Primary hyperparathyroidism in pregnancy: a case report highlighting uncommon complication.

Primary hyperparathyroidism (PHPT) is characterized by elevated levels of calcium and parathyroid hormone (PTH). However, the interpretation of diagnostic tests, such as serum calcium and PTH levels, is complex in pregnant women. The aim of this report is to present a case of PHTP in a pregnant adolescent, with a special emphasis on an uncommon complication, as well as diagnostic and treatment strategies. A 17-year-old pregnant female presented with hyperemesis gravidarum and neurological symptoms, leading to the diagnosis of cerebral venous thrombosis. Further investigations revealed hypercalcemia and persistently elevated PTH levels, consistent with PHPT. After localization studies, the patient underwent an emergency parathyroidectomy with a diagnosis of parathyroid adenoma. During follow-up, intrauterine growth restriction and severe preeclampsia developed, necessitating an emergency cesarean section. Both the mother and neonate had favorable outcomes. PHPT is an infrequent condition in the pregnant population, and its diagnosis can be challenging due to the overlap of symptoms with normal physiological changes during pregnancy. The occurrence of uncommon complications, such as thrombotic phenomena, highlights the need for a comprehensive approach to ensure early detection and management. In most cases, parathyroidectomy is the treatment of choice.

El hiperparatiroidismo primario (HPTP) se caracteriza por niveles elevados de calcio y hormona paratiroidea (PTH). Sin embargo, la interpretación de pruebas diagnósticas, como los niveles de calcio sérico y PTH, es compleja en mujeres embarazadas. El objetivo de este reporte es presentar un caso de HPTP en una adolescente embarazada, con especial hincapié en una complicación infrecuente, así como en las estrategias diagnósticas y de tratamiento. Una mujer embarazada de 17 años presentó hiperémesis gravídica y síntomas neurológicos, lo que llevó al diagnóstico de trombosis venosa cerebral. Posteriores investigaciones revelaron hipercalcemia y niveles persistentemente elevados de PTH, consistentes con HPTP. Tras la realización de estudios de localización, la paciente fue sometida a una paratiroidectomía de emergencia con diagnóstico de adenoma de paratiroides. Durante el seguimiento, se desarrolló restricción del crecimiento intrauterino y preeclampsia grave, lo que resultó en la necesidad de realizar una cesárea de emergencia. Tanto la madre como el neonato evolucionaron favorablemente. El HPTP es una condición infrecuente en la población embarazada y su diagnóstico puede ser desafiante por la superposición de síntomas con los cambios fisiológicos normales del embarazo. La aparición de complicaciones infrecuentes, como fenómenos trombóticos, resalta la necesidad de un abordaje integral para garantizar la detección y el manejo temprano. En la mayoría de los casos, la paratiroidectomía es el tratamiento de elección.

[Colorectal cancer in pregnancy. Case reports]. / Cáncer colorectal en el embarazo. Reportes de caso.

Colon rectal cancer (CRC) during pregnancy is a rare neoplasia, with an incidence between 0.07-0.1% in the population. For an early diagnosis, a high suspicion is necessary and with it, timely diagnostic tests are carried out. When there is no suspicion and no diagnosis is sought, the prognosis is usually poor since it is often in an advanced state. We present the cases of two pregnant women aged 27 and 31 diagnosed with moderately differentiated colorectal adenocarcinoma at 29 and 30 weeks of gestation, respectively. Due to the importance of making an opportune diagnosis to improve the survival of the patients, a search of information was carried out in the literature in relation to the diagnosis, management and prognosis of this pathology.

Jaw osteosarcoma and pregnancy: a rare coexistence

Osteosarcoma of the jaw represents less than 1% of all head and neck malignancies. This malignancy in pregnant women occurs in one per 1000 deliveries. We report a case of a 29-year-old woman, in the 33rd week of gestation, who presented with an expansive tumor destroying the maxillary alveolar bone, histologically composed of pleomorphic, round, spindle, or epithelioid cells and osteoid/chondroid matrix. Upon final diagnosis of osteosarcoma, the lesion was excised. To the best of our knowledge, only 10 cases of jaw osteosarcoma in pregnant women have been reported to date in the English language literature. The use of ancillary examinations, malignancy diagnosis, and cancer treatment can be challenging during pregnancy. Knowledge about jaw osteosarcoma in pregnancy can increase healthcare providers' awareness, avoid delays and misdiagnosis and potentially improve maternal and neonatal outcomes.

Prognosis of breast cancer diagnosed during pregnancy and early postpartum according to immunohistochemical subtype: A matched case-control study.

PURPOSE: Pregnancy-associated breast cancer (PABC) poses a clinical challenge and its prognosis remains controversial. During the pregnancy and postpartum periods, the breast undergoes biological events that may uniquely influence disease behavior and treatment response. This study aimed to assess if a PABC diagnosis influences survival compared to non-PABC. METHODS: A single-center record review was performed to identify PABC patients diagnosed from January 2007 through June 2018. Two controls were matched to each PABC case by stage, immunohistochemical (IHC) subtype, age (± 3) and year of diagnosis (± 2). Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis was used to assess the impact of PABC on outcomes. RESULTS: 125 PABC patients (pregnant: 62; postpartum: 63) and 250 controls were included. Median follow-up was 67.7 and 73.4 months, respectively. 4-year DFS was 62% in pregnant vs 78% in controls (p = 0.010), and 63% in postpartum vs 83% in controls (p = 0.034). Subanalysis by IHC subtype revealed a significantly inferior DFS in PABC with hormone receptor-positive/HER2-negative (p = 0.032) and HER2-positive disease (p = 0.005) compared to corresponding non-PABC patients. 4-year OS was similar between case groups and controls. Multivariate analysis supported the independent impact of pregnant and postpartum status on DFS (p < 0.05). CONCLUSION: Patients diagnosed during pregnancy and early postpartum are at high risk of recurrence. Further research is warranted to better characterize PABC tumor biology and enable the identification of novel therapeutic interventions to improve treatment outcomes.

Multidisciplinary consensus on cancer management during pregnancy.

Cancer during pregnancy is a challenge for multi- and interdisciplinary collaboration due to the diagnostic, prognostic and therapeutic implications, the need for an integrated harmonization of medical action for the pregnant patient and the embryo or foetus and the characteristics of each gestational period, which will determine the protocol to be proposed and its limitations. For this reason, a group of experts appointed by participating scientific societies, which includes the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica-SEOM), the Spanish Association of Surgeons (Asociación Española de Cirujanos-AEC), the Spanish Society of Gynaecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia-SEGO), the Spanish Society of Nuclear Medicine and Molecular Imaging (Sociedad Española de Medicina Nuclear e Imagen Molecular-SEMNIM), the Spanish Society of Oncological Radiotherapy (Sociedad Española de Oncología Radioterápica-SEOR) and the Spanish Society of Medical Radiology (Sociedad Española de Radiología Médica-SERAM), have worked together to establish consensus recommendations that allow the harmonization of management and ultimately the optimization of the healthcare of pregnant patients with cancer. When cancer is detected in a pregnant woman, the week of gestation in which the diagnosis is made must be considered, as well as the characteristics of the tumour. It is strongly recommended that a multidisciplinary team assesses the situation and guides the patient and her family during the informing, diagnosis and treatment process. Likewise, the foetus should be monitored and managed by specialized obstetricians who are part of a multidisciplinary cancer committee.

Preeclampsia as an Inaugural Manifestation of Primary Hyperparathyroidism: A Case Report.

Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsia motivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.

O hiperparatiroidismo primário é um distúrbio endócrino caraterizado pela elevação do cálcio sérico associada a níveis de paratormona elevados ou inapropriadamente normais. O diagnóstico é baseado em análises bioquímicas, e, na gravidez, o exame de imagem de primeira linha é a ecografia cervical. É uma doença rara na gravidez, e pode se apresentar com complicações ameaçadoras de vida, pelo que o seu diagnóstico é desafiante. O tratamento médico disponível é limitado, havendo poucos dados relativos à sua eficácia e segurança na gravidez. A cirurgia é o único tratamento curativo, e pode ser realizada no segundo ou terceiro trimestres. Tem sido descrita uma relação entre hiperparatiroidismo primário e pré-eclâmpsia. Apresenta-se um caso de uma grávida de 27 semanas com pré-eclâmpsia com critérios de gravidade, o que obrigou ao término da gravidez por cesariana. Verificou-se agravamento clínico no período pós-parto, com aparecimento de complicações graves, tais como hipercalcemia grave e pancreatite aguda. Ecograficamente, constataram-se duas massas paratiróideias sugestivas de adenomas da paratiroide. A doente recebeu tratamento médico, e teve melhora apenas após a correção dos níveis de cálcio sérico.

Preeclampsia as an inaugural manifestation of primary hyperparathyroidism: A case report / Pré-eclâmpsia como manifestação inaugural de hiperparatiroidismo primário: Um caso clínico

Abstract Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsiamotivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.

Resumo O hiperparatiroidismo primário é umdistúrbio endócrino caraterizado pela elevação do cálcio sérico associada a níveis de paratormona elevados ou inapropriadamente normais. O diagnóstico é baseado em análises bioquímicas, e, na gravidez, o exame de imagem de primeira linha é a ecografia cervical. É uma doença rara na gravidez, e pode se apresentar com complicações ameaçadoras de vida, pelo que o seu diagnóstico é desafiante. O tratamento médico disponível é limitado, havendo poucos dados relativos à sua eficácia e segurança na gravidez. A cirurgia é o único tratamento curativo, e pode ser realizada no segundo ou terceiro trimestres. Tem sido descrita uma relação entre hiperparatiroidismo primário e pré-eclâmpsia. Apresenta-se um caso de uma grávida de 27 semanas com pré-eclâmpsia com critérios de gravidade, o que obrigou ao término da gravidez por cesariana. Verificou-se agravamento clínico no período pós-parto, com aparecimento de complicações graves, tais como hipercalcemia grave e pancreatite aguda. Ecograficamente, constataram-se duas massas paratiróideias sugestivas de adenomas da paratiroide. A doente recebeu tratamento médico, e teve melhora apenas após a correção dos níveis de cálcio sérico.

Primary retroperitoneal tumor during pregnancy: Case report and review of the literature / Tumor retroperitoneal primario durante el embarazo: reporte de un caso y revisión de la literatura

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.

TITULO: TUMOR RETROPERITONEAL PRIMARIO DURANTE EL EMBARAZO: REPORTE DE UN CASO Y REVISIÓN DE LA LITERATURA. OBJETIVO: Reportar el caso de una paciente gestante con diagnóstico de tumor retroperitoneal primario y hacer revisión de la literatura del diagnóstico, tratamiento y pronóstico materno-fetal de esta entidad durante el embarazo. METODOS: Gestante de 19 años que consulta por tumor retroperitoneal identificado por ecografía, se realizó biopsia percutánea con resultado de tumor benigno; parto por cesárea con recién nacido sano. A los 4 meses se realizó resección quirúrgica, la histopatología mostró un teratoma quístico maduro. Se realizó búsqueda en las bases de datos de: Medline vía PubMed, Lilacs, SciELO y ScienceDirect, con los términos: "embarazo", "neoplasias" y "neoplasias retroperitoneales", incluyendo reportes y series de caso de tumores retroperitoneales en el embarazo. Se identificó el diagnóstico, tratamiento y pronóstico materno-fetal. RESULTADOS: Se identificaron 1.658 títulos, de los cuales 34 reportes de casos y una serie de casos cumplieron con los criterios de inclusión. El 62,9 % eran tumores benignos. El diagnóstico se hizo como hallazgo incidental en el 63 % de los casos, el ultrasonido identificó la masa en el 77 %, la biopsia percutánea se utilizó en el 8 % de los casos incluyendo el reportado. El tratamiento quirúrgico fue utilizado en el 88 % de los casos, generalmente después del parto. Hubo mortalidad materna en el 8,5 % de los casos. El pronóstico fetal fue bueno en el 65 % de las gestaciones. CONCLUSIONES: Los tumores retroperitoneales en la gestación, a pesar de ser principalmente benignos, tienen un pronóstico materno y fetal reservado en un importante número de casos. Se requiere evaluar los beneficios y riesgo de la biopsia percutánea.

Evaluation of uterine cervical cancer in pregnancy: A cross-sectional study.

OBJECTIVE: Evaluate the prevalence and the regression rate of cytological alteration in pregnant patients below the recommended age by the Brazilian Guidelines for the Screening of Uterine Cervical Cancer Guideline in the prenatal service of Maternidade Escola da Universidade Federal do Rio de Janeiro. STUDY DESIGN: We included the cytopathological exams of all pregnant patients that attended on the outpatient from January 2010 to May 2016. For the identification of the pregnant women, the Management and Integrated System and the Uterine Cervical Cancer Information System of the institution were used. We performed X2 test. The level of significance was 0.05. RESULTS: The study totaled 5825 cytopathological exams, of which 1822 were from pregnant patients ≤ 24 years of age. Only 4.06 % (74/1822) of altered results were found (p < 0.05). The most frequent change was low-grade squamous intraepithelial lesion with a prevalence of 1.92 % (35/1822) whereas high-grade squamous intraepithelial lesion had 0.16 % (3/1822). The regression rate in pregnant patients ≤24 years of age was 34,32 %. CONCLUSION: There was a low prevalence of cytological abnormalities in pregnant patients ≤ 24 years, low frequency of high-grade squamous intraepithelial lesion among the altered cytologies and a high spontaneous regression rate, therefore screening is not recommended before the age determined by the Brazilian Guideline.

Hyperparathyroidism during pregnancy. Is it a diagnostic and therapeutic challenge?

BACKGROUND: Primary hyperparathyroidism (PHPT) is characterized by an increase in parathyroid hormone (PTH) and hypercalcemia, which, when present during pregnancy, increases both maternal and fetal morbidity and mortality. OBJECTIVE: Emphasize the importance of surgical intervention in primary hyperparathyroidism during pregnancy. CLINICAL CASE: A 27-year-old female with a pregnancy of 27.2 weeks of gestation, with a diagnosis of symptomatic primary hyperparathyroidism secondary to parathyroid adenoma, a history of nephrolithiasis and severe acute pancreatitis, surgery was decided upon finding intrathyroid right parathyroid adenoma, post-surgical course with adequate evolution and remission of hyperparathyroidism. CONCLUSIONS: Parathyroidectomy in primary hyperparathyroidism during pregnancy is safe.

INTRODUCCIÓN: El hiperparatiroidismo primario (HPTP) se caracteriza por un aumento de la hormona paratiroidea (PTH) e hipercalcemia, que aumenta la morbimortalidad materna y fetal cuando se presenta durante el embarazo. OBJETIVO: Enfatizar la importancia de la intervención quirúrgica en el hiperparatiroidismo primario durante el embarazo. CASO CLÍNICO: Paciente femenino de 27 años de edad con embarazo de 27.2 semanas de gestación, con diagnóstico de hiperparatiroidismo primario sintomático secundario a adenoma paratiroideo, antecedentes de nefrolitiasis y pancreatitis aguda grave; al decidir realizar un procedimiento quirúrgico se identificó un adenoma paratiroideo derecho intratiroideo; el curso posquirúrgico mostró adecuada evolución y remisión del hiperparatiroidismo. CONCLUSIÓN: La paratiroidectomía en el hiperparatiroidismo primario durante el embarazo es segura.

Miocardiopatia não compactada em gestante com linfoma não Hodgkin. Relato de caso / Non-compaction cardiomyopathy in pregnant women with non-Hodgkin lymphoma: a case report

A miocardiopatia não compactada é uma doença congênita rara, que pode ocorrer isoladamente ou associada a outros defeitos, por falha no processo de compactação das fibras miocárdicas, resultando na persistência de trabeculações e recessos profundos. A associação entre a miocardiopatia não compactada e gestação é incomum na literatura, assim como a relação com macroglobulinemia de Waldenstrom, um tipo de linfoma não Hodgkin. Descrevemos aqui a rara associação destas três patologias. Trata-se de paciente do sexo feminino, sem antecedentes hematológicos, neoplasias ou cardiopatias, que procurou o serviço com queixa de astenia progressiva, dores no corpo, perda ponderal importante e anemia. Na investigação diagnóstica, a imunoeletroforese de proteína constatou pico monoclonal em IgM Kappa, com inventário medular por imunofenotipagem e biópsia de medula óssea com Kappa+, CD19+, CD20+, CD38 e CD79b, confirmando diagnóstico de neoplasia de linfócitos B maduros. Na terapêutica, optou-se pelo esquema de primeira linha com dexametasona, rituximabe e ciclofosfamida (DRC) − este último considerado agente alquilante cardiotóxico. Em triagem pré-quimioterápica, o eletrocardiograma mostrou alteração da repolarização ventricular anterosseptal. O ecocardiograma transtorácico evidenciou trabeculações excessivas no ápice do ventrículo esquerdo, sugerindo não compactação do miocárdio. A ressonância magnética confirmou o diagnóstico. Foi iniciada terapia com metoprolol e ácido acetilsalisílico. Todavia, após o último ciclo de terapia quimioterápica, paciente descobriu gravidez (G1P1A0). O período gestacional e o puerpério evoluíram sem manifestações clínicas de insuficiência cardíaca, em classe funcional I (New York Heart Association), mesmo com redução da fração de ejeção do ventrículo esquerdo ao ecocardiograma transtorácico. (AU)

Non-compaction cardiomyopathy is a rare congenital disease that can occur in isolation or associated with other defects, due to failure in compaction of myocardial fiber, resulting in persistence of myocardial trabeculations and deep recesses. The association between non-compaction cardiomyopathy and gestation, as well as the relationship with Waldenstrom's macrobulinemia, a type of Non-Hodgkin's Lymphoma (NHL), are not common in the literature. This study describes the rare association of these three pathologies. This is the case of a female patient with no history of hematological, neoplastic, or heart diseases, who sought the service with complaints of progressive weakness, body aches, important weight loss, and anemia. During the diagnostic investigation, protein immunoelectrophoresis showed a monoclonal peak in IgM Kappa monoclonal gammopathy, with a medullary inventory by immunophenotyping and bone marrow biopsy with Kappa+, CD19+, CD20+, CD38 and CD79b, confirming the diagnosis of mature B-cell lymphocyte neoplasm. The first line therapy chosen was dexamethasone, rituximab, and cyclophosphamide (CKD), with the latter being considered a cardiotoxic alkylating agent. At pre-chemotherapy screening, the electrocardiogram showed an alteration of the anteroseptal ventricular repolarization. Transthoracic echocardiography (ETT) showed excessive trabeculations at the apex of the left ventricle (LV), suggesting no compaction of the myocardium. The magnetic resonance imaging confirmed the diagnosis.Therapy with metoprolol and acetylsalicylic acid was started. However, after the last cycle of chemotherapy, the patient found she was pregnant (G1P1A0). The gestational and puerperium period progressed with no clinical manifestations of heart failure, in functional class I (New York Heart Association), albeit the reduction of the ejection fraction of the left ventricular shown in the transthoracic echocardiography. (AU)

Luteoma del embarazo. Reporte de caso / Luteoma of pregnancy. A case report

Luteoma of pregnancy is an infrequent non-neoplastic pathology of the ovary. It is usually an incidental finding during the evaluation of a pregnant patient in the third trimester or during a cesarean section. Occasionally, it may raise suspicion of cancer, resulting in unnecessary surgical resection of the ovary. We present the case of a 34-year-old woman who was in her third pregnancy and during the cesarean section, a 9 cm tumor of the right ovary was incidentally found and resected. The histological study was compatible with luteoma of pregnancy.

El luteoma del embarazo es una patología no neoplásica del ovario, de incidencia poco frecuente. Suele presentarse como hallazgo incidental durante la evaluación de una paciente embarazada en el tercer trimestre o en el momento del acto quirúrgico de una cesárea. En ocasiones, puede llevar a sospechar una neoplasia maligna, derivando así en una resección quirúrgica innecesaria del ovario. Presentamos el caso de una mujer de 34 años que cursaba su tercera gestación y a quien, durante la cesárea, se le halló una tumoración ovárica derecha de 9 cm de diámetro que fue resecada. El estudio histológico fue compatible con luteoma del embarazo.

Coloretal cancer in pregnant women / Cancro colorectal na mulher grávida

Abstract Background Colorectal cancer in pregnancy is a rare pathology with limited high-grade evidence available for guidance. The diagnosis of CRC in pregnant women is usually delayed, and once diagnosis is made, challenges exist as treatment options may be limited. Objective The study aims to highlight the importance of early investigation of symptomatic patients during pregnancy, as well as to update treatment and prognosis in CRC. Methods A literature search in PubMed database, including articles from 2006 to 2016 and cross-research articles with the initial research. Results Pregnancy can limit and contraindicate the utilization of standard diagnostic and therapeutic tools, which in particular can hamper the liberal use of colonoscopy and CT. Physical evaluation and abdominal US are first recommended; besides, MRI or CT may be used, only in indicated cases. Surgery is the main stay of treatment but radiotherapy and chemotherapy have significant role in posterior management of tumour. Conclusions Many studies are needed in order to achieve development in CRC pathogenesis during pregnancy as well as in treatment outcomes. The potential curative treatment of the disease should be the main aim of treatment when considering CRC in pregnancy. However, it is crucial to adapt the treatment to each patient, taking into account conscious decision on pregnancy further management.

Resumo Introdução O cancro colorretal na gravidez é uma patologia rara, com limitada evidência científica para orientação terapêutica. O diagnóstico de cancro coloretal em mulheres grávidas é tardio e, quando o diagnóstico é feito, as opções de tratamento podem ser limitadas. Objetivo O objetivo deste estudo é ressalvar a importância da investigação precoce de pacientes sintomáticas durante a gravidez, assim como avaliar os atuais métodos de tratamento e prognóstico no CCR. Métodos A pesquisa bibliográfica foi realizada na base de dados PubMed, incluindo artigos a partir de 2006 até 2016, assim como artigos de pesquisa cruzada com os artigos iniciais. Resultados A gravidez pode limitar e contra-indicar a utilização de ferramentas de diagnóstico e terapêuticas convencionais, assim como dificultar o uso indiscriminado de colonoscopia e tomografia computadorizada. A avaliação física e a ecografia abdominal são a primeira linha para diagnóstico. No entanto, em casos selecionados, a ressonância magnética ou a tomografia computadorizada também podem ser usadas. A cirurgia é o gold-standard mas a radioterapia e a quimioterapia assumem um papel cada vez mais relevante no tratamento multidisciplinar destes tumores. Discussão Como os sintomas abdominais são comuns na gravidez e cancro coloretal pode simulá-los, o diagnóstico diferencial entre estas duas patologias é crucial, já que intervenções precoces podem ser curativas. Após diagnóstico, o seguimento das grávidas deve ser individualizado, dependendo de vários fatores. Porém, já que atualmente o tratamento do cancro é possível na gravidez, a probabilidade de sobrevivência da paciente não deve ser diminuída devido ao diagnóstico tardio. Conclusões Mais estudos são necessários para saber mais acerca da patogénese do cancro coloretal na gravidez, assim como os resultados após tratamento. O potencial objetivo é o tratamento oncológico do cancro coloretal. No entanto, é crucial adaptar o tratamento a cada paciente, tendo em conta a sua decisão consciente acerca da continuação da gravidez.

[Gastrointestinal stromal tumor in young pregnant woman: case report]. / Tumor del estroma gastrointestinal en mujer gestante joven.

Female patient, 28 years old, with a gestation of 14 weeks, natural and from Ilo-Moquegua. Came with a time of disease 4 days with hematemesis, melena, epigastric pain and syncope. Background of colonic resection for peritonitis due to trauma 20 years ago; upper gastrointestinal bleeding three years ago; paternal grandparents died of gastric cancer; chronic gastritis diagnosed from 19 year old. In laboratory studies hemoglobin of 9.2. In the upper gastrointestinal endoscopy was found absence of active upper gastrointestinal bleeding, a large tumor in proximal body toward greater curvature and posterior wall, 8 cm in diameter approximately, lobed appearance, with most of the mucosal surface unscathed is evidence, areas of ulceration of 2-3 mm covered with fibrin (biopsies taken), hard consistency, tent sign (positive) and cushionsign (negative). Imaging studies such as MRI or CT were not possible due to the pregnancy. In the complete abdominal ultrasound only grade I hepatic steatosis was reported. The results of endoscopic biopsy showed cell proliferation ofepithelioid characteristics with atypia. Immunohistochemistry was performed indicating CD117 (positive), CD 34 (negative), Ki 67 (positive 1%). The final diagnosis was a gastrointestinal stromal tumor epithelioid type with mitotic rate lower of 1%. Finally, surgical resection of the tumor was performed in which addition of 3 implants was found up to 1 cm in diameter in pancreatic peritoneum covering surface. We present the case as this is an unusual presentation of this tumor.

Tumor del estroma gastrointestinal en mujer gestante joven / Gastrointestinal stromal tumor in young pregnant woman: case report

Paciente mujer de 28 años de edad, con gestación de 14 semanas, natural y procedente de Ilo, Moquegua. Acudió con tiempo de enfermedad de 4 días con hematemesis, melenas, epigastralgia y síncope. Antecedente de resección colónica por peritonitis debido a un traumatismo hace 20 años; cuadro de hemorragia digestiva alta hace 3 años; abuelos paternos fallecidos de cáncer gástrico; gastritis crónica diagnosticada desde los 19 años de edad. Dentro de los estudios laboratoriales hemoglobina de 9,2. En el estudio de endoscopia digestiva alta se evidencia ausencia de hemorragia digestiva alta activa, una gran tumoración en cuerpo proximal hacia curvatura mayor y pared posterior, de aproximadamente 8 cm de diámetro, de aspecto lobulado, con la mayor parte de la superficie mucosa indemne, áreas de ulceración de 2 a 3 mm cubiertas de fibrina (de las cuales se toma biopsias), de consistencia dura, signo de la carpa (positivo) y signo del cojín (negativo). No se pudo realizar estudios de imagen como resonancia magnética o tomografía debido a la gestación. En la ecografía abdominal completa sólo se reportó esteatosis hepática de I grado. Los resultados de biopsia endoscópica indicaron proliferación celular de características epitelioides con atipia. Se realizó inmunohistoquímica indicando CD 117 (positivo), CD 34 (negativo), Ki 67 (positivo 1%). El diagnóstico final fue un tumor del estroma gastrointestinal de tipo epitelioide con tasa mitótica menor de 1%. Finalmente se realizó resección quirúrgica del tumor, en la que además se encontró 3 implantes de hasta 1 cm de diámetro en peritoneo que cubrían la superficie pancreática. Presentamos el caso por ser esta una inusual presentación de este tipo de tumor

Female patient, 28 years old, with a gestation of 14 weeks, natural and from Ilo-Moquegua. Came with a time of disease 4 days with hematemesis, melena, epigastric pain and syncope. Background of colonic resection for peritonitis due to trauma 20 years ago; upper gastrointestinal bleeding three years ago; paternal grandparents died of gastric cancer; chronic gastritis diagnosed from 19 year old. In laboratory studies hemoglobin of 9.2. In the upper gastrointestinal endoscopy was found absence of active upper gastrointestinal bleeding, a large tumor in proximal body toward greater curvature and posterior wall, 8 cm in diameter approximately, lobed appearance, with most of the mucosal surface unscathed is evidence, areas of ulceration of 2-3 mm covered with fibrin (biopsies taken), hard consistency, tent sign (positive) and cushionsign (negative). Imaging studies such as MRI or CT were not possible due to the pregnancy. In the complete abdominal ultrasound only grade I hepatic steatosis was reported. The results of endoscopic biopsy showed cell proliferation ofepithelioid characteristics with atypia. Immunohistochemistry was performed indicating CD117 (positive), CD 34 (negative), Ki 67 (positive 1%). The final diagnosis was a gastrointestinal stromal tumor epithelioid type with mitotic rate lower of 1%. Finally, surgical resection of the tumor was performed in which addition of 3 implants was found up to 1 cm in diameter in pancreatic peritoneum covering surface. We present the case as this is an unusual presentation of this tumor

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.

Adnexal germ cell carcinoma with bone metastases in pregnant women: case report and review. / Carcinoma anexial de células germinales con metástasis ósea en gestante: reporte de un caso y revisión.

Germ cell carcinoma during pregnancy is rare. However, its detection has increased due to the use of ultrasound fetal monitoring in the antenatal care program. In this article, we present the case of a Germ cell carcinoma during pregnancy is rare. However, its detection has increased due to the use of ultrasound fetal monitoring in the antenatal care program. In this article, we present the case of a pregnant 27-year-old diagnosed with an adnexal germ cell carcinoma at six weeks of gestation, whose initial approach was local resection (suboptimal cytoreduction). Four weeks after surgery, the patient presented with grade IV peripheral neuropathy in the lower limbs; magnetic resonance imaging scan indicated an infiltrative lesion at D5. The local medical board decided on chemotherapy starting on the 19th week of gestation. The rest of the pregnancy period was uneventful and the patient had a cesarean section at 34 weeks of gestation and a live newborn with no complications. Unfortunately, four days after caesarean section, the patient died of a septic shock with respiratory focus.

El carcinoma de células germinales durante el embarazo es una entidad poco frecuente, a pesar de que su detección ha aumentado debido al posicionamiento de la ecografía de control fetal dentro del programa de control prenatal. En este artículo se reporta el caso de una gestante de 27 años de edad, diagnosticada de carcinoma anexial de células germinales a las seis semanas de gestación, cuyo abordaje inicial fue la resección local (citorreducción subóptima). Cuatro semanas después de la cirugía, la paciente debutó con neuropatía periférica grado IV en miembros inferiores, cuyo hallazgo por imagenología (resonancia magnética nuclear) indicó lesión infiltrante paravertebral a nivel de D5. En junta médica se decidió que reciba tratamiento de quimioterapia a partir de la semana 19 de la gestación. El embarazo cursó sin complicaciones y la paciente fue sometida a cesárea a las 34 semanas de gestación teniendo como producto un recién nacido vivo sin complicaciones. Desafortunadamente, cuatro días luego de la cesárea, la paciente falleció a consecuencia de un shock séptico de foco respiratorio.