Counseling and surveillance of obstetrical risks for female childhood, adolescent, and young adult cancer survivors: recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group.

Female childhood, adolescent, and young adult cancer survivors have an increased risk of adverse pregnancy outcomes related to their cancer- or treatment-associated sequelae. Optimal care for childhood, adolescent, and young adult cancer survivors can be facilitated by clinical practice guidelines that identify specific adverse pregnancy outcomes and the clinical characteristics of at-risk subgroups. However, national guidelines are scarce and vary in content. Here, the International Late Effects of Childhood Cancer Guideline Harmonization Group offers recommendations for the counseling and surveillance of obstetrical risks of childhood, adolescent, and young adult survivors. A systematic literature search in MEDLINE database (through PubMed) to identify all available evidence published between January 1990 and December 2018. Published articles on pregnancy and perinatal or congenital risks in female cancer survivors were screened for eligibility. Study designs with a sample size larger than 40 pregnancies in childhood, adolescent, and young adult cancer survivors (diagnosed before the age of 25 years, not pregnant at that time) were eligible. This guideline from the International Late Effects of Childhood Cancer Guideline Harmonization Group systematically appraised the quality of available evidence for adverse obstetrical outcomes in childhood, adolescent, and young adult cancer survivors using Grading of Recommendations Assessment, Development, and Evaluation methodology and formulated recommendations to enhance evidence-based obstetrical care and preconception counseling of female childhood, adolescent, and young adult cancer survivors. Healthcare providers should discuss the risk of adverse obstetrical outcomes based on cancer treatment exposures with all female childhood, adolescent, and young adult cancer survivors of reproductive age, before conception. Healthcare providers should be aware that there is no evidence to support an increased risk of giving birth to a child with congenital anomalies (high-quality evidence). Survivors treated with radiotherapy to volumes exposing the uterus and their healthcare providers should be aware of the risk of adverse obstetrical outcomes such as miscarriage (moderate-quality evidence), premature birth (high-quality evidence), and low birthweight (high-quality evidence); therefore, high-risk obstetrical surveillance is recommended. Cardiomyopathy surveillance is reasonable before pregnancy or in the first trimester for all female survivors treated with anthracyclines and chest radiation. Female cancer survivors have increased risks of premature delivery and low birthweight associated with radiotherapy targeting the lower body and thereby exposing the uterus, which warrant high-risk pregnancy surveillance.

The effect of chorionic villus sampling on the fraction of cell-free fetal DNA in maternal plasma.

OBJECTIVE: This study aims to assess whether the fraction of cell-free fetal DNA (cffDNA) is different at 24 h or 7 days after chorionic villus sampling (CVS), compared to subjects that do not undergo CVS. METHODS: Pregnant women undergoing CVS for genetic testing and matched subjects undergoing first trimester combined screening alone were enrolled between 11(0/7) and 13(6/7) weeks gestation. The fractions of cffDNA were compared before the procedure, 24 h after and 7 days after between CVS patients and ultrasound-only patients. RESULTS: Forty-five women underwent CVS and 45 had ultrasound alone. The women undergoing CVS were, on average, older (36.8 years versus 28.5 years, p=0.001) and had a higher baseline fraction of cffDNA than women in the comparison group (11.4% versus 9.8%, p=0.033). Both groups had a decrease in the mean fraction of cffDNA after 24 h. After 7 days, the trend of the mean fraction of cffDNA continued to decline in the CVS group but began to trend toward an increase in the ultrasound only group. CONCLUSIONS: CVS does not significantly increase the fraction of cell free fetal (placental) DNA in the maternal plasma. A downward trend in cffDNA in maternal plasma is seen at 24 h and 7 days following CVS compared to baseline.

Metastatic ovarian serous carcinoma presenting as inflammatory breast cancer: a case report.

A 42-year-old woman presented with localized irritation, erythema and sharp pain in the one breast. After unsuccessful treatment for mastitis, an oncology consultation was obtained. A breast biopsy revealed an invasive carcinoma and a diagnosis of inflammatory breast cancer was made. The patient was treated with neo-adjuvant chemotherapy and subsequently underwent bilateral mastectomy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was also performed at the same time due to the presence of a pelvic mass. Morphologic and immunohistochemical examination of the specimens helped to clarify the correct diagnosis of primary ovarian carcinoma with widespread metastases to bilateral breasts.

Avoiding treatment of leiomyosarcomas: the role of magnetic resonance in focused ultrasound surgery.

OBJECTIVE: To report early diagnosis of a uterine leiomyosarcoma during screening for magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) for leiomyomas. DESIGN: Case report. SETTING: University hospital conducting an institutional review board-approved clinical trial. PATIENT(S): A 47-year-old premenopausal woman with presumed symptomatic leiomyomas for 5 years and minimal interval growth. INTERVENTION(S): Magnetic resonance imaging screening protocol used as a routine part of MRgFUS treatment protocol. MAIN OUTCOME MEASURE(S): Surgical pathology report. RESULT(S): The diagnosis of leiomyosarcoma was suspected at the time of screening, and inadvertent treatment of a leiomyosarcoma was avoided. The patient underwent hysterectomy performed by her referring physician and confirmed the diagnosis of leiomyosarcoma. CONCLUSION(S): The possibility of inadvertent treatment of malignant disease and thus delayed diagnosis exists with all non-excisional therapies for uterine leiomyomas. The pretreatment imaging before MRgFUS in this case led to an expedited diagnosis of malignancy. Although this did not lead to a change in prognosis for this patient, careful review of magnetic resonance imaging before MRgFUS may allow early diagnosis for uterine malignancies.