Honda Michiko, Yamada Manabu, Kumasaka Toshio, Samejima Taiki, Satoh Hirohisa, Sugimoto Mitsuhiro
Department of Obstetrics and Gynecology, Japanese Red Cross Medical Center, Tokyo, Japan.
Department of Obstetrics and Gynecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan.
Case Rep Oncol. 2017 Sep 15;10(3):824-831. doi: 10.1159/000479959. eCollection 2017 Sep-Dec.
A 39-year-old primiparous Japanese female was admitted to the obstetrical emergency department of our hospital because of respiratory distress resulting from a large amount of pleural effusion, soon after a caesarean delivery (CD) at another hospital. While she was undergoing the CD, a giant ovarian tumour was identified. However, the tumour could not be removed at that facility and she was transferred to our hospital. Three days after the CD, a left salpingo-oophorectomy was performed with the purpose of controlling pleural and peritoneal effusions. Based on her past treatment history and the information gathered from this surgery, recurrence of ovarian cancer was considered the final diagnosis. Earlier, at the age of 37 years, she had been diagnosed with stage IC ovarian adenocarcinoma arising from a mature cystic teratoma detected after a right salpingo-oophorectomy. These kinds of situations of accidental detection of recurrent advanced ovarian cancer in a newly pregnant patient in the emergency department are rare. Amongst them, we have identified an extremely rare case showing placental metastasis. The important lesson learnt from this case report is that detailed medical interviews and physical examinations are crucial when a pregnant woman visits a hospital without a letter of referral, especially in the third trimester of pregnancy.
一名39岁的初产日本女性在另一家医院剖宫产术后不久,因大量胸腔积液导致呼吸窘迫而被收治入我院产科急诊。剖宫产术中发现一个巨大的卵巢肿瘤。然而,该肿瘤在那家医院无法切除,她被转至我院。剖宫产术后三天,为控制胸腔和腹腔积液,实施了左侧输卵管卵巢切除术。根据她过去的治疗史以及此次手术收集到的信息,最终诊断为卵巢癌复发。更早之前,37岁时,她在右侧输卵管卵巢切除术后被诊断为1C期卵巢腺癌,起源于成熟囊性畸胎瘤。在急诊科新怀孕患者中意外发现复发性晚期卵巢癌的情况很少见。其中,我们发现了一例极为罕见的胎盘转移病例。从本病例报告中学到的重要经验是,当孕妇无转诊信前来医院就诊时,尤其是在妊娠晚期,详细的医学问诊和体格检查至关重要。