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Fulminant adenocarcinoma of the rectum with hepatic metastasis in a young pregnant woman: a case report.

Araujo Júnior E, Campanharo FF, Sun SY, Nardozza LM, Mattar R, Moron AF - Case Rep Oncol (2012)

Bottom Line: We present a case of a young primiparous woman who had a quick and bad evolution of an adenocarcinoma of the rectum diagnosed during pregnancy.This patient had extensive involvement of the liver with metastasis and she died two weeks after diagnosis.In this case, we present the clinical, radiological and pathology findings of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics, São Paulo Federal University (UNIFESP), São Paulo, Brazil.

ABSTRACT
Cancer is the second leading cause of death during the reproductive years, but the incidence during pregnancy is low. The incidence of cancer of the rectum during pregnancy is very rare (1:50,000 to 1:100,000 pregnancies). Usually, the symptoms of this type of cancer are nonspecific and sometimes they are confused with normal changes of pregnancy. The diagnosis of rectal cancer is usually made in the late stage of pregnancy. The treatment of this cancer involves surgery, chemotherapy and radiotherapy, but each type of treatment involves risks to the fetus and the pregnant woman. We present a case of a young primiparous woman who had a quick and bad evolution of an adenocarcinoma of the rectum diagnosed during pregnancy. This patient had extensive involvement of the liver with metastasis and she died two weeks after diagnosis. In this case, we present the clinical, radiological and pathology findings of this disease.

No MeSH data available.


Related in: MedlinePlus

a Photomicrograph of liver biopsy showing the positive immunohistochemical reaction to carcinoembryonic antigen. b Photomicrograph of rectal biopsy with hematoxylin and eosin confirming the diagnosis of adenocarcinoma.
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Figure 3: a Photomicrograph of liver biopsy showing the positive immunohistochemical reaction to carcinoembryonic antigen. b Photomicrograph of rectal biopsy with hematoxylin and eosin confirming the diagnosis of adenocarcinoma.

Mentions: A 17-year-old primiparous woman was admitted to our service with fever (38°C), abdominal pain, weakness and recent weight loss of 5 kg. At general physical exam, she was discolored (+/+4), eupneic and anicteric. Her weight was 66 kg, and she reported a weight of 58 kg before pregnancy. The abdomen was distended and with evident vascularization (fig. 1a). The liver was enlarged, hardened and several nodules were observed. Soft edema (Godet sign) was present in the lower members (fig. 1b). The obstetric exam showed a fundal height of 14.0 cm and a fetal heart rate of 144 beats per minute. The laboratory exams showed Hb/Ht of 12.7 g/dl/38%, fasting glucose of 89 mg/dl, α-fetoprotein of 75.25 ng/dl and carcinoembryonic antigen of 4,487 ng/ml. She was hospitalized, and T2-sequence magnetic resonance imaging in the coronal plane was performed, which revealed an enlarged liver, with several nodules with central hypersignal, suggestive of metastasis (fig. 2). The obstetrical scan evidenced a unique and topic pregnancy with the fetus presenting biometric parameters of 21 weeks. The fetus showed no malformations, the amniotic fluid volume was normal and the estimated fetal weight was 411 g. The patient progressed to vomiting blood, and there was also blood in her stool. The liver biopsy confirmed infiltration by adenocarcinoma with several metastases (fig. 3a). The sigmoidoscopy evidenced an ulcerative-vegetative lesion 10.0 cm from the anal verge; the biopsy confirmed adenocarcinoma of the rectum (fig. 3b). The patient evolved with significant abdominal pain, hypotension and cardiopulmonary arrest. Death occurred two weeks after hospitalization. Necropsy confirmed the diagnosis of adenocarcinoma of the rectum with liver metastases.


Fulminant adenocarcinoma of the rectum with hepatic metastasis in a young pregnant woman: a case report.

Araujo Júnior E, Campanharo FF, Sun SY, Nardozza LM, Mattar R, Moron AF - Case Rep Oncol (2012)

a Photomicrograph of liver biopsy showing the positive immunohistochemical reaction to carcinoembryonic antigen. b Photomicrograph of rectal biopsy with hematoxylin and eosin confirming the diagnosis of adenocarcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3362226&req=5

Figure 3: a Photomicrograph of liver biopsy showing the positive immunohistochemical reaction to carcinoembryonic antigen. b Photomicrograph of rectal biopsy with hematoxylin and eosin confirming the diagnosis of adenocarcinoma.
Mentions: A 17-year-old primiparous woman was admitted to our service with fever (38°C), abdominal pain, weakness and recent weight loss of 5 kg. At general physical exam, she was discolored (+/+4), eupneic and anicteric. Her weight was 66 kg, and she reported a weight of 58 kg before pregnancy. The abdomen was distended and with evident vascularization (fig. 1a). The liver was enlarged, hardened and several nodules were observed. Soft edema (Godet sign) was present in the lower members (fig. 1b). The obstetric exam showed a fundal height of 14.0 cm and a fetal heart rate of 144 beats per minute. The laboratory exams showed Hb/Ht of 12.7 g/dl/38%, fasting glucose of 89 mg/dl, α-fetoprotein of 75.25 ng/dl and carcinoembryonic antigen of 4,487 ng/ml. She was hospitalized, and T2-sequence magnetic resonance imaging in the coronal plane was performed, which revealed an enlarged liver, with several nodules with central hypersignal, suggestive of metastasis (fig. 2). The obstetrical scan evidenced a unique and topic pregnancy with the fetus presenting biometric parameters of 21 weeks. The fetus showed no malformations, the amniotic fluid volume was normal and the estimated fetal weight was 411 g. The patient progressed to vomiting blood, and there was also blood in her stool. The liver biopsy confirmed infiltration by adenocarcinoma with several metastases (fig. 3a). The sigmoidoscopy evidenced an ulcerative-vegetative lesion 10.0 cm from the anal verge; the biopsy confirmed adenocarcinoma of the rectum (fig. 3b). The patient evolved with significant abdominal pain, hypotension and cardiopulmonary arrest. Death occurred two weeks after hospitalization. Necropsy confirmed the diagnosis of adenocarcinoma of the rectum with liver metastases.

Bottom Line: We present a case of a young primiparous woman who had a quick and bad evolution of an adenocarcinoma of the rectum diagnosed during pregnancy.This patient had extensive involvement of the liver with metastasis and she died two weeks after diagnosis.In this case, we present the clinical, radiological and pathology findings of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics, São Paulo Federal University (UNIFESP), São Paulo, Brazil.

ABSTRACT
Cancer is the second leading cause of death during the reproductive years, but the incidence during pregnancy is low. The incidence of cancer of the rectum during pregnancy is very rare (1:50,000 to 1:100,000 pregnancies). Usually, the symptoms of this type of cancer are nonspecific and sometimes they are confused with normal changes of pregnancy. The diagnosis of rectal cancer is usually made in the late stage of pregnancy. The treatment of this cancer involves surgery, chemotherapy and radiotherapy, but each type of treatment involves risks to the fetus and the pregnant woman. We present a case of a young primiparous woman who had a quick and bad evolution of an adenocarcinoma of the rectum diagnosed during pregnancy. This patient had extensive involvement of the liver with metastasis and she died two weeks after diagnosis. In this case, we present the clinical, radiological and pathology findings of this disease.

No MeSH data available.


Related in: MedlinePlus