Outcomes in pregnant women with leukemia and their offsprings / 中华围产医学杂志

Objective:To analyze the maternal and neonatal outcomes of pregnant women with leukemia.Methods:This retrospective study analyzed the clinical data of singleton pregnant women with leukemia and their neonates at the Obstetrics Department of Peking University People's Hospital from June 2009 to May 2021. Statistical analysis was performed using a two-sample t-test, the Wilcoxon Mann-Whitney rank sum test, and the Chi-square test (or Fisher's exact test). Results:(1) Ninety-one pregnant women were enrolled in this study, accounting for 2.8‰ of all deliveries during the same period. Among them, there were 15 (16.5%) with acute lymphoblastic leukemia, 38 (41.8%) with acute myeloid leukemia, and 38 (41.8%) with chronic myelogenous leukemia. Twenty-nine of the 91 pregnancies (31.9%) were terminated in the second or third trimester, and 62 babies (68.1%) were born through spontaneous delivery or cesarean section. The 62 parturients were (30.1±5.0) years old, of whom two died of complications of leukemia within 7 d after delivery, and five were transferred to the intensive care unit after delivery. Of the 62 cases, 18 (29.0%) received a blood transfusion and 12 (19.3%) received chemotherapy during pregnancy. (2) The proportion of patients with unremitted leukemia during pregnancy or newly developed leukemia was higher in women with terminated pregnancy than in those who continued the pregnancy [96.6% (28/29) vs 54.8% (34/62), χ2=15.83, P<0.001]. (3) The gestational age of the 62 newborns was (37.7±2.7) weeks. Premature, low birth weight and small-for-gestational-age infants accounted for 29.0% (18/62), 25.8% (16/62), and 12.9% (8/62), respectively. Hyperbilirubinemia occurred in 10 neonates (16.1%) and hypoglycemia in two (3.2%). Perinatal anoxia and asphyxia were reported in 13 cases (21.0%). Appearance, organ malformations, or chromosomal abnormalities were found in four neonates (6.4%) whose mothers did not receive chemotherapy during pregnancy. Fifty-nine infants underwent routine blood tests within 3 d after birth. The results showed that the mean white blood cell count, hemoglobin concentration, and platelet count were (16.1±7.0)×10 9/L, (181.5±20.0) g/L and (266.2±63.7)×10 9/L, respectively, and no juvenile cells were detected in their peripheral blood samples. Twenty children were followed up to 4 years and 4 months (9 months to 10 years and 3 months). No abnormalities in physical or mental development, motor function, or hematological system were reported. Conclusions:Pregnancy complicated by leukemia is rare and dangerous, which requires an individualized management strategy besides therapy for leukemia. A good prognosis is still expected with appropriate treatment.

Telemedicine in post-molar follow-up: is it a useful tool?

BACKGROUND: Telemonitoring is an alternative to in-person appointments and overcomes geographic distance barriers. OBJECTIVE: The primary objective of this study was to evaluate adherence to post-molar follow-up using both WhatsApp and in-person appointments compared with standard care. The secondary objective was to evaluate the rate of completion of post-molar follow-up of complete moles, considering 6 and 3 months of duration. METHODS: This retrospective cohort study was conducted at the Gestational Trophoblastic Disease Center, São Paulo Hospital. Patients with complete or partial mole treatment between January 1, 2009 and December 31, 2018 were included in two groups: group 1 (patients from 2009 to 2013) and group 2 (from 2014 to 2018), before and after telemonitoring implementation, respectively. Complete follow-up was considered if after the first normal human chorionic gonadotropin (hCG) level (<5 mIU/mL), the patient was followed up for an additional 30 days (partial mole) or 180 days (complete mole). Loss to post-molar follow-up with positive hCG was also evaluated. Statistical analysis was performed using Pearson's Χ2 test, 5% significance level (p=0.05), and R version 4.0.2. RESULTS: A total of 308 patients were included in the study, 92 of them were assessed in group 1 and 216 patients in group 2. There was no difference between the rates of complete follow-up after telemonitoring implementation (complete mole: 42/72=58.3% group 1 vs 85/163=52.1% group 2; p=0.38; partial mole: 16/20=80% group 1 vs 37/53=69.8 group 2; p=0.3), and no increase of loss to post-molar follow-up with positive hCG (8/92=8.7% group 1 vs 14/216=6.5% group 2; p=0.49). The shortening of follow-up of complete moles to 90 days increased the rate of complete post-molar follow-up (from 127/235=54.0% to 189/235=80.4%, p<0.001). CONCLUSIONS: The association of telemonitoring with in-person appointments could have had an advantage in post-molar follow-up since it did not reduce adherence to hormonal surveillance. Shortening post-molar follow-up after complete mole to 90 days after the first normal hCG level increased the rate of complete post-molar follow-up.

Postpartum pyomyoma: two cases report and literature review / 中华围产医学杂志

Objective:To investigate the clinical characteristics of postpartum pyomyoma.Methods:Clinical data of two patients with postpartum pyomyoma admitted to the Department of Obstetrics and Gynecology, Peking University First Hospital, between 2019 and 2020, were collected. Another 16 postpartum pyomyoma reported in China and foreign areas from 2000 to 2020 were reviewed.Results:Apart from three patients without reported gravidity and parity, 12 out of the remaining 15 patients were primiparous. The median maximum diameter of uterine fibroids in pregnancy was 10 cm (6-25 cm). Of the 18 patients, 12 had a history of intrauterine manipulation, 10 had anemia or severe postpartum hemorrhage, and four had other infections. All patients manifested as fever at first, and most were accompanied by abdominal pain. The onset time of 14 cases was within postpartum two weeks. CT, MRI, and ultrasound detection rate in diagnosing postpartum pyomyoma was 11/13, 3/6, and 1/8, respectively. Pus culture had the highest positive rate, with Escherichia coli as the most common pathogen. No death was reported, but 14 patients developed severe complications, including sepsis, septic shock, disseminated intravascular coagulation, rupture of pyomyoma, peritonitis, and incision infection. As failing in anti-infection medication, all patients received surgical treatment, which controlled infections. Three patients were conceived two years after the operation (16 months to two years). Conclusions:Pyomyoma should be considered once postpartum fever develops in patients complicated by uterine fibroids ≥10 cm in diameter during pregnancy, especially those with anemia, infection, or a history of intrauterine manipulation. Surgical treatment should be performed once pyomyoma is diagnosed.

Safety analysis of cesarean myomectomy in twin pregnancies with intramural myomas / 中华妇产科杂志

Objective:To estimate the safety of myomectomy in twin pregnant women with intramural myomas during cesarean section.Methods:The clinical data of 145 cases of twin pregnancies with intramural myomas who were delivered by cesarean section in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from June 2013 to December 2021 were collected. Maternal demographics, fibroids′ characteristics, maternal and fetal outcomes were compared between groups of cesarean section with myomectomy (myomectomy group, 49 cases) and cesarean section only (non-myomectomy group, 96 cases).Results:Compared with non-myomectomy group, myomectomy group had significantly prolonged operative time [50.0 minutes (37.5-57.5 minutes) vs 40.0 minutes (35.0-50.0 minutes), respectively; P=0.007] and significantly longer postoperative hospital stay [4.0 days (3.0-4.0 days) vs 3.0 days (3.0-4.0 days), respectively; P=0.047). Other maternal and fetal outcomes such as estimated blood loss, hemoglobin difference, postpartum hemorrhage, blood transfusion, B-Lynch structure, uterine artery ligation, postoperative fever and neonatal Apgar score showed no significant differences (all P>0.05). For intramural myomas <5 cm, there were no significant differences in maternal and fetal outcomes between myomectomy group and non-myomectomy group (all P>0.05). For intramural myomas ≥5 cm, operative time [55.0 minutes (40.0-60.0 minutes) vs 42.5 minutes (40.0-50.0 minutes), respectively; P=0.019] was significantly prolonged, postoperative hospital stay [4.0 days (4.0-5.0 days) vs 4.0 days (3.0-4.0 days), respectively; P=0.048] was significantly longer in myomectomy group than non-myomectomy group, but there were no significant differences in other maternal and fetal outcomes (all P>0.05). Conclusion:For twin pregnancies with intramural myomas, it is safe and feasible to remove intramural myomas during cesarean section by experienced obstetricians.

Leiomioma primario de páncreas en una gestante: presentación de caso / Primary pancreatic leimyoma in a pregnant woman: case report

RESUMEN Introducción: Los tumores pancreáticos en el embarazo son muy raros, el diagnóstico y tratamiento en este grupo de pacientes es complejo. Objetivo: Presentar el primer caso de un leiomioma primario del páncreas en una gestante. Caso clínico: Embarazada de 26 años de edad, sin antecedentes relevantes. Primigesta, que se encontraba cursando la semana 13 de gestación. Durante una evaluación ecográfica de rutina, se le detecta una tumoración en la glándula pancreática. Se remitió a la consulta multidisciplinaria de atención a la materna y en conjunto deciden realizar la interrupción voluntaria del embarazo. Luego la paciente fue remitida a la consulta de la especialidadde Cirugía General. Al recibir a la misma, se quejaba de dolor en epigastrio e hipocondrio izquierdo, además de hipo ocasional. Al examen físico se encontró una tumoración palpable en epigastrio. Se realizaron exámenes analíticos básicos sin encontrarse alteraciones, en los estudios de imagen realizados, ecografía abdominal y tomografía contrastada de abdomen se demostró una tumoración en el cuerpo y cola del páncreas. Se planificó tratamiento quirúrgico electivo, se realizó pancreatectomía distal con esplenectomía, por invasión del estómago, se complementó con gastrectomía subtotal. La paciente evoluciona sin complicaciones. La biopsia informó un tumor mesenquimal benigno primario de páncreas, tipo leiomioma, bien encapsulado. Conclusiones: Se presenta el primer caso de un leiomioma primario del páncreas en una gestante. Los tumores pancreáticos en embarazadas son enfemedades raras, el manejo por un equipo multidisciplinario es la mejor forma de obtener resultados satisfactorios para la paciente.

ABSTRACT Introduction: Pancreatic tumors during pregnancy are very rare, diagnosis and treatment are always difficult. Objective: To present the first case of a primary pancreatic leiomyoma in a pregnant woman. Case report: A 26 years old primiparous pregnant is reported, with no relevant backgrounds. She was in her first trimesters of pregnancy. Diagnosed with a pancreatic tumor during a routine evaluation. She was referred to a multidisciplinary consult, deciding the voluntary interruption of pregnancy, then she is evaluated by the General Surgery specialty clinic for complaining of epigastric pain and hiccup. On physical examination an epigastric tumor was found. Auxiliary exams were normal. Imagenologic studies confirm a tumor in the pancreatic body and tail. Surgical treatment was scheduled, distal pancreatectomy with splenectomy, due to invasion of gastric wall subtotal distal gastrectomy was performed. Patient evolution without complications. Biopsy reported a well capsulated, leiomyoma type, primary mesenchymal pancreatic tumor. Conclusions: The first case of a primary pancreatic leiomyoma in a pregnant woman is presented. Pancreatic tumors during pregnancy are rare. Multidisciplinary approach is the best way to improve results.

Transformación maligna de un teratoma maduro de ovario durante la gestación / Malignant transformation of an ovarian mature teratoma during pregnancy

RESUMEN El riesgo de cáncer de ovario a lo largo de la vida de una mujer es menor de 2 %, y durante la vida reproductiva es de 0,01 %. La incidencia de cáncer de ovario durante el embarazo es de 1: 10 000 - 100 000 casos. La mayoría de las masas anexiales en la gestación son asintomáticas. El diagnóstico se realiza frecuentemente mediante un hallazgo casual en la ecografía obstétrica; se ha estimado una incidencia de 0,2 - 2 %, y de estas, 1 - 6 % son malignas. El carcinoma epidermoide desarrollado en un teratoma quístico maduro es una rara neoplasia que representa, aproximadamente, el 2 % de los tumores primarios del ovario. Se presenta una paciente con diagnóstico accidental de teratoma ovárico maduro con diferenciación de carcinoma epidermoide, durante la realización de una cesárea.

ABSTRACT The risk of ovarian cancer throughout a woman's life is less than 2%, and during reproductive life it is 0.01%. The incidence of ovarian cancer during pregnancy is 1: 10,000 - 100,000 cases. Most adnexal masses in pregnancy are asymptomatic. Diagnosis is frequently made by casual finding on obstetric ultrasound; an incidence of 0.2 - 2% has been estimated, and 1 - 6% of them are malignant. Squamous cell carcinoma developed in a mature cystic teratoma is a rare neoplasm that represents approximately 2% of primary ovarian tumors. We present a patient with an accidental diagnosis of mature ovarian teratoma with differentiation of squamous cell carcinoma, during a cesarean section.

Manejo del cáncer de tiroides durante el embarazo / Management of thyroid cancer during pregnancy

RESUMEN El embarazo es una condición favorable para la formación y crecimiento del cáncer de tiroides, ya que el equilibrio de yodo puede ser negativo además de aumentar la producción de hormonas con actividad estimuladora de la tiroides. La mayoría de los cánceres encontrados durante el embarazo son cánceres de tiroides diferenciados con un pronóstico excelente. Aquellos casos diagnosticados durante el primer trimestre pueden ser extirpados por cirugía. La tiroidectomía puede realizarse de manera segura en el segundo trimestre del embarazo o retrasarse al periodo posparto, dependiendo de la edad gestacional. La paciente debe recibir levotiroxina en una dosis suficiente para mantener baja las concentraciones séricas de hormona tiroestimulante. La tiroglobulina sérica es un valioso método no invasivo para evaluar los efectos de este tratamiento. El objetivo de la revisión es establecer el manejo de cáncer de tiroides durante el embarazo.

ABSTRACT Pregnancy is a favorable condition for the formation and growth of thyroid cancer, since the iodine balance can be negative in addition to increasing the production of hormones with thyroid stimulating activity. Most of the cancers found during pregnancy are differentiated thyroid cancers with an excellent prognosis. Those cases diagnosed during the first trimester can be removed by surgery. Thyroidectomy can be safely performed in the second trimester of pregnancy or delayed to the postpartum period, depending on gestational age. The patient should receive levothyroxine at a dose sufficient to keep serum thyroid-stimulating hormone levels low. Serum thyroglobulin is a valuable noninvasive method for evaluating the effects of this treatment. The purpose of this review is to establish the management of thyroid cancer during pregnancy.

Leiomyomatosis peritonealis disseminata during pregnancy: a case report and literature review / 中华围产医学杂志

Objective:To review the clinical and pathological features, pathogenesis, and differential diagnosis of leiomyomatosis peritonealis disseminata (LPD) during pregnancy.Methods:We report the diagnosis and treatment of LPD in a pregnant woman admitted to Jiaozhou Central Hospital of Qingdao. We retrieved relevant literature from China and abroad to review the clinical characteristics and outcomes.Results:(1) Case report: The 33-year-old pregnant woman who had had previous cesarean sections was admitted at 37 +2 weeks gestation due to premature rupture of membranes 30 minutes before arriving at the hospital with a pelvic mass which was first diagnosed seven months earlier, in the first trimester. A lower segment cesarean section was performed, and the pelvic mass was removed on admission. No relapse was reported during the postoperative follow-up for 26 months. (2) Literature review: thirteen papers involving 15 cases, including the present case, were retrieved. The age at onset was 32 years old (19-47 years old); five of them had a history of myomectomy. Twelve cases had no significant symptoms, and the diagnosis was made at delivery or postpartum; the other three had noticeable features, mainly with abdominal pain. Six had obstetrical complications, including hypertensive disorders of pregnancy, premature rupture of membrane, abnormal fetal position, and oligohydramnios. Two cases had a history of assisted reproductive technology. Eleven cases delivered after 32 gestational weeks, three before 28 weeks, one aborted at ten gestational weeks due to severe complications. Twelve had cesarean section and myomectomy and the uterus and appendages were preserved. Three cases had a cesarean hysterectomy and two of them also had bilateral salpingo-oophorectomy. The pathological manifestations of seven cases were extensive and massively distributed small fibroids, similar to malignant tumor infiltration, with the diameter of 0.5 to 1.0 cm; five cases had multiple large fibroids, accompanied by scattered small fibroids. Conclusion:LPD during pregnancy is rare, and usually benign, with no obvious clinical symptoms. LPD is more likely to be misdiagnosed as a malignant tumor before the operation, and the diagnosis is usually confirmed by postoperative histopathology. A common surgical strategy is a cesarean section combined with pelvic mass resection.

Câncer durante a gravidez: análise dos casos com ênfase nos resultados obstétricos e neonatais / Cáncer durante el embarazo: análisis de casos con énfasis sobre resultados obstétricos y neonatales / Cancer during pregnancy: analysis of cases with emphasis on obstetric and neonatal results

Objetivos: Conhecer as interferências do câncer no processo gestacional e seu desfecho, identificar as neoplasias mais frequentemente diagnosticadas em mulheres no período reprodutivo. Métodos: Foram coletadas, informações dos prontuários de mulheres que vivenciaram o câncer, durante a gestação, no período de 2011 a 2018, acompanhadas em um hospital de referência. Resultados: Os cânceres mais prevalentes, durante a gestação foram: mama, colo do útero, leucemia e linfoma, 64,29% das grávidas estavam no segundo trimestre. A faixa etária foi de 27 a 44 anos, 80% receberam quimioterapia, 73,68% apresentaram complicações na gestação/puerpério, 42,11% das mulheres foram a óbito. Observaram-se 70,59% recém-nascidos pré-termo, 56,25% baixo peso, ocorrência de dois abortos espontâneos e um natimorto. Conclusão: Neoplasias associadas à gravidez têm aumentando em incidência e, contribuindo para a mortalidade indireta na gravidez e no pós-parto. Desca-se a abordagem multidisciplinar, centrada no bem-estar maternofetal, além de incluir a mulher e a família no processo(AU)

Objectives: To know how cancer interferes with pregnancy , to identify the most frequently diagnosed neoplasms in women in the reproductive period. Methods: Information was collected from the medical records of women who experienced cancer during pregnancy, from 2011 to 2018, and were treated at a reference hospital. Results: The most prevalent cancers during pregnancy were breast, cervix, leukemia and lymphoma. 64.29% of pregnant women were in the second trimester. The age range was between 27 and 44 years. 80% of these weomen received chemotherapy, 73.68% had complications during pregnancy / postpartum, and 42.11% died. There were 70.59% preterm newborns, 56.25% underweight, two spontaneous abortions and one stillbirth. Conclusion: The incidence of neoplasms associated with pregnancy have increased and contributed to indirect mortality in pregnancy and postpartum. The multidisciplinary approach is centeredon mother-fetus well-being, in addition to including women and family in the process(AU)

Objetivos: Conocer las interferencias del cáncer en el proceso gestacional y su desenlace, identificar las neoplasias más frecuentemente diagnosticadas en mujeres en período reproductivo. Métodos: Se recopiló información de las historias clínicas de mujeres que experimentaron cáncer durante el embarazo, de 2011 a 2018, acompañadas en un hospital de referencia. Resultados: Los cánceres más prevalentes durante el embarazo fueron: mama, cérvix, leucemia y linfoma, el 64,29% de las gestantes estaban en el segundo trimestre. El rango de edad fue de 27 a 44 años, el 80% recibió quimioterapia, el 73,68% presentó complicaciones durante el embarazo/puerperio, fallecieron el 42,11% de las mujeres. Hubo 70,59% de recién nacidos prematuros, 56,25% de bajo peso, dos abortos espontáneos y un mortinato. Conclusión: Las neoplasias asociadas al embarazo han aumentado en incidencia, contribuyendo a la mortalidad indirecta en el embarazo y posparto. El enfóque se centra en el punto de vista multidisciplinario, dirigido al bienestar materno-fetal, además de incluir a la mujer y la familia en el proceso(AU)

Melanoma y embarazo / Melanoma and pregnancy

RESUMEN El melanoma cutáneo es un tumor maligno que deriva de los melanocitos. Es el segundo cáncer en orden de frecuencia en mujeres de edad fértil, y por consiguiente, representa uno de los tipos de cáncer más frecuentes diagnosticados durante el embarazo. Se presentó una paciente embarazada de 32,5 semanas de edad gestacional, con cambios clínicos a nivel de un nevo preexistente. Se realizaron una dermatoscopia, la exéresis y la biopsia de la lesión, con diagnóstico histopatológico de melanoma maligno melanocítico nodular.

ABSTRACT Cutaneous melanoma is a malignant tumor derived from melanocytes. It is the second cancer in order of frequency in women of childbearing age, and therefore represents one of the most frequent types of cancer diagnosed during pregnancy. We present a 32.5-week gestational age pregnant patient with clinical changes at the level of a pre-existing nevus. A dermoscopy, exeresis, and biopsy of the lesion were performed, with histopathological diagnosis of nodular melanocytic malignant melanoma.

Câncer do colo do útero na gravidez / Cancer of the cervix in pregnancy

O câncer do colo do útero é o câncer mais comum na gravidez, com uma estimativa de 1 a 12 casos por 10.000 gestações. Com a melhora do rastreio do câncer do colo do útero e uma tendência feminina de engravidar em idade mais avançada, observa-se que cerca de 43% das pacientes diagnosticadas com câncer do colo do útero têm menos de 45 anos e 20% a 28% são menores de 40 anos. O diagnóstico e o tratamento da doença na gravidez são difíceis e desafiadores, pois geram angústia para a gestante, sua família e os profissionais de saúde. Novos estudos destacam que a preservação da fertilidade e a qualidade de vida estão se tornando preocupações cada vez mais importantes de mulheres jovens com câncer e que os procedimentos cirúrgicos devem ser menos invasivos. O comitê de oncologia da FIGO revisou o sistema de estadiamento do câncer do colo do útero. Este artigo discute o diagnóstico e tratamento do câncer do colo do útero com base no estágio da doença, incluindo atenção a questões de fertilidade e qualidade de vida.(AU)

Cervical cancer is the most common cancer in pregnancy, with an estimated 1-12 cases per 10,000 pregnancies. With improved cervical cancer screening and a tendency to become pregnant at a later age, it is noted that about 43% of patients diagnosed with cervical cancer are younger than 45 and 20-28% are younger than 40 years. Diagnosis and treatment of the disease in pregnancy are difficult and challenging, as they create distress for pregnant women, their families and health professionals. New studies highlight that preserving fertility and quality of life are becoming increasingly important concerns for young women with cancer and that surgical procedures should be less invasive. The FIGO oncology committee reviewed the staging system for cervical cancer. This article discusses the diagnosis and treatment of cervical cancer based on the stage of the disease, including attention to issues of fertility and quality of life.(AU)

Maternal and infant outcomes after elective neurosurgery for occupying lesions in saddle area during pregnancy / 中华围产医学杂志

Objective To investigate the perinatal outcomes after elective neurosurgery in pregnant women complicated by space-occupying lesions in saddle area.Methods Clinical data were retrospectively collected and analyzed from five gravidas with space-occupying lesions in saddle area,who underwent neurosurgery at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to February 2018,including gestational age,perioperative management,surgical procedures,postoperative complications,pregnancy outcomes and pathological results.Results (1) Progressively deteriorated impaired vision was the chief complaint of all five patients.Space-occupying lesions in saddle area were detected by cranial MRI (plain scan).The surgical indication was clear as there was compression on optic nerve and a risk of blindness due to optic nerve atrophy,Two patients were operated in the third trimester and three in the second trimester.Postoperative pathology showed there were two cases with meningioma,two with pituitary macro adenoma and one with abscess of pituitary.Only one patient had mild postoperative cerebrospinal fluid rhinorrhea,which was improved three months later,and no complications were reported in the other four cases.All five patients had obvious improvement of vision after surgical intervention and no relapse was reported during a follow-up of 4-12 months.(2) Four gravidas continued their pregnancies to full or nearly full term,among which three underwent cesarean section due to obstetrical indications (one breech pregnancy,one twin pregnancy with scarred uterus and one complicated by hypertensive diseases of pregnancy with poor blood pressure control) and one delivered vaginally.Postpartum involution of the uterus was well in all of the four cases 42 d after delivery.The women with pituitary abscess terminated the pregnancy due to intraamniotic injection of ethacridine lactate at 20 weeks of gestation.Five neonates were all born with Apgar scores of 10 at 1,5 and 10 min without any visible defects at birth and all grew and developed normally at 4-12 months after birth.Conclusions For gravidas with space-occupying lesions in saddle area,it is necessary to weigh the pros and cons and choose an individualized treatment plan.Resection of saddle area lesions in the second or third trimester backed by a multidisciplinary team is a safe and feasible procedure if postponing the operation until delivery may cause irreversible or even life-threatening consequences.

[Pregnancy after Breast Cancer: State of the Art]. / Gravidez após o Cancro da Mama: Estado da Arte.

Breast cancer survivors have given rise to several issues of major relevance from a clinical and scientific point of view. In fact, breast cancer is the most prevalent malignancy in women of reproductive age. The effect of pregnancy on overall survival and in the recurrence after treatment of breast cancer, as well as the questions related to heredity continue to be matter of the highest timeliness and scientific interest. Most recent studies seem to agree in admitting that pregnancy after breast cancer appears to be potentially safe to both the women and her offspring, although this issue remains complex. Heredity and genetics seem to play an important role in this subject, but the conclusions lack absolute and unequivocal consistency. There is a need for meta-analysis, cohort and case-control studies, translational and prospective studies extended in time, in order to obtain greater safety in the establishment of strategies and guidelines for clinicians and adequate objective information for young breast cancer patients.

As sobreviventes de cancro da mama têm originado um conjunto de questões da maior relevância sob o ponto de vista clínico e científico. De facto, o cancro da mama é a neoplasia mais prevalente em mulheres em idade reprodutiva. O efeito da gravidez na sobrevida global e na recorrência após tratamento de cancro da mama, bem como as questões relacionadas com a hereditariedade continuam a ser matéria da maior atualidade e do mais elevado interesse científico. Os estudos mais recentes são consensuais em admitir que a gravidez após o cancro da mama é potencialmente segura para a doente e sua descendência, embora a questão permaneça complexa. A hereditariedade e a genética parecem desempenhar um papel importante nesta temática mas, também aqui, as conclusões carecem de absoluta e inequívoca consistência. Verifica-se a necessidade de meta-análises, estudos coorte e caso-controlo, translacionais e prospetivos, alargados e prolongados no tempo, no sentido de obter uma maior segurança no estabelecimento de estratégias e linhas de orientação para os clínicos e informação adequada e objetiva para as jovens doentes com cancro da mama.

Current management of pregnancy-associated breast cancer.

Pregnancy-associated breast cancer is the most common malignancy during pregnancy with an expected rise in incidence. The belief in the need for termination of pregnancy and that chemotherapy is contra-indicated during pregnancy is challenged by recent evidence. Patients can consider breast-conserving surgery and sentinel lymph node biopsy with acceptably low fetal risk from radiation exposure. A range of chemotherapeutics is possible in the second trimester in terms of drug class and frequency. Hormonal therapy and monoclonal antibody therapy are contra-indicated during pregnancy and lactation. Fetal outcome after in-utero exposure to chemotherapy appears similar to that in a non-pregnant population. Future pregnancy, in most situations, does not appear to be contra-indicated but a multidisciplinary and patient-centred approach is recommended. Fertility preservation techniques are also being developed with reported success and consequent pregnancies.

Magnetic resonance imaging for pelvic tumors during pregnancy: manifestations and clinical application / 中华围产医学杂志

Objective To investigate the manifestations and clinical application of magnetic resonance imaging (MRI) in the diagnosis of pelvic tumors during pregnancy.Methods Clinical data and MRI manifestations of 161 patients attending Women's Hospital,School of Medicine,Zhejiang University with pelvic tumors during pregnancy between March 2013 and July 2016 were retrospectively analyzed.MRI manifestations and clinical treatments of different tumors in pregnancy were summarized.All data were analyzed by descriptive statistics.Results (1) The gestational ages at initial diagnosis of the 161 patients ranged between 8-39 weeks and the average gestational age was (29±-4) weeks.Of all patients,147 (91.3％) had benign tumor,while the other 14(8.7％) were diagnosed as malignanices.The sensitivity,specificity and accuracy of MRI in the diagnosis of malignancy during pregnancy were 92.8％ (13/14),97.3％ (143/147) and 96.7％ (156/161).Uterine neoplasm,ovarian tumor,intestinal tumor and pelvic peripheral nerve schwannoma respectively accounted for 67.1％ (108/161),29.8％ (48/161),1.9％ (3/161) and 1.2％ (2/161) of all cases.(2) Among the 108 gravidas with uterine neoplasm,104 cases of leiomyoma continued to term pregnancy,among which 71 underwent myomectomy after vaginal delivery and 33 had myomectomy during cesarean section;the other four cases of cervical cancer terminated their pregnancy.(3) Among the 48 gravidas with ovarian tumor,38 were diagnosed as having benign tumor by MRI and continued to term pregnancy;five were diagnosed with tumor pedicle torsion and treated with emergency operation because of acute abdominal disease;two patients who were both in their second trimester (16 and 20 gestational weeks) were diagnosed with ovarian cancer complicated with peritoneal metastasis by MRI and decided to terminate pregnancy;another two patients with uncertain preoperative diagnosis of ovarian cancer were followed up closely to term and the tumor was removed during cesarean section;one patient with ovarian malignant tumor,which was diagnosed by MRI at the 32nd gestational week,received cesarean section and cytoreductive surgery.(4) In the three gravidas with intestinal tumor,one was complicated with sigmoid colon cancer and underwent cesarean section,radical resection of sigmoid colon tumor,colostomy and enterodialysis at 28+3 weeks of gestation;one with appendiceal mucinous adenocarcinoma was monitored closely until full-term pregnancy and received right hemicolectomy during cesarean section;the third case with malignant stromal tumor of the small intestine underwent cesarean section at 30+5 weeks of gestation as well as the completer resection of tumor.(5) One gravida with pelvic peripheral nerve schwannomas was diagnosed with pelvic schwannoma and underwent cesarean section and tumor extirpation at term.The other one underwent tumor extirpation prior to delivery due to the larger size of tumor and had a vaginal delivery at term.Conclusions MRI can provide more precise information for prenatal diagnosis of pelvic tumors during pregnancy.

Carcinoma renal cromófobo: uma causa rara de hipertensão na gravidez / Chromophobe renal cell carcinoma: a rare cause of hypertension in pregnancy

O carcinoma de células renais, em particular o tipo cromófobo, é uma patologia rara na idade fértil, o que explica a pouca informação disponível na literatura. Os autores apresentam o caso de uma mulher de 37 anos, multípara, com hipertensão arterial de novo, de difícil controle e hematúria às 10 semanas de gravidez, tendo o estudo etiológico do quadro hipertensivo demostrado a existência de um tumor renal. Às 17 semanas de gravidez, a doente foi submetida à nefrectomia esquerda, tendo a cirurgia decorrido sem intercorrências. A histologia demostrou tratar-se de um carcinoma do subtipo cromófobo. O restante da gravidez decorreu sem complicações, com perfil tensional controlado, com um parto vaginal de termo com um recém-nascido saudável.

Renal cell carcinoma, particularly the chromophobe type, is a rare pathology in childbearing age, and consequently, in literature, few cases during pregnancy have been reported. The authors present the case of a 37-year-old, multiparous woman, with de novo high blood pressure of difficult control, and hematuria at 10-week gestation. The etiological study of the hypertensive disorder has demonstrated the existence of a renal tumor. The patient underwent left radical nephrectomy at 17-week gestation. Histology was compatible with chromophobe subtype renal cell carcinoma. The remaining pregnancy period progressed with no complications, with controlled tension profile, and resulted in spontaneous vaginal delivery of a healthy infant at term.

Conducta anestésica integral en embarazo pretérmino y tumor de ovario recidivante / Integral anesthetic behavior in preterm pregnancy and ovarian tumor

Fundamento: la anestesia obstétrica constituye un reto para el anestesiólogo y más cuando se producen comorbilidades que complejizan el manejo habitual. Objetivo: exponer la conducta anestésica integral que se realizó en una paciente con embarazo pretérmino, tumor de ovario y antecedentes de tromboembolismo pulmonar. Caso clínico: se presentó la conducta anestésica con anestesia peridural, manejo de la posición por la concurrencia de dos tumoraciones, el uso de heparina preoperatoria y la conducta del apoyo a la ventilación. Conclusiones: la discusión y seguimiento multidisciplinario de las pacientes con embarazo pretérmino y tumor de ovario, es fundamental para el logro de un resultado satisfactorio al tener que enfrentar numerosas comorbilidades.

Background: obstetric anesthesia represents a challenge to the anesthesiologist, and even more when comorbidities which complicate the regular conduct occur. Objective: to state the integral anesthetic actions carried out in a patient with preterm pregnancy, ovarian tumor, and a history of pulmonary thromboembolism. Clinical case: anesthetic actions are presented in the patient with epidural anesthesia, position management because of the concurrence of two tumors, the preoperative use of heparin, and ventilation support management. Conclusions: the discussion and multidisciplinary monitoring of these patients is critical in order to achieve a successful outcome when facing numerous comorbidities.

Diagnosis and treatment of breast cancer during pregnancy: a review of twelve cases / 中华围产医学杂志

Objective To investigate the principles of diagnosis and treatment of breast cancer during pregnancy.Methods Clinical data of twelve patients with breast cancer during pregnancy admitted to Peking Union Medical College Hospital between January 1995 and October 2015 were analyzed retrospectively.Follow-up studies on the prognosis of the mothers and infants and the long-term survival were carried out,and data were analyzed with descriptive statistical analysis.Results Of these twelve patients,eleven were diagnosed with breast cancer preliminarily by ultrasound.In the remaining one who presented with paraneoplastic neurological syndrome,breast tumor was discovered by the whole-body positron emission tomography/computed tomography (PET-CT) examination after emergent cesarean section.The mean gestational age at ultrasonic diagnosis in the eleven patients was (26.3 ±3.0) weeks,and all of them received surgical treatment during pregnancy.The mean gestational age at surgery was (28.2±4.4) weeks.Ten patients with epithelial tumor underwent modified radical mastectomy.One patient with breast malignant phyllodes tumor received local extended lumpectomy.Postoperative pathological staging revealed one patient with stage Ⅰ a,two with stage Ⅱ a,one with stage Ⅱ b,six with stage Ⅲ a,and one with stage Ⅲ b.The patient with paraneoplastic neurological syndrome was diagnosed as having stage Ⅳ breast cancer,and received chemotherapy,radiotherapy and endocrinotherapy.One patient received chemotherapy during pregnancy.None of the patients received radiotherapy during pregnancy.All twelve patients,except one with breast malignant phyllodes tumor,received postpartum adjuvant therapy.All patients were followed up regularly.Five patients were followed up for more than five years,the progressionfree survival rate was 4/5 and the overall survival was 5/5.The other seven patients were followed up for less than five years,the progression-free survival rate was 6/7 and the overall survival was 7/7.Eleven of the twelve patients had live birth.Eleven cases received cesarean section at (36.5±2.8) gestational weeks,and the other one had mid-trimester induction of labor at 27 gestational weeks.Of four premature infants,three were sent to neonatal intensive care unit because of neonatal respiratory distress syndrome,and one died of intracranial hemorrhage.The prognosis of the ten survived infants was good.Conclusions Breast cancer is one of the most common malignant tumors during pregnancy,and it often presents in more advanced stages compared with that in non pregnant women.Multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary.