A narrative review of pregnancy after malignancies in young women that don't originate in the female genital organs or in the breast.
Girardelli Serena,Mangili Giorgia,Cosio Stefania,Rabaiotti Emanuela,Fanucchi Antonio,Valsecchi Luca,Candiani Massimo,Gadducci Angiolo
Critical reviews in oncology/hematology
While cancer during pregnancy and its treatment has grown to be a popular topic in recent years, little is known on how to advise patients looking to conceive or conceiving after cancer treatment. The aim of this paper is to review the available literature on the impact of pregnancy on survivors of the most common childhood cancers, brain cancer, haematological malignancies, thyroid cancer, melanomas and sarcomas. Its main objective is to be a source of information for clinicians looking to counsel patients in these delicate moments exploiting all the available literature, albeit scarce. Given the available literature, we conclude that the presence of a multidisciplinary team is of great importance in supporting the patient and her loved ones when facing pregnancy with a previous cancer diagnosis.
Masson's tumor presenting as a left frontal intraparenchymal hemorrhage resulting in severe expressive aphasia during pregnancy: case report.
Sankey Eric W,Hynes Jenna S,Komisarow Jordan M,Maule Jake,Griffin Andrew S,Dotters-Katz Sarah K,Mitchell Courtney J,Friedman Allan H
Journal of neurosurgery
Intravascular papillary endothelial hyperplasia (IPEH), commonly known as Masson's tumor, is a benign lesion that manifests as an excessive proliferation of endothelial cells within a vessel wall. IPEH is extremely rare in the brain, with only 36 intracranial cases previously described in the literature. It is commonly mistaken for more malignant pathologies, such as angiosarcoma. Careful histopathological examination is required for diagnosis, as no clinical or radiographic features are characteristic of this lesion. In this first published case of intracranial IPEH presenting during pregnancy, the authors describe a 32-year-old female with a left frontal intraparenchymal hemorrhage resulting in complete expressive aphasia at 28 weeks 6 days' gestation. An MRI scan obtained at a local hospital demonstrated an area of enhancement within the hemorrhage. The patient underwent a left frontoparietal craniotomy for hematoma evacuation and gross-total resection (GTR) of an underlying hemorrhagic mass at 29 weeks' gestation. This case illustrates the importance of multidisciplinary patient care and the feasibility of intervention in the early third trimester with subsequent term delivery. While GTR of IPEH is typically curative, the decision to proceed with surgical treatment of any intracranial lesion in pregnancy must balance maternal stability, gestational age, and suspected pathology.
Gastric cancer during pregnancy: A report on 13 cases and review of the literature with focus on chemotherapy during pregnancy.
Maggen Charlotte,Lok Christianne A,Cardonick Elyce,van Gerwen Mathilde,Ottevanger Petronella B,Boere Ingrid A,Koskas Martin,Halaska Michael J,Fruscio Robert,Gziri Mina M,Witteveen Petronella O,Van Calsteren Kristel,Amant Frédéric,
Acta obstetricia et gynecologica Scandinavica
INTRODUCTION:Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. MATERIAL AND METHODS:Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. RESULTS:In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6-30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. CONCLUSIONS:The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account.
Brain metastases from breast cancer during pregnancy.
Sharma Ashish,Nguyen Ha Son,Lozen Andrew,Sharma Abhishiek,Mueller Wade
Surgical neurology international
BACKGROUND:Brain metastasis during pregnancy is a rare occurrence. In particular, there have only been three prior cases regarding breast cancer metastasis. We report a patient with breast cancer metastasis to the brain during pregnancy and review the literature. CASE DESCRIPTION:The patient was a 35-year-old female with a history of breast cancer (estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2/neu positive, status post-neoadjuvant docetaxel/carboplatin/trastuzumab/pertuzumab therapy, status post-bilateral mastectomies), and prior right frontal brain metastases (status post-resection, capecitabine/lapatinib/temozolomide therapy, and cyberknife treatment). Patient was found to be pregnant at 9 weeks' gestation while on chemotherapy; the patient elected to continue with the pregnancy and chemotherapy was discontinued. At 14 weeks' gestation, she returned with recurrent right frontal disease. She was taken for a craniotomy at 16 weeks' gestation, which confirmed metastases. Six weeks later, patient returned with worsening headaches and fatigue, with more recurrent right frontal disease. She was started on decadron and chemotherapy (5-fluorouracil, adriamycin, and cyclophosphamide). Serial magnetic resonance imaging (MRI) demonstrated enlarging right frontal lesions. She underwent a craniotomy at 27 weeks' gestation, and chemotherapy was discontinued promptly. Starting at 30 weeks' gestation, she received whole brain radiation for 2 weeks. Subsequently, she delivered a baby girl via cesarean section at 32 weeks' gestation. At 6 weeks follow-up, an MRI brain demonstrated no new intracranial disease, with stable postoperative findings. CONCLUSION:There is a lack of guidelines and clinical consensus on medical and surgical treatment for breast cancer metastases in pregnant patients. Treatment usually varies based upon underlying tumor burden, location, gestational age of the fetus, and patient's preference and symptomatology.
Proliferative and Invasive Effects of Progesterone-Induced Blocking Factor in Human Glioblastoma Cells.
Gutiérrez-Rodríguez Araceli,Hansberg-Pastor Valeria,Camacho-Arroyo Ignacio
BioMed research international
Progesterone-induced blocking factor (PIBF) is a progesterone (P) regulated protein expressed in different types of high proliferative cells including astrocytomas, the most frequent and aggressive brain tumors. It has been shown that PIBF increases the number of human astrocytoma cells. In this work, we evaluated PIBF regulation by P and the effects of PIBF on proliferation, migration, and invasion of U87 and U251 cells, both derived from human glioblastomas. PIBF mRNA expression was upregulated by P (10 nM) from 12 to 24 h. Glioblastoma cells expressed two PIBF isoforms, 90 and 57 kDa. The content of the shorter isoform was increased by P at 24 h, while progesterone receptor antagonist RU486 (10 M) blocked this effect. PIBF (100 ng/mL) increased the number of U87 cells on days 4 and 5 of treatment and induced cell proliferation on day 4. Wound-healing assays showed that PIBF increased the migration of U87 (12-48 h) and U251 (24 and 48 h) cells. Transwell invasion assays showed that PIBF augmented the number of invasive cells in both cell lines at 24 h. These data suggest that PIBF promotes proliferation, migration, and invasion of human glioblastoma cells.
Malignancies associated with pregnancy: an analysis of 21 clinical cases.
Liu Y,Liu Y,Wang Y,Chen X,Chen H,Zhang J
Irish journal of medical science
AIM:This study aimed at investigating the clinical characteristics of malignancies associated with pregnancy and to provide information for the development of suitable strategies of treating maternal malignancies. METHODS:We conducted a retrospective analysis of 21 pregnant women with cancer who were admitted to our hospital between 2006 and 2012. The patients' clinical characteristics, treatment during pregnancy and postpartum, and pregnancy outcome were recorded. RESULTS:There were 21 cases of malignancies associated with pregnancy, including 6 cases of cervical cancer, 6 cases of breast cancer, 3 cases of liver cancer, 2 cases of ovarian cancer, 2 cases of thyroid cancer, 1 case of nasopharyngeal carcinoma, and 1 case of malignant brain tumor. Of the 21 patients, 15 patients continued their pregnancies (9 of these patients received cancer treatment), whereas the other 6 terminated pregnancy. The modes of delivery included cesarean section (12 cases) and vaginal delivery (3 cases), which resulted in 17 newborns, 12 of them with preterm birth (12/17, 70.6 %). The gestational age was from 30 weeks + 5 days to 39 weeks. No neonatal malformations were found. CONCLUSIONS:The management of malignancies associated with pregnancy is a challenge for doctors and patients. It should be based on histological subtype, disease stage, gestational age, obstetrics complications, and patient's preference regarding continuing the pregnancy.
Brainstem gliomas in pregnancy: a systematic review†.
Rosen Adam,Anderson Valerie,Bercovici Eduard,Laperriere Normand,D'Souza Rohan
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Although brainstem gliomas are a rare group of neoplasias, when they affect pregnant women, there can be challenges with diagnosis and management. This study describes a case of brainstem glioma diagnosed in pregnancy and systematically reviews the literature on brainstem gliomas in pregnancy to provide guidance for management. We searched five databases from inception until October 2016 using subject headings and keywords related to pregnancy and brainstem glioma, and included original research articles that described pregnancy outcomes in women with brainstem glioma. Data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Checklist for case reports were performed in duplicate. Outcomes were reported as proportions. The study protocol was registered with the Prospero International Prospective Register of Systematic Reviews (CRD42017060196). We screened 2737 titles and abstracts, and 89 full-texts. Twelve articles describing 17 pregnancies in 16 women were included in the analysis. The median gestational age at presentation was 23 weeks. All but one case presented with neurologic deficit. Magnetic resonance (MRI) imaging conclusively diagnosed all cases. Surgical tumor resection ( = 4) and radiation therapy ( = 3) were successfully undertaken during pregnancy. There were no reported sequelae of maternal oncological management on neonatal wellbeing. Maternal mortality was high (8/16, 50%) both during ( = 5) and within 4 weeks ( = 3) of pregnancy. Pregnancy losses included one pregnancy termination and four miscarriages (associated with maternal mortality). Of the 12 live-born babies, five were premature. Two of these were the result of spontaneous preterm labor and three were delivered prematurely to facilitate glioma management. There was one case of fetal growth restriction. Although the symptoms of brainstem gliomas often mimic those commonly encountered in pregnancy, neurologic deficits warrant urgent investigation. MRI is the diagnostic modality of choice in pregnancy. Brainstem gliomas are associated with high maternal mortality and appropriate management, including surgical tumor resection and radiation therapy, should not be delayed on account of pregnancy. Pregnancy outcomes are favorable although there is a risk of preterm birth.Key messageBrainstem gliomas are associated with high maternal mortality and timely diagnosis using magnetic resonance imaging and treatment including surgical resection and radiation therapy should not be delayed during pregnancy. Pregnancy outcomes are generally favorable except for risk of preterm birth.
Management of glioblastoma multiforme in pregnancy.
Jayasekera Bodiabaduge A P,Bacon Andrew D,Whitfield Peter C
Journal of neurosurgery
Glioblastoma multiforme presenting during pregnancy presents unique challenges to the clinician. In planning treatment, potential benefits to the mother must be balanced against the risks to the fetus. In addition, evidence relating to timing of surgery and the use of radiotherapy and chemotherapy in pregnancy is limited. Management of peritumoral edema and seizures in pregnancy is also complicated by the potential for drug-related teratogenic effects and adverse neonatal outcomes on the fetus. The general anesthetic used for surgery must factor obstetric and neurosurgical considerations. In this review article, the authors seek to examine the role, safety, and timing of therapies for glioblastoma in the context of pregnancy. This covers the use of radiotherapy and chemotherapy, timing of surgery, postoperative care, anesthetic considerations, and use of anticonvulsant medications and steroids. The authors hope that this will provide a framework for clinicians treating pregnant patients with glioblastomas.
Foramen Magnum Meningioma with Brainstem Compression During Pregnancy.
Choudhri Omar,Ravikumar Vinod K,Gephart Melanie Hayden
BACKGROUND:Meningiomas can present during pregnancy as the result of hormonal as well as fluid changes. Foramen magnum meningiomas are particularly rare. We present the first reported case successfully treated during pregnancy. CASE DESCRIPTION:A 34-year-old female patient in her second trimester of pregnancy presented with a several-week history of neck pain, clonus, and right-sided upper extremity weakness. Magnetic resonance imaging of the brain demonstrated a 3.5-cm foramen magnum meningioma causing severe compression of the cervicomedullary junction. The patient underwent a far lateral craniotomy with successful decompression of the brainstem, resection of the tumor, and no permanent postoperative neurologic deficits. She made an excellent recovery and delivered a normal baby at 38 weeks with no complications. A small residual tumor engulfing the vertebral artery was treated with stereotactic radiosurgery 3 months postpartum. Diagnostic and treatment challenges unique to this case are discussed. CONCLUSIONS:Large skull base tumors symptomatic in pregnancy can be safely treated with careful planning and close monitoring.
Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy.
Gurcay Ahmet Gurhan,Bozkurt Ismail,Senturk Salim,Kazanci Atilla,Gurcan Oktay,Turkoglu Omer Faruk,Beskonakli Ethem
Asian journal of neurosurgery
The most common benign tumor of the brain is meningiomas. Usually diagnosed between the ages of 40-60, they are more common in women. Studies have shown a strong relationship between hormones and malignancies. Although meningiomas are slow-growing tumors of the brain, pregnancy seems to induce its growth speed. Studies concerning meningiomas and hormone relationship may explain the reason why symptoms during pregnancy flare. More specifically, the estrogen and progesterone receptor may take an active role through signal transduction in inducing the growth of the tumor. Thus, the dilemma of pregnancy + meningioma arises. In this case, a 21-year-old pregnant with a giant meningioma diagnosed on the symptom of loss of sight is reported. Her pregnancy was terminated, and the tumor was excised. Her vision improved and the histopathological examination showed a progesterone receptor positive meningioma. It is a challenging decision to be made by the physician, the patient and the family when deciding if and when pregnancy should be terminated once an intracranial meningioma is diagnosed.
Anaplastic Large Cell Lymphoma in Pregnancy. A Case Report.
Kanj Rula V,Gerber Deanna,Frey Melissa K,Rahmanou Farzin,Hardy Curtis
The Journal of reproductive medicine
BACKGROUND:Anaplastic large cell lymphoma is rarely diagnosed during pregnancy, and patients may be erroneously diagnosed with a dermatosis. CASE:A 34-year-old female was diagnosed with pruritic urticarial papules and plaques of pregnancy in the third trimester. She underwent elective repeat cesarean section with a postoperative course complicated by skin and gingival ulcers and persistent fever. Imaging revealed lung and brain nodules. Video-assisted thoracic surgery lung biopsy demonstrated anaplastic large cell lymphoma. CONCLUSION:It is important to consider the diagnosis of anaplastic large cell lymphoma in a pregnant patient who presents with cutaneous symptoms.
Increased growth rate of a WHO grade I ganglioglioma during pregnancy.
Knafo Steven,Goutagny Stéphane,Pallud Johan
British journal of neurosurgery
We report the case of a 32-year-old woman with a left frontal ganglioglioma (WHO grade I). Quantitative analysis based on three dimensional magnetic resonance images revealed a threefold increase of growth rate during pregnancy as compared to pre-pregnancy, causing neurological deterioration and leading to prompt surgical treatment 3 months after delivery.
Multidisciplinary team efforts improve the surgical outcomes of sellar region lesions during pregnancy.
Zhong Hui Ping,Tang Hao,Zhang Yong,Luo Yan,Yao Hong,Cheng Yu,Gu Wei Ting,Wei Yong Xu,Wu Zhe Bao
PURPOSE:Treatment of space-occupying lesions (SOLs) in the sellar region is a clinical challenge, especially in pregnant women because many treatment decisions are restrained due to pregnancy. We attempt to discuss the surgical indications and timing for pregnant patients and highlight the importance of multidisciplinary team (MDT) treatment. METHODS:From August 2017 to February 2018, four pregnant women were admitted to our hospital with severe visual impairment due to sellar region SOLs, including two cases of tuberculum sellae meningioma, one case of giant pituitary adenoma and one case of a pituitary abscess. All four patients were safely treated by surgery during the second and third trimesters of pregnancy through concerted efforts of the MDT, including a neurosurgeon as the team leader in combination with experts in obstetrics, ophthalmology and endocrinology. RESULTS:The SOLs were removed completely from all four patients, resulting in significantly improved vision without operation-related complications. Pregnancy continued postoperatively to full-term delivery in three of the four patients. The other patient with a pituitary abscess selected to terminate the pregnancy at a gestational age of 20 weeks because of her own concerns. The four babies (including a pair of twins) were born healthy and had developed normally at the 6-week postpartum follow-up. CONCLUSIONS:With the MDT guiding the decision-making process, surgical resection of sellar region SOLs in pregnant women with severe visual impairment is practical to improve the prognosis without affecting the outcomes of pregnancy for either the mother or the infant.
Reproductive factors and exogenous hormone use in relation to risk of glioma and meningioma in a large European cohort study.
Michaud Dominique S,Gallo Valentina,Schlehofer Brigitte,Tjønneland Anne,Olsen Anja,Overvad Kim,Dahm Christina C,Kaaks Rudolf,Lukanova Annekatrin,Boeing Heiner,Schütze Madlen,Trichopoulou Antonia,Bamia Christina,Kyrozis Andreas,Sacerdote Carlotta,Agnoli Claudia,Palli Domenico,Tumino Rosario,Mattiello Amalia,Bueno-de-Mesquita H Bas,Ros Martine M,Peeters Petra H M,van Gils Carla H,Lund Eiliv,Bakken Kjersti,Gram Inger T,Barricarte Aurelio,Navarro Carmen,Dorronsoro Miren,Sánchez Maria José,Rodríguez Laudina,Duell Eric J,Hallmans Göran,Melin Beatrice S,Manjer Jonas,Borgquist Signe,Khaw Kay-Tee,Wareham Nick,Allen Naomi E,Tsilidis Konstantinos K,Romieu Isabelle,Rinaldi Sabina,Vineis Paolo,Riboli Elio
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
BACKGROUND:The etiologies of glioma and meningioma tumors are largely unknown. Although reproductive hormones are thought to influence the risk of these tumors, epidemiologic data are not supportive of this hypothesis; however, few cohort studies have published on this topic. We examined the relation between reproductive factors and the risk of glioma and meningioma among women in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS:After a mean of 8.4 years of follow-up, 193 glioma and 194 meningioma cases were identified among 276,212 women. Information on reproductive factors and hormone use was collected at baseline. Cox proportional hazard regression was used to determine hazard ratios (HR) and 95% confidence intervals (95% CI). RESULTS:No associations were observed between glioma or meningioma risk and reproductive factors, including age at menarche, parity, age at first birth, menopausal status, and age at menopause. A higher risk of meningioma was observed among postmenopausal women who were current users of hormone replacement therapy (HR, 1.79; 95% CI, 1.18-2.71) compared with never users. Similarly, current users of oral contraceptives were at higher risk of meningioma than never users (HR, 3.61; 95% CI, 1.75-7.46). CONCLUSION:Our results do not support a role for estrogens and glioma risk. Use of exogenous hormones, especially current use, seems to increase meningioma risk. However, these findings could be due to diagnostic bias and require confirmation. IMPACT:Elucidating the role of hormones in brain tumor development has important implications and needs to be further examined using biological measurements.
Benign and malignant tumors of the central nervous system and pregnancy.
Eckenstein Midori,Thomas Alissa A
Handbook of clinical neurology
Tumors of the central nervous system (CNS) are rare entities, typically affecting the very young or the very old, but span a spectrum of disease that may present in any age group. Women of reproductive age are more likely to be affected by benign tumors, including pituitary adenomas and meningiomas, and aggressive intracranial malignancies, such as brain metastases and glioblastoma, rarely present in pregnancy. Definitive management of CNS tumors may involve multimodal therapy, including surgery, radiation, and chemotherapy, and each of these treatments carries risk to the mother and developing fetus. CNS tumors often present with challenging and morbid symptoms such as headache and seizure, which need to be managed throughout a pregnancy. Decisions about timing treatment during pregnancy or delaying until after delivery, continuing or electively terminating a pregnancy, and future family planning and fertility are complex and require a multidisciplinary care team to evaluate the implications to both mother and baby. There are no guidelines or consensus recommendations regarding brain tumor management in pregnancy, and thus, individual treatment decisions are made by the care team based on experiential evidence, extrapolation of guidelines for nonpregnant patients, and patient values and preferences.
Rapid malignant transformation of low-grade astrocytoma in a pregnant woman.
Hanada Tomoko,Rahayu Tri Uji,Yamahata Hitoshi,Hirano Hirofumi,Yoshioka Takako,Arita Kazunori
The journal of obstetrics and gynaecology research
We report rapid malignant transformation of diffuse astrocytoma to glioblastoma during pregnancy in a young woman. A 21-year-old woman was found to have a non-enhancing right frontal lesion, supposed to be a low-grade astrocytoma according to magnetic resonance imaging (MRI) studied for chronic headache. Due to the absence of clinical symptoms, the patient refused further investigations and delivered a baby and then became pregnant with a second baby. At first, she refused the biopsy because she was afraid, although the size of the lesion on MRI was increasing; however, due to repeated persuasion, she underwent a biopsy during the 4th month of her second gestation, with a result of diffuse astrocytoma (WHO grade II). At 1 month after the second delivery and 6 months after the biopsy, MRI revealed further enlargement of the tumor and a heterogeneous kenhancement effect. A gross tumor removal was carried out, and the tumor was histologically diagnosed as glioblastoma (WHO grade IV). This is the quickest ever malignant transformation of diffuse astrocytoma during pregnancy in the published reports.
Occurrence of Glioma in Pregnant Patients: An Institutional Case Series and Review of the Literature.
Singh Pawan,Mantilla Emmanuel,Sewell Josie,Hatanpaa Kimmo J,Pan Edward
BACKGROUND/AIM:Gliomas present a uniquely challenging clinical situation in the context of pregnancy, with no standard recommendations. This case series aimed to describe the treatment regimen and outcomes of five pregnant patients with gliomas. PATIENTS AND METHODS:This is a retrospective study. A patient database from electronic medical records was evaluated to identify pregnant patients with gliomas treated at our institution between 2008-2018. RESULTS:Five study patients who were pregnant with gliomas were identified. Of these, 4 were diagnosed during pregnancy, while 1 was diagnosed prior to her pregnancy. One patient had grade 2 astrocytoma, 1 had grade 3 anaplastic astrocytoma, and 3 had grade 4 glioblastomas (GBM). All patients received surgery, and one patient received radiation therapy without concurrent chemotherapy during her pregnancy. All delivered healthy babies. Three of the 5 patients remain alive, and 2 of the 5 were progression-free at the last follow-up. CONCLUSION:Treatment plans must be specifically tailored to the individual patient based on the glioma grade, the mother's desire to continue the pregnancy, and the risks of delaying treatment until after pregnancy. Additional studies need to be performed to definitively establish uniform guidelines for the treatment of pregnant patients with glioma.
Post-traumatic malignant glioma in a pregnant woman: case report and review of the literature.
Han Zongli,Du Yanli,Qi Hui,Yin Wei
To add a further contribution to the literature supporting the relationship between previous head trauma and the development of glioma. We present the first case of pregnancy-related post-traumatic malignant glioma in a 29-year-old female who was admitted because of left sided hemiplegia and epilepsy due to a malignant glial tumor. She had been operated for a right frontal hematoma caused by a motorbike accident 9 years before. Neuroimaging showed a large neoplasia in the right frontal region beneath the material used for cranialplasty, and postoperative pathological revealed a glioblastoma multiforme (GBM) in continuity with the scar resulting from the trauma. While epidemiologic studies may not be conclusive, a pathologic basis has been suggested which show that trauma act as a cocarcinogen in the presence of an initiating carcinogen. Our case fulfilled the widely established criteria for brain tumors of traumatic origin. We believe that in specific cases it is reasonable to acknowledge an etiological association between head trauma and glioma. And additional factors such as pregnancy may promote the manifestation of the clinical symptoms.
The effect of pregnancy on survival in a low-grade glioma cohort.
Rønning Pål A,Helseth Eirik,Meling Torstein R,Johannesen Tom B
Journal of neurosurgery
OBJECTIVE The impact of pregnancy on survival in female patients with low-grade glioma (LGG) is unknown and controversial. The authors designed a retrospective cohort study on prospectively collected registry data to assess the influence of pregnancy and child delivery on the survival of female patients with LGG. METHODS In Norway, the reporting of all births and cancer diagnoses to the Medical Birth Registry of Norway (MBRN) and the Cancer Registry of Norway (CRN), respectively, is compulsory by law. Furthermore, every individual has a unique 11-digit identification number. The CRN was searched to identify all female patients with a histologically confirmed diagnosis of World Health Organization (WHO) Grade II astrocytoma, oligoastrocytoma, oligodendroglioma, or pilocytic astrocytoma who were 16-40 years of age at the time of diagnosis during the period from January 1, 1970, to December 31, 2008. Obstetrical information was obtained from the MBRN for each patient. The effect of pregnancy on survival was evaluated using a Cox model with parity as a time-dependent variable. RESULTS The authors identified 65 patients who gave birth to 95 children after an LGG diagnosis. They also identified 281 patients who did not give birth after an LGG diagnosis. The median survival was 14.3 years (95% CI 11.7-20.6 years) for the entire study population. The effect of pregnancy was insignificant in the multivariate model (HR 0.71, 95% CI 0.35-1.42). CONCLUSIONS Pregnancy does not seem to have an impact on the survival of female patients with LGG.
Progression of Low-Grade Glioma During Pregnancy With Subsequent Regression Postpartum Without Treatment-A Case Report.
Shah Amar S,Nicoletti Lisa K,Kurtovic Elvisa,Tsien Christina I,Benzinger Tammie L S,Chicoine Michael R
BACKGROUND AND IMPORTANCE:This report illustrates a case of a low-grade glioma that showed significant disease progression during pregnancy, and then subsequent regression spontaneously in the postpartum period without treatment. This is a rare case of spontaneous glioma regression in the postpartum period, and may suggest underlying mechanisms of hormonal influences upon glioma progression. CLINICAL PRESENTATION:The patient is a 27-yr-old female who underwent placement of a right-sided ventriculoperitoneal shunt for aqueductal stenosis at 8 wk of age. At the age of 24 yr, she was evaluated for chronic headaches and was found on magnetic resonance imaging (MRI) for the first time to have a small nonenhancing tectal glioma that remained stable on follow-up MRI. At the age of 25 yr, she returned for annual follow-up after giving birth and reported a significant increase in headache frequency and severity during the pregnancy. Repeat imaging now showed a larger, contrast-enhancing lesion. A decision was made to pursue radiosurgery, but during the pretreatment planning phase, the lesion and symptoms regressed spontaneously, and the lesion has remained stable on repeat MRI studies over a 30-mo period since delivery of her child. CONCLUSION:A young woman with a tectal glioma developed symptomatic disease progression during pregnancy, and subsequently had regression of the lesion and symptoms in the postpartum period without treatment. This case supports watchful waiting in select cases and suggests a potential role of hormones in glioma progression.
Management strategies for neoplastic and vascular brain lesions presenting during pregnancy: A series of 29 patients.
Pereira Celestino Esteves,Lynch Jose Carlos
Surgical neurology international
BACKGROUND:The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event, but when it happens, it jeopardizes the lives of both the mother and infant. It also creates challenges of a neurosurgical, obstetric, and ethical nature. A multidisciplinary approach should be used for their care. METHODS:Between 1986 and 2015, 12 pregnant women diagnosed with brain tumors and 17 women with intracranial vascular lesion underwent treatment at the Neurosurgery Department of the Servidores do Estado Hospital and Rede D'Or/São Luis. The Neurosurgery Department teamed up with Obstetrics Anesthesiology Departments in establishing the procedures. The patients' records, surgical descriptions, imaging studies, and histopathological material were reviewed. RESULTS:Among 12 patients presenting with brain tumors, there were neither operative mortality nor fetal deaths. Among the vascular lesions, aneurysm rupture was responsible for bleeding in 6 instances. Arteriovenous malformation was diagnosed in 7 patients. In this subgroup, the maternal and fetal mortality rates were 11.7% and 23.7%, respectively. CONCLUSIONS:We can assert that the association between a brain tumor and vascular lesions with pregnancy is a very unusual event, which jeopardizes both the lives of the mother and infant. It remains incompletely characterized due to the rare nature of these potentially devastating events. Knowing the exact mechanism responsible for the interaction of pregnancy and with these lesions will improve the treatment of these patients.
Outcomes of hospitalization in pregnant women with CNS neoplasms: a population-based study.
Terry Anna R,Barker Fred G,Leffert Lisa,Bateman Brian T,Souter Irene,Plotkin Scott R
Managing a CNS neoplasm during pregnancy presents complex challenges, and population-based studies are lacking. We designed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) to investigate pregnancy outcomes in women with CNS neoplasms. We constructed a logistic regression model for maternal mortality, preterm labor, intrauterine growth restriction (IUGR), and Caesarean delivery, controlling for age, comorbidities, and demographic characteristics. We identified 379 malignant brain tumors, 437 benign brain tumors, and 44 spine tumors among 19 million pregnancy-related admissions from 1988 through 2009. Malignant brain tumors were associated with maternal mortality (odds ratio [OR], 143), preterm labor (OR, 3.4), and IUGR (OR, 2.9). Benign brain tumors were associated with preterm labor (OR, 2.3). A diagnosis of hyperemesis gravidarum was more common in malignant (OR, 2.2) and benign (OR, 2.8) brain tumors. Compared with the general population, Caesarean delivery was more frequent for malignant (OR, 6.4) and benign (OR, 2.8) brain tumors and spine tumors (OR, 3.9). Admission without delivery was more common for malignant (OR, 8.6) and benign (OR, 4.3) brain tumors and spine tumors (OR, 3.8; P < .05 for all outcomes). Thirty-three percent of all hospitalizations involved neurosurgical procedures, but pregnancy complications were not significantly more likely to occur in surgical patients. In conclusion, malignant brain tumors were associated with adverse pregnancy outcomes, and CNS neoplasms were associated with higher rates of Caesarean delivery. Additional research is needed to improve understanding of obstetric risk in these patients and to assist with treatment, counseling, and monitoring during delivery.
Pineal chordoid meningioma complicated by repetitive hemorrhage during pregnancy: case report and literature review.
Lee Kyung-Hwa,Lall Rohan R,Chandler James P,Bigio Eileen H,Mao Qinwen
Neuropathology : official journal of the Japanese Society of Neuropathology
Chordoid meningioma is an uncommon variant of meningioma, and is very rarely found in the pineal region. We report a case of pineal region chordoid meningioma occurring in a young woman complicated by repetitive hemorrhages in the setting of pregnancy. A 23-year-old woman, 28 weeks pregnant, was transferred to our hospital for further management of a multi-septated, hemorrhagic pineal region mass and hydrocephalus. MRI revealed a heterogeneous T2-hyperintense lesion measuring 1.7 × 1.7 cm in the pineal gland. Resection of the tumor through an occipital transtentorial approach was performed. Histopathologic examination of the lesion confirmed the diagnosis of chordoid meningioma demonstrating cords and clusters of eosinophilic cells with rare cytoplasmic vacuolation arranged in a mucinous stroma. Additionally, there was abundant lymphoplasmacytic infiltration within the tumor. The details of this case are presented with a review of the literature.
Reproductive factors and risk of primary brain tumors in women.
Anic Gabriella M,Madden Melissa H,Nabors L Burton,Olson Jeffrey J,LaRocca Renato V,Thompson Zachary J,Pamnani Shitaldas J,Forsyth Peter A,Thompson Reid C,Egan Kathleen M
Journal of neuro-oncology
Gender-specific incidence patterns and the presence of hormonal receptors on tumor cells suggest that sex hormones may play a role in the onset of primary brain tumors. However, epidemiological studies on the relation of hormonal risk factors to the risk of brain tumors have been inconsistent. We examined the role of reproductive factors in the onset of glioma and meningioma in a case-control study conducted in the Southeastern US that included 507 glioma cases, 247 meningioma cases, and 695 community-based and friend controls. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) adjusting for age, race, US state of residence, and education. An older age at menarche was associated with an increased risk of glioma (≥ 15 vs. ≤ 12 years: OR 1.65; 95% CI 1.11-2.45), with a stronger association observed in pre-menopausal (OR 2.22; 95% CI 1.12-4.39) than post-menopausal (OR 1.55; 95% CI 0.93-2.58) women. When compared to controls, meningioma cases were more likely to have undergone natural menopause (OR 1.52; 95% CI 1.04-2.21) whereas glioma cases were less likely to be long term users of oral contraceptives (OR 0.47; 95% CI 0.33-0.68). Increasing parity was not related to the risk of either tumor. Current findings are consistent with a limited role for hormones in the onset of brain tumors in women. Results contribute to a growing body of evidence that a later age at menarche increases the risk of glioma in women.
Pregnancy increases the growth rates of World Health Organization grade II gliomas.
Pallud Johan,Mandonnet Emmanuel,Deroulers Christophe,Fontaine Denys,Badoual Mathilde,Capelle Laurent,Guillet-May Frédérique,Page Philippe,Peruzzi Philippe,Jouanneau Emmanuel,Frenay Marc,Cartalat-Carel Stéphanie,Duffau Hugues,Taillandier Luc, ,
Annals of neurology
Twelve pregnancies in 11 adult women harboring World Health Organization (WHO) grade II gliomas (GIIGs) prior to pregnancy were reviewed to address whether pregnancy affects tumor growth using a quantitative approach of the radiological velocity of diametric expansion (VDE) on successive magnetic resonance images. VDE was significantly increased during pregnancy as compared to prepregnancy (p < 0.001) and to postdelivery (p = 0.012) periods. Pregnancy increases the radiological growth rates of GIIGs. An increase in seizure frequency was observed concomitantly in 40% of cases and further oncological treatment was started after delivery in 25% of cases.
Management of brain tumors presenting in pregnancy: a case series and systematic review.
Rodrigues Adrian J,Waldrop Anne R,Suharwardy Sanaa,Druzin Maurice L,Iv Michael,Ansari Jessica R,Stone Sarah A,Jaffe Richard A,Jin Michael C,Li Gordon,Hayden-Gephart Melanie
American journal of obstetrics & gynecology MFM
Patients who present with brain tumors during pregnancy require unique imaging and neurosurgical, obstetrical, and anesthetic considerations. Here, we review the literature and discuss the management of patients who present with brain tumors during pregnancy. Between 2009 and 2019, 9 patients were diagnosed at our institution with brain tumors during pregnancy. Clinical information was extracted from the electronic medical records. The median age at presentation was 29 years (range, 25-38 years). The most common symptoms at presentation included headache (n=5), visual changes (n=4), hemiparesis (n=3), and seizures (n=3). The median gestational age at presentation was 20.5 weeks (range, 11-37 weeks). Of note, 8 patients (89%) delivered healthy newborns, and 1 patient terminated her pregnancy. In addition, 5 patients (56%) required neurosurgical procedures during pregnancy (gestational ages, 14-37 weeks) because of disease progression (n=2) or neurologic instability (n=3). There was 1 episode of postneurosurgery morbidity (pulmonary embolism [PE]) and no surgical maternal mortality. The median length of follow-up was 15 months (range, 6-45 months). In cases demonstrating unstable or progressive neurosurgical status past the point of fetal viability, neurosurgical intervention should be considered. The physiological and pharmacodynamic changes of pregnancy substantially affect anesthetic management. Pregnancy termination should be discussed and offered to the patient when aggressive disease necessitates immediate treatment and the fetal gestational age remains previable, although neurologically stable patients may be able to continue the pregnancy to term. Ultimately, pregnant patients with brain tumors require an individualized approach to their care under the guidance of a multidisciplinary team.
Dysembryoplastic neuroepithelial tumor in pregnancy.
Terauchi Masakazu,Kubota Toshiro,Aso Takeshi,Maehara Taketoshi
Obstetrics and gynecology
BACKGROUND:Dysembryoplastic neuroepithelial tumor is a rare, low-grade brain tumor that is characterized by intractable, partial seizures of juvenile onset. CASE:A 36-year-old pregnant woman with dichorionic, diamniotic twins temporarily lost consciousness at 27 weeks of gestation. Magnetic resonance imaging evaluation showed a 3-cm multicystic nodule in her right temporal lobe that was diagnosed, together with her history of recurrent anxiety attacks, as dysembryoplastic neuroepithelial tumor. The lesion did not enlarge during pregnancy, and healthy male infants were delivered by cesarean at 36 weeks. The tumor was successfully removed 2 months postpartum, and the patient has experienced no further seizures. CONCLUSION:Dysembryoplastic neuroepithelial tumor was conservatively managed during pregnancy without neurosurgical intervention.
Clinical challenges of glioma and pregnancy: a systematic review.
van Westrhenen A,Senders J T,Martin E,DiRisio A C,Broekman M L D
Journal of neuro-oncology
INTRODUCTION:This review aims to summarize challenges in clinical management of concomitant gliomas and pregnancy and provides suggestions for this management based on current literature. METHODS:PubMed and Embase databases were systematically searched for studies on glioma and pregnancy. Observational studies and articles describing expert opinions on clinical management were included. The strength of evidence was categorized as arguments from observational studies, consensus in expert opinions, or single expert opinions. Risk of bias was assessed by the Newcastle-Ottawa Scale (NOS). RESULTS:27 studies were selected, including 316 patients with newly diagnosed (n = 202) and known (n = 114) gliomas during pregnancy. The median sample size was 6 (range 1-65, interquartile range 1-9). Few recommendations originated from observational studies; the remaining arguments originated from consensus in expert opinions. CONCLUSION:Findings from observational studies of adequate quality include (1) There is no known effect of pregnancy on survival in low-grade glioma patients; (2) Pregnancy can provoke clinical deterioration and tumor growth on MRI; (3) In stable women at term, there is no benefit of cesarean section over vaginal delivery, with respect to adverse events in mother or child. Unanswered questions include when pregnancy should be discouraged, what best monitoring schedule is for both mother and fetus, and if and how chemo- and radiation therapy can be safely administered during pregnancy. A multicenter individual patient level meta-analysis collecting granular information on clinical management and related outcomes is needed to provide scientific evidence for clinical decision-making in pregnant glioma patients.
Primitive neuroectodermal tumor (PNET) of the brain diagnosed during pregnancy.
Bodner-Adler Barbara,Bodner Klaus,Zeisler Harald
BACKGROUND:Brain tumors in pregnancy are extremely rare events. A case of a patient with primitive neuroectodermal tumor (PNET) of the brain diagnosed during the second half of pregnancy is reported. CASE REPORT:The first case of PNET of the brain diagnosed in a 26-year-old woman, gravida 1 para 0, in her 20th week of pregnancy is presented. The patient presented with headache, nausea and blurred vision. Magnetic resonance imaging revealed a large ill-defined tumoral mass in the left frontal cortex. Gross subtotal resection was achieved via a left frontal craniotomy. Pathological evaluation revealed histology and immuno-histochemistry consistent with the diagnosis of PNET. Adjuvant radiation therapy to the neurocranium was administered. Additionally, chemotherapy with Temodal 5 mg (Temozolomid) was initiated at 30 weeks of gestation. The patient delivered her baby via Cesarean section at 34 weeks of gestation. After delivery, external beam radiation to the craniospinal axis completed the therapy. The patient is currently being followed-up at the Department of Oncology University of Vienna Medical School, without any evidence of disease, 3 months after diagnosis. CONCLUSION:This case is the first reported description of a PNET in pregnancy. A brief discussion of this rare disease and its management in pregnancy is presented. The treatment options seem to be reduced in pregnant women and mainly depend on the patient's condition as well as the gestational age at presentation. In a multidisciplinary approach, an optimal therapy schedule should be assessed depending on these two parameters.
Effect of pregnancy on growth of intracranial meningiomas.
Quddusi Ayesha,Shamim Muhammad Shahzad,Virani Quratulain
JPMA. The Journal of the Pakistan Medical Association
Meningiomas are the most common benign primary intracranial tumours in adults. Their rapid growth during pregnancy has been well reported. Moreover, the relationship of increased progesterone expression during pregnancy and extensive tumour growth has been debated. In this review, we discuss not only the effect of progesterone on meningiomal growth but also other mechanisms involved in gestational meningiomas.
Tumor progression and transformation of low-grade glial tumors associated with pregnancy.
Daras Mariza,Cone Christina,Peters Katherine B
Journal of neuro-oncology
Brain tumor growth or progression has been shown to occur in low-grade glial tumors and meningiomas. While progression has been documented in this population, transformation to a more aggressive high-grade glial tumor that can lead to increased morbidity and mortality has not been identified. In this case series, we document transformation from low-grade gliomas to high-grade gliomas (WHO grade III and IV) in young women during pregnancy. We further discuss the possible etiologies of this phenomenon.
Pregnancy in women with gliomas: a case-series and review of the literature.
Zwinkels Hanneke,Dörr Joep,Kloet Fred,Taphoorn Martin J B,Vecht Charles J
Journal of neuro-oncology
The occurrence of pregnancy in women with brain tumors confronts both patients and physicians with difficult decision making at each stage of pregnancy. We studied the course of events of nine pregnancies in seven women with low-grade glioma in our hospital over a 10 year period. Five patients had a surgical resection, one a biopsy and one woman was followed by wait-and-see policy before pregnancy. In two women, a therapeutic abortion was carried out in the first trimester because of signs of progression, necessitating surgical removal of the tumor. In the other five women pregnancy had an uncomplicated course. Based on a literature review, we found 28 women diagnosed with a known glioma before becoming pregnant. All pregnancies but one, were uneventful and all women had a normal delivery, including the seven cases with exposure to chemotherapy and in whom healthy babies were born. A total of 75 pregnant women were identified in whom new onset glioma developed, which was high-grade in 56 %, and becoming symptomatic in 51 % during the third trimester, usually by focal neurological deficits. We conclude that in relation to pregnancy, low-grade gliomas are more often seen in women already known with a brain tumor, while high-grade gliomas represent more frequently a new onset phenomenon. Based on these observations, guidelines are given on initiation of antitumor therapy during pregnancy, seizure management, counseling on therapeutic abortion, and on the timing and choice of obstetrical interventions.
[Intracranial meningioma in pregnancy. Case report and literature review].
Reyes-Myrna C,Torres-Hernández C M,Herrera-Ortiz A,Figueroa-Angel V
Ginecologia y obstetricia de Mexico
BACKGROUND:Brain tumors are the fifth leading cause of death in women of 20-39 years of age, including pregnant with similar onset and evolution. CASE REPORT:33 years of age with neurological manifestations due to an intracranial meningioma and 37 weeks pregnant. The pregnancy was terminated and the tumor was removed; the results were favorable for the mother and child. CONCLUSIONS:The incidence of intracranial tumors during pregnancy is extremely low. Headache is the first symptom in almost 90% of cases, but are also common: nausea, vomiting, seizures and neurological deficits. MRI is the diagnostic study of choice. Meningiomas are the most common benign primary brain tumors of the central nervous system. They are a rare association; pregnant patients often experience more symptoms under accelerated tumor growth of a neoplasm usually slow growing. The treatment is surgical, although the current trend is the conservative treatment to achieve viable pregnancies. Emergency neurosurgery is reserved for cases with suspected increase in ICP, herniation, progressive neurological deterioration or other condition that threatens the life of the mother. The choice between Caesarean delivery and not only neurosurgery, there are multiple obstetrical, neurological and anesthesia to be taken into account factors. The prognosis is generally excellent with a 5-year survival greater than 90%.
Interactions between glioma and pregnancy: insight from a 52-case multicenter series.
Peeters Sophie,Pagès Mélanie,Gauchotte Guillaume,Miquel Catherine,Cartalat-Carel Stéphanie,Guillamo Jean-Sébastien,Capelle Laurent,Delattre Jean-Yves,Beauchesne Patrick,Debouverie Marc,Fontaine Denys,Jouanneau Emmanuel,Stecken Jean,Menei Philippe,De Witte Olivier,Colin Philippe,Frappaz Didier,Lesimple Thierry,Bauchet Luc,Lopes Manuel,Bozec Laurence,Moyal Elisabeth,Deroulers Christophe,Varlet Pascale,Zanello Marc,Chretien Fabrice,Oppenheim Catherine,Duffau Hugues,Taillandier Luc,Pallud Johan
Journal of neurosurgery
OBJECTIVE The goal of this study was to provide insight into the influence of gliomas on gestational outcomes, the impact of pregnancy on gliomas, and the identification of patients at risk. METHODS In this multiinstitutional retrospective study, the authors identified 52 pregnancies in 50 women diagnosed with a glioma. RESULTS For gliomas known prior to pregnancy (n = 24), we found the following: 1) An increase in the quantified imaging growth rates occurred during pregnancy in 87% of cases. 2) Clinical deterioration occurred in 38% of cases, with seizures alone resolving after delivery in 57.2% of cases. 3) Oncological treatments were immediately performed after delivery in 25% of cases. For gliomas diagnosed during pregnancy (n = 28), we demonstrated the following: 1) The tumor was discovered during the second and third trimesters in 29% and 54% of cases, respectively, with seizures being the presenting symptom in 68% of cases. 2) The quantified imaging growth rates did not significantly decrease after delivery and before oncological treatment. 3) Clinical deterioration resolved after delivery in 21.4% of cases. 4) Oncological treatments were immediately performed after delivery in 70% of cases. Gliomas with a high grade of malignancy, negative immunoexpression of alpha-internexin, or positive immunoexpression for p53 were more likely to be associated with tumor progression during pregnancy. Deliveries were all uneventful (cesarean section in 54.5% of cases and vaginal delivery in 45.5%), and the infants were developmentally normal. CONCLUSIONS When a woman harboring a glioma envisions a pregnancy, or when a glioma is discovered in a pregnant patient, the authors suggest informing her and her partner that pregnancy may impact the evolution of the glioma clinically and radiologically. They strongly advise a multidisciplinary approach to management. ■ CLASSIFICATION OF EVIDENCE Type of question: association; study design: case series; evidence: Class IV.
[Brain tumors and pregnancy].
Lynch José Carlos,Emmerich João Cláudio,Kislanov Sara,Gouvêa Fabiano,Câmara Lygia,Santos Silva Sonia Maria,D'Ippolito Marcos Machado
Arquivos de neuro-psiquiatria
BACKGROUND:Despite not being a common fact, the occurrence of brain tumors during pregnancy poses a risk to both the mother and infant. AIM:To identify the best medical procedure to be followed for a pregnant patient harboring a brain tumor. METHOD:The records of 6 patients with brain tumors, diagnosed during pregnancy were examined. RESULTS:Several types of brain tumors have been associated with pregnancy, but the meningioma is, by far, the most frequent. It seems that pregnancy aggravates the clinical course of intracranial tumors. There were no operative mortality in these series. In 2 patients the labor occurred before the craniotomy and in others, the delivery occurred after the surgery. CONCLUSION:The best moment to recommend the craniotomy and the neurosurgical removal of the tumor will depend of the mothers neurological condition, the tumor histological type as well as the gestational age.
Ganglioneuroblastoma during pregnancy--A rare case report.
Moga M A,Daniilidis A,Bigiu N F,Andrei C,Dinas K,Festila D G
Clinical and experimental obstetrics & gynecology
PURPOSE:To report a rare case of ganglioneuroblastoma encountered rarely in adults, especially during pregnancy. Materials and METHODS:The authors present a case of ganglioneuroblastoma relapse during the third trimester of pregnancy in a patient previously treated for ganglioneuroblastoma who had a eight-year disease-free interval. Late manifestation of neurological symptoms (vestibular syndrome, nystagmus, slightly right motor deficit) was perhaps influenced by the hormonal pregnancy effects. In this case the option was for caesarean section under general anesthesia at 36 weeks. RESULTS:Based on MRI result, the neurosurgical consultation stated the need of postpartum brain tumor excision. Recovery of the mother was complication-free with persistent, constant postoperative neurological symptoms. It resulted in a healthy newborn, not requiring special follow-up. CONCLUSIONS:Pregnancy and brain tumor have mutual negative effect on the patient. Therapeutic management in this case was a medical dilemma regarding mode setting and timing of delivery, taking into account the maternal-fetal risk-benefit.
[Anaplastic astrocytoma in pregnancy].
Šrýtrová P,Bydžovská I
OBJECTIVE:We describe the diagnose and treatment of patient with anaplastic astrocytoma in the third trimestr of pregnancy. DESIGN:Case report. SETTING:Department of Gynecology and Obstetrics, Regional Hospital Liberec. CONCLUSION:Malignant brain tumors are fortunately a rare disease. There is no difference in incidence between pregnant and non-pregnant women, but faster development of symptoms and progression of disease is suspected. There is a problem of small number of patients in these studies. In our opinion most important is early and effective multidisciplinary management according to condition of patient and age of pregnancy.
Reproductive factors in relation to risk of brain tumors in women: an updated meta-analysis of 27 independent studies.
Zong Hailiang,Xu Hongsheng,Geng Zhongqun,Ma Chong,Ming Xing,Shang Ming,Li Kai,He Xiaoguang,Du Hai,Zhao Jianping,Cao Lei
Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine
Previous studies on the association between reproductive factors and brain tumor risk in women have provided inconclusive findings. Thus, an updated meta-analysis was performed to obtain more precise risk estimates for brain tumor regarding several common reproductive factors. A comprehensive literature search for relevant publications in the PubMed and Embase databases was carried out from their inception up to June 20, 2014. Pooled relative risks (RRs) with corresponding 95% confidence intervals (CIs) were calculated. There were 27 independent studies with a total of 12,129 cases and 1,433,915 controls included into the present meta-analysis. We found that an elevated risk of brain tumors (RR=1.17, 95% CI 1.06-1.29, P=0.002), particularly glioma (RR=1.33, 95% CI 1.15-1.54, P<0.001), was related to older age at menarche. Interestingly, stratified analysis by type of brain tumors showed that the longer duration of breast feeding was associated with the risk of meningioma negatively but glioma positively (for meningioma: RR=0.76, 95% CI 0.64-0.91, P=0.002; for glioma: RR=1.70, 95% CI 1.14-2.55, P=0.010). No significant association was observed when estimating the roles of other reproductive factors including parity, age at first birth, menopausal status, and age at menopause in brain tumorigenesis. Our study suggests that older age at menarche is a risk factor of brain tumors and glioma in particular. Additionally, more studies are warranted to further elucidate roles and mechanisms of common reproductive factors in the risk of brain tumors.
Primary brain tumours, meningiomas and brain metastases in pregnancy: report on 27 cases and review of literature.
Verheecke Magali,Halaska Michael J,Lok Christianne A,Ottevanger Petronella B,Fruscio Robert,Dahl-Steffensen Karina,Kolawa Wojciech,Gziri Mina Mhallem,Han Sileny Naeyu,Van Calsteren Kristel,Van den Heuvel Frank,De Vleeschouwer Steven,Clement Paul M,Menten Johannes,Amant Frédéric,
European journal of cancer (Oxford, England : 1990)
BACKGROUND:The concurrence of intracranial tumours with pregnancy is rare. The purpose of this study was to describe all reported patients registered in the international Cancer in Pregnancy registration study (CIP study; http://www.cancerinpregnancy.org), and to review the literature in order to obtain better insight into outcome and possibilities of treatment in pregnancy. METHODS:We collected all intracranial tumours (primary brain tumour, cerebral metastasis, or meningioma) diagnosed during pregnancy, registered prospectively and retrospectively by international collaboration since 1973. Patients diagnosed postpartum were excluded. We summarised the demographic features, treatment decisions, obstetrical and neonatal outcomes. RESULTS:The mean age of the 27 eligible patients was 31years (range 23-41years), of which 13 and 12 patients were diagnosed in the second and third trimesters, respectively. Eight patients (30%) underwent brain surgery, seven patients (26%) had radiotherapy and in three patients (11%) chemotherapy was administered during gestation. Two patients died during pregnancy and four pregnancies were terminated. In 16 (59%) patients elective caesarean section was performed of which 14 (52%) were still preterm (range 30-36weeks, mean 33weeks). Five patients had a vaginal delivery (range 36-40weeks). Of the 21 ongoing pregnancies all children were born alive without visible congenital malformations and the available long-term follow-up data (range 2-25years) of six children were reassuring. CONCLUSION:Adherence to standard protocol for the treatment of brain tumours during pregnancy appears to allow a term delivery and a higher probability of a vaginal delivery.
From epidemiology and neurodevelopment to antineoplasticity. Medroxyprogesterone reduces human glial tumor growth in vitro and C6 glioma in rat brain in vivo.
Altinoz Meric A,Nalbantoglu Josephine,Ozpinar Aysel,Emin Ozcan M,Del Maestro Rolando F,Elmaci Ilhan
Clinical neurology and neurosurgery
OBJECTIVE:Glial tumor growth may accelerate during gestation, but epidemiological studies consistently demonstrated that parousity reduces life long risk of glial tumors. Pregnancy may also accelerate growth of medulloblastoma and meningioma, but parousity does not confer protection against these tumors. We were the first to show that medroxyprogesterone acetate (MPA) reduces rat C6 glioma growth in vitro. Now we aimed to determine the effects of MPA on human brain cancers (particularly glioblastoma) in vitro and C6 glioma in vivo. PATIENTS AND METHODS:We evaluated the effects of MPA on: i) monolayer growth of human U87 and U251 glioblastoma, ii) 3D-spheroid growth and invasion of C6 rat glioma and human U251 glioma, iii) interactions with PI3-Kinase inhibitors and coxsackie-adenovirus receptor (CAR) in modifying 3D-spheroid invasion of glioma. RESULTS:MPA at low doses (3.25-13 μM) insignificantly stimulated and at high doses (above 52 μM) strongly suppressed the growth of human U87 and U251 cells in vitro. MPA also binds to glucocorticoid receptors similar to dexamethasone (Dex) and unexpectedly, PI3-Kinase inhibitors at low doses suppressed anti-invasive efficacies of MPA and Dex. MPA exerted higher invasion-inhibitory effects on CAR-expressing human glioma cells. Lastly, MPA suppressed growth of C6 glioma implanted into rat brain. CONCLUSION:Progesterone analogues deserve to be studied in future experimental models of high grade glial brain tumors.
Influence of pregnancy on glioma patients.
Forster Marie-Therese,Baumgarten Peter,Gessler Florian,Maurer Gabriele,Senft Christian,Hattingen Elke,Seifert Volker,Harter Patrick N,Franz Kea
BACKGROUND:Data about the influence of pregnancy on progression-free survival and overall survival of glioma patients are sparse and controversial. We aimed at providing further evidence on this relation. METHODS:The course of 18 glioma patients giving birth to 23 children after tumor surgery was reviewed and compared to the course of 18 nulliparous female patients matched for tumor diagnosis including molecular markers, extent of resection, and tumor location. RESULTS:Tumor pathology was astrocytoma, oligodendroglioma, and ependymoma in 9, 6, and 3 patients, respectively. Time interval between tumor resection and delivery was 5.3 ± 4.4 years. All newborns were healthy after uneventful deliveries. Tumor progression was diagnosed before pregnancy in 4 patients and during pregnancy in 1 patient, and 4 patients displayed progressive disease 31.0 ± 11 months after delivery. Three of these latter patients underwent second surgery, whereas resection of recurrent tumor had been performed in 2 women before pregnancy. Among nulliparous patients, 9 women suffered from tumor progression, resulting in re-operation in 7 patients and/or further adjuvant treatment in 6 cases. Progression-free survival did not differ between patients with and patients without children (p = 0.4). Moreover, in both groups, median overall survival was not reached after a mean follow-up period of 9.7 ± 5.7 years in glioma patients who gave birth to a child and 8.9 ± 4.2 years in nulliparous glioma patients. CONCLUSION:Pregnancy does not seem to influence the clinical course of glioma patients. Likewise, glioma seems not to have an impact on delivered children's health.
[Metastatic brain tumour in pregnancy: a case report].
Pantović Sveto,Sparić Radmila,Mijalčić Radovan
Srpski arhiv za celokupno lekarstvo
INTRODUCTION:Malignant tumours of the central nervous system in pregnancy are rare and are most frequently diagnosed in the second part of pregnancy. Of all malignant tumours which may occur in pregnancy, intracranial tumours bear the highest risk of maternal and foetal morbidity and mortality. CASE OUTLINE:A 29-year-old primipara was admitted to our hospital as an emergency in the twenty-ninth week of pregnancy due to headache, right eye sight disorders (double vision), nausea and vomiting. The patient had a total thyroidectomy and a dissection of lymph glands of the neck at the age of seven years due to papillary carcinoma of the thyroid glands. The clinical and sonographic test revealed regular foetal growth and morphology. The MRI showed expansive changes in the brain parenchyma corresponding to metastatic lesion with the subtentorial herniation of the uncus of the hippocampus by compressive effect onto the right cerebral peduncle of the mesencephalon. Emergent neurosurgical intervention was indicated. Having in mind the age at pregnancy, it was decided to perform a caesarean operation. Alive female child was born weighing 1,370 grams. The post-operative procedure was normal. The patient was transferred to the neurosurgery department on the first post-operative day, where she underwent emergent surgery. Immunohistochemistry confirmed the metastatic tumour originating from the primary papillary adenocarcinoma of the thyroid gland. CONCLUSION:Neurosurgical diseases in pregnancy simultaneously jeopardize two lives and represent both medical and ethical problem. Upon confirming the presence of intracranial malignancy in pregnancy, further procedure is very individual and it implies cooperation of gynaecologists, neurologists, neurosurgeons, oncologists, anaesthesiologists and neonatologists.
Malignant PRES and RCVS after brain surgery in the early postpartum period.
Cossu G,Daniel R T,Hottinger A F,Maduri R,Messerer M
Clinical neurology and neurosurgery
The management of women with brain tumors in the early post-partum period may be demanding as the patho-physiological changes that occur during pregnancy may also manifest in the early post-partum period. The aim of our paper is to report a case of late-onset post-partum pre-eclampsia after brain tumor surgery, complicated by posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). Hemicraniectomy and intensive care management were necessary to obtain a favorable neurological outcome. The inherent literature on the subject is also analyzed through a systematic research. This is the first case of supratentorial decompressive hemicraniectomy in post-partum PRES, while there has been only one other case of posterior fossa decompression described in this cohort of patients. PRES and RCVS can complicate the neurosurgical management of women in the postpartum period. A careful evaluation of the clinical presentation is necessary as in some particular cases an aggressive medical and surgical treatment is required to obtain a favorable outcome.
Alveolar soft part sarcoma with multiple brain and lung metastases in pregnancy: A case report and literature review.
Wang Yubo,Cui Jiayue,Yan Xu,Jin Rihua,Hong Xinyu
RATIONAL:Alveolar soft part sarcomas (ASPSs) with multiple brain metastases in pregnancy is a rare entity. PATIENT CONCERNS:We report our experience with a 19-year-old pregnant woman who presented with intermittent headaches and vomiting at 38 weeks gestation. DIAGNOSES:The patient was initially diagnosed as brain metastasis according to computed tomography and magnetic resonance imaging (MRI) imaging. INTERVENTIONS:Cesarean section and craniotomy (complete resection of both brain metastatic lesions) was performed sequentially. OUTCOMES:A healthy baby girl was delivered safely and no neonatal malformations were found. Histological analysis confirmed the diagnosis of ASPS. Follow-up MRI performed 10 months after surgery revealed no residual tumor or signs of recurrence. LESSONS:We report a case of ASPS with multiple brain and lung metastases in a pregnant woman. We recommend timely MRI examination for diagnosis and have discussed the approach to the treatment of pregnant women with brain metastasis.
[Preterm delivery in a patient with frontal lobe brain tumor].
Cutura Nedo,Soldo Vesna
INTRODUCTION/AIM:Brain tumors are very rare in pregnancy. Diagnosis could be very simple if one consider brain tumor alongside blurred symptoms of headache, repetitive vomiting and/or epileptic attacks during pregnancy. The aim of this paper was to emphasize the importance of such pregnancy expert control and completion. CASE REPORT:We presented a 45-year-old pregnant woman at 30 weeks of gestation, and with brain tumor recidive in frontal lobe, hystologicaly confirmed as astrocytoma. The patient was newly diagnosed with tumor in 1995, and monitored until 2003, when she was operated. Due to malignant profile and a partial removal of tumor masses, postoperative gamma-ray therapy was recommended. Because of the continuous need for that kind of therapy, termination of preganancy was also recommended. It was carried out by the application of PGE2 vaginal tablets. Delivery lasted for 8 hours and 50 minutes, and with auxilium manuale sec. Bracht, due to the breech presentation, newborn was delivered 1 550 gramms in weight and 39 cm length. Apgar score was 6/7. CONCLUSION:Pregnancy in patient with brain tumors can be intensively monitored by neurosurgeons and obstetricians, and with the use of the symptomatical therapy almost up to the delivery term. Surgical intervention is recommended to be performed during the second and/or third trimester if the condition requires. The way of delivery in these patients should be individually determined in the most appropriate way both for the mother and the newborn, under given circumstances.
Management strategy for brain tumour diagnosed during pregnancy.
Lynch José Carlos,Gouvêa Fabiano,Emmerich João Cláudio,Kokinovrachos Georges,Pereira Celestino,Welling Leonardo,Kislanov Sara
British journal of neurosurgery
The occurrence of brain tumours during pregnancy is unusual, when this happen jeopardises the lives of both the mother and infant. This article aims at identifying the best medical management to be followed for a pregnant patient harbouring a brain tumour. The records of 10 patients with brain tumours diagnosed during pregnancy were retrospectively examined. The histological diagnosis revealed 3 grade 2 astrocytomas, and 1 grade 2 oligodendroglioma. All this gliomas (100%) developed dedifferentiation in the mean period of 27 months. The histology of the others tumours were 2 grade 1 meningiomas, 1 melanoma metastasis, 1 epidermoid tumour, 1 case of chemodectoma and 1 patient with a pituitary apoplexy in a non-function adenoma. There was no operative mortality in these series, and no fetal deaths were observed. Prior to craniotomy, five patients had caesarean sections, two others had vaginal deliveries. In three patients the delivery took place after the brain tumour treatment. Two patients had vaginal delivery and eight caesarean sections. The best moment to recommend the craniotomy and the neurosurgical removal of the tumour will depend of the mother's neurological condition, the tumour histological type as well as the gestational age. A multi-disciplinary approach was used to determine the optimal management for each patient.
[Anesthetic management of a pregnant woman with brain tumor].
Shiota Nobuhiro,Satomoto Maiko,Hakusui Takashi,Nakazawa Koichi,Makita Koshi
Masui. The Japanese journal of anesthesiology
A 35-year-old parturient, 35 weeks pregnant, pre- sented with intracranial tumor with increased intracra- nial pressure. She underwent emergency cesarean section under general anesthesia, followed by craniotomy. The intraoperative and postoperative courses were uneventful. The occurrence of brain tumors during pregnancy is very rare; meanwhile pregnancy may aggravate the natural history of an intracranial tumor, and may even unmask previously unknown diagnosis. The decision to proceed with cesarean section and neurosurgery depends on the site, size, type of tumor, neurological signs and symptoms, age of the fetus, and the patient's wishes. Therefore, close communication between the neurologist, neurosurgeon, anesthesiologist, obstetrician and the patient is very important.
Pregnancy and glial brain tumors.
Yust-Katz Shlomit,de Groot John F,Liu Diane,Wu Jimin,Yuan Ying,Anderson Mark D,Conrad Charles A,Milbourne Andrea,Gilbert Mark R,Armstrong Terri S
BACKGROUND:Improvements in brain tumor treatments have led to an increase in the number of young women with brain tumors who are now considering pregnancy. The aim of this study is to evaluate the influence of pregnancy on brain tumor biology. METHODS:In this institutional review board-approved retrospective study, we searched the institution's database for patients with glial brain tumors who were pregnant at the time of diagnosis or became pregnant during the course of their illness. We identified 34 such patients and reviewed their charts to determine each patient's clinical course and pregnancy outcome. RESULTS:Fifteen patients were diagnosed with a primary brain tumor during pregnancy: 3 with glioblastomas, 6 with grade III gliomas, and 6 with grade II gliomas. Pregnancy was terminated in only 2 of these patients, and the remainder delivered healthy babies. Twenty-three patients became pregnant after diagnosis (4 patients were pregnant at diagnosis and again after diagnosis). Of the patients who became pregnant after diagnosis, the 5 with grade I tumors had stable disease during and after pregnancy. However, of the 18 patients with grade II or III gliomas, 8 (44%) had confirmed tumor progression during pregnancy or within 8 weeks of delivery. CONCLUSIONS:In contrast to grade I gliomas, the tumor biology of grades II and III gliomas may be altered during pregnancy, leading to an increased risk of tumor progression. These findings support the need for increased tumor surveillance and patient counseling and for additional data collection to further refine these results.
Radiation treatment planning and delivery strategies for a pregnant brain tumor patient.
Labby Zacariah E,Barraclough Brendan,Bayliss R Adam,Besemer Abigail E,Dunkerley David A P,Howard Steven P
Journal of applied clinical medical physics
The management of a pregnant patient in radiation oncology is an infrequent event requiring careful consideration by both the physician and physicist. The aim of this manuscript was to highlight treatment planning techniques and detail measurements of fetal dose for a pregnant patient recently requiring treatment for a brain cancer. A 27-year-old woman was treated during gestational weeks 19-25 for a resected grade 3 astrocytoma to 50.4 Gy in 28 fractions, followed by an additional 9 Gy boost in five fractions. Four potential plans were developed for the patient: a 6 MV 3D-conformal treatment plan with enhanced dynamic wedges, a 6 MV step-and-shoot (SnS) intensity-modulated radiation therapy (IMRT) plan, an unflattened 6 MV SnS IMRT plan, and an Accuray TomoTherapy HDA helical IMRT treatment plan. All treatment plans used strategies to reduce peripheral dose. Fetal dose was estimated for each treatment plan using available literature references, and measurements were made using thermoluminescent dosimeters (TLDs) and an ionization chamber with an anthropomorphic phantom. TLD measurements from a full-course radiation delivery ranged from 1.0 to 1.6 cGy for the 3D-conformal treatment plan, from 1.0 to 1.5 cGy for the 6 MV SnS IMRT plan, from 0.6 to 1.0 cGy for the unflattened 6 MV SnS IMRT plan, and from 1.9 to 2.6 cGy for the TomoTherapy treatment plan. The unflattened 6 MV SnS IMRT treatment plan was selected for treatment for this particular patient, though the fetal doses from all treatment plans were deemed acceptable. The cumulative dose to the patient's unshielded fetus is estimated to be 1.0 cGy at most. The planning technique and distance between the treatment target and fetus both contributed to this relatively low fetal dose. Relevant treatment planning strategies and treatment delivery considerations are discussed to aid radiation oncologists and medical physicists in the management of pregnant patients.
Radiation dose to the fetus during CyberKnife radiosurgery for a brain tumor in pregnancy.
Pantelis Evaggelos,Antypas Christos,Frassanito Maria Cristina,Sideri Liana,Salvara Katerina,Lekas Leonidas,Athanasiou Olga,Piperis Maria,Salvaras Nikolaos,Romanelli Pantaleo
Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB)
PURPOSE:Pregnancy during radiosurgery is extremely rare in clinical practice. We report fetal dose results during CyberKnife radiosurgery for a brain tumor in pregnancy. METHODS AND MATERIALS:A 26 year old pregnant woman with a rapidly growing deep-seated grade-III glioma was treated during the third trimester of gestation using CyberKnife. Ultrasound imaging was used to determine the position of the embryo prior to treatment. A dose of 1400 cGy was prescribed aiming to control tumor growth until delivery of the child. Prior to radiosurgery, the treatment was simulated on an anthropomorphic phantom. Radiation dose to the embryo was measured using a Farmer chamber and EBT3 films. RESULTS:Fetal doses of 4.4 cGy and 4.1 cGy were measured for the embryo's head and legs, lying at 56 cm and 72 cm from the isocenter, respectively, using the Farmer chamber situated at 8.5 cm depth beneath the phantom surface. Dose results of 4.4 cGy, 3.5 cGy and 2.0 cGy were measured with the films situated at depths of 6.5 cm, 9.5 cm and 14.5 cm, respectively. An average dose of 4.2 cGy to the fetus was derived from the above values. A corresponding dose of 3.2 cGy was also calculated based on results obtained using EBT3 films situated upon the patient skin. CONCLUSIONS:The measured fetal doses are below the threshold of 10 cGy for congenital malformations, mental and growth retardation effects. The radiogenic cancer risk to the live-born embryo was estimated less than 0.3% over the normal incidence. The treatment was administered successfully, allowing the patient to deliver a healthy child.
Brain Tumor, Pheochromocytoma, and Pregnancy: A Case Report of a Cesarean Delivery in a Patient With Von Hippel-Lindau Disease.
Burnette Michelle S,Mann Taylor S,Berman David J,Nguyen Truc-Anh T
A young woman first diagnosed with von Hippel-Lindau disease (VHL) during pregnancy underwent an uncomplicated cesarean delivery despite having multiple classic VHL tumors, including a large cerebellopontine brain mass and vasoactive pheochromocytoma. Patients with VHL may have multiple tumors of the central nervous system and viscera that greatly impact anesthetic management. This case highlights the anesthetic considerations for a parturient with pheochromocytoma and elevated intracranial pressure, as well as the importance of a multidisciplinary team approach.
Recurrent brain tumor with hydrocephalus in pregnancy.
Taylan Enes,Akdemir Ali,Zeybek Burak,Ergenoglu Ahmet Mete,Yeniel Ahmet Ozgur
The journal of obstetrics and gynaecology research
Brain tumors during pregnancy are very rare. Diagnosis of this condition is difficult because the symptoms imitate pregnancy-related ailments. The management of this condition also presents challenges. This case report aims to present a successful treatment and delivery of a patient with recurrent brain tumor during pregnancy with hydrocephalus.