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Bohlin KS, Brännström M, Dahm‐Kähler P. Gynecological cancer during pregnancy-From a gyne-oncological perspective. Acta Obstet Gynecol Scand 2024; 103:761-766. [PMID: 38183316 PMCID: PMC10993343 DOI: 10.1111/aogs.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
Gynecological cancer diagnosed during pregnancy requires accurate diagnosis and staging to determine optimal treatment based on gestational age. Cervical and ovarian cancers are the most common and multidisciplinary team collaboration is pivotal. Magnetic resonance imaging and ultrasound can be used without causing fetal harm. In cervical cancer, early-stage treatments can often be delayed until fetal lung maturation and cesarean section is recommended if disease prevails, in combination with a simple/radical hysterectomy and lymphadenectomy. Chemoradiotherapy, the recommended treatment for advanced stages, is not compatible with pregnancy preservation. Most gestational ovarian cancers are diagnosed at an early stage and consist of nonepithelial cancers or borderline tumors. Removal of the affected adnexa during pregnancy is often necessary for diagnosis, though staging can be performed after delivery. In selected cases of advanced cervical and ovarian cancers, neoadjuvant chemotherapy may be an option to allow gestational advancement but only after thorough multidisciplinary discussions and counseling.
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Affiliation(s)
- Katja Stenström Bohlin
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Mats Brännström
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Pernilla Dahm‐Kähler
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
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2
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Basri NI, Dasrilsyah RA. Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour. BMJ Case Rep 2024; 17:e258979. [PMID: 38320830 PMCID: PMC10860011 DOI: 10.1136/bcr-2023-258979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Ruptured renal angiomyolipoma in pregnancy is uncommon. Pregnant women may present with nonspecific symptoms such as flank or abdominal pain, contraction pain and haematuria. A thorough assessment is needed to reach the correct diagnosis. Management varies between conservative measures, radiological intervention or surgery depending on the patient's haemodynamic status and foetal condition. We present a case of a woman in her 30s, gravida 5 para 3+1 at 28 weeks of gestation, who presented with pain. The pain worsened, and she went into hypovolaemic shock. An exploratory laparotomy and emergency caesarean section were done. Retroperitoneal haematoma was found intraoperatively, but the source of bleeding was difficult to determine. An abdominal CT angiogram subsequently revealed an ongoing bleeding from a ruptured angiomyolipoma. An emergency nephrectomy was performed, and the bleeding was secured.
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Affiliation(s)
- Nurul I Basri
- Obstetrics and Gynaecology Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rima A Dasrilsyah
- Obstetrics and Gynaecology Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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3
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Pyle C, Hill M, Sharafi S, Forton C, Sohaey R. Pregnancy-associated Breast Cancer: Why Breast Imaging During Pregnancy and Lactation Matters. J Breast Imaging 2023; 5:732-743. [PMID: 38141239 DOI: 10.1093/jbi/wbad074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Indexed: 12/25/2023]
Abstract
Pregnancy-associated breast cancer is characterized as breast cancer diagnosed during pregnancy, within the first postpartum year, or during lactation. It usually presents as a palpable mass, although the large majority of palpable masses during pregnancy are benign. Breast cancer is the most common invasive malignancy diagnosed during pregnancy and lactation, and its incidence is increasing as more women delay childbearing. Understanding the appropriate methods for screening and diagnostic workup of breast findings in this population is imperative for radiologists to promptly diagnose pregnancy-associated breast cancer. Use of available imaging modalities should be tailored to patient-specific factors, with US typically the first-line modality due to patient age and decreased sensitivity of mammography in the setting of lactational changes. This article illustrates the spectrum of imaging appearances of pregnancy-associated breast cancer, the appropriate diagnostic imaging workup, and the unique challenges encountered in evaluation of this patient population.
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Affiliation(s)
- Chelsea Pyle
- Oregon Health & Science University, Diagnostic Radiology/Women's Imaging, Portland, OR, USA
| | - Molly Hill
- University of Kansas Medical Center, Department of Radiology/Breast Imaging, Kansas City, KS, USA
| | - Shahrzad Sharafi
- Oregon Health & Science University, Diagnostic Radiology/Women's Imaging, Portland, OR, USA
| | - Camelia Forton
- Oregon Health & Science University, Diagnostic Radiology/Women's Imaging, Portland, OR, USA
| | - Roya Sohaey
- Oregon Health & Science University, Diagnostic Radiology/Women's Imaging, Portland, OR, USA
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4
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Shen J, Li J, Tao X, Feng Y, Li B. Antenatal diagnosis and management of pregnancy luteoma: A case report and literature review. Medicine (Baltimore) 2023; 102:e34521. [PMID: 37505122 PMCID: PMC10378968 DOI: 10.1097/md.0000000000034521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Pregnancy luoteomas are tumor-like ovarian lesions that emerge during pregnancy and spontaneously regress after delivery. Antenatal diagnosis is infrequently reported, and unnecessary surgery appears to be common in literature reports. CASE SUMMARY A 28-year-old primigravida with bilateral adnexal masses was discovered at 32 + 5 weeks during prenatal ultrasound evaluation. Combined with clinical presentation, auxiliary examinations including blood test, magnetic resonance imaging, gastroscopy, and consultation of multi-disciplinary team, we successfully made a diagnosis of pregnancy luteoma and provided conservative management recommendations. A cesarean section was conducted on this patient at 34 + 2 weeks of gestation due to fetal distress. The newborn was small for gestational age but normal in appearance. We performed biopsies of the adnexal masses, which were confirmed to be pregnancy luteomas using both intraoperative frozen section and final pathological diagnosis. Serum testosterone, cancer antigen 125, and alpha-fetoprotein levels gradually declined and normalized on postoperative day 28. The masses significantly decreased in size as shown by ultrasonic and magnetic resonance imaging examination on postoperative day 7, with the ovaries returning to their normal size by postoperative day 30. CONCLUSION Prenatal diagnosis of pregnancy luteoma poses a challenge, requiring hormonal examinations, ultrasound, magnetic resonance imaging, and gastrointestinal endoscopy for identification. Caution must be exercised to avoid overtreatment. While additional cases are needed to summarize the imaging features and effects of excess hormones on the both mother and fetus, further research is necessary for a comprehensive understanding.
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Affiliation(s)
- Junhua Shen
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, P.R. China
| | - Jingyi Li
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Xia Tao
- Department of Ultrasonography, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Yan Feng
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, P.R. China
| | - Baohua Li
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
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5
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Maas AP, Eckrich J, Send T, Bernhardt M, Strieth S, Ernst BP. [Deforming endonasal mass during pregnancy]. HNO 2023; 71:323-327. [PMID: 36947200 PMCID: PMC10126015 DOI: 10.1007/s00106-023-01290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
This article presents the case of a 33-year-old woman who consulted the authors' ENT clinic in the 39th week of pregnancy with recurrent epistaxis. A livid endonasal mass was found on the left side, subtotally displacing the nose and leading to deformation of the external nose. External biopsy provided no indications of malignancy. Postpartum CT of the paranasal sinuses revealed a mass destroying the cartilaginous nasal septum. Endoscopic resection of the finding was performed with preservation of the clinically sound nasal septal cartilage. Histopathological examination revealed a capillary hemangioma, which was classified as granuloma gravidarum due to its occurrence during pregnancy.
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Affiliation(s)
- A P Maas
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - J Eckrich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T Send
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - M Bernhardt
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Institut für Pathologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - B P Ernst
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Fazeli S, Sakala M, Rakow-Penner R, Ojeda-Fournier H. Cancer in pregnancy: breast cancer. Abdom Radiol (NY) 2023; 48:1645-1662. [PMID: 36750478 DOI: 10.1007/s00261-023-03824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/09/2023]
Abstract
Breast cancer is the most common malignancy in women, and for women under 40, it is the leading cause of cancer-related deaths. A specific type of breast cancer is pregnancy-associated breast cancer, which is diagnosed during pregnancy, the first-year postpartum, or during lactation. Pregnancy-associated breast cancer is seen in 3/1000 pregnancies and is increasing in incidence as women delay pregnancy. This type of breast cancer is more aggressive, and not infrequently, there is a delay in diagnosis attributed to physiologic changes that occur during pregnancy and a lack of awareness among physicians. In this review, we discuss the demographics of pregnancy-associated breast cancer, provide differential considerations, and illustrate the multimodality imaging features to bring attention to the radiologist about this aggressive form of breast cancer.
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Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, Division of Breast Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, 92037, USA
| | | | - Rebecca Rakow-Penner
- Department of Radiology, Division of Breast Imaging and Body Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, USA
| | - Haydee Ojeda-Fournier
- Department of Radiology, Division of Breast Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, 92037, USA.
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7
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Ye BY, He P, Liu Y. Retrospective analysis of 26 cases of pregnancy luteoma. Technol Health Care 2023; 31:1825-1833. [PMID: 37125581 DOI: 10.3233/thc-220685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Pregnancy luteoma is a rare hormone-dependent ovarian tumor-like lesion caused by increased androgenic activity during pregnancy. OBJECTIVE To explore the clinical history, ultrasound manifestations, and differential diagnosis of pregnancy luteoma. METHOD A retrospective analysis was conducted on 26 cases of pregnancy luteoma diagnosed by postoperative pathology, from 2009 to 2022. All cases were from two hospitals: Shanghai First Maternity and Infant Hospital and International Peace Maternity and Child Health Hospital. The clinical history data and ultrasound characteristics were analyzed and the relevant literature was reviewed. RESULTS Among the 26 cases, five of them had preoperative ultrasound images. Among these five cases, three patients showed hyperechoic masses with less internal uniformity, while two demonstrated loculated anechoic zones, with clear boundary and regular morphology. Color Doppler showed no obvious internal blood flow signals, or that blood flow signals were visible within the cyst wall and hyperechoic mass. Among the cases, 16 had multiple gestations, while two visited the clinic due to sudden abdominal pain and a huge ovarian mass was found by ultrasonography. The ovarian lump was detected during routine obstetric ultrasound in three cases. The remaining were ovarian cysts found incidentally during caesarean section. Four patients presented with hairy manifestations and one patient had a deepened voice. CONCLUSION There is no characteristic ultrasound of pregnancy luteoma, and its diagnosis is mainly based on clinical history data and laboratory tests.
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Affiliation(s)
- Bao-Ying Ye
- Department of Ultrasonography, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping He
- Department of Ultrasonography, Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuan Liu
- Department of Pathology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Ciccarone F, Biscione A, Moro F, Fischerova D, Savelli L, Munaretto M, Jokubkiene L, Sladkevicius P, Chiappa V, Fruscio R, Franchi D, Epstein E, Timmerman D, Froyman W, Valentin L, Scambia G, Testa AC. Imaging in gynecological disease (23): clinical and ultrasound characteristics of ovarian carcinosarcoma. Ultrasound Obstet Gynecol 2022; 59:241-247. [PMID: 34225386 DOI: 10.1002/uog.23733] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of ovarian carcinosarcoma. METHODS This was a retrospective multicenter study. Patients with a histological diagnosis of ovarian carcinosarcoma, who had undergone preoperative ultrasound examination between 2010 and 2019, were identified from the International Ovarian Tumor Analysis (IOTA) database. Additional patients who were examined outside of the IOTA study were identified from the databases of the participating centers. The masses were described using the terms and definitions of the IOTA group. Additionally, two experienced ultrasound examiners reviewed all available images to identify typical ultrasound features using pattern recognition. RESULTS Ninety-one patients with ovarian carcinosarcoma who had undergone ultrasound examination were identified, of whom 24 were examined within the IOTA studies and 67 were examined outside of the IOTA studies. Median age at diagnosis was 66 (range, 33-91) years and 84/91 (92.3%) patients were postmenopausal. Most patients (67/91, 73.6%) were symptomatic, with the most common complaint being pain (51/91, 56.0%). Most tumors (67/91, 73.6%) were International Federation of Gynecology and Obstetrics (FIGO) Stage III or IV. Bilateral lesions were observed on ultrasound in 46/91 (50.5%) patients. Ascites was present in 38/91 (41.8%) patients. The median largest tumor diameter was 100 (range, 18-260) mm. All ovarian carcinosarcomas contained solid components, and most were described as solid (66/91, 72.5%) or multilocular-solid (22/91, 24.2%). The median diameter of the largest solid component was 77.5 (range, 11-238) mm. Moderate or rich vascularization was found in 78/91 (85.7%) cases. Retrospective analysis of ultrasound images and videoclips using pattern recognition in 73 cases revealed that all tumors had irregular margins and inhomogeneous echogenicity of the solid components. Forty-seven of 73 (64.4%) masses appeared as a solid tumor with cystic areas. Cooked appearance of the solid tissue was identified in 28/73 (38.4%) tumors. No pathognomonic ultrasound sign of ovarian carcinosarcoma was found. CONCLUSIONS Ovarian carcinosarcomas are usually diagnosed in postmenopausal women and at an advanced stage. The most common ultrasound appearance is a large solid tumor with irregular margins, inhomogeneous echogenicity of the solid tissue and cystic areas. The second most common pattern is a large multilocular-solid mass with inhomogeneous echogenicity of the solid tissue. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Ciccarone
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - A Biscione
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Savelli
- Gynecologic and Obstetric Unit, Women's and Children's Department, Forlì Hospital, Forlì, Italy
| | - M Munaretto
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - L Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - V Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milano-Bicocca, Department of Medicine and Surgery, San Gerardo Hospital, Monza, Italy
| | - D Franchi
- Gynecologic Oncology Unit, Division of Gynecology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Epstein
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - W Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Arora S, Khera N, Kaul A. Three-dimensional color Doppler acquisition of a highly vascular giant placental chorioangioma. Am J Obstet Gynecol 2022; 226:259-260. [PMID: 34453931 DOI: 10.1016/j.ajog.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Saloni Arora
- Department of Fetal Medicine and Imaging, Apollo Cradle & Children's Hospital, New Delhi, India.
| | - Nidhi Khera
- Department of Obstetrics and Gynaecology, Apollo Cradle & Children's Hospital, New Delhi, India
| | - Anita Kaul
- Department of Fetal Medicine and imaging, Apollo Cradle & Children's Hospital, New Delhi, India; Indraprastha Apollo Hospitals, New Delhi, India
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10
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Molina-Botello D, Rodríguez-Sanchez JR, Cuevas-García J, Cárdenas-Almaraz BV, Morales-Acevedo A, Mejía-Pérez SI, Ochoa-Martinez E. Pregnancy and brain tumors; a systematic review of the literature. J Clin Neurosci 2021; 86:211-216. [PMID: 33775330 DOI: 10.1016/j.jocn.2021.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/13/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
The incidence of primary brain tumors during pregnancy is uncommon. The etiology of these can range from different genetic syndromes such as Li Fraumeni, neurofibromatosis type I, and hormonal associated tumors. The number of meningiomas gradually tends to increase during pregnancy, suggesting a relationship between non-malignant meningiomas and hormonal changes. Clinical features are non specific or can be misinterpreted with pregnancy symptoms such as headache, vomiting and dizziness. It is worth mentioning that the symptoms due to intracranial tumors are no different in pregnant compared with non pregnant patients. However, retrospective studies in glioma behavior suggested that both tumor volume and growth, increased during pregnancy. These changes were correlated with clinical worsening and increased frequency of seizures. The diagnosis requires a proper neurologic exploration and the support of imaging studies. Treatment of tumors is very controversial since we look for the preservation of both mother and fetus. In theory, the best therapy for the mother will also be the best therapy for the fetus. During pregnancy, ideally the treatment is symptomatic, to preserve the fetus, and definite treatment may be performed after birth; the latter is not always accomplished since patients may present with impending herniation or a malignant tumor for which immediate management is necessary. We intend to give an updated review in the literature on the adequate treatment of brain tumors during pregnancy and the anesthetic management during the definite treatment. Literature data was obtained from Pubmed using the search terms: "Pregnancy", "Brain", "Tumors". A total of forty-three articles were selected.
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Affiliation(s)
- Diego Molina-Botello
- Department of Neurological Surgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico; Universidad Anáhuac México, Av Universidad Anáhuac 46, Lomas Anáhuac, 52786 Naucalpan de Juárez, Mexico
| | - Jesus René Rodríguez-Sanchez
- Department of Neurological Surgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico
| | - Jesús Cuevas-García
- Department of Neuroanesthesia, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico
| | | | - Adrian Morales-Acevedo
- Hospital Angeles México, Agrarismo 208, Escandón II Secc, Miguel Hidalgo, 11800 México City, Mexico
| | - Sonia Iliana Mejía-Pérez
- Department of Neurological Surgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico
| | - Edith Ochoa-Martinez
- Department of Neuroanesthesia, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" (INNN), 3877 Insurgentes Sur Av, La Fama, Tlalpan, 14269 Mexico City, Mexico.
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11
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Sowithayasakul P, Boekhoff S, Bison B, Müller HL. Pregnancies after Childhood Craniopharyngioma: Results of KRANIOPHARYNGEOM 2000/2007 and Review of the Literature. Neuroendocrinology 2021; 111:16-26. [PMID: 32074615 DOI: 10.1159/000506639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data on female fertility, pregnancy, and outcome of offspring after childhood-onset craniopharyngioma (CP) are rare. STUDY DESIGN Observational study on pregnancy rate and offspring outcome in female CP patients recruited in KRANIOPHARYNGEOM 2000/2007 since 2000. RESULTS A total of 451 CP patients (223 female) have been recruited, and 269 (133 female) were postpubertal at study. Six of 133 female CP patients (4.5%) with a median age of 14.9 years at CP diagnosis had 9 pregnancies, giving birth to 10 newborns. Three patients achieved complete surgical resections. No patient underwent postoperative irradiation. Five natural pregnancies occurred in 3 CP patients without pituitary deficiencies. Four pregnancies in 3 CP patients with hypopituitarism were achieved under assisted reproductive techniques (ART) (median 4.5 cycles, range: 3-6 cycles). Median maternal age at pregnancy was 30 years (range: 22-41 years). Six babies (60%) were delivered by caesarean section. Median gestational age at delivery was 38 weeks (range: 34-43 weeks); median birth weight was 2,920 g (range: 2,270-3,520 g), the rate of preterm delivery was 33%. Enlargements of CP cysts occurred in 2 women during pregnancy. Other complications during pregnancy, delivery, and postnatal period were not observed. CONCLUSIONS Pregnancies after CP are rare and were only achieved after ART in patients with hypopituitarism. Close monitoring by an experienced reproductive physician is necessary. Due to a potentially increased risk for cystic enlargement, clinical, ophthalmological, and MRI monitoring are recommended in patients at risk. Severe perinatal complications, birth defects, and postnatal morbidity of mothers and offspring were not observed.
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Affiliation(s)
- Panjarat Sowithayasakul
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital, Würzburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany,
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Dudiak KM, Maturen KE, Akin EA, Bell M, Bhosale PR, Kang SK, Kilcoyne A, Lakhman Y, Nicola R, Pandharipande PV, Paspulati R, Reinhold C, Ricci S, Shinagare AB, Vargas HA, Whitcomb BP, Glanc P. ACR Appropriateness Criteria® Gestational Trophoblastic Disease. J Am Coll Radiol 2020; 16:S348-S363. [PMID: 31685103 DOI: 10.1016/j.jacr.2019.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Abstract
Gestational trophoblastic disease (GTD), a rare complication of pregnancy, includes both benign and malignant forms, the latter collectively referred to as gestational trophoblastic neoplasia (GTN). When metastatic, the lungs are the most common site of initial spread. Beta-human chorionic gonadotropin, elaborated to some extent by all forms of GTD, is useful in facilitating disease detection, diagnosis, monitoring treatment response, and follow-up. Imaging evaluation depends on whether GTD manifests in one of its benign forms or whether it has progressed to GTN. Transabdominal and transvaginal ultrasound with duplex Doppler evaluation of the pelvis are usually appropriate diagnostic procedures in either of these circumstances, and in posttreatment surveillance. The appropriateness of more extensive imaging remains dependent on a diagnosis of GTN and on other factors. The use of imaging to assess complications, typically hemorrhagic, should be guided by the location of clinical signs and symptoms. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Maria Bell
- Sanford Health, Sioux Falls, South Dakota, American College of Obstetricians and Gynecologists
| | | | - Stella K Kang
- New York University Medical Center, New York, New York
| | | | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Refky Nicola
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | | | - Stephanie Ricci
- Cleveland Clinic, Cleveland, Ohio, American College of Obstetricians and Gynecologists
| | - Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Bradford P Whitcomb
- University of Connecticut, Farmington, Connecticut, Society of Gynecologic Oncology
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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13
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Levy L, Meuwly JY, Sarivalasis A, Achtari C, Mathevet P, Herrera FG. Survival of the fetus: cervical cancer and pregnancy, a challenging combination. Lancet 2020; 396:725. [PMID: 32891213 DOI: 10.1016/s0140-6736(20)31794-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/06/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Laura Levy
- Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean-Yves Meuwly
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Apostolos Sarivalasis
- Medical Oncology and Immuno-Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Chahin Achtari
- Service of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrice Mathevet
- Service of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Fernanda G Herrera
- Radiation Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Medical Oncology and Immuno-Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland.
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14
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Chatzianagnostou K, Morelli L, Pollina L, Torregrossa L, Clemente A, Fommei E, di Franco G, Funel N, Emdin M, Chiappino D, Vassalle C. Unilateral Adrenal Hyperplasia in the Presence of a Reninoma in a Young Pregnant Woman. Am J Med Sci 2020; 360:607-609. [PMID: 32739038 DOI: 10.1016/j.amjms.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/05/2020] [Accepted: 07/09/2020] [Indexed: 02/05/2023]
Affiliation(s)
| | - Luca Morelli
- Dipartimento Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, SD Chirurgia Generale Universitaria P.O. di Cisanello, Pisa, Italy
| | - Luca Pollina
- U.O. Anatomia ed Istologia Patologica II Universitaria, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Liborio Torregrossa
- U.O. Anatomia ed Istologia Patologica III Universitaria, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Enza Fommei
- Fondazione CNR-Regione Toscana G Monasterio, Pisa, Italy
| | - Gregorio di Franco
- Dipartimento Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, SD Chirurgia Generale Universitaria P.O. di Cisanello, Pisa, Italy
| | - Niccola Funel
- U.O. Anatomia ed Istologia Patologica II Universitaria, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Michele Emdin
- Fondazione CNR-Regione Toscana G Monasterio, Pisa, Italy
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15
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Siesel C, Muhammad B, Weiner S. Giant Cell Tumor After Distal Radius Open Reduction and Internal Fixation in a Pregnant Woman: A Case Report. JBJS Case Connect 2020; 10:e2000165. [PMID: 32910571 DOI: 10.2106/jbjs.cc.20.00165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 32-year-old pregnant woman presented with new wrist pain after a fall. She had undergone surgical repair to the same wrist 6 years previously for a distal radius fracture. At that time, there was no evidence of a bone lesion. Current radiographs revealed a radiolucent lesion in the metaepiphyseal region. Intraoperative frozen section confirmed a giant cell tumor (GCT). Definitive management consisted of intralesional curettage, burring, and cementation of the distal radius with reapplication of distal radius plate. CONCLUSION Currently, there is no known link between GCT and fracture or pregnancy.
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Affiliation(s)
- Craig Siesel
- 1Department of Orthopaedic Surgery, Summa Health, Akron, Ohio 2Northeast Ohio Medical University, Rootstown, Ohio
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Aragón-Mendoza RL, Arenas-Gamboa J, Vieira-Serna S, Sierra IAJ. Primary retroperitoneal tumor during pregnancy: Case report and review of the literature. Rev Colomb Obstet Ginecol 2020; 71:195-207. [PMID: 32770874 DOI: 10.18597/rcog.3477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To report the case of a pregnant patient diagnosed with a primary retroperitoneal tumor and to conduct a review of the literature pertaining to the diagnosis, treatment and maternal-fetal prognosis of this disease condition during pregnancy. METHODS A 19-year-old patient who presented with a retroperitoneal tumor identified on ultrasound. The results of the percutaneous biopsy showed a benign tumor. A healthy neonate was delivered by cesarean section. Surgical resection was performed four months later, and histopathology showed a mature cystic teratoma. A search was conduced in the Medline via PubMed, Lilacs, SciELO and ScienceDirect databases using the terms "pregnancy," "neoplasms," and "retroperitoneal neoplasms," including case reports and case series of retroperitoneal tumors during pregnancy. Diagnosis, treatment and maternal-fetal prognosis were identified. RESULTS Overall, 1658 titles were identified. Of these, 34 case reports and 1 case series met the inclusion criteria. Of the cases, 62.9 % were benign. Diagnosis was made as an incidental finding in 63 % of cases, and 77 % of the masses were identified on ultrasound. Percutaneous biopsy was used in 8 % of cases, including the case reported here. Surgical treatment was used in 88 % of cases usually after delivery. Maternal mortality occurred in 8.5 % of cases. Fetal prognosis was good in 65 % of the pregnancies. CONCLUSIONS Despite being frequently benign, retroperitoneal tumors during gestation have a reserved maternal and fetal prognosis in a substantial number of cases. There is a need to assess the risks and benefits of percutaneous biopsy.
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Affiliation(s)
| | - Jaime Arenas-Gamboa
- Médico ginecobstetra, especialista Unidad Medicina Materno-Fetal, Clínica Universitaria Colombia; docente Universidad Nacional de Colombia. Bogotá (Colombia)
| | - Santiago Vieira-Serna
- Médico residente ginecología y obstetricia, Fundación Universitaria Sanitas, Clínica Universitaria Colombia. Bogotá (Colombia)
| | - Isaac Alfonso Juan Sierra
- Médico residente radiología e imágenes diagnósticas, Fundación Universitaria Sanitas, Clínica Universitaria Colombia. Bogotá (Colombia)
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Li S, Yang C, Fan J, Yao Y, Lv X, Guo Y, Zhang S. Pregnancy-induced Cushing's syndrome with an adrenocortical adenoma overexpressing LH/hCG receptors: a case report. BMC Endocr Disord 2020; 20:62. [PMID: 32393232 PMCID: PMC7216527 DOI: 10.1186/s12902-020-0539-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pregnancy-induced Cushing's syndrome (CS) with an adrenocortical adenoma overexpressing luteinizing hormone (LH)/human choriogonadotropin (hCG) receptors (LHCGR) has been rarely reported in the literatures. This peculiar condition challenges the canonical diagnosis and management of CS. CASE PRESENTATION A 27-year-old woman (G2P0A1) presented at 20 weeks gestational age (GA) with overt Cushingoid clinical features. Adrenocorticotropic hormone (ACTH)-independent CS was diagnosed based on undetectable ACTH and unsuppressed cortisol levels by dexamethasone. Magnetic resonance imaging (MRI) scanning without contrast revealed a left adrenal nodule while pituitary MRI scanning was normal. A conservative treatment strategy of controlling Cushingoid comorbidities was conducted. At 36 weeks GA, a caesarean operation was performed and a live female infant was delivered. At 8 weeks after parturition, our patient achieved normalization of blood pressure, blood glucose, serum potassium, and urinary cortisol level spontaneously. During non-pregnancy period, stimulation testing with exogenous hCG significantly evoked a cortisol increase. The woman underwent resection of the adrenal tumor at 6 months after parturition. Immunohistochemistry (IHC) showed the tumor tissue that stained positive for luteinizing hormone (LH)/human choriogonadotropin (hCG) receptor (LHCGR), whereas negative for both melanocortin 2 receptor (MC2R) and G protein-coupled receptor-1 (GPER-1). CONCLUSIONS Stimulation test with exogenous hCG after parturition is necessary for the diagnosis of pregnancy-induced CS. LHCGR plays an essential role in the pathogenesis of this rare condition.
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Affiliation(s)
- Shaohua Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Chen Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Jing Fan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Yao Yao
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Xiaomei Lv
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Ying Guo
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Shaoling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China.
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18
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Buca D, Iacovella C, Khalil A, Rizzo G, Sirotkina M, Makatsariya A, Liberati M, Silvi C, Acharya G, D'Antonio F. Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2020; 55:441-449. [PMID: 31034661 DOI: 10.1002/uog.20304] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To report the perinatal outcome of singleton pregnancies complicated by placental chorioangioma diagnosed on prenatal ultrasound. METHODS MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov databases were searched for studies reporting the outcome of pregnancies complicated by placental chorioangioma. Inclusion criteria were singleton pregnancy diagnosed with placental chorioangioma on prenatal ultrasound, with no other associated structural anomaly. The primary outcome was perinatal mortality. Secondary outcomes included associated non-structural anomalies detected on prenatal ultrasound (including fetal hydrops, anemia, polyhydramnios, signs of hyperdynamic circulation and small-for-gestational-age (SGA) fetus), SGA at birth, composite neonatal morbidity and preterm birth. Outcome was assessed separately in pregnancies undergoing and those not undergoing fetal therapy. Subanalyses were performed according to the presence of hydrops and the size of the tumor in all pregnancies diagnosed with chorioangioma. Random-effects meta-analyses of proportions were used to analyze the data. RESULTS Twenty-eight studies (161 pregnancies) were included. In pregnancies complicated by chorioangioma that did not undergo intervention, intrauterine death occurred in 8.2% (95% CI, 3.8-15.0%), while neonatal death and perinatal death occurred in 3.8% (95% CI, 1.0-8.1%) and 11.1% (95% CI, 5.0-19.4%), respectively. SGA at birth was present in 24.0% (95% CI, 13.5-36.5%) of cases, while preterm birth < 37 weeks complicated 34.1% (95% CI, 21.1-48.3%) of pregnancies. Composite neonatal morbidity occurred in 12.0% (95% CI, 4.5-22.3%) of cases. On ultrasound, signs of fetal hyperdynamic circulation were present in 21.0% (95% CI, 9.6-35.3%) of cases, while peak systolic velocity in the fetal middle cerebral artery was increased in 20.6% (95% CI, 10.9-32.3%). Subanalysis according to the size of chorioangioma, including both pregnancies that did and those that did not undergo intervention, showed a progressive increase in the occurrence of most of the outcomes explored with increasing size of the tumor. Furthermore, the prevalence of adverse perinatal outcome was high in pregnancies complicated by chorioangioma presenting with fetal hydrops. There was no randomized controlled trial comparing intervention vs expectant management in pregnancies complicated by chorioangioma with signs of fetal compromise (hydrops or hyperdynamic circulation). Overall, perinatal mortality occurred in 31.2% (95% CI, 18.1-46.1%) of fetuses undergoing in-utero therapy, and 57.3% (95% CI, 39.2-74.4%) had resolution of hydrops or hyperdynamic circulation after treatment. CONCLUSIONS Placental chorioangioma is associated with adverse perinatal outcome. The size of the mass and presence of fetal hydrops are likely to be the main determinants of perinatal outcome in affected pregnancies. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Buca
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - C Iacovella
- Department of Gynecology and Obstetrics, Goethe University, Frankfurt, Germany
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - G Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Sirotkina
- Section of Perinatal Pathology, Department of Pathology, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Liberati
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - C Silvi
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
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19
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Schwarze V, Marschner C, Negrão de Figueiredo G, Rübenthaler J, Clevert DA. Single-Center Study: Evaluating the Diagnostic Performance and Safety of Contrast-Enhanced Ultrasound (CEUS) in Pregnant Women to Assess Hepatic Lesions. Ultraschall Med 2020; 41:29-35. [PMID: 31362328 DOI: 10.1055/a-0973-8517] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ultrasound is an essential imaging tool for evaluating physiological and pathological fetal or maternal conditions during pregnancy. Published data is limited with respect to the application of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow, cesarean scar pregnancy and invasive placenta percreta. CT and MRI scans during pregnancy must be thoroughly evaluated due to harmful ionizing radiation and cerebral gadolinium deposition, respectively. PURPOSE The aim of the present retrospective single-center study is to assess the diagnostic performance and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity. METHODS 6 pregnant patients who underwent CEUS between 2005 and 2014 (mean age: 32 years; mean weeks of pregnancy: 28 weeks) were included in this study. The applied contrast agent was a second-generation blood-pool agent (SonoVue®, Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single radiologist with experience since 2000 (EFSUMB Level 3). RESULTS CEUS was safely performed on all included pregnant women without the occurrence of adverse fetal or maternal events. In the context of the present study, CEUS helped to safely differentiate hepatic metastases, focal nodular hyperplasia, atypical hemangioma, hepatic arteriovenous malformation and cystic echinococcosis. In two patients CEUS determined immediate therapy. CONCLUSION Although not clinically approved in obstetrics so far, CEUS is a safe imaging modality which, in addition to B-mode and color Doppler ultrasonography, may be applied during pregnancy for further medical indications and to provide helpful information.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, Ludwig-Maximilians-University of Munich - Großhadern Campus, Munich, Germany
| | - Constantin Marschner
- Department of Radiology, Ludwig-Maximilians-University of Munich - Großhadern Campus, Munich, Germany
| | | | - Johannes Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University of Munich - Großhadern Campus, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, Ludwig-Maximilians-University of Munich - Großhadern Campus, Munich, Germany
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20
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Oguz SH, Soylemezoglu F, Dagdelen S, Erbas T. A case of atypical macroprolactinoma presenting with pituitary apoplexy during pregnancy and review of the literature. Gynecol Endocrinol 2020; 36:109-116. [PMID: 31389277 DOI: 10.1080/09513590.2019.1650339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Pituitary apoplexy (PA) during pregnancy is a rare acute clinical situation which could have life-threatening consequences. Here we reported a case of 26-year-old nulliparous woman presenting with PA at the second trimester of her pregnancy. We also have reviewed reported cases of PA during pregnancy and conducted a detailed discussion on presenting symptoms, underlying pituitary pathology, management of apoplexy during pregnancy and outcomes.
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Affiliation(s)
- Seda Hanife Oguz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Figen Soylemezoglu
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Selcuk Dagdelen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tomris Erbas
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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21
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Buechel J, Bruder E, Manegold-Brauer G. Three-dimensional imaging of rare mesenchymal tumor of umbilical cord. Ultrasound Obstet Gynecol 2020; 55:279-280. [PMID: 31115104 DOI: 10.1002/uog.20349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Affiliation(s)
- J Buechel
- Department of Obstetrics and Gynecology,Division of Gynecologic and Prenatal Ultrasound, University Hospital Basel, Basel, Switzerland
| | - E Bruder
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - G Manegold-Brauer
- Department of Obstetrics and Gynecology,Division of Gynecologic and Prenatal Ultrasound, University Hospital Basel, Basel, Switzerland
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22
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Cerdeira AS, Tome M, Moore N, Lim L. Seeing red degeneration in uterine fibroids in pregnancy: proceed with caution. Lancet 2019; 394:e37. [PMID: 31777390 DOI: 10.1016/s0140-6736(19)32322-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/08/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Ana Sofia Cerdeira
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford, UK; Nuffield Department of Women's Health and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
| | - Mariana Tome
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Niall Moore
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Lee Lim
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
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Tarannum A, Sheikh H, Appiah-Sakyi K, Lindow SW. The diagnostic use of magnetic resonance imaging for acute abdominal and pelvic pain in pregnancy. Eur J Obstet Gynecol Reprod Biol 2019; 246:177-180. [PMID: 31955872 DOI: 10.1016/j.ejogrb.2019.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Acute abdomino-pelvic pain in pregnancy represents a diagnostic challenge. In many cases, radiological and laparoscopic diagnostic modalities are hazardous or contraindicated. Magnetic Resonance Imaging (MRI) is not commonly used for this indication and the results are not widely published. DESIGN AND SETTING A single-center retrospective observational study. POPULATION 34 cases of pregnant women with abdomino-pelvic pain who underwent MRI as an additional modality when clinical, laboratory and ultrasound (USS) findings were indeterminate. METHODS Case notes were reviewed where pregnant women underwent a MRI investigation for abdominal-pelvic pain. Primary Obstetric indications for an MRI eg placenta accreta were excluded. MAIN OUTCOME MEASURES The differential diagnosis after; 1) history and physical examination and 2) with the addition of USS and 3) with the further addition of an MRI were all individually compared to the eventual diagnosis. RESULTS The diagnoses reached by MRI corresponded with the final diagnosis in 22 out of 23 cases. In the remaining 11 cases MRI accurately ruled out presence of pathology. MRI was inaccurate in 1 case. CONCLUSION The additional use of MRI was more accurate than clinical assessment and USS combined. The accurate exclusion of pathology in 11 cases is particularly significant. MRI should be considered in cases of abdomino-pelvic pain in pregnant women.
