Maternal Pulmonary Adenocarcinoma Metastatic to the Fetus: First Recorded Case Report and Literature Review

Abstract

We report the ¢rst maternal pulmonary adenocarcinoma metastatic to the fetus, as well as an updated literature review. Review of the literature revealed that there have been only 67 cases of maternal malignancy metastatic to the products of conception.These were mostly malignant melanoma and hematopoietic tumors. A 46-year-old multiparous woman with metastatic pulmonary adenocarcinoma, diagnosed at 23 weeks gestation, delivered a male infant who appeared normal at birth.The mother died 2 days after delivery.The child developed multiple scalp tumors at 2 weeks ofage.The tumors recurred rapidly after initial resection.W|de local excision of the involved scalp and skin graft coverage was performed at 14 weeks of age. Histopathology of these tumors was identical to that of the maternal tumor. The maternal origin of these tumors was con¢rmed by £uorescence in situ hybridization (FISH).The child is now 5 years old and free of disease.Although the incidence of life-threatening neoplasms in pregnant women has been estimated to be approximately 1:1000 [1] to 1:1,500 [2], the incidence of metastases to the products of conception (POC) is surprisingly infrequent. The largest series reported to date is that of Ackerman and Gilbert-Barness, with 64 cases from the period 1866^1997 [3]. These nine cases of maternal pulmonary carcinoma were all metastatic to the placenta [4].This is the ¢rst reported case of metastatic pulmonary carcinoma to the fetus. We present a comprehensive review of the literature regarding this phenomenon, including theories on tumor biology and mechanisms of spread.

Metastatic Melanoma in Pregnancy: Risk of Transplacental Metastases in the Infant

“…Placental involvement of maternal cancer was defined as gross or microscopic evidence of maternal cancer within any section of the placenta. 8,33 These combined search strings resulted in a total of 86 primary reports of placental or fetal metastasis in the worldwide literature. Initially, a broad search was performed to obtain an accurate incidence of placental involvement and fetal metastasis caused by any cancer, using a PubMed search of MEDLINE (1966 to July 2002) and the search string [("Neoplasms" AND "Neoplasm Metastasis" AND (pregnancy OR placenta OR placental OR transplacental OR fetal OR fetus OR products of conception OR vertical transmission) NOT (choriocarcinoma OR trophoblastic tumors)].…”

“…1,2 The types of cancer observed in pregnancy mirror those seen in nonpregnant women of the same age. 7,8 The only other cancers that have been reported to affect the fetus are hematopoietic malignancies and lung cancer. The estimated incidence of melanoma complicating pregnancy has ranged from 0.1 to 2.8 per 1,000 pregnancies, 4,6 although data from this population have not been systematically ascertained.…”

“…Data adapted7,8,[10][11][12][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] . Therefore, there are 69 previously reviewed cases.…”

Advanced lung cancer presenting with a generalized seizure in pregnancy

“…The baby developed metastatic scalp lesions at the age of 2 months. The placenta was not histologically examined in this case (1). The authors were thus unable to comment on whether location of the tumor within the placenta had any bearing on the location of tumor in the baby.…”

“…Malignant disease is uncommon in pregnancy and it is estimated to occur in 1 in 1000 to 1 in 1500 of pregnancies (1). Metastasis of a malignancy to the feto‐placental unit occur much less frequently and in a review published by Walker et al in 2001 only 68 cases have been recorded (1). There have been only eight reported cases of maternal pulmonary carcinoma metastatic to the placenta (1).…”