Advanced simultaneous intrauterine and abdominal pregnancy. A case report

Liver metastases

Liver metastases are commonly detected in a range of malignancies including colorectal cancer (CRC), pancreatic cancer, melanoma, lung cancer and breast cancer, although CRC is the most common primary cancer that metastasizes to the liver. Interactions between tumour cells and the tumour microenvironment play an important part in the engraftment, survival and progression of the metastases. Various cells including liver sinusoidal endothelial cells, Kupffer cells, hepatic stellate cells, parenchymal hepatocytes, dendritic cells, resident natural killer cells as well as other immune cells such as monocytes, macrophages and neutrophils are implicated in promoting and sustaining metastases in the liver. Four key phases (microvascular, pre-angiogenic, angiogenic and growth phases) have been identified in the process of liver metastasis. Imaging modalities such as ultrasonography, CT, MRI and PET scans are typically used for the diagnosis of liver metastases. Surgical resection remains the main potentially curative treatment among patients with resectable liver metastases. The role of liver transplantation in the management of liver metastasis remains controversial. Systemic therapies, newer biologic agents (for example, bevacizumab and cetuximab) and immunotherapeutic agents have revolutionized the treatment options for liver metastases. Moving forward, incorporation of genetic tests can provide more accurate information to guide clinical decision-making and predict prognosis among patients with liver metastases.

Malformations and deformations in abdominal pregnancy

Abdominal gestation is a relatively uncommon complication of pregnancy. Previous reports describe a high incidence of fetal deformations and mortality as well as maternal mortality. A case of twin abdominal gestation is presented and the literature concerning abdominal pregnancy since 1809 is reviewed. The survival rate of liveborn infants of 30 or more weeks gestation was 63%. The maternal mortality rate since 1809 was 18.2%, but this has decreased to 4.5% during the last 20 years. The combined rate of malformations and deformations in the infants was 21.4%. The most common deformations observed were facial and/or cranial asymmetry and various joint abnormalities. Among the most common malformations were limb deficiency and central nervous system malformations. Proposed mechanisms of compression and vascular disruption are discussed.

Continuation of abdominal pregnancy complicated by preeclampsia three weeks after birth of an intrauterine twin

A case of heterotopic pregnancy in a 22-year-old multigravida is presented. The extrauterine baby was delivered alive three weeks after the intrauterine pregnancy had ended at term in spite of an associated preeclampsia. The inhibition of lactation resulting from the continuation of the extrauterine pregnancy resulted in marasmus for the first baby. The implications and especially the etiology of preeclampsia occurring in extrauterine pregnancy are discussed.