Poorly differentiated large cell adenocarcinoma of the lung metastatic to the placenta: a case report.

BACKGROUND

Cancer is an uncommon diagnosis during pregnancy. Advanced disease is unusual; metastasis to the placenta is exceptionally rare. Primary cancers that have been reported to produce placental metastasis include melanoma, breast, hematologic and lung.

CASE

A 41-year-old, Caucasian woman, para 4014, at 35 4/7 weeks' gestational age with a singleton pregnancy, presented with weight loss, nausea, vomiting, diarrhea and a nonproductive cough. A detailed evaluation revealed widely metastatic disease with a suspected lung origin. Biopsy of a supraclavicular lymph node revealed poorly differentiated large cell adenocarcinoma. Due to the patient's rapidly deteriorating condition and suspected asymmetric intrauterine growth restriction, induction of labor was undertaken. A female infant, Apgar scores 8 and 9, weight 1,885 g, was delivered vaginally. Pathologic evaluation of the placenta revealed metastatic poorly differentiated large cell adenocarcinoma within the intravillous spaces. The placental tumor appeared to be identical to the tumor identified on the lymph node biopsy. The patient's condition continued to deteriorate, and she died a few weeks after the delivery. The infant was doing well 6 months after birth.

CONCLUSION

Placental metastasis is a rare complication among women with widely metastatic large cell adenocarcinoma of the lung. Vaginal delivery can be successful for seriously compromised patients with widespread malignant disease.