Signet Ring Cell Carcinoma with Lymphangitic Carcinomatosis in Pregnancy: A Case Report of an Unexpected Maternal Death and Review of the Literature

Abstract

Patient: Female, 26-year-oldFinal Diagnosis: Adenocarcinoma with signet-ring cell featuresSymptoms: 32 week gestation with new onset chest pain and shortness of breathMedication: —Clinical Procedure: —Specialty: Obstetrics and GynecologyObjective:Rare co-existance of disease or pathologyBackground:Cancer in pregnancy is extremely rare, and gastric cancers are rarer still. Diagnosis is difficult in pregnancy due to overlapping symptoms with pregnancy such as nausea, pain, anemia, and fatigue.Case Report:A 26-year-old G1 woman at 32 weeks gestation with a past medical history of systemic lupus erythematosus presented with new-onset chest pain and shortness of breath. Computed tomography of the chest, electrocardiogram, and echocardiogram were normal. Laboratory evaluation revealed thrombocytopenia, proteinuria of 480 milligrams, and normal complement. She delivered on hospital day 3 due to worsening chest pain. During cesarean delivery, the patient became hypotensive and hypoxic and required intensive care unit admission after a cesarean hysterectomy. On postoperative day 2 she had a pulmonary embolus and was started on therapeutic anticoagulation. She clinically improved until postoperative day 4, when she was found unresponsive with pulseless electrical activity. After 38 minutes of Advanced Cardiac Life Support, death was pronounced. An autopsy was performed and the cause of death found to be complications of multi-organ system involvement of adenocarcinoma with signet ring cell features. Lymphangitic carcinomatosis was noted throughout the lungs.Conclusions:This patient had adenocarcinoma with signet ring cell features and associated lymphangitic carcinomatosis, which led to her postpartum death. Lymphangitic carcinomatosis is associated with an exceedingly poor prognosis, especially in pregnancy.

Metastatic gastric cancer in a full-term pregnancy

“…These findings are supported by recent reports from Patan [2], Yildiz [1] and Fory [3]. However, in our case, the patient was only 24 years old, similar to the cases reported by Prieto-Montaño [4] and Whittington [5].…”

Lymphangitic carcinomatosis as the initial manifestation of primary signet-ring cell adenocarcinoma of the lung: A case report

“…The presence of signet-ring cells in carcinomas causing LC has been documented in several case reports, all of which were secondary to SRCCs of gastrointestinal origin. [9][10][11][12] To our knowledge, there is no report of LC secondary to primary lung SRCCs to this date. Nonetheless, other reported cases of primary lung SRCCs share similar characteristics, and thus sub-diagnosis of LC among reports remains feasible.…”

Manejo de neoplasias malignas gastrointestinales durante el embarazo

“…Esta experiencia sugiere que en casos de diagnóstico antes de las 24 semanas de embarazo, la conducta debe ser interrupción inmediata del embarazo y tratamiento quirúrgico, pero si el diagnóstico es entre las 24 y 29 semanas, el tratamiento depende de la resecabilidad de la lesión y, en el caso de poder ser extirpada, la cirugía debe ser la primera opción, independientemente de los riesgos fetales. Luego de las 29 semanas se debe posponer la cirugía hasta después del parto (12,13…”