphate) (NAD(P)H), and flavin adenine dinucleotide (FAD). The NAD(P)H data showed that a PABC case had significant differences compared with normal cases, which may indicate increased glycolysis. The FAD data showed that both maternal and cord blood of PABC had shorter mean lifetimes and higher bound-FAD ratios. The significant differences suggested that FLIM testing of blood samples may be a potential method to assist in PABC non-radiative screening.
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Affiliation(s)
- Li Zhou
- Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, 220 Handan Road, Shanghai 200433, China; (L.Z.); (Y.K.); (J.W.); (Y.F.); (J.M.)
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Fudan University, 220 Handan Road, Shanghai 200433, China
| | - Yawei Kong
- Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, 220 Handan Road, Shanghai 200433, China; (L.Z.); (Y.K.); (J.W.); (Y.F.); (J.M.)
| | - Junxin Wu
- Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, 220 Handan Road, Shanghai 200433, China; (L.Z.); (Y.K.); (J.W.); (Y.F.); (J.M.)
| | - Xingzhi Li
- School of Materials Science and Engineering, Hubei University of Automotive Technology, 167 Checheng West Road, Shiyan 442002, China;
| | - Yiyan Fei
- Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, 220 Handan Road, Shanghai 200433, China; (L.Z.); (Y.K.); (J.W.); (Y.F.); (J.M.)
| | - Jiong Ma
- Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, 220 Handan Road, Shanghai 200433, China; (L.Z.); (Y.K.); (J.W.); (Y.F.); (J.M.)
- Institute of Biomedical Engineering and Technology, Academy for Engineer and Technology, Fudan University, 220 Handan Road, Shanghai 200433, China
- Shanghai Engineering Research Center of Industrial Microorganisms, The Multiscale Research Institute of Complex Systems (MRICS), School of Life Sciences, Fudan University, 220 Handan Road, Shanghai 200433, China
| | - Yulan Wang
- Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Str., Wuhan 430014, China
- Correspondence: (Y.W.); (L.M.)
| | - Lan Mi
- Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, 220 Handan Road, Shanghai 200433, China; (L.Z.); (Y.K.); (J.W.); (Y.F.); (J.M.)
- Institute of Biomedical Engineering and Technology, Academy for Engineer and Technology, Fudan University, 220 Handan Road, Shanghai 200433, China
- Correspondence: (Y.W.); (L.M.)
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5
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Wolters VERA, Lok CAR, Gordijn SJ, Wilthagen EA, Sebire NJ, Khong TY, van der Voorn JP, Amant F. Placental pathology in cancer during pregnancy and after cancer treatment exposure. Placenta 2021; 111:33-46. [PMID: 34153795 DOI: 10.1016/j.placenta.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/03/2021] [Indexed: 01/07/2023]
Abstract
Cancer during pregnancy has been associated with (pathologically) small for gestational age offspring, especially after exposure to chemotherapy in utero. These infants are most likely growth restricted, but sonographic results are often lacking. In view of the paucity of data on underlying pathophysiological mechanisms, the objective was to summarize all studies investigating placental pathology related to cancer(treatment). A systematic search in PubMed/Medline, Embase (OVID) and SCOPUS was conducted to retrieve all studies about placental pathology in cancer during pregnancy or after cancer treatment, published until August 2020. The literature search yielded 5784 unique publications, of which 111 were eligible for inclusion. Among them, three groups of placental pathology were distinguished. First, various histopathologic changes including maternal vascular malperfusion have been reported in pregnancies complicated by cancer and after cancer treatment exposure, which were not specific to type of cancer(treatment). Second, cancer(treatment) has been associated with placental cellular pathology including increased oxidative damage and apoptosis, impaired angiogenesis and genotoxicity. Finally, involvement of the placenta by cancer cells has been described, involving both the intervillous space and rarely villous invasion, with such fetuses are at risk of having metastases. In conclusion, growth restriction is often observed in pregnancies complicated by cancer and its cause can be multifactorial. Placental histopathologic changes, cellular pathology and genotoxicity caused by the cancer(treatment) may each play a role.
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Affiliation(s)
- Vera E R A Wolters
- Department of Gynecologic Oncology and Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute - Antoni van Leeuwenhoek and University Medical Centers Amsterdam, Plesmanlaan 121, 1066, CX Amsterdam, the Netherlands.
| | - Christine A R Lok
- Department of Gynecologic Oncology and Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute - Antoni van Leeuwenhoek and University Medical Centers Amsterdam, Plesmanlaan 121, 1066, CX Amsterdam, the Netherlands.
| | - Sanne J Gordijn
- Department of Gynaecology and Obstetrics, University of Groningen, University Medical Center Groningen, CB 20 Hanzeplein 1, 9713, GZ Groningen, the Netherlands.
| | - Erica A Wilthagen
- Scientific Information Service, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX Amsterdam, the Netherlands.
| | - Neil J Sebire
- Department of Paediatric Pathology, NIHR Great Ormond Street Hospital BRC, London, WC1N 3JH, United Kingdom.
| | - T Yee Khong
- SA Pathology, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA5006, Australia.
| | - J Patrick van der Voorn
- Department of Pathology, University Medical Centers Amsterdam, Location VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Frédéric Amant
- Department of Gynecologic Oncology and Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute - Antoni van Leeuwenhoek and University Medical Centers Amsterdam, Plesmanlaan 121, 1066, CX Amsterdam, the Netherlands; Department of Oncology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
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6
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Oliveira MDMS, Salgado CDM, Viana LR, Gomes-Marcondes MCC. Pregnancy and Cancer: Cellular Biology and Mechanisms Affecting the Placenta. Cancers (Basel) 2021; 13:1667. [PMID: 33916290 PMCID: PMC8037654 DOI: 10.3390/cancers13071667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer during pregnancy is rarely studied due to its low incidence (1:1000). However, as a result of different sociocultural and economic changes, women are postponing pregnancy, so the number of pregnant women with cancer has been increasing in recent years. The importance of studying cancer during pregnancy is not only based on maternal and foetal prognosis, but also on the evolutionary mechanisms of the cell biology of trophoblasts and neoplastic cells, which point out similarities between and suggest new fields for the study of cancer. Moreover, the magnitude of how cancer factors can affect trophoblastic cells, and vice versa, in altering the foetus's nutrition and health is still a subject to be understood. In this context, the objective of this narrative review was to show that some researchers point out the importance of supplementing branched-chain amino acids, especially leucine, in experimental models of pregnancy associated with women with cancer. A leucine-rich diet may be an interesting strategy to preserve physiological placenta metabolism for protecting the mother and foetus from the harmful effects of cancer during pregnancy.
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Affiliation(s)
| | | | - Lais Rosa Viana
- Nutrition and Cancer Laboratory, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Sao Paulo 13083-862, Brazil; (M.d.M.S.O.); (C.d.M.S.)
| | - Maria Cristina Cintra Gomes-Marcondes
- Nutrition and Cancer Laboratory, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Sao Paulo 13083-862, Brazil; (M.d.M.S.O.); (C.d.M.S.)
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7
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Gastric cancer during pregnancy with placental involvement: case report and review of published works. Obstet Gynecol Sci 2019; 62:357-361. [PMID: 31538080 PMCID: PMC6737060 DOI: 10.5468/ogs.2019.62.5.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/26/2018] [Accepted: 01/22/2019] [Indexed: 01/22/2023] Open
Abstract
Gastric cancer involving the placenta during pregnancy is rare; however, we present 1 such case in this report. A 31-year-old Japanese woman was referred at 26 weeks of gestation for the evaluation of a swollen left supraclavicular lymph node. Biopsy revealed poorly differentiated adenocarcinoma, and esophagogastroduodenoscopy with biopsy of the stomach confirmed the diagnosis of gastric cancer. Her epigastric and back pain became more pronounced and her general status worsened, and we performed a cesarean delivery at 29 weeks. Microscopic examination of the placental specimen revealed poorly differentiated adenocarcinoma cells diffused into the intervillous space. Postpartum chemotherapy consisted of S-1 plus oxaliplatin. Unfortunately, this treatment was ineffective, and the patient died 3 months after delivery. The infant did well, without clinical or laboratory manifestations of metastasis. In patients with advanced gastric cancer during pregnancy, it is important to perform a microscopic examination of the placenta to evaluate for metastatic involvement.
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8
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AlQattan AS, Alkuwaiti FA, Alghusnah ES, Bojal SA, Alqahtani MS. Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature. Int J Surg Case Rep 2019; 61:38-43. [PMID: 31306902 PMCID: PMC6626975 DOI: 10.1016/j.ijscr.2019.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Ampullary adenocarcinoma is a rare entity during pregnancy. It accounts for 0.5% of all gastrointestinal malignancies. The best treatment modality for resectable tumors with the best reported outcome is surgical resection in the form of pancreaticoduodenectomy (Whipple procedure). In this case report, we discuss the challenges in the management of ampullary adenocarcinoma in a pregnant patient. CASE PRESENTATION We report a case of 22 years old pregnant women who presented with vague abdominal pain and jaundice at the 28th week of gestation. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture around the ampulla and distal common bile duct (CBD). The CBD was stented and a biopsy was taken. Histopathology revealed: an invasive adenocarcinoma. The patient was managed by elective pancreaticoduodenectomy after induction of vaginal delivery at the 34th week of gestation. CONCLUSION Diagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother & fetus in case of early stage disease.
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Affiliation(s)
| | | | | | - Shoukat Ahmad Bojal
- Department of General Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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9
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Kuo E, Kumarapeli AR. Placental Pathology in Down Syndrome-Associated Transient Abnormal Myelopoiesis. Arch Pathol Lab Med 2019; 144:388-393. [PMID: 30969155 DOI: 10.5858/arpa.2018-0248-rs] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transient abnormal myelopoiesis is a hematopoietic disorder that occurs in up to 10% of neonates with Down syndrome. It is characterized by leukocytosis and the presence of circulating blast cells harboring truncating GATA1 mutations with variable multiorgan system involvement. Placental involvement of transient abnormal myelopoiesis is infrequently described. Placental examination and identifying features related to transient abnormal myelopoiesis could be one of the early, if not the only, means of diagnosis of this condition in affected stillbirths, premature infants, and a subset of asymptomatic neonates. This article provides an overview of the placental pathology in transient abnormal myelopoiesis with review of the literature, and also discusses the important differential diagnoses.
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Affiliation(s)
- Enoch Kuo
- From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
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10
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Şahin Aker S, Katlan DC, Yüce T, Söylemez F. Placental, hepatic, and supraclavicular lymph node metastasis in pancreatic adenocarcinoma during pregnancy: A case report. Turk J Obstet Gynecol 2016; 13:161-163. [PMID: 28913114 PMCID: PMC5558309 DOI: 10.4274/tjod.39327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/20/2016] [Indexed: 12/27/2022] Open
Abstract
The occurrence of coexisting cancer in pregnant women is not a common phenomenon. It complicates approximately 1 in 1000 to 1500 pregnancies. We present a multiparous woman aged 27 years in her 28th week of pregnancy who was admitted to our clinic with right upper quadrant pain and was finally revealed to have multiple metastatic pancreatic adenocarcinoma. To the best of our knowledge, this is the first documented case of pancreatic adenocarcinoma to metastasize both to the placenta and multiple maternal sites (liver, supraclavicular, para-aortic lymph nodes) in a pregnant patient. Unpredictable metastases to the placenta may be encountered and may even lead to definitive diagnosis, as in our case. Therefore, the placenta in any patient with known malignancy should be sent for pathologic evaluation.
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Affiliation(s)
- Seda Şahin Aker
- Dr. Sami Ulus Maternity and Children's Health Training and Research Hospital, Clinic of Gynecology and Obstetrics, Ankara, Turkey
| | - Doruk Cevdi Katlan
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Tuncay Yüce
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Feride Söylemez
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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11
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Epstein Shochet G, Drucker L, Pomeranz M, Fishman A, Pasmanik-Chor M, Tartakover-Matalon S, Lishner M. First trimester human placenta prevents breast cancer cell attachment to the matrix: The role of extracellular matrix. Mol Carcinog 2016; 56:62-74. [PMID: 26859229 DOI: 10.1002/mc.22473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 12/27/2015] [Accepted: 01/28/2016] [Indexed: 01/13/2023]
Abstract
The extracellular matrix (ECM) affects cancer cell characteristics. Its detachment from the ECM induces cell apoptosis, termed anoikis. Cancer cells can develop anoikis resistance, a necessary step for metastasis, by switching integrins, over-expressing growth factor receptors, and inducing epithelial mesenchymal transition (EMT). The placenta is a non-supportive microenvironment for cancer cells. We showed that breast cancer cells (BCCL) were eliminated from placental implantation sites. During implantation, the placenta manipulates its surrounding matrix, which may induce BCCL elimination. Here, we explored the effect of placenta-induced ECM manipulations on BCCL. During experiments, BCCL (MCF-7/T47D) were cultured on placenta/BCCL-conditioned ECM (Matrigel used for first trimester placenta/BCCL culture and cleared by NH4 OH). After culturing the cells, we analyzed cancer cell phenotype (death, count, aggregation, MMP) and signaling (microarray analysis and pathway validation). We found that the BCCL did not attach to previous placental implantation sites and instead, similarly to anoikis-resistant cells, migrated away, displayed increased MMP levels/activity, and formed aggregates in distant areas. T47D were less affected than the MCF-7 cells, since MCF-7 also showed modest increases in cell death, EMT, and increased proliferation. Microarray analysis of the MCF-7 highlighted changes in the integrin, estrogen, EGFR, and TGFβ pathways. Indeed, placental ECM reduced ERα, induced Smad3/JNK phosphorylation and increased integrin-α5 expression (RGD-dependent integrin) in the BCCL. Addition of RGD or TGFβR/JNK inhibitors reversed the phenotypic changes. This study helps explain the absence of metastases to the placenta and why advanced cancer is found in pregnancy, and provides possible therapeutic targets for anoikis-resistant cells. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Gali Epstein Shochet
- Oncogenetic Laboratory, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Drucker
- Oncogenetic Laboratory, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Pomeranz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Ami Fishman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Metsada Pasmanik-Chor
- Bioinformatics Unit, Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Tartakover-Matalon
- Oncogenetic Laboratory, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Lishner
- Oncogenetic Laboratory, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
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12
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Chen Y, Li Y, Wang H, Lu J, Jin M, Zhang Z. Maternal gastric carcinoma with metastasis to the placenta: A case report. Oncol Lett 2014; 8:2509-2510. [PMID: 25364418 PMCID: PMC4214481 DOI: 10.3892/ol.2014.2529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 05/29/2014] [Indexed: 11/21/2022] Open
Abstract
In the current report a case of maternal gastric carcinoma with metastasis to the placenta is presented. Gastric cancer is a worldwide health issue, which accounts for ~8.6% of newly diagnosed cancer cases annually. However, the simultaneous occurrence of gastric cancer and pregnancy is rare; to date, only 0.1% of all cases of gastric cancer occur during pregnancy. Furthermore, among all cases of gestational gastric cancer, only six cases have been reported to exhibit metastasis to the placenta or fetus. In the current study another such case is presented. Based on the results of previous studies, further discussion regarding the diagnosis and prognosis of gastric cancer during pregnancy in the mother and fetus is presented.
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Affiliation(s)
- Yuxuan Chen
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing 100020, P.R. China
| | - Yao Li
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing 100020, P.R. China
| | - Hong Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing 100020, P.R. China
| | - Junli Lu
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing 100020, P.R. China
| | - Mulan Jin
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing 100020, P.R. China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing 100020, P.R. China
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13
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Dai Q, Reddy VVB, Choi JK, Faye-Petersen OM. Trisomy 21-associated transient abnormal myelopoiesis involving the maternal space of the placenta: a case report and literature review. Pediatr Dev Pathol 2014; 17:366-73. [PMID: 24972120 DOI: 10.2350/14-04-1476-cr.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of a male newborn with trisomy 21 and transient abnormal myelopoiesis at birth whose placenta showed extravasated fetal blasts in the perivillous (maternal) space. Concern for possible maternal spread of fetal malignancy prompted a Kleihauer-Betke test and flow cytometric analysis of the maternal peripheral blood on postpartum day 2. Notably, no evidence of the persistence of fetal cells in the maternal blood was identified, a finding that likely reflected successful maternal immunologic clearance of the fetal blasts and erythrocytes, and/or blast cellular fragility and limited viability. Ours is the first report, to our knowledge, documenting maternal peripheral-blood follow-up evaluation of this disorder in the English literature. We discuss our case in the context of a comprehensive review of fetoneonatal solid tumor and leukemic proliferative disorders with placental involvement and evidence of maternal metastasis.
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Affiliation(s)
- Qian Dai
- 1 Department of Pathology, Division of Anatomic Pathology, University of Alabama at Birmingham, 619 19th Street South, NP 3547, Birmingham, AL 35294-6823, USA
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14
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Jeong B, Shim JY, Kim CJ, Won HS, Lee PR, Kim A. Massive perivillous fibrin deposition in the placenta and uterine metastasis of gastric adenocarcinoma during pregnancy. J Obstet Gynaecol Res 2014; 40:1150-3. [DOI: 10.1111/jog.12292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/05/2013] [Indexed: 01/16/2023]
Affiliation(s)
- Bada Jeong
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| | - Chong Jai Kim
- Department of Pathology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| | - Pil Ryang Lee
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
| | - Ahm Kim
- Department of Obstetrics and Gynecology; Asan Medical Center; Seoul Korea
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15
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Miller K, Zawislak A, Gannon C, Millar D, Loughrey MB. Maternal gastric adenocarcinoma with placental metastases: what is the fetal risk? Pediatr Dev Pathol 2012; 15:237-9. [PMID: 22339159 DOI: 10.2350/11-08-1074-cr.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The incidence of maternal cancer during pregnancy is low, and metastatic disease involving the placenta is rare. We present a case of rapidly progressive and fatal gastric carcinoma presenting during pregnancy, with spread to the maternal blood space within the placenta but no chorionic villous invasion and no evidence of fetal transmission at the time of delivery or on 12-month follow up. To the best of our knowledge, there have been only 5 previous single case reports of gastric carcinoma metastatic to the placenta. This case highlights the need for clinical vigilance against dismissing gastrointestinal symptoms as pregnancy related and for pathologists to carefully examine the placenta in the setting of maternal malignancy. When placental metastases are present but with no villous invasion, the risk of fetal metastasis may be extremely low, even in the setting of aggressive, terminal malignancy in the mother.
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Affiliation(s)
- Keith Miller
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland.
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Boyd CA, Benarroch-Gampel J, Kilic G, Kruse EJ, Weber SM, Riall TS. Pancreatic neoplasms in pregnancy: diagnosis, complications, and management. J Gastrointest Surg 2012; 16:1064-71. [PMID: 22160782 PMCID: PMC3354643 DOI: 10.1007/s11605-011-1797-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 11/23/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neoplasms of the pancreas during pregnancy are rare, with less than 25 cases of benign and malignant tumors reported in the literature. METHODS We present three unique cases of pancreatic tumors occurring during pregnancy--one mucinous cystic neoplasm and two adenocarcinomas. We review the literature regarding pancreatic neoplasms during pregnancy and discuss the diagnosis, complications, and management of these tumors. RESULTS Magnetic resonance imaging and ultrasound are the imaging modalities of choice in pregnancy. In patients with benign or premalignant tumors, surgical resection may be postponed until the second trimester. In symptomatic patients, or if there is a concern for intrauterine growth restriction, urgent surgical intervention should be performed. With malignant tumors, the benefit of delaying surgery must be balanced with the risk of maternal disease progression. Termination of the pregnancy should be discussed when a malignant tumor is diagnosed during the first trimester. Pancreatic tumors diagnosed during the third trimester may be resected after delivery. If malignant, early delivery of the fetus and subsequent maternal operation can be considered at appropriate fetal maturity. CONCLUSION When these tumors occur during pregnancy, they present a diagnostic and treatment dilemma, with variation in treatment based on gestational age and patient preference.
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Affiliation(s)
| | | | - Gokhan Kilic
- Departments of Surgery and Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Edward J. Kruse
- Department of Surgery, Georgia Health Sciences University, Augusta, GA
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Taylor S. Riall
- Departments of Surgery and Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
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17
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Epstein Shochet G, Tartakover Matalon S, Drucker L, Pomeranz M, Fishman A, Rashid G, Oron-Karni V, Pasmanik-Chor M, Lishner M. Hormone-dependent placental manipulation of breast cancer cell migration. Hum Reprod 2011; 27:73-88. [DOI: 10.1093/humrep/der365] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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18
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Baker AM, Haeri S, Shafer A, Moldenhauer JS. Maternal gastric carcinoma metastatic to the placenta. Eur J Obstet Gynecol Reprod Biol 2010; 153:225-6. [DOI: 10.1016/j.ejogrb.2010.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 06/17/2010] [Accepted: 07/06/2010] [Indexed: 11/27/2022]
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19
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Tan K, Sinclair E, Angus G, Hill J, Snyman N, Russell P. Mucinous adenocarcinoma of the breast metastatic to the placenta. Pathology 2010; 42:688-90. [DOI: 10.3109/00313025.2010.523689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Tartakover-Matalon S, Mizrahi A, Epstein G, Shneifi A, Drucker L, Pomeranz M, Fishman A, Radnay J, Lishner M. Breast cancer characteristics are modified by first trimester human placenta: in vitro co-culture study. Hum Reprod 2010; 25:2441-54. [PMID: 20719812 DOI: 10.1093/humrep/deq227] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pregnant women with breast cancer present with a more advanced disease compared with non-pregnant women. Nevertheless, breast cancer metastasis to the placenta is rare. Trophoblast/tumor implantations share the same biochemical mediators, while only the first is stringently controlled. We hypothesized that the same mechanisms that affect/restrain placental implantation may inhibit metastatic growth in the placenta. We aimed to analyze the effects of human placenta on breast cancer cells. METHODS First trimester human placental explants were co-cultured with MCF-7/T47D-eGFP tagged cells. Following culture, placenta/cancer cells/both were fixed, paraffin embedded and sliced for immunohistochemical analysis or sorted by their eGFP expression for future analysis. The tested parameters were: proliferation (immunohistochemistry)/cell cycle (FACS), apoptosis (immunohistochemistry/FACS), cell count/adhesion/distribution around the placenta (cell sorter, visual observation and counting), matrix metalloproteinase activity (zymogram) and estrogen receptor (ER) expression (western blotting, immunohistochemistry). RESULTS Reduced breast cancer cell numbers (45%↓, 48%↓ for MCF-7/T47D, respectively, P < 0.05) were observed near the placenta. The placenta elevated MCF-7 sub-G1 phase and modestly elevated apoptosis (3-17%↑ for T47D/MCF-7, respectively, P < 0.05). Our findings demonstrate breast cancer cell migration from the placenta as: (i) T47D/MCF-7 cells changed their morphology to that of motile cells; (ii) elevated MMPs activity was found in the co-culture; (iii) placental soluble factors detached breast cancer cells; and (4) the placenta reduced MCF-7/T47D cells' ER expression (a characteristic of motile cells). CONCLUSIONS MCF-7/T47D cells are eliminated from the placental surroundings. Analyzing the causes of these phenomena may suggest biological pathways for this event and raise new therapeutic targets.
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Affiliation(s)
- S Tartakover-Matalon
- Oncogenetic Laboratory, Meir Medical Center, 45 Tschernehovski St, Kfar Saba 44281, Israel.
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21
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Kakoza RM, Vollmer CM, Stuart KE, Takoudes T, Hanto DW. Pancreatic adenocarcinoma in the pregnant patient: a case report and literature review. J Gastrointest Surg 2009; 13:535-41. [PMID: 18815844 DOI: 10.1007/s11605-008-0697-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 09/08/2008] [Indexed: 01/31/2023]
Abstract
Pancreatic cancer is the fifth most common cause of cancer-related death in the USA. However, the antepartum diagnosis of pancreatic adenocarcinoma in the pregnant patient is exceedingly rare, with only six cases previously reported in the literature. Optimizing both maternal and fetal health outcomes is particularly challenging when surgical procedures are necessary for staging and/or therapeutic purposes--as these interventions often pose significant risks to both the mother and the developing fetus. In this article, we report a case of pancreatic adenocarcinoma diagnosed during pregnancy and review the literature on the management issues confronted in this unique clinical situation.
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Affiliation(s)
- Rose M Kakoza
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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22
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Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:235-244. [PMID: 19009536 DOI: 10.1002/uog.6246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Fetal and placental malignancies are rare complications during pregnancy, but when they occur they may present significant challenges for the perinatology team. Owing to their rarity, there is limited information on many of these entities, with much data derived from individual case reports or small case series. Prenatal diagnosis of these entities is rare and inconsistent, usually in the form of isolated case reports. In the majority of fetal tumors, prenatal features are those of a mass lesion, with or without other non-specific features of fetal compromise such as polyhydramnios, fetal hydrops or intrauterine death, the final diagnosis in most cases being based on postnatal pathological examination.Expectant management is almost always indicated antenatally, with serial ultrasound examinations performed to detect rapid enlargement, metastasis or secondary fetal complications, such as non-immune hydrops, which may require intervention. Delivery should be planned in a specialist center in conjunction with pediatric surgeons and oncologists to allow appropriate neonatal management. Placental malignancy is most commonly in the form of gestatational trophoblastic disease, which requires assessment and management in specialist centers.
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Affiliation(s)
- N J Sebire
- Department of Paediatric Pathology, Great Ormond Street Hospital, London, UK
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Abstract
Placental pathology continues to be an underutilized, undertaught, and inadequately handled surgical subspecialty. The requests for placental pathology are soaring, due partly to demands from obstetricians and to the litigious environment in which they practice, and to improved obstetrical care leading to pregnancies in medically challenging situations. Evaluation of the placenta requires a good understanding of the questions and issues concerning both the fetus/infant and the mother. Information from placental pathology can be critical in early neonatal care and in reproductive planning for the family, and it can provide risk assessment for neurologic outcome of the infant. A comfortable interaction among the obstetric staff, mothers, and pathologists often obviates need for legal intervention in unexpected pregnancy outcomes. Some critical pathologic features that involve maternal and fetal management are illustrated herein. A template for gross examination and a few critical histopathologic diagnostic features with clincopathologic correlation are included.
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Affiliation(s)
- Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02115, USA.
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Abramowicz JS, Sheiner E. Ultrasound of the placenta: a systematic approach. Part I: Imaging. Placenta 2008; 29:225-40. [PMID: 18262643 DOI: 10.1016/j.placenta.2007.12.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/17/2007] [Accepted: 12/20/2007] [Indexed: 11/28/2022]
Abstract
Diagnostic ultrasound has been in use in clinical obstetrics for close to half-a-century. However, in the literature, examination of the placenta appears to be treated with less attention than the fetus or the pregnant uterus. This is somewhat unexpected, given the obvious major functions this organ performs during the entire pregnancy. Examination of the placenta plays a foremost role in the assessment of normal and abnormal pregnancies. A methodical sonographic evaluation of the placenta should include: location, visual estimation of the size (and, if appearing abnormal, measurement of thickness and/or volume), implantation, morphology, anatomy, as well as a search for anomalies, such as additional lobes and tumors. Additional assessment for multiple gestations consists of examining the intervening membranes (if present). The current review considers the various placental characteristics, as they can be evaluated by ultrasound, and the clinical significance of abnormalities of these features. Numerous and varied pathologies of the placenta can be detected by routine ultrasound. It is incumbent on the clinician performing obstetrical ultrasound to examine the placenta in details and in a methodical fashion because of the far reaching clinical significance and potentially avoidable severe consequences of many of these abnormalities.
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Affiliation(s)
- J S Abramowicz
- Department of Obstetrics and Gynecology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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