Jeong Bada, Shim Jae-Yoon, Kim Chong Jai, Won Hye-Sung, Lee Pil Ryang, Kim Ahm
Department of Obstetrics and Gynecology, Asan Medical Center, Seoul, Korea.
J Obstet Gynaecol Res. 2014 Apr;40(4):1150-3. doi: 10.1111/jog.12292. Epub 2014 Jan 15.
The prognosis of gastric cancer during pregnancy is unfavorable because of delayed diagnosis and advanced stage. We present a case of gastric carcinoma metastasized to the placenta and uterus during pregnancy. Pathological examination revealed a poorly differentiated adenocarcinoma of the stomach with lymph node metastasis. After counseling, the patient decided to terminate the pregnancy and begin immediate treatment for gastric cancer. Hysterectomy and subtotal hysterectomy were performed because medical termination of the pregnancy was unsuccessful. Pathological examination of the placenta and uterus revealed metastases of gastric adenocarcinoma. All the uterine vessels were packed with tumor cells and the myometrium showed extensive coagulative necrosis. Moreover, microscopic findings of the placenta were consistent with massive perivillous fibrin deposition. Our case clearly suggests that massive perivillous fibrin deposition in the placenta can be associated with malignancy during pregnancy and that uterine metastasis of maternal malignancy may result in myometrial dysfunction unresponsive to uterotonics.
由于诊断延迟和病情晚期，妊娠期胃癌的预后不佳。我们报告一例妊娠期胃癌转移至胎盘和子宫的病例。病理检查显示为低分化胃腺癌伴淋巴结转移。经过咨询，患者决定终止妊娠并立即开始胃癌治疗。由于药物流产未成功，遂行子宫切除术和次全子宫切除术。胎盘和子宫的病理检查显示胃腺癌转移。所有子宫血管均充满肿瘤细胞，子宫肌层出现广泛的凝固性坏死。此外，胎盘的显微镜检查结果与绒毛周围大量纤维蛋白沉积一致。我们的病例清楚地表明，胎盘中大量绒毛周围纤维蛋白沉积可能与妊娠期恶性肿瘤有关，母体恶性肿瘤的子宫转移可能导致子宫肌层功能障碍，对宫缩剂无反应。
