1
|
Grubman O, Taylor D, Rayapudi M, Brustman L. A case report of a pregnant woman diagnosed with intrahepatic cholangiocarcinoma (ICC) complicated by opioid tolerance. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2019-0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Intrahepatic cholangiocarcinoma (ICC) is a rare form of cancer that has a poor prognosis with a 5-year survival rate for localized disease of approximately 15%.
Case presentation
This is a report of a case of cholangiocarcinoma (CC) diagnosed in pregnancy in a patient with an opioid use disorder. The patient is a 37-year-old G7P2042 who presented at 29 weeks of gestation with acute right upper quadrant pain along with jaundince, and changes to her urine and stool. Her workup revealed CC, a rare diagnosis in pregnancy. Approximately 6 months after the diagnosis of ICC the patient died.
Conclusion
Along with the management of this cancer in pregnancy, this case was further complicated by opioid tolerance and the difficulty in controlling the patient’s pain in pregnancy.
Collapse
Affiliation(s)
- Olivia Grubman
- Department of Obstetrics and Gynecology, Mount Sinai West , Icahn School of Medicine at Mount Sinai , New York, NY 10019, USA
| | - Dyese Taylor
- Department of Obstetrics and Gynecology, Mount Sinai West , Mount Sinai, New York, NY , USA
| | - Madhavi Rayapudi
- Department of Gastroenterology, Mount Sinai , New York, NY , USA
| | - Lois Brustman
- Department of Obstetrics and Gynecology, Mount Sinai West , Mount Sinai, New York, NY , USA
| |
Collapse
|
2
|
Das S, Job M, Kodiatte T, Iyadurai R. Atypical presentation of intrahepatic cholangiocarcinoma---Fever and ascites in a postpartum lady. J Family Med Prim Care 2019; 8:3748-3751. [PMID: 31803685 PMCID: PMC6881913 DOI: 10.4103/jfmpc.jfmpc_748_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 11/04/2022] Open
Abstract
Intrahepatic cholangiocarcinoma is an uncommon malignancy which usually occurs in the 7th decade. Here we present a postpartum patient with fever, hepatomegaly, and ascites, who was diagnosed to have metastatic intrahepatic cholangiocarcinoma.
Collapse
Affiliation(s)
- Sohini Das
- Department of Medicine, Christian Medical College and Hospital, Vellore, India
| | - Manoj Job
- Department of Medicine, Christian Medical College and Hospital, Vellore, India
| | - Thomas Kodiatte
- Department of General Pathology, Christian Medical College and Hospital, Vellore, India
| | - Ramya Iyadurai
- Department of Medicine, Christian Medical College and Hospital, Vellore, India
| |
Collapse
|
3
|
Francis AP, Chang M, Dolin CD, Chervenak J, Cardonick E. Recurrent Cholangiocarcinoma in Pregnancy: A Case Report. AJP Rep 2018; 8:e261-e263. [PMID: 30425881 PMCID: PMC6232044 DOI: 10.1055/s-0038-1675376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/05/2018] [Indexed: 12/13/2022] Open
Abstract
Hepatobiliary malignancies during pregnancy are extremely rare and portend a poor prognosis. There are only seven published cases of cholangiocarcinoma in an obstetrical patient, all are cases of primary cholangiocarcinoma (1-7). Herein, we describe the first case of recurrent cholangiocarcinoma during pregnancy. The patient did not receive chemotherapy during pregnancy and required prolonged hospitalizations for nutritional and intensive medical support. She delivered preterm, at 30 2/7 weeks gestation, after developing pre-eclampsia with severe features. The infant was healthy, with no malformations, and currently exhibits no neurological or behavioral sequelae at 8months of age. We discuss themanagement considerations inherent to this complex clinical scenario including metastatic disease severity, ethical considerations, and palliative care treatment options.
Collapse
Affiliation(s)
- Antonia P Francis
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Michelle Chang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cara D Dolin
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
| | - Judith Chervenak
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, New Jersey
| |
Collapse
|
4
|
Intrahepatic Cholangiocarcinoma Masquerading as Acute Fatty Liver of Pregnancy: A Case Report and Review of the Literature. Case Reports Hepatol 2018; 2018:6939747. [PMID: 29682369 PMCID: PMC5846373 DOI: 10.1155/2018/6939747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/09/2018] [Indexed: 12/26/2022] Open
Abstract
Cholangiocarcinoma (CCA) is an uncommon cancer and accounts only for 3% of all gastrointestinal malignancies. In this report, we present a case of an intrahepatic cholangiocarcinoma masquerading as acute fatty liver of pregnancy (AFLP). A 38-year-old female who is 36-week pregnant presented with a 1-week history of headache, nausea, vomiting, and right upper abdominal pain, along with hepatomegaly. Laboratory investigations were remarkable for mild leukocytosis, hyperbilirubinemia, proteinuria, and elevated transaminases and prothrombin time. Ultrasound of the liver revealed hepatomegaly, fatty infiltration, and a right hepatic lobe mass. Based on the overall picture, AFLP was suspected, and the patient underwent delivery by Cesarean section. However, bilirubin and liver enzyme levels gradually increased after delivery. MRI revealed a large dominant hepatic mass along with multiple satellite lesions in both lobes. Biopsy revealed the presence of intrahepatic CCA. CCA presenting during pregnancy is extremely rare with only 9 other cases reported in the literature. Therefore, the signs and symptoms can be easily confused with other more common disorders that occur during pregnancy.
Collapse
|
5
|
Abeysinghe V, Sundararajan S, Delriviere L, Tibballs J. Selective internal radiation therapy (SIRT) with yttrium-90 microspheres for unresectable intrahepatic cholangiocarcinoma. BMJ Case Rep 2018. [PMID: 29523614 DOI: 10.1136/bcr-2017-223539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Unresectableintrahepaticcholangiocarcinoma has a very poor prognosis despite various treatment options. The case presented describes the diagnostic challenges of a young pregnant woman with unresectable cholangiocarcinoma. The current treatment options for cholangiocarcinoma have limited evidence and high recurrence rate. Given the young age of this patient, selective internal radiotherapy was trialled with traditional chemotherapy with a clinically significant result. This case highlights the delays when diagnosing cholangiocarcinoma in younger patients and the possibility of selective internal radiation therapy in combination with chemotherapy as a potential first-line treatment for a complete response in unresectable disease.
Collapse
Affiliation(s)
- Vindya Abeysinghe
- General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Luc Delriviere
- General Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia
| | | |
Collapse
|
6
|
Pencovich N, Younis M, Lessing Y, Zac L, Lessing JB, Yogev Y, Kupferminc MJ, Nachmany I. Major liver resection in pregnancy: three cases with different etiologies and review of the literature. J Matern Fetal Neonatal Med 2017; 32:203-211. [DOI: 10.1080/14767058.2017.1376315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Niv Pencovich
- Department of Surgery, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Tel Aviv, Israel
| | - Muhammad Younis
- Department of Surgery, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Tel Aviv, Israel
| | - Yonatan Lessing
- Department of Surgery, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Tel Aviv, Israel
| | - Lilach Zac
- Division of Anesthesiology, Pain, and Intensive Care, Tel Aviv, Israel
| | - Joseph B. Lessing
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Michael J. Kupferminc
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Department of Surgery, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Tel Aviv, Israel
| |
Collapse
|
7
|
Wiesweg M, Aydin S, Koeninger A, Stein A, Schara U, van Roye C, Hense J, Welt A, Schuler M. Administration of Gemcitabine for Metastatic Adenocarcinoma during Pregnancy: A Case Report and Review of the Literature. AJP Rep 2014; 4:17-22. [PMID: 25032054 PMCID: PMC4078105 DOI: 10.1055/s-0034-1368091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/17/2013] [Indexed: 12/12/2022] Open
Abstract
We present the case of a 38-year-old woman diagnosed with metastatic adenocarcinoma of the biliary tract in the 18th week of pregnancy. Chemotherapy based on cisplatin and gemcitabine was administered, reaching disease stabilization until late-preterm delivery at 35 + 0 weeks of gestation. The infant was healthy and showed no malformations. Her head circumference was small, yet no neurological and behavioral defects have been detected. Development was normal during 14 months of follow-up. We discuss the implications of metastatic cancer in pregnancy with focus on therapeutic options for metastatic adenocarcinoma of the biliary tract. In this context, available data for the active regimens in biliary tract cancers-platinum compounds and gemcitabine-are discussed. This report is the fourth in the literature detailing the application of gemcitabine during pregnancy and the first presenting longer term follow-up, complementing available evidence that gemcitabine-based regimens are feasible in this situation.
Collapse
Affiliation(s)
- M Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - S Aydin
- Dipartimento di Ematologia ed Oncologia, Azienda ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - A Koeninger
- Department of Gynecology and Obstetrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - A Stein
- Department of Neonatology, Clinic for Pediatrics I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - U Schara
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Clinic for Pediatrics I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - C van Roye
- Hematology/Oncology Group Practice, Koblenz, Germany
| | - J Hense
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - A Welt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
8
|
Labgaa I, Carrasco-Avino G, Fiel MI, Schwartz ME. Pancreatic recurrence of intrahepatic cholangiocarcinoma: Case report and review of the literature. World J Gastrointest Surg 2014; 6:65-69. [PMID: 24829624 PMCID: PMC4013712 DOI: 10.4240/wjgs.v6.i4.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/15/2014] [Accepted: 03/18/2014] [Indexed: 02/06/2023] Open
Abstract
Intrahepatic cholangiocarcinomas (ICC) are malignant tumors arising from the intrahepatic bile ducts that frequently recur after resection. The main sites of recurrence are the remnant liver, lymph nodes and lungs. Metastasis to the pancreas has never been reported. This case describes a 24-year-old woman who underwent a hepatic lobectomy in 2008 for an ICC. Almost 4 years after her surgery she presented with a pancreatic mass and lung nodules. An endoscopic ultrasound guided fine needle aspiration of the pancreatic mass and a video-assisted thoracoscopic surgery resection for the lung nodules were performed for diagnostic purposes. Pathological analyses of specimens revealed recurrence of her primary ICC in both pancreas and lungs. Subsequently, the patient received systemic chemotherapy. The patient is currently off chemotherapy and remains well. Moreover, she is pregnant. This is the first report of an ICC with pancreatic metastasis.
Collapse
|
9
|
Abstract
Pregnancy is a physiological condition that affects all organs. Diseases unrelated to pregnancy may present coincidentally during pregnancy or may be exacerbated by pregnancy, and may increase maternal and/or fetal morbidity or mortality. Compared with many other systems, the changes within the biliary tree and pancreas are relatively minimal. However, pregnancy is associated with an increased likelihood of cholelithiasis, which can have significant implications for the parturient.
Collapse
|
10
|
Stone S, Girling JC. Deranged liver function tests in pregnancy: the importance of postnatal follow-up. Obstet Med 2009; 2:32-3. [PMID: 27582804 DOI: 10.1258/om.2008.080036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2008] [Indexed: 02/06/2023] Open
Abstract
We report an asymptomatic 40-year-old woman with persistently deranged liver function tests found incidentally in the first trimester of her second pregnancy. No cause was apparent clinically, serologically or with imaging studies until a new finding of hepatomegaly led to a repeat ultrasound scan six weeks following delivery. A mass in the region of the common hepatic duct was confirmed to be a cholangiocarcinoma, with vascular invasion precluding curative surgical resection. This case highlights the need for close vigilance of patients with unexplained and persistently abnormal liver function tests, antenatally and postdelivery.
Collapse
Affiliation(s)
- Sophia Stone
- Department of Obstetrics and Gynaecology , St Mary's Hospital , Portsmouth PO3 6AD , UK
| | - Joanna C Girling
- Department of Obstetrics and Gynaecology , West Middlesex University Hospital , Twickenham Road, Isleworth, Middlesex TW7 6AF, London , UK
| |
Collapse
|
11
|
Marasinghe JP, Karunananda SA, Angulo P. Cholangiocarcinoma in pregnancy: a case report. J Obstet Gynaecol Res 2009; 34:635-7. [PMID: 18840169 DOI: 10.1111/j.1447-0756.2008.00810.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A 32-year-old pregnant woman underwent laparotomy for suspected intra-abdominal mass lesion obstructing the biliary tree. Imaging studies revealed a mass in the fourth segment of the liver. Microscopic examination of the biopsy revealed a cholangiocarcinoma. The clinical course of the malignancy was worsened by her gravid state.
Collapse
|
12
|
Sadoon S, Hodgett S. Unusual cause of itching in a pregnancy (cholangiocarcinoma). J OBSTET GYNAECOL 2008; 28:230-1. [PMID: 18393029 DOI: 10.1080/01443610801916296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S Sadoon
- Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester
| | | |
Collapse
|
13
|
|