MyMedR

Navigating an unexpected diagnosis - experience of a tertiary referral centre with two cases of intraplacental choriocarcinoma

Lim CCW, Punjabi LS, Bhatia A, Ng QJ, Jevon GP, Aggarwal IM

Malays J Pathol, 2024 Apr;46(1):91-94.

PMID: 38682848

Intraplacental choriocarcinoma is a rare tumour, with approximately 62 reported cases. It may manifest as a spectrum of disease ranging from an incidental lesion diagnosed on routine placental examination to disseminated maternal and/or neonatal disease. In this case series, we presented two rare cases of intraplacental choriocarcinoma with extremely varied clinical presentations. The extremely varied clinical presentations of both patients described in the case series complicated the process of arriving at the diagnosis. In both cases, subsequent investigations showed no maternal or neonatal metastasis, and maternal serum beta-hCG levels downtrended with conservative management. We aim to highlight the importance of performing a detailed physical examination and evaluation of the patient and multidisciplinary management with oncology opinion. A detailed examination of the placenta should also be considered when faced with obstetric complications so that early diagnosis and the required management can be executed in a prompt fashion.

Matched MeSH terms: Pregnancy Complications, Neoplastic/diagnosis; Pregnancy Complications, Neoplastic/pathology

Fulltext Pregnancy complicated by Hodgkin's disease

Fadilah SA, Leong CF, Jamil MY, Cheong SK, Rozilaila R

Med J Malaysia, 2006 Aug;61(3):358-60.

PMID: 17240590 MyJurnal

Hodgkin's disease (HD) in association with pregnancy is rarely reported. Thus, the data in the management of pregnancy complicated by HD is limited. We report here the management of advanced HD in pregnancy that was treated successfully with chemotherapy.

Matched MeSH terms: Pregnancy Complications, Neoplastic/surgery*

Fulltext Breast cancer in pregnancy--our experience with six patients in the University Hospital, Kuala Lumpur

Yip CH, Taib NA, Abdullah MM, Wahid I

Med J Malaysia, 2000 Sep;55(3):308-10.

PMID: 11200709

Presentation of breast cancer during pregnancy is a rare situation and one that requires a multidisciplinary approach involving an obstetrician, surgeon and oncologist. Management should be along the same principles as in non-pregnant patients and delay is not justifiable. Mastectomy and axillary clearance is the best option, followed by chemotherapy, which is safe after the first trimester. Radiation if required should be delayed until after delivery of the baby. We present here our experience with 6 patients who presented with breast cancer during pregnancy. Five patients refused any treatment until after delivery, while one underwent only a mastectomy and axillary clearance. The outcome was poor; all of them died between 14 months and 52 months. The poor outcome probably reflects the late stage at presentation in four of the patients (State 3 and 4) rather than the delay in treatment, while delay in treatment in the two who presented with early cancer (Stage 1 and 2) led to a more advanced stage after delivery.

Matched MeSH terms: Pregnancy Complications, Neoplastic/mortality; Pregnancy Complications, Neoplastic/radiotherapy; Pregnancy Complications, Neoplastic/surgery*

Chien-Tien Hsu Memorial Lecture. Fertility and gynaecologic malignancies

Sivanesaratnam V

J Obstet Gynaecol Res, 2001 Feb;27(1):1-15.

PMID: 11330724

Fertility and gynaecological malignancies have an important relationship. A clear inverse relationship exists between family size and the incidence of ovarian and endometrial cancer. Current methods of fertility control have an influence on subsequent development of various gynaecological malignancies. A slightly increased risk of breast cancer has been reported in current users and those who had used hormonal contraceptives (OCs) within 10 years; this risk declined with time and disappeared after 10 years. Women who started OC before age 20 had a higher relative risk; the disease did not spread beyond the breast in the majority. Most studies found OC to reduce the risk of ovarian and endometrial cancer. The relative risks of squamous cell carcinoma and adenomatous carcinoma of the cervix have been reported to be 1.3 and 1.5, respectively in ever-users of OCs; however, the aetiology of cervical cancer is multifactoral. Several reports suggest the beneficial effect of tubal ligation and breast feeding in reducing the risk of ovarian cancer. Therapy of gynaecological malignancies may have an influence on subsequent fertility. Amenorrhoea developing after treatment of hydatidiform mole may be due to choriocarcinoma, recurrent mole or a normal pregnancy. Choriocarcinoma can also develop after a partial mole. The risk of fetal teratogenicity from chemotherapy is present only if conception occurs during or immediately following the treatment cycles. Fertility is not impaired following chemotherapy. Successful pregnancies have occurred in women who have had widespread GTD including cerebral metastases. In the young patient with gynaecological malignancy preservation of fertility is possible. Fertility-sparing surgery may be safe in early ovarian epithelial cancers and even in advanced germ cell tumours. Recently, the fertility-sparing surgery of radical trachelectomy and pelvic lymphadenectomy has been carried out for early invasive cervical cancer in young women. Gynaecological cancer occurring in pregnancy is uncommon; it presents the clinician with a difficult situation to manage. In most instances the cancer is treated as though the patient is not pregnant; the timing and mode of delivery needs individualization. The overall prognosis for breast cancer complicating pregnancy is poor. Survival in cervical cancers diagnosed antepartum is similar to the non-pregnant patient. Ovarian cancer in pregnancy has a good prognosis because of the early stage at diagnosis.

Matched MeSH terms: Pregnancy Complications, Neoplastic*

Anaesthetic management of a parturient with a mediastinal mass for caesarean delivery

Lee CY, Izaham A, Zainuddin K

Int J Obstet Anesth, 2013 Nov;22(4):356-8.

PMID: 23993805 DOI: 10.1016/j.ijoa.2013.03.017

Matched MeSH terms: Pregnancy Complications, Neoplastic*

Fulltext Large lower segment myoma--myomectomy at lower segment caesarean section--a report of two cases

Omar SZ, Sivanesaratnam V, Damodaran P

Singapore Med J, 1999 Feb;40(2):109-10.

PMID: 10414171

Uterine leiomyoma is found in approximately 2% of pregnant women. One in ten women will have complications related to myoma in pregnancy. Myomectomy during pregnancy especially at Caesarean section is much discouraged in the literature. We present here 2 cases of large uterine myoma, situated in the anterior aspect of the lower segment, complicating pregnancy at term. Myomectomy in both instances allowed delivery of the fetus through the lower segment, making vaginal delivery in subsequent pregnancies possible.

Matched MeSH terms: Pregnancy Complications, Neoplastic/surgery*

Safety of Pregnancy After Breast Cancer in BRCA Mutation Carriers

Newman LA, Shippee Rockefeller E, Yip CH

JAMA Surg, 2024 May 01;159(5):482-483.

PMID: 38536201 DOI: 10.1001/jamasurg.2024.0005

Matched MeSH terms: Pregnancy Complications, Neoplastic/genetics

Surgical management of early invasive cancer of the cervix associated with pregnancy

Sivanesaratnam V, Jayalakshmi P, Loo C

Gynecol Oncol, 1993 Jan;48(1):68-75.

PMID: 8423024

The simultaneous occurrence of carcinoma of the cervix in pregnancy is uncommon. In a prospective study of 397 patients undergoing type III radical hysterectomy for early invasive cancer of the cervix, 18 were pregnant at the time of surgery; 4 of these were operated after delivery elsewhere. Two others had a type I extrafascial hysterectomy. The incidence was 1 in 4077 deliveries. The clinical and histological characteristics of these patients are presented. Routine speculum examination and cervical cytology in all pregnant patients early in pregnancy are vital for early diagnosis. Bleeding in pregnancy should not automatically be assumed to be caused by pregnancy-related conditions. The strategies in surgical management are discussed. Radical hysterectomy in pregnancy is safe. No major complications were encountered; the mean blood loss was 1.4 liters. The incidence of pelvic node metastases was similar to that seen in nonpregnant patients. The overall 5-year survival rate was 77.7%. Of the 4 patients who died, 3 presented in the puerperium; all succumbed within 27 months. Poor histological prognostic features contributed to the significantly poorer survival in the puerperal patients (P = 0.0445). The 5-year survival in those presenting during the antepartum period (92.8%) was, however, similar to that in the nonpregnant patients. Metastases to the placenta or fetus were not encountered.

Matched MeSH terms: Pregnancy Complications, Neoplastic/drug therapy; Pregnancy Complications, Neoplastic/pathology; Pregnancy Complications, Neoplastic/surgery*

Fulltext Nasal septal haemangioma in pregnancy

Noorizan Y, Salina H

Med J Malaysia, 2010 Mar;65(1):70-1.

PMID: 21265255 MyJurnal

A pregnant lady in her third trimester presented with a rapidly growing right-sided nasal mass associated with epistaxis and nasal obstruction for two months. Examination showed a non tender, protruding mass completely occluding her right nostril. Wide surgical excision was done under local anaesthesia. Histopathology revealed capillary haemangioma. In a gravid patient with a rapidly growing intranasal lesion, capillary haemangioma should be considered as a differential diagnosis. Due to the rapidity of growth, presentation with epistaxis and its macroscopic appearance which often mimics malignancy; histologic confirmation is crucial.

Matched MeSH terms: Pregnancy Complications, Neoplastic/pathology*; Pregnancy Complications, Neoplastic/surgery

Angiosarcoma of the breast complicating pregnancy

Kaur G

Malays J Pathol, 1998 Jun;20(1):41-4.

PMID: 10879263

A 32-year-old pregnant lady presented with a rapidly enlarging right breast mass. A fine needle aspiration was suggestive of a malignant phylloides tumour. However histopathological examination after mastectomy revealed a moderately differentiated angiosarcoma. The histopathological and cytological features of this rare tumour together with the diagnostic pitfalls are discussed.

Matched MeSH terms: Pregnancy Complications, Neoplastic/pathology*; Pregnancy Complications, Neoplastic/surgery

Fulltext Phaeochromocytoma during pregnancy: ultrasound and MRI appearances

Puvaneswary M, Beckhouse M

Med J Malaysia, 1992 Mar;47(1):81-5.

PMID: 1387457

Matched MeSH terms: Pregnancy Complications, Neoplastic/diagnosis*; Pregnancy Complications, Neoplastic/ultrasonography

Phyllodes Tumor of the Breast during Pregnancy and Lactation; A Systematic Review

Alipour S, Eskandari A, Johar FM, Furuya S

Arch Iran Med, 2020 07 01;23(7):488-497.

PMID: 32657600 DOI: 10.34172/aim.2020.46

BACKGROUND: Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy, gathering up to 14 patients. We performed a thorough systematic review of the literature in an attempt to find all reported cases, and identify their common characteristics.

METHODS: We searched Google scholar, PubMed, Ovid Medline, Scopus and ClinicalTrials.gov with several relevant combinations of keywords, looking for texts or abstracts without any date or language limitations, but using only English keywords. The existing literature only consisted of case reports and series; therefore any paper including one or several cases of PT presenting during pregnancy or breastfeeding was recognized as eligible. Articles with vague description of the tumor which made the diagnosis uncertain, and those lacking data about the tumor and management data were excluded. We contacted authors for more details in cases with incomplete information.

RESULTS: After excluding those with very deficient data, we included 37 studies, counting 43 cases. The mean age of the patients was 31 years (21-43 years). Some features were different from usual PT: bilaterality (16.2%), large size (14.2 ± 8.6 cm), rapid enlargement (79.5%), and rate of malignancy (60.5%).

CONCLUSION: Our findings show high rates of bilaterality, large size, rapid growth, and malignant pathology in the reported gestational PTs.

Matched MeSH terms: Pregnancy Complications, Neoplastic/epidemiology*; Pregnancy Complications, Neoplastic/pathology

Uterine leiomyomata in pregnancy

Hasan F, Arumugam K, Sivanesaratnam V

Int J Gynaecol Obstet, 1991 Jan;34(1):45-8.

PMID: 1671020

Sixty cases with uterine leiomyomata in pregnancy are presented. The incidence was 1 in 1033 deliveries. The median age of the patients was 33.4 years. The majority were primigravidae (60%). A significant number of patients gave a history of infertility (43%) and spontaneous abortions (25%). The commonest antenatal complication was malpresentation and in all these patients the myomata were larger than 6 cm. Typical features of red degeneration occurred in 10% of cases. The cesarean section rate was 73%, the commonest indication being obstructed labor. Severe hemorrhage was encountered at cesarean section in 10 patients, 3 of whom needed hysterectomy. There were no perinatal deaths.

Matched MeSH terms: Pregnancy Complications, Neoplastic/epidemiology*; Pregnancy Complications, Neoplastic/surgery

Fulltext Maternal melanoma with placental metastasis

Shuhaila A, Rohaizak M, Phang KS, Mahdy ZA

Singapore Med J, 2008 Mar;49(3):e71-2.

PMID: 18362990

A 40-year-old woman, a grand multipara with uncertain gestation, presented with severe, prolonged diarrhoea. She was previously diagnosed to have melanoma. Examination revealed gross ascites with hepatosplenomegaly and uterus corresponding to 29 weeks gestation. An emergency caesarean section confirmed widespread metastases to the ovaries, mesentery and placenta. A viable male foetus was delivered with features of intrauterine growth restriction. The baby survived, but the mother died a week later. This case highlights the importance of thoroughly assessing placentas and babies of patients with melanoma for metastases.

Matched MeSH terms: Pregnancy Complications, Neoplastic/diagnosis*; Pregnancy Complications, Neoplastic/pathology

Anesthetic management of a parturient with superior vena cava obstruction for cesarean section

Chan YK, Ng KP, Chiu CL, Rajan G, Tan KC, Lim YC

Anesthesiology, 2001 Jan;94(1):167-9.

PMID: 11135739

Matched MeSH terms: Pregnancy Complications, Neoplastic/radiotherapy*

Fulltext A successful pregnancy outcome in treated vulval rhabdomyosarcoma

Ariza M, Rafaee T, Adeeb N, Muhaizan WM, Isa MR

Med J Malaysia, 1999 Sep;54(3):371-3.

PMID: 11045067

A 14 year old girl presented in 1986 with a huge perineal swelling which was progressively increasing in size and associated with loss of weight and loss of appetite. Biopsy from the mass revealed rhabdomyosarcoma of the vulva. She was treated with chemotherapy and radium implant. She responded well to the regime. Fibrosis of the vulva and vagina caused difficulty in consummation. Once it was corrected, she conceived easily and proceeded to a normal pregnancy and delivery.

Matched MeSH terms: Pregnancy Complications, Neoplastic*

Fulltext Perforated malignant gastric ulcer in a pregnant young adult: a case report

Jasmi AY, Normala B, al-Amin MD

Med J Malaysia, 2000 Mar;55(1):135-7.

PMID: 11072499

Gastric cancer in the young adult is rare and has been said to be more aggressive than gastric cancers of the older age group. Its unique association with pregnancy is even rarer. However, they have similar complications of haemorrhage, obstruction and perforation. We report a 27 year old lady at 16 weeks gestation who presented with a perforated malignant gastric ulcer and carcinomatosis peritonei. Reviewing the literature, we realised that such complication of a gastric cancer occurring in a pregnant young adult has not been previously documented.

Matched MeSH terms: Pregnancy Complications, Neoplastic*

Carcinoma of the vulva in pregnancy: a rare occurrence

Sivanesaratnam V, Pathmanathan R

Asia Oceania J Obstet Gynaecol, 1990 Sep;16(3):207-10.

PMID: 2088243

A rare case of squamous cell carcinoma diagnosed in early pregnancy in a 28-year-old woman is described. At the time of radical surgery, which was carried out in the puerperium, the growth had already advanced to Stage IV disease. The rapid growth of the tumor seen in this patient suggests that although treatment needs to be individualised, the definitive radical surgery should not be delayed.

Matched MeSH terms: Pregnancy Complications, Neoplastic*

Hydroxyurea treatment for chronic myeloid leukaemia during pregnancy

Jackson N, Shukri A, Ali K

Br J Haematol, 1993 Sep;85(1):203-4.

PMID: 8251394

A patient being treated for chronic myeloid leukaemia with hydroxyurea became pregnant. Despite an increase in the dose of hydroxyurea (to 3 g per day) during the pregnancy, her white blood cell count could only be controlled at about 150 x 10(9)/l. A healthy baby girl was born at 37 weeks with normal blood counts and no evidence of congenital abnormality. There are now five reports of the use of hydroxyurea in pregnancy, and where leukapheresis is not available it may be the treatment of choice.

Matched MeSH terms: Pregnancy Complications, Neoplastic/drug therapy*

Fulltext Pregnancy in a patient receiving busulphan for chronic myeloid leukaemia

Norhaya MR, Cheong SK, Hamidah NH, Ainoon O

Singapore Med J, 1994 Feb;35(1):102-3.

PMID: 8009265

A 33-year-old Malay lady with chronic myeloid leukaemia (CML) became amenorrhoeic during therapy with busulphan. Pregnancy was diagnosed via a urine pregnancy test and an ultrasound confirmed a viable foetus at 16 weeks. The busulphan was stopped. Her pregnancy was unremarkable and continued till term. She delivered a healthy child.

Matched MeSH terms: Pregnancy Complications, Neoplastic/drug therapy*

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