Lung cancer in pregnancy

Authors: Kornelia Holzmann Roland Kropfmüller Herwig Schinko Stephan Bogner Franz Fellner Wolfgang Arzt Bernd Lamprecht

Publish Date: 2015/03/03

Volume: 127, Issue: 15-16, Pages: 639-644

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Abstract

In the 26th week of gestation a 29yearold pregnant office employee was referred to the pulmonary department of Linz General Hospital AKH under the suspicion of tuberculosis She complained of a cough with intermittent hemoptysis and pain in the thoracic spine from which she had been suffering the past 9 weeks A plain chest Xray showed a dense infiltrate on the right side and multiple smaller shadows in both lungs Laboratory testing revealed anemia leukocytosis and an increase of Creactive protein All tests for tuberculosis were negativeA bronchoscopy was performed and biopsies were taken from the right upper and middle lobe The histopathological examination found cells of an adenocarcinoma A magnetic resonance imaging MRI revealed a large tumor and surrounding atelectasis were seen in the right upper and middle lobe as well as multiple intrapulmonary metastases in both lungs In addition not only metastases in the thoracic spine level Th2/3 but also at other osseous locations and multiple cerebral metastases were detected The patient received one cycle of chemotherapy consisting of docetaxel and carboplatin AUC5 in the 27th week of gestation Additional radiotherapy was applied to the involved thoracic spine Due to positive epidermal growth factor receptor mutation therapy with gefitinib 250 mg/day was started 2 days after a Caesarean section preceded by treatment for fetal lung maturation A healthy girl was delivered in the 30th week of pregnancy Staging with computed tomography CT after delivery revealed an unstable fracture of Th2 with compression of the spinal cord Neurosurgery was performed consisting of a ventral corporectomy of Th1–2 followed by an anterior and posterior osteosynthesis for stabilization The patient was discharged without neurological deficits within 1 week Subsequent treatment with gefitinib improved the performance status of the patient and CT scans of the chest and an MRI of the brain showed the size of the tumor to be shrinking Meanwhile the infant developed appropriately for her ageAfter 14 months of the first diagnosis the patient experienced neurological symptoms aphasia confusion due to neoplastic meningeosis and cerebral venous sinus thrombosis together with local tumor progression in the lung One course of chemotherapy combining carboplatin/pemetrexed/bevacizumab was given without clinical response Despite best supportive care the patient died 17 months after diagnosis in October 2013

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