Ghosh Sharda Brata, Tempe Anjali
Maulana Azad Medical College, Lok Narayak Hospital, New Delhi 110002, India.
Arch Gynecol Obstet. 2009 Mar;279(3):427-9. doi: 10.1007/s00404-008-0742-0. Epub 2008 Jul 30.
Metastatic retroperitoneal adenocarcinoma presenting as obstructed labor is extremely rare.
An unbooked 35-year-old multipara came to our casualty in obstructed labor at 38 weeks of pregnancy. A palpable retroperitoneal mass was found behind the gravid uterus and cervix after delivery of a live baby during emergency cesarean section. Needle biopsy was taken from the mass and abdomen was closed due to nonavailability of frozen section facility at night. Post cesarean section CT scan confirmed the pelvic mass, which was subjected to open biopsy. A diagnosis of retroperitoneal adenocarcinoma with an unknown primary was made based on histopathology and a negative workup for the possible primary sites. Patient was treated successfully with chemotherapy and did not show recurrence for last 2 years of follow-up.
Surgeons should be aware of this extremely rare entity and it highlights the importance of proper antenatal care to pick up such pathology at an early stage by careful examination and ultrasound to minimize the morbidity and mortality. We also suggest frozen biopsy in a suspected pelvic mass during surgery and early cesarean section to avoid the complications of obstructed labor in such advanced stages of malignant tumor.
以梗阻性分娩为表现的转移性腹膜后腺癌极为罕见。
一名未预约的35岁经产妇在妊娠38周时因梗阻性分娩来到我院急诊。在急诊剖宫产术中娩出活婴后，在妊娠子宫和宫颈后方发现一个可触及的腹膜后肿块。对肿块进行了穿刺活检，由于夜间无法进行冰冻切片检查，遂关闭腹部。剖宫产术后CT扫描证实了盆腔肿块，对其进行了开放活检。根据组织病理学及对可能的原发部位的检查结果为阴性，诊断为原发灶不明的腹膜后腺癌。患者接受化疗后成功治愈，在最后2年的随访中未出现复发。
外科医生应了解这种极为罕见的情况，这凸显了适当产前护理的重要性，即通过仔细检查和超声在早期发现此类病变，以尽量降低发病率和死亡率。我们还建议在手术中对疑似盆腔肿块进行冰冻活检，并尽早进行剖宫产，以避免在恶性肿瘤晚期出现梗阻性分娩的并发症。