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Affiliation(s)
- Asma Tarannum
- Womens Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar.
| | - Haifa Sheikh
- Womens Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
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Goidescu I, Nemeti G, Caracostea G, Eniu DT, Chiorean A, Pintican R, Cruciat G, Muresan D. The role of imaging techniques in the diagnosis, staging and choice of therapeutic conduct in pregnancy associated breast cancer. Med Ultrason 2019; 21:336-343. [PMID: 31476214 DOI: 10.11152/mu-1958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Breast cancer diagnosed during pregnancy is at increasing incidence due to the increased frequency of obesity, the postponement of the first pregnancy to later decades of life and the advances of diagnostic techniques. Clinical and imaging diagnosis is difficult during gestation due to adaptive changes of the maternal organism , the mammary glads in particular. Furthermore, the therapeutic approach is limited both by the possible side effects on the fetus and by the skepticism of the couple over these therapeutic regimens.The present paper aims to review the main diagnostic steps to confirm pregnancy associated breast cancer, as well as the therapeutic possibilities during this period, related to the potential adverse effects concerning pregnancy.
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Affiliation(s)
- Iulian Goidescu
- Obstetrics and Gynecology I Clinic, Mother and Child Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Georgiana Nemeti
- Obstetrics and Gynecology I Clinic, Mother and Child Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Gabriela Caracostea
- Obstetrics and Gynecology I Clinic, Mother and Child Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Dan Tudor Eniu
- Department "Surgical oncology and Oncological Gynecology", University of Medicine and Pharmacy "Iuliu Haţieganu", Romania.
| | | | | | - Gheorghe Cruciat
- Obstetrics and Gynecology I Clinic, Mother and Child Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Daniel Muresan
- Obstetrics and Gynecology I Clinic, Mother and Child Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
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25
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Taşkın F, Polat Y, Erdoğdu İH, Soyder A. Pregnancy-associated breast cancer: A review of 47 women. Clin Imaging 2019; 58:182-186. [PMID: 31404824 DOI: 10.1016/j.clinimag.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Pregnancy-associated breast cancer (PABC) is a rare disease. However, its expected incidence tends to be increased because of delayed maternal age. The purpose of this study was to describe the clinical, radiological, and histopathological characteristics of PABC cases diagnosed in our center. METHODS The clinical-radiological findings and histopathological characteristics of patients diagnosed and treated with PABC at our institution between January 2011 and January 2017 were retrospectively evaluated. RESULTS Mammography and ultrasonography were performed in all patients. MRI examination was performed in 18 patients. Nine (19.1%) out of 47 patients were diagnosed with breast cancer during pregnancy, and 38 (80.9%) were in their first year after delivery. The most frequent finding (95.7%) during imaging was one or more masses. Mammography-detected pure or accompanying microcalcifications were found in 12 (25.5%) patients. MRI detected additional multifocal and multicentric disease in 14 (29.8%) patients and contralateral cancer in one (2.1%) patient. CONCLUSIONS Pregnancy-related breast cancer tends to be diagnosed in an advanced stage with poor prognosis. Any breast abnormalities observed in this period should alert clinicians, and a meticulous radiological evaluation is mandatory. The early diagnosis of this disease would increase the chances of successful treatment.
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Affiliation(s)
- Füsun Taşkın
- Acibadem University School of Medicine, Department of Radiology, 34303 Istanbul, Turkey.
| | - Yasemin Polat
- Adnan Menderes University School of Medicine, Department of Radiology, 09010 Aydin, Turkey
| | - İbrahim H Erdoğdu
- Adnan Menderes University School of Medicine, Department of Pathology, 09010 Aydin, Turkey
| | - Aykut Soyder
- Adnan Menderes University School of Medicine, Department of General Surgery, 09010 Aydin, Turkey
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26
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Sutton PA, Rooney P, Ali N, Chandrasekar CR. Surgical management of large abdominal wall fibromatosis during pregnancy. BMJ Case Rep 2019; 12:e227811. [PMID: 31331925 PMCID: PMC6663169 DOI: 10.1136/bcr-2018-227811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Paul Anthony Sutton
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Paul Rooney
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Nasim Ali
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - Coonoor R Chandrasekar
- Trauma and Orthopaedic Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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27
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Nieto AJ, Trochez L, Ramírez D, Arguello P, Guzman G, Pachajoa H, Escobar Vidarte MF. Paraganglioma in pregnancy: interdisciplinary management during pregnancy. Gynecol Endocrinol 2019; 35:567-570. [PMID: 30786782 DOI: 10.1080/09513590.2019.1576619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Paragangliomas are tumors that originate from the extra-adrenal neural crest, the incidence of which during pregnancy is not more than two to eight cases per million people per year and are known to be highly morbid. The purpose of this report is to describe the experience and results obtained during management of a primigravida diagnosed with paraganglioma on week 21.2 and received both medical and surgical management with good maternal and perinatal outcomes. This case report evidences the importance of practicing interdisciplinary management of patients with clinical suspicion of paragangliomas or pheochromocytomas during pregnancy at high-complexity centers even in a medium-income country.
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Affiliation(s)
- Albaro J Nieto
- a High Complexity Obstetric Unit, Department of Gynecology and Obstetrics , Fundación Valle del Lili , Santiago de Cali , Colombia
- b Department of Health Sciences, Faculty of Medicine , ICESI University , Santiago de Cali , Colombia
| | - Lizette Trochez
- b Department of Health Sciences, Faculty of Medicine , ICESI University , Santiago de Cali , Colombia
| | - Daniela Ramírez
- b Department of Health Sciences, Faculty of Medicine , ICESI University , Santiago de Cali , Colombia
| | - Pedro Arguello
- c Department of Surgery , Fundación Valle del Lili , Santiago de Cali , Colombia
| | - Guillermo Guzman
- d Department of Endocrinology , Fundación Valle del Lili , Santiago de Cali , Colombia
| | - Harry Pachajoa
- e Department of Genetics , Fundación Valle del Lili , Santiago de Cali , Colombia
| | - María Fernanda Escobar Vidarte
- a High Complexity Obstetric Unit, Department of Gynecology and Obstetrics , Fundación Valle del Lili , Santiago de Cali , Colombia
- b Department of Health Sciences, Faculty of Medicine , ICESI University , Santiago de Cali , Colombia
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28
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Quddusi A, Shamim MS, Virani Q. Effect of pregnancy on growth of intracranial meningiomas. J PAK MED ASSOC 2019; 69:1057-1058. [PMID: 31983749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Meningiomas are the most common benign primary intracranial tumours in adults. Their rapid growth during pregnancy has been well reported. Moreover, the relationship of increased progesterone expression during pregnancy and extensive tumour growth has been debated. In this review, we discuss not only the effect of progesterone on meningiomal growth but also other mechanisms involved in gestational meningiomas.
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Affiliation(s)
| | | | - Quratulain Virani
- Department of Surgery, Section of Neurosurgery, Aga Khan University, Karachi
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29
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Dell'Atti L, Borghi C, Galosi AB. Laparoscopic Approach in Management of Renal Cell Carcinoma During Pregnancy: State of the Art. Clin Genitourin Cancer 2019; 17:e822-e830. [PMID: 31227431 DOI: 10.1016/j.clgc.2019.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 01/13/2023]
Abstract
Renal cell carcinoma (RCC) is extremely rare in pregnant women. However, this is one of the most reported urologic tumors during pregnancy. The aim of this review was to evaluate RCC during pregnancy in terms of epidemiology, risk factors, diagnosis, natural history of disease, and the safety of laparoscopic approach in the management of this tumor. RCC presentation is frequently made incidentally during an ultrasonography performed for other reasons, such as hydronephrosis owing to non-neoplastic causes. The optimal time for surgery during pregnancy and the consequences of surgery on the maternal and fetal well-being are major considerations. Risks for adverse pregnancy outcomes should be explained, and the patient's decision about pregnancy termination should be considered. Ultrasound is good in diagnosing renal masses, with a sensitivity comparable to that of computed tomography only for exophytic masses larger than 3 cm. Magnetic resonance imaging is reproducible and a good, though expensive, alternative to computed tomography scans for the evaluation of renal lesions in pregnant women. Radical nephrectomy or nephron-sparing surgery are essential treatments for management of RCC. Laparoscopic surgery has historically been considered dangerous during pregnancy and avoided whenever possible, because of concerns regarding surgery-related risks, such as uterine injury, miscarriage, teratogenesis, preterm birth, and hypercapnia. The laparoscopic treatment during pregnancy is becoming increasingly accepted where feasible with low morbidity. However, the combination of a multidisciplinary approach, multi-specialty communication, and skilled surgeons can give the best possible outcomes for mother and fetus.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, University Hospital "Ospedali Riuniti" and Polythecnic University of Marche Region, Ancona, Italy.
| | - Chiara Borghi
- Unit of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and S. Anna Hospital of Ferrara, Ferrara, Italy
| | - Andrea Benedetto Galosi
- Department of Urology, University Hospital "Ospedali Riuniti" and Polythecnic University of Marche Region, Ancona, Italy
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30
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Pepe F, Valenti O, Insalaco G, Zigarelli MMG, Pepe L, Piana M. Struma ovarii complicating pregnancy. Case report and literature review. G Chir 2019; 40:199-207. [PMID: 31484009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 19-year-old woman at 12th week of pregnancy was referred to our hospital with severe acute abdominal pain, nausea and vomiting. Patient's abdomen was untreatable. Routine examinations, except neutrophilic leukocytosis, were normal. Ultrasound imaging showed the presence of intrauterine pregnancy corresponding to amenorrhea and a right complex ovarian mass, with well defined margins without papillary projection, 14x12 cm in diameter. No free fluid was evident. Due to untreatable abdomen and suspecting torsion of the ovarian tumor the patient underwent laparotomy under general anesthesia. The pregnant uterus was normal. The right ovary had increased volume for a cystic-solid mass of the size of 14 cm with smooth surface and twisted on the vascular peduncle. A right adnexectomy was performed. Intraoperative frozen section was negative for malignancy and postoperative histological examination revealed a struma ovarii without atypia of the follicular cells. Postoperative course was normal. The patient was discharged after three days and she delivered at term a normal baby. Mostly struma ovarii represents an incidental finding during cesarean section, but in rare case it may be cause of complications such as torsion, rupture, hypertiroidism and rarely may be a malignant tumor. The AA describe literature data on struma ovarii diagnosed in pregnancy.
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31
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Abstract
Trans-radial access offers several unique advantages and is being used more frequently for interventional radiology procedures. We report the use of trans-radial arterial access to embolize a large bleeding angiomyolipoma in a 30-year-old pregnant patient presenting in the first trimester. Trans-radial approach was chosen to minimize the effects of radiation on the fetus. Subsequent postprocedural pregnancy course was uneventful with stability of the angiomyolipoma and no further hemorrhage. This case highlights the benefits of trans-radial embolotherapy in gravid patients to reduce the risk of radiation exposure to the fetus.
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Affiliation(s)
| | - Ifechi Momah-Ukeh
- Department of Radiology, MedStar Georgetown University Hospital, Washington D.C., USA
| | - Alexander Y Kim
- Department of Radiology, MedStar Georgetown University Hospital, Washington D.C., USA
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32
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Khalil N, Fowler C. Misconceptions surrounding pregnancy-associated breast cancer. BMJ Case Rep 2018; 11:e226719. [PMID: 30567280 PMCID: PMC6301761 DOI: 10.1136/bcr-2018-226719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2018] [Indexed: 11/03/2022] Open
Abstract
This case report describes a 31-year-old woman who presented with a right painless breast lump. A mammogram and ultrasound scan showed the lump was suspicious of cancer. Core biopsy and immunohistochemistry of the lump confirmed a triple negative, poorly differentiated, invasive ductal carcinoma of the right breast. One week following her diagnosis, the patient found out she was pregnant. The patient was worried about what the implications this diagnosis would have on both her baby and her own cancer treatment.
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MESH Headings
- Adult
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/therapy
- Combined Modality Therapy
- Delivery, Obstetric
- Diagnosis, Differential
- Female
- Humans
- Infant, Newborn
- Mammography
- Pregnancy
- Pregnancy Complications, Neoplastic/diagnosis
- Pregnancy Complications, Neoplastic/diagnostic imaging
- Pregnancy Complications, Neoplastic/therapy
- Pregnancy Trimester, First
- Triple Negative Breast Neoplasms/diagnosis
- Triple Negative Breast Neoplasms/diagnostic imaging
- Triple Negative Breast Neoplasms/therapy
- Ultrasonography, Prenatal
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Affiliation(s)
- Nada Khalil
- University of Bristol Medical School, Bristol, UK
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33
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Abstract
Hypercalcemia due to primary hyperparathyroidism during pregnancy is a rare condition and associated with increased morbidity and mortality for the mother and the unborn child. Whereas parathyroidectomy is favored during the second trimester, no clear recommendations exist for its management during the third trimenon. We here report the case of a 26-year-old woman in the 29th week of her first pregnancy, who was admitted to our clinic with hypertension, intra-uterine growth retardation and polyhydramnios. Severe hypercalcemia due to primary hyperparathyroidism was diagnosed (total calcium 3.34 mmol/l; PTH 216 pg/ml), but no enlarged parathyroid gland could be localized by ultrasound. Treatment with calcitonin and cinacalcet could not control hypercalcemia. Therefore explorative surgery was performed and a single parathyroid adenoma was resected, resulting in normalization of serum calcium levels. The surgical procedure was tolerated well by the mother and fetus. Hypercalcemia-induced hypertension and polyhydramnios ameliorated before C-section was performed two weeks later and unrelated to the intervention. This case report underlines the importance of early diagnosis and treatment of primary hyperparathyroidism during pregnancy. If diagnosed in the third trimenon, an interdisciplinary approach is crucial. If medical treatment fails to sufficiently control hypercalcemia, surgical parathyroid exploration should be considered even in cases of unsuccessful localization of adenomatous parathyroid glands.
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Affiliation(s)
- Julie Refardt
- a Division of Endocrinology, Diabetes and Metabolism , University Hospital Basel , Switzerland
| | - Patricia Farina
- b Department of Obstetrics and Gynecology , University Hospital Basel , Switzerland
| | - Irene Hoesli
- b Department of Obstetrics and Gynecology , University Hospital Basel , Switzerland
| | - Christian Meier
- a Division of Endocrinology, Diabetes and Metabolism , University Hospital Basel , Switzerland
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34
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Abstract
RATIONALE Ganglioneuroma (GN) is a rare tumour arising from the sympathetic nervous system. GN is constantly asymptomatic, easily ignored and likely damages other organs during tumour progression. PATIENT CONCERNS The case report involved a 21-year-old girl who was admitted to a hospital because of a computed tomography result after her pregnancy examination showed retroperitoneal tumour and scoliosis. The scoliosis was considered as a tumour complication. DIAGNOSES The tumour was finally diagnosed as GN by pathological examination. INTERVENTIONS We carried out surgical treatment and performed a pathological examination on postoperative tumour specimens. OUTCOMES The patient was followed up for 19 months and did not show tumour recurrence. However, the condition of the scoliosis did not improve. LESSONS This paper reports a case of GN with scoliosis at the same time. GN is a benign tumour consisting of cells with a special origin. GN grows extensively and leads to different complications. Presently, pathological examination after an operation is the only approach to formulate an exact diagnosis. We should consider the possibility of retroperitoneal tumour, especially GN, if a patient suffers from scoliosis with an unknown cause. Thus, CT and MRI are needed to provide additional information that would help formulate a diagnosis.
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Affiliation(s)
| | - Lu Yang
- Department of Urology/Institute of Urology, West China Hospital/West China Medical School, Sichuan University, Chengdu, China
| | - Ming Shi
- Department of Urology/Institute of Urology, West China Hospital/West China Medical School, Sichuan University, Chengdu, China
| | | | - Ya Liu
- Department of Breast Surgery
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35
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Papaioannou GK, Evangelinakis N, Kourtis P, Konstantinidou A, Papantoniou N. Giant chorioangioma treated with interstitial laser coagulation. Ultrasound Obstet Gynecol 2018; 52:280-281. [PMID: 29072331 DOI: 10.1002/uog.18941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/02/2017] [Accepted: 10/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- G K Papaioannou
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
| | - N Evangelinakis
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
| | - P Kourtis
- Private Fetal Medicine Clinic, Athens, Greece
| | - A Konstantinidou
- Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - N Papantoniou
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
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36
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Łubińska M, Hoffmann M, Jendrzejewski J, Kobiela P, Kobiela J, Sworczak K. Successful surgical treatment of pheochromocytoma during pregnancy. Pol Arch Intern Med 2018; 128:322-323. [PMID: 29657311 DOI: 10.20452/pamw.4247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Kudlicki J, Kania A, Frania-Baryluk A, Tomaszewski A, Wysokiński A, Czekajska-Chehab E. Right atrial angiosarcoma in a pregnant woman: diagnostic and therapeutic dilemmas. Pol Arch Intern Med 2018; 128:129-131. [PMID: 29511149 DOI: 10.20452/pamw.4208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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38
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De Nola R, Di Naro E, Schonauer LM, Lucarelli G, Battaglia M, Fiore MG, Mastrolia SA, Loverro G. Clinical management of a unique case of PNET of the uterus during pregnancy, and review of the literature. Medicine (Baltimore) 2018; 97:e9505. [PMID: 29480840 PMCID: PMC5943895 DOI: 10.1097/md.0000000000009505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE PNETs (primitive neuroectodermal tumors) are a family of highly malignant neoplasms characterized by small round cells of neuroepithelial origin. They usually involve bone and soft tissues, and have a higher incidence in childhood. PATIENT CONCERNS In this case report, we describe the obstetric and oncological outcome of a huge mass diagnosed as a leiomyoma in a 39-year-old pregnant woman who complained of low back pain, dysuria, and urinary frequency at 22 weeks of gestation. DIAGNOSES During the 25th week of pregnancy, the patient was referred to our hospital at night with severe anemia and suspected hemoperitoneum. She underwent an emergency caesarean section, delivering a female fetus weighing 400 g, with an Apgar score of 7 at 1 minute and 9 at 5 minutes. INTERVENTION During surgery, we found a huge uterine sarcoma-like metastatic tumor, invading the pelvic peritoneum and parametria bilaterally; the adnexae seemed disease-free. We performed a type B radical hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, omentectomy, appendectomy, and excision of a bulky lymph node. Seven days after delivery, staging computed tomography (CT) scan demonstrated a large lombo-aortic lymph node compressing the left renal vein and we completed debulking with a second surgery, including diaphragmatic peritonectomy and excision of a huge lymph node by lombo-aortic lymphadenectomy, requiring partial reconstruction of an infiltrated renal vein. OUTCOME Ten days after the second surgery, echo-color Doppler showed a regular microcirculation in the left kidney. The patient was discharged after 10 days, and the baby after 1 month, both in good health.Histological examination revealed a uterine body cPNET (central primitive neuroectodermal tumor) orienting the clinical management toward chemotherapy with cisplatin and etoposide. LESSONS PNETs are aggressive neoplasms, usually diagnosed at an advanced stage. Due to their low incidence, universally accepted guidelines are still unavailable. Radical surgery leaving no macroscopic residual disease is mandatory in advanced stages. A good fertility-sparing procedure can be performed only in young women at early stages of disease, when the wish for childbearing is not yet fulfilled.
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Affiliation(s)
- Rosalba De Nola
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Luca Maria Schonauer
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | | | | | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
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39
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Moro F, Mascilini F, Casella E, Pasciuto T, Scambia G, Testa AC. Small cell lung cancer metastatic to the ovary diagnosed during pregnancy. Ultrasound Obstet Gynecol 2017; 50:802-803. [PMID: 28233352 DOI: 10.1002/uog.17437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 06/06/2023]
Affiliation(s)
- F Moro
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - F Mascilini
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - E Casella
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - T Pasciuto
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - G Scambia
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - A C Testa
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
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40
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Ozdemir O, Sarı ME, Atalay CR, Kurban Y, Asgarova V, Unal DT. Cystic lymphangioma of the lesser omentum in a pregnant woman: a case report and review of the literature. J Exp Ther Oncol 2017; 11:155-158. [PMID: 28976139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 06/12/2015] [Indexed: 06/07/2023]
Abstract
Lymphangiomas are rare benign tumors which are generally seen in pediatric population and the etiopathogenesis has not yet been understood. They occasionally occur in the head and neck or axillary region with only 5% of them being located in the abdominal or mediastinal cavity. These tumors may be asymptomatic or may cause acute abdominal symptoms due to the location and extention. In the English literature, only 4 cases of lymphangioma were reported to have occurred in the pregnancy period. Herein, we report a case of cystic lymphangioma of the lesser omentum detected incidentally on the ultrasonogram of a 21 year-old, 26-week pregnant woman. The patient was followed up uneventfully during pregnancy. Caesarean section was performed due to transverse presentation of the fetus, and the tumor was completely resected during the same session. The patient is recurrence-free after 1 year of postoperative follow-up.
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Affiliation(s)
- Ozhan Ozdemir
- Department of Obstetrics and Gynecology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mustafa Erkan Sarı
- Department of Obstetrics and Gynecology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Cemal Resat Atalay
- Department of Obstetrics and Gynecology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Yüksel Kurban
- Department of Obstetrics and Gynecology, Keciören Education and Research Hospital, Ankara, Turkey
| | - Vusale Asgarova
- Department of Obstetrics and Gynecology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Devrim Tuba Unal
- Department of Clinics Pathalogy, Ankara Numune Education and Research Hospital, Ankara, Turkey
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41
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Mascilini F, Savelli L, Scifo MC, Exacoustos C, Timor-Tritsch IE, De Blasis I, Moruzzi MC, Pasciuto T, Scambia G, Valentin L, Testa AC. Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis. Ultrasound Obstet Gynecol 2017; 50:116-123. [PMID: 27484484 DOI: 10.1002/uog.17216] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/30/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To elucidate the ultrasound features that can discriminate between benign and malignant ovarian cysts with papillary projections but no other solid component in pregnant women. METHODS Thirty-four women with an ultrasound diagnosis of an ovarian cyst with papillary projections but no other solid component that had been removed surgically during pregnancy were identified from the databases of four ultrasound units. Some clinical and ultrasound information was collected prospectively. Missing information was obtained retrospectively from ultrasound images, ultrasound reports and patient records. Using prospectively and retrospectively collected data, the ultrasound appearance of the tumors was described using the terms and definitions of the International Ovarian Tumor Analysis group. The ultrasound characteristics were compared with the histological diagnosis. RESULTS Of the 34 cases included, 19 (56%) lesions were benign (16 decidualized endometriomas, one cystadenofibroma, one simple cyst, one struma ovarii), 12 (35%) were borderline tumors and three (9%) were primary invasive tumors (two immature teratomas, one endometrioid cystadenocarcinoma). The contour of the cyst papillations was smooth in 79% (15/19) of benign tumors vs 27% (4/15) of malignant tumors (P = 0.002). The cystic content showed ground-glass echogenicity in 74% (14/19) of benign tumors vs 13% (2/15) of malignant tumors (P = 0.0006). All ovarian masses with smooth papillations and ground-glass content (n = 12) were decidualized endometriomas. The papillary projections were vascularized and the color score was 3 or 4 in 88% (14/16) of decidualized endometriomas vs 42% (5/12) of borderline tumors (P = 0.013). CONCLUSIONS In pregnant women, ovarian cysts with ground-glass echogenicity and papillations with a smooth contour on ultrasound are most likely to be decidualized endometriomas. Cysts with anechoic or low-level echogenicity and papillations with an irregular contour suggest borderline malignancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Mascilini
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - L Savelli
- Gynecology and Early Pregnancy, Ultrasound Unit, Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - M C Scifo
- Gynecology and Early Pregnancy, Ultrasound Unit, Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - C Exacoustos
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - I E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - I De Blasis
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - M C Moruzzi
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - T Pasciuto
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - A C Testa
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Sparks A, Carlan SJ, Wilson J, Busowski J. Adrenal Mass Diagnosed in the Third Trimester of Pregnancy: A Case Report. J Reprod Med 2017; 62:207-210. [PMID: 30230798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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43
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Satcher RL, Ravi V, Wang WL, Oates S. Postpartum Treatment of Metastatic Recurrent Giant Cell Tumor of Capitate Bone of Wrist. Am J Orthop (Belle Mead NJ) 2017; 46:E269-E275. [PMID: 28856360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Giant cell tumors (GCTs) are aggressive benign lesions that occur in the bone epiphysis. They are most often found in the long bones of the lower extremities. Wrist bone involvement is rare, capitate bone involvement exceedingly rare. Treatment in the wrist usually consists of excision, local adjuvant treatment, and cementing and/or bone grafting. GCTs also metastasize to the lungs; pulmonary lesions are excised and systemic therapy provided. We present the case of a 19-year-old woman with GCT of the capitate bone. After initial excision and cementing, the GCT recurred with lung metastases during a pregnancy. Rapid expansion of the GCT during pregnancy was reversed with systemic treatment with denosumab after pregnancy. Excellent response to this chemotherapy permitted limb-sparing surgery and wrist reconstruction with structural cortical autogenous bone graft. Resection of pulmonary metastases after a year of treatment with denosumab revealed lung parenchyma with calcification and ossification and limited viable tumor.
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Affiliation(s)
- Robert L Satcher
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
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Fujibuchi T, Matsumoto S, Shimoji T, Ae K, Tanizawa T, Gokita T, Hayakawa K, Motoi N. Two-stage surgery on pregnant woman with a giant cell tumor of bone who refused blood transfusion: A case report. J Orthop Sci 2017; 22:169-172. [PMID: 26740439 DOI: 10.1016/j.jos.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Taketsugu Fujibuchi
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan.
| | - Seiichi Matsumoto
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Takashi Shimoji
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Keisuke Ae
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Taisuke Tanizawa
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Tabu Gokita
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Keiko Hayakawa
- Department of Orthopaedic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
| | - Noriko Motoi
- Division of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan
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45
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Giasna GK, Micu MC, Micu R. Schwannoma of the median nerve mimicking carpal tunnel syndrome in a pregnant patient. Case report. Med Ultrason 2016; 18:521-523. [PMID: 27981288 DOI: 10.11152/mu-883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In patients with symptoms of a peripheral neuropathy especially during pregnancy, use of imaging techniques such as Ultrasound (US) and Magnetic Resonance Imaging (MRI) may be essential for the diagnostic accomplishment. A 30-weekspregnant diabetic female attending US evaluation due to intermittent hand pain, numbness, and weakness bilaterally. Although, the US evaluation revealed the median nerve (MN) normal size, echogenicity and echo-texture within the right carpal tunnel; the US assessment applied proximally to the carpal tunnel, revealed a hypoechoic tumor-like mass and increased MN cross section area. In transverse view, the MN was detected as an eccentric, hypoechoic structure compressed by the aforementioned mass. A presence of MN schwannoma or neurofibroma was suspected. US has been proved to be extremely useful to determine location, extent as well as the type of nerve lesion.
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Affiliation(s)
- Giokits-Kakavouli Giasna
- Department of Sports Medicine and physiology, University of Medicine, 69 Svetozara Markovica Street, 34000 Kragujevac, Serbia, Private Office, 10 Solomou Street, 60132 Katerini, Greece
| | - Mihaela C Micu
- Rheumatology Division, 2nd Rehabilitation Department, Clinical Rehabilitation Hospital Cluj- Napoca, Romania
| | - Romeo Micu
- Assisted Reproduction Department, Gynecology I Clinic Cluj- Napoca, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj- Napoca, Romania.
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Fuller C, Bale C, Bishop J, Cool P. Lesson of the month 2: Oncology, obstetrics and orthopaedics: an unusual partnership. Clin Med (Lond) 2016; 16:599-601. [PMID: 27927830 PMCID: PMC6297329 DOI: 10.7861/clinmedicine.16-6-599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Breast cancer diagnosed during pregnancy is a relatively uncommon event. This challenging situation presents clinicians with difficult decisions, often requiring a multidisciplinary approach at a time of heightened anxiety for the patient and their family. This paper describes the case of a young woman with metastatic breast cancer diagnosed in early pregnancy, and outlines how this complex clinical situation was managed.
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Affiliation(s)
| | | | - Jill Bishop
- North Wales Cancer Treatment Centre, Rhyl, UK
| | - Paul Cool
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
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Lin WM, Juan YH, Lin YC, Ueng SH, Lo YF, Cheung YC. Awareness of primary spontaneous hemorrhagic angiosarcoma of the breast associated with Kasabach-Merritt syndrome in a pregnant woman by enhanced magnetic resonance imaging: A CARE-compliant case report. Medicine (Baltimore) 2016; 95:e5276. [PMID: 27858895 PMCID: PMC5591143 DOI: 10.1097/md.0000000000005276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Primary breast angiosarcoma with spontaneous intratumoral bleeding associating with Kasabach-Merritt Syndrome is rarely reported. CASE FINDINGS/PATIENT CONCERNS We herein present such a case in a 30-year-old pregnant woman who was initially diagnosed to hemangioma at her early gestation. However, the sudden rapid tumor growth was aware of the attention and intended for receiving the breast enhanced magnetic resonance imaging. DIAGNOSES AND INTERVENTIONS The dynamic MRI enhancement showed inhomogenous enhancement at the periphery of the lobulated tumor on both early and delayed scans, otherwise a large hematoma was revealed at the center. Surgical resection was performed after baby delivery by Caeserean section, and histopathologic study confirmed breast angiosarcoma. CONCLUSION Despite its rarity, clinicians should recognize the association of breast angiosacroma with Kasabach-Merritt Syndrome with suggestive finding of enhanced MRI in order to decide the surgical approach.
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Affiliation(s)
- Wei-Ming Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi
- Medical College of Chang Gung University, Taiwan
| | - Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou
- Medical College of Chang Gung University, Taiwan
| | - Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung
- Medical College of Chang Gung University, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology
- Medical College of Chang Gung University, Taiwan
| | - Yung-Feng Lo
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Medical College of Chang Gung University, Taiwan
| | - Yun-Chung Cheung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou
- Medical College of Chang Gung University, Taiwan
- Correspondence: Yun-Chung Cheung, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Gueishan, Taoyuan, Taiwan. (e-mail: )
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Meng J, Kang Y, Cheng H, Gu Y, Zhang X, Wang S. Misdiagnosed ovarian Krukenberg tumor during pregnancy with virilization. EUR J GYNAECOL ONCOL 2016; 37:587-590. [PMID: 29894093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Krukenberg tumor with pregnancy is rare but it is a challenge for treatment and diagnosis. The authors report a case of a 29-week pregnant patient with a massive bilateral Krukenberg tumor which was misdiagnosed as myoma preoperatively and as ovarian stromal tumor intraoperatively. Prenatally the woman was asymptomatic except for preeclamptic symptoms, but red acne on the skin and elevated testosterone were observed. Pelvic ultrasound detected a heterogeneous solid mass mimicking a subserous myoma. The deterioration of preeclampsia prompted a cesarean section, but the neonate died nine days after he was born. A bilateral adnexal mass was found and considered as stromal tumor by frozen section because of luteinization of the stroma. The final pathology showed low differentiation adenocarcinoma of ovary, which was confirmed by gastric biopsies. The patient had undergone chemotherapy 16 times without surgical debulking and she was in generally well 1.5-year follow-up.
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Yamaguchi R, Kohga H, Tosaka M, Sekine A, Mizushima K, Harigaya Y, Yoshimoto Y. A Case of Optic Neuritis Concomitant with Pituitary Tumor During Pregnancy. World Neurosurg 2016; 93:488.e1-4. [PMID: 27373939 DOI: 10.1016/j.wneu.2016.06.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Optic neuritis (ON) is unilateral painful optic nerve inflammation in a young healthy female diagnosed by excluding glaucoma. ON onset during pregnancy is rare, with only 2 cases reported to date. CASE DESCRIPTION A 35-year-old previously healthy parous woman who was pregnant with her second child suffered rapidly progressive visual acuity loss. Magnetic resonance imaging (MRI) revealed a pituitary tumor. Emergency surgery was performed for optic nerve compression; however, her visual impairment worsened. Postoperative diffusion-weighted MRI showed high intensity in the bilateral optic nerves, and ON was diagnosed. Administration of methylprednisolone was effective, and her visual acuity recovered over 6 months. CONCLUSIONS Associated pituitary macroadenoma complicated the true diagnosis of ON, because contrast medium cannot be used in pregnant women. The diffusion-weighted MRI findings were useful for diagnosing this complex clinical condition.
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Affiliation(s)
- Rei Yamaguchi
- Department of Neurosurgery, General Fujioka Hospital, Fujioka, Gunma, Japan; Department of Neurosurgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan.
| | - Hideaki Kohga
- Department of Neurosurgery, General Fujioka Hospital, Fujioka, Gunma, Japan
| | - Masahiko Tosaka
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akiko Sekine
- Department of Neurology, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kazuyuki Mizushima
- Department of Neurology, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Yasuo Harigaya
- Department of Neurology, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Yuhei Yoshimoto
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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50
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Tariq N, Ghazali U, Uddin Z, Rasheed K, Tariq H. Complete Hydatidiform Mole Coexisting with Three Viable Fetuses in a Quadruplet Pregnancy. J Coll Physicians Surg Pak 2016; 26:326-328. [PMID: 27097708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 09/21/2015] [Indexed: 06/05/2023]
Abstract
We hereby report a case of quadruplet pregnancy with delivery of 3 viable infants and a complete mole. This was an induced conception with clomiphene citrate. At 22 weeks, cystic structures were noticed in one of the placentae and a suspicion of co-existant molar pregnancy was made. The case discussed with oncologist and pregnancy was continued with close monitoring of &beta;-hCG and Ultrasound. Her &beta;-hCG at 23 weeks was 748 mIU/ml, which continued to rise until the 29th week of gestation to a level of 305881.68 mIU/ml and declined gradually thereafter. Similarly, hydropic change in placenta also continued to increase progressively. She was given steroid cover at 32 weeks and delivery was aimed at 34 weeks of gestation. The patient went into preterm labour at 33 weeks and 3 female infants delivered by lower segment cesarean section (LSCS) followed by removal of 3 placentae along with copious molar tissue at the end. The newborns were kept in the nursery, non-requiring assisted ventilation and discharged in satisfactory condition. The histopathologyand immunohistochemistry confirmed the diagnosis of a quadruplet pregnancy comprising of one complete mole with 3 normal placentae.
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Affiliation(s)
- Nabia Tariq
- Department of Obstetrics and Gynaecology, Shifa International Hospital, Islamabad
| | - Usman Ghazali
- Medical Student, Shifa College of Medicine, Shifa International Hospital, Islamabad
| | - Zeeshan Uddin
- Department of Pathology, Shifa College of Medicine, Shifa International Hospital, Islamabad
| | - Kamran Rasheed
- Department of Oncology, Shifa College of Medicine, Shifa International Hospital, Islamabad
| | - Hina Tariq
- Department of Pathology, Shifa College of Medicine, Shifa International Hospital, Islamabad
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