Download PDF
Zentralbl Gynakol 2006; 128(4): 224-228
DOI: 10.1055/s-2006-933429
Kasuistik

© Georg Thieme Verlag Stuttgart · New York

Magenkarzinom in der Schwangerschaft - Ein Fallbericht

Gastric Cancer in Pregnancy - A Case ReportD. Brüggmann1 , M. K. Bohlmann1 , R. M. Bohle2 , H.-R. Tinneberg1
  • 1Zentrum für Gynäkologie und Geburtshilfe, Universitätsklinikum Gießen und Marburg, Gießen, Deutschland
  • 2Institut für Pathologie, Universitätsklinikum Gießen und Marburg, Gießen, Deutschland
Further Information

Publication History

Publication Date:
11 July 2006 (online)

    Permissions and Reprints

Zusammenfassung

Die Symptome „Übelkeit und Erbrechen” werden bei Schwangeren selten mit der Differenzialdiagnose eines Magenkarzinoms in Verbindung gebracht, da diese Erkrankung nur mit einer Wahrscheinlichkeit von 0,1 % in der Gravidität auftritt. Die Verkennung der Symptome führt - verglichen mit Nicht-Schwangeren - zu einer verzögerten Diagnose. Im fortgeschrittenen Stadium ist meist nur noch ein palliatives Vorgehen möglich. Eine Gefährdung des Feten durch Metastasierung gilt als weitgehend ausgeschlossen; daher ist unter palliativen Bedingungen ein abwartendes Vorgehen gerechtfertigt. Nach Erreichen der fetalen Lebensreife sollte die Schnittentbindung mit anschließender Chemotherapie erfolgen. Ziel sollte es sein, bei entsprechenden Symptomen an ein Magenkarzinom zu denken und es frühzeitig zu diagnostizieren. Denn nur bei lokal begrenztem Tumorleiden ist eine R0-Resektabilität möglich, welche ein gutes Langzeit-Überleben der Patientin sichert.

Abstract

Nausea and vomiting are common sufferings of pregnant woman. No gynaecologist would consider carcinoma of the stomach as a probable differential diagnosis according the extremely rare probability of this disease during pregnancy. Consequently, a late diagnosis in pregnancy can result in spreading throughout the whole abdomen. In this advanced stage, it is only possible to recommend palliative care to the patient followed by short survival. Fetal metastasis is a rare entity, therefore caesarean section and chemotherapy should not be performed until fetal maturity. If vomiting and nausea are prolonged after the sixteenth week of pregnancy a malignant disease of the stomach should be excluded. Only in case of short delay between symptoms and diagnosis, the stomach cancer can be resected totally followed by a better overall survival of the patient.

Schlüsselwörter

Schwangerschaft - Übelkeit und Erbrechen - Magenkarzinom

Key words

pregnancy - nausea - vomiting - gastric cancer

Literatur

  • 1 Bertz J, Hentschel S, Hundsdörfer G, Kaatsch P, Katalinic A, Lehnert M, Schön D, Stegmaier C, Ziegler H. Krebs in Deutschland. 4. überarbeitete, aktualisierte Ausgabe. Herausgeber: Arbeitsgemeinschaft Bevölkerungsbezogener Krebsregister in Deutschland, Saarbrücken 2004
    Google Scholar
  • 2 Chen C N, Hsieh F J, Cheng Y M, Cheng W F, Su Y N, Chang K J, Lee P H. The significance of placenta growth factor in angiogenesis and clinical outcome of human gastric cancer.  Cancer Lett. 2004;  213 73-82
    CrossrefPubMedGoogle Scholar
  • 3 Donegan W L. Comment on “Prognosis of gastric cancer associated with pregnancy”.  World J Surg. 1991;  15 293-298
    CrossrefPubMedGoogle Scholar
  • 4 Dupont Jr J B, Lee J R, Burton G R, Cohn Jr I. Adenocarcinoma of the stomach: Review of 1 497 cases.  Cancer. 1978;  41 941-947
    PubMedGoogle Scholar
  • 5 Gips H, Braems G. Endokrinologische Aspekte von Emesis und Hyperemesis gravidarum. In: Künzel W, Wulff KH (Hrsg). Klinik der Frauenheilkunde und Geburtshilfe. Urban und Schwarzenberg, München, Wien, Baltimore 1994; 115-119
    Google Scholar
  • 6 Heuch I, Kvale G. Menstrual and reproductive factors and risk of gastric cancer: a Norwegian cohort study.  Cancer Causes Control. 2000;  11 869-874
    CrossrefPubMedGoogle Scholar
  • 7 Hirabayashi M, Ueo H, Okudeira Y, Matsumata T, Hanawa S, Sugimachi K. Case report: Early gastric cancer and a concomitant pregnancy.  Am Surg. 1987;  53 730-732
    PubMedGoogle Scholar
  • 8 Holtz F, Hart W R. Krukenberg tumor of the ovary: A clinopathologic analysis of 27 cases.  Cancer. 1982;  50 2438-2447
    PubMedGoogle Scholar
  • 9 Jaspers V K, Gillessen A, Quakernack K. Gastric cancer in pregnancy: Do pregnancy, age or female sex alter the prognosis? Case reports and review.  Eur J Obstet Gynecol Reprod Biol. 1999;  87 13-22
    CrossrefPubMedGoogle Scholar
  • 10 Kath R, Fiehler J, Schneider C P, Hoffken K. Gastric cancer in very young adults: apropos four patients and a review of the literature.  J Cancer Res Clin Oncol. 2000;  126 233-237
    CrossrefPubMedGoogle Scholar
  • 11 Khatib F, Shaya M, Samueloff A. Gastric carcunoma with metastasis to the placenta and amnionic fluid: Case report and review of the literature.  Eur J Obstet Gynecol Reprod Biol. 2003;  107 208-209
    CrossrefPubMedGoogle Scholar
  • 12 Kitaoka H. Sex hormone dependency and endocrine therapy for patients with diffuse carcinoma of the stomach.  Jpn J Cancer Chemother. 1983;  10 2453-2460
    PubMedGoogle Scholar
  • 13 Kodama I, Takeda J, Koufuji K, Yano S, Hanzawa M, Shirouzu K. Gastric cancer during pregnancy.  Kurume Med J. 1997;  44 179-183
    PubMedGoogle Scholar
  • 14 Kojima O, Takahashi T. Endocrine therapy for the scirrhous carcinoma of the stomach.  Jpn J Cancer Chemother. 1986;  13 2526-2531
    PubMedGoogle Scholar
  • 15 Macdonald J S, Smalley S R, Benedetti J, Hundahl S A, Estes N C, Stemmermann G N, Haller D G, Ajani J A, Gunderson L L, Jessup J M, Martenson J A. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.  N Engl J Med. 2001;  345 725-730
    CrossrefPubMedGoogle Scholar
  • 16 Maeta M, Yamashiro H, Oka A, Tsujitani S, Ikeguchi M, Kaibara N. Gastric cancer in the young, with special reference to 14 pregnancy associated cases: analysis based on 2 325 consecutive cases of gastric cancer.  J Surg Oncol. 1995;  54 424-427
    PubMedGoogle Scholar
  • 17 Matley P J, Dent D M, Madden M V, Price S K. Gastric carcinoma in young adults.  Am Surg. 1988;  208 593-596
    PubMedGoogle Scholar
  • 18 Matsusaka T, Soejima K, Kodoma Y, Saito T, Inokuchi K. Carcinomas of the stomach in the young.  J Jpn Surg. 1976;  6 170-177
    PubMedGoogle Scholar
  • 19 McNeer G. Cancer of the stomach in the young.  Am J Roentgenol. 1941;  41 537-550
    PubMedGoogle Scholar
  • 20 Ohtsu A. Current status and future prospects of chemotherapy for metastatic gastric cancer: a review.  Gastric Cancer. 2005;  8 95-102
    CrossrefPubMedGoogle Scholar
  • 21 Plesko I, Preston-Martin S, Day N, Tzonou A, Dimitrova E, Somogyi J. Parity and cancer risk in Slovakia.  Int J Cancer. 1985;  36 529-533
    PubMedGoogle Scholar
  • 22 Scharl A, Ahr A, Göring U J. Malignome in der Schwangerschaft. In: Kaufmann M, Costa SD, Scharl A (Hrsg). Die Gynäkologie. Springer-Verlag, Berlin, Heidelberg, New York 2003; 519
    Google Scholar
  • 23 Skokos C K, Lipshits J. Adenocarcinoma of the stomach associated with pregnancy.  J Tenn Med Assoc. 1982;  75 103
    PubMedGoogle Scholar
  • 24 Tabernero J, Macarulla T, Ramos F J, Baselga J. Novel targeted therapies in the treatment of gastric and esophageal cancer.  Ann Oncol. 2005;  [Epub ahead of print]
    PubMedGoogle Scholar
  • 25 Tokunaga A, Nishi K, Matsukura N. et al . Estrogen and progesterone receptors in gastric cancer.  Cancer. 1986;  57 1376-1379
    CrossrefPubMedGoogle Scholar
  • 26 Ueo H, Matsuoka H, Tamura S, Sato K, Tsunematsu Y, Kato T. Prognosis of gastric cancer associated with pregnancy.  World J Surg. 1991;  15 293-298
    CrossrefPubMedGoogle Scholar
  • 27 Varga P, Scharl A, Szcekeres-Bartho J, Bolte A, Szereday Z. Zur Bedeutung der zytologischen Aktivität der mütterlichen Lymphozyten für die Ätiologie der intrauterinen Mangelentwicklung.  Z Geburth Perinatol. 1989;  193 167-171
    PubMedGoogle Scholar
  • 28 Wagner A D, Grothe W, Behl S, Kleber G, Grothey A, Haerting J, Fleig W E. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2005; (2): CD004064
    Google Scholar
  • 29 Hamilton S R, Aaltonen  (eds) L A. World Health Organization classification of tumours. Pathology and Genetics of tumours of the Digestive system. IARC Press Lyon 2000; 38-49
    Google Scholar
  • 30 Yakushiji M, Tazaki T, Nishimura H, Kato T. Krunkenberg tumors of the ovary: a clinopathologic analysis of 112 cases.  Nippon Sanka Fujinka Gakkai Zasshi. 1987;  39 479-485
    PubMedGoogle Scholar
  • 31 Acikalin M F, Vardareli E, Tel N, Saricam T, Urer S. Erysipelas-like cutaneous metastasis from gastric signet ring cell carcinoma.  J Eur Acad Dermatol Venereol. 2005;  19 642-643
    PubMedGoogle Scholar
  • 32 Antunes A A, Siqueira Jr T M. Falcao E. Vesical metastasis of gastric adenocarcinoma.  Int Braz J Urol. 2004;  30 403-405
    PubMedGoogle Scholar
  • 33 Braeuninger S, Mawrin C, Malfertheiner P, Schildhaus H U, Seiler C, Dietzmann K, Lins H. Gastric adenocarcinoma with leptominengeal carcinomatosis as the presenting manifestation: an autopsy case report.  Eur Gastroenterol Hepatol. 2005;  17 577-579
    PubMedGoogle Scholar
  • 34 Chang H C, Lew K H, Low C O. Metastasis of an adenocarcinoma of the stomach to the 4th metacarpal bone.  Hand Surg. 2001;  6 239-242
    CrossrefPubMedGoogle Scholar
  • 35 Deguchi Y, Shioya M, Sakai M, Takenaka K, Doi H, Komai Y, Higushi A. A case of advanced gastric cancer with pulmonary carcinomatous lymphangiosis responding remarkably to combination chemotherapy of docetaxel (TXT) and TS-1.  Gan To Kagaku Ryoho. 2005;  32 519
    PubMedGoogle Scholar
  • 36 Domanski H A. Metastases to the breast from extramammary neoplasms. A report of six cases with diagnosis by fine needle aspiration cytology.  Acta Cytol. 1996;  40 1293-1300
    PubMedGoogle Scholar
  • 37 Fukino K, Terao T, Kojima T, Adachi K, Teramoto A. Chronic subdural hematoma following dural metastasis of gastric cancer: measurment of pre- and postoperative cerebral blood flow with N-isopropyl-p-(123I) iodoamphetamine - a case report.  Neurol Med Chir. 2004;  44 646-649
    PubMedGoogle Scholar
  • 38 Kagawa S, Fujiwara T, Nishizaki M, Tokunaga N, Gochