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Pancreatic Neoplasms in Pregnancy: Diagnosis, Complications, and Management

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Neoplasms of the pancreas during pregnancy are rare, with less than 25 cases of benign and malignant tumors reported in the literature.

Methods

We present three unique cases of pancreatic tumors occurring during pregnancy—one mucinous cystic neoplasm and two adenocarcinomas. We review the literature regarding pancreatic neoplasms during pregnancy and discuss the diagnosis, complications, and management of these tumors.

Results

Magnetic resonance imaging and ultrasound are the imaging modalities of choice in pregnancy. In patients with benign or premalignant tumors, surgical resection may be postponed until the second trimester. In symptomatic patients, or if there is a concern for intrauterine growth restriction, urgent surgical intervention should be performed. With malignant tumors, the benefit of delaying surgery must be balanced with the risk of maternal disease progression. Termination of the pregnancy should be discussed when a malignant tumor is diagnosed during the first trimester. Pancreatic tumors diagnosed during the third trimester may be resected after delivery. If malignant, early delivery of the fetus and subsequent maternal operation can be considered at appropriate fetal maturity.

Conclusion

When these tumors occur during pregnancy, they present a diagnostic and treatment dilemma, with variation in treatment based on gestational age and patient preference.

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References

  1. Al-Adnani M, Kiho L, Scheimberg I. Maternal pancreatic carcinoma metastatic to the placenta: a case report and literature review. Pediatr Dev Pathol. 2007;10: 61–5.

    Article  PubMed  Google Scholar 

  2. Blackbourne LH, Jones RS, Catalano CJ, Iezzoni JC, Bourgeois FJ. Pancreatic adenocarcinoma in the pregnant patient: case report and review of the literature. Cancer. 1997;79: 1776–9.

    Article  PubMed  CAS  Google Scholar 

  3. Hakamada K, Miura T, Kimura A, Nara M, Toyoki Y, Narumi S, Sasak M. Anaplastic carcinoma associated with a mucinous cystic neoplasm of the pancreas during pregnancy: report of a case and a review of the literature. World J Gastroenterol. 2008;14: 132–5.

    Article  PubMed  Google Scholar 

  4. Kakoza RM, Vollmer CM, Jr., Stuart KE, Takoudes T, Hanto DW. Pancreatic adenocarcinoma in the pregnant patient: a case report and literature review. J Gastrointest Surg. 2009;13: 535–41.

    Article  PubMed  Google Scholar 

  5. Marinoni E, Di Netta T, Caramanico L, Tomei B, Moscarini M, Di Iorio R. Metastatic pancreatic cancer in late pregnancy: a case report and review of the literature. J Matern Fetal Neonatal Med. 2006;19: 247–9.

    Article  PubMed  Google Scholar 

  6. Onuma T, Yoshida Y, Yamamoto T, Kotsuji F. Diagnosis and management of pancreatic carcinoma during pregnancy. Obstet Gynecol. 2010;116 Suppl 2: 518–20.

    Article  PubMed  Google Scholar 

  7. Porcel JM, Ordi J, Castells L, Farran I. Probable pancreatic cancer in a pre-eclamptic patient. Eur J Obstet Gynecol Reprod Biol. 1992;44: 80–2.

    Article  PubMed  CAS  Google Scholar 

  8. Simchuk EJ, 3rd, Welch JP, Orlando R, 3rd. Antepartum diagnosis of pancreatic carcinoma: a case report. Conn Med. 1995;59: 259–62.

    PubMed  Google Scholar 

  9. Asciutti S, Kanninen TT, Clerici G, Nardi E, Castellani D, GC DIR, Clerici C. Acute pancreatitis with a mucinous cystoadenoma of the pancreas in pregnancy. Anticancer Res. 2010;30: 1025–8.

    PubMed  Google Scholar 

  10. Baiocchi C, Landonio G, Majno M, Minola E, Scanzi F, Ghislandi E. Pancreatic cystadenocarcinoma and pregnancy: a case report. Tumori. 1990;76: 294–5.

    PubMed  CAS  Google Scholar 

  11. Ganepola GA, Gritsman AY, Asimakopulos N, Yiengpruksawan A. Are pancreatic tumors hormone dependent?: a case report of unusual, rapidly growing pancreatic tumor during pregnancy, its possible relationship to female sex hormones, and review of the literature. Am Surg. 1999;65: 105–11.

    PubMed  CAS  Google Scholar 

  12. Herring AA, Graubard MB, Gan SI, Schwaitzberg SD. Mucinous cystadenocarcinoma of the pancreas during pregnancy. Pancreas. 2007;34: 470–3.

    Article  PubMed  Google Scholar 

  13. Ikuta S, Aihara T, Yasui C, et al. Large mucinous cystic neoplasm of the pancreas associated with pregnancy. World J Gastroenterol. 2008;14: 7252–5.

    Article  PubMed  Google Scholar 

  14. Ishikawa K, Hirashita T, Kinoshita H, Kitano M, Matsuo S, Matsumata T, Kitano S. Large mucinous cystadenoma of the pancreas during pregnancy: report of a case. Surg Today. 2007;37: 1013–7.

    Article  PubMed  Google Scholar 

  15. Kato M, Kubota K, Kita J, et al. Huge mucinous cystadenoma of the pancreas developing during pregnancy: a case report. Pancreas. 2005;30: 186–8.

    Article  PubMed  Google Scholar 

  16. Lopez-Tomassetti Fernandez EM, Martin Malagon A, Arteaga Gonzalez I, Muniz Montes JR, Diaz Luis H, Gonzalez Hermoso F, Carrillo Pallares A. Mucinous cystic neoplasm of the pancreas during pregnancy: the importance of proper management. J Hepatobiliary Pancreat Surg. 2005;12: 494–7.

    Article  PubMed  Google Scholar 

  17. Naganuma S, Honda K, Noriki S, et al. Ruptured mucinous cystic neoplasm with an associated invasive carcinoma of pancreatic head in a pregnant woman: report of a case and review of literature. Pathol Int. 2011;61: 28–33.

    Article  PubMed  Google Scholar 

  18. Olsen ME, Greer MS, Feintuch TA. Pancreatic mucinous cystadenoma during pregnancy. The American Journal of Gynecologic Health. 1993;7: 27–30.

    Google Scholar 

  19. Ozden S, Haliloglu B, Ilter E, Akin FT, Kebudi A, Peker O. An extremely rare cause of acute abdomen in pregnancy: ruptured pancreatic mucinous cystadenocarcinoma. Pancreas. 2007;34: 474–6.

    Article  PubMed  Google Scholar 

  20. Smithers BM, Welch C, Goodall P. Cystadenocarcinoma of the pancreas presenting in pregnancy. Br J Surg. 1986;73: 591.

    Article  PubMed  CAS  Google Scholar 

  21. Wiseman JE, Yamamoto M, Nguyen TD, Bonadio J, Imagawa DK. Cystic pancreatic neoplasm in pregnancy: a case report and review of the literature. Arch Surg. 2008;143: 84–6.

    Article  PubMed  Google Scholar 

  22. Kamphues CH, Rocken C, Neuhaus P, Neumann UP. Non-functioning, malignant pancreatic neuroendocrine tumour (PNET): a rare entity during pregnancy. Langenbecks Arch Surg. 2009;394: 387–91.

    Article  PubMed  Google Scholar 

  23. Sciscione AC, Villeneuve JB, Pitt HA, Johnson TR. Surgery for pancreatic tumors during pregnancy: a case report and review of the literature. Am J Perinatol. 1996;13: 21–5.

    Article  PubMed  CAS  Google Scholar 

  24. Goh BK, Tan YM, Chung YF, Chow PK, Cheow PC, Wong WK, Ooi LL. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg. 2006;30: 2236–45.

    Article  PubMed  Google Scholar 

  25. Le Borgne J, de Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann Surg. 1999;230: 152–61.

    Google Scholar 

  26. Thompson LD, Becker RC, Przygodzki RM, Adair CF, Heffess CS. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol. 1999;23: 1–16.

    Article  PubMed  CAS  Google Scholar 

  27. Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol. 1999;23: 410–22.

    Article  PubMed  CAS  Google Scholar 

  28. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6: 17–32.

    Article  PubMed  Google Scholar 

  29. Baysinger CL. Imaging during pregnancy. Anesth Analg. 2010;110: 863–7.

    Article  PubMed  Google Scholar 

  30. Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: algorithms and 12radiation dose considerations. Radiographics. 2007;27: 1705–22.

    Article  PubMed  Google Scholar 

  31. Tham TC, Vandervoort J, Wong RC, et al. Safety of ERCP during pregnancy. Am J Gastroenterol. 2003;98: 308–11.

    Article  PubMed  CAS  Google Scholar 

  32. Riall TS, Nealon WH, Goodwin JS, Zhang D, Kuo YF, Townsend CM, Jr., Freeman JL. Pancreatic cancer in the general population: Improvements in survival over the last decade. J Gastrointest Surg. 2006;10: 1212–23; discussion 23–4.

    Article  PubMed  Google Scholar 

  33. ACOG Committee Opinion No. 474: Nonobstetric surgery during pregnancy. Obstet Gynecol.117: 420–1.

  34. Ishikawa O. Adenosquamous carcinoma of the pancreas: a clinicopathologic study and report of three cases. Cancer. 1980;46: 1192–6.

    Article  PubMed  CAS  Google Scholar 

  35. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5: 283–91.

    Article  PubMed  CAS  Google Scholar 

  36. Cardonick E, Usmani A, Ghaffar S. Perinatal outcomes of a pregnancy complicated by cancer, including neonatal follow-up after in utero exposure to chemotherapy: results of an international registry. Am J Clin Oncol. 33: 221–8.

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Acknowledgments

This study was supported by the NIH K07 Cancer Prevention, Control, and Population Sciences Career Development Award (grant number 1K07CA130983-01A1 and T32 DK007639).

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Correspondence to Casey A. Boyd.

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Boyd, C.A., Benarroch-Gampel, J., Kilic, G. et al. Pancreatic Neoplasms in Pregnancy: Diagnosis, Complications, and Management. J Gastrointest Surg 16, 1064–1071 (2012). https://doi.org/10.1007/s11605-011-1797-y

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  • DOI: https://doi.org/10.1007/s11605-011-1797-y

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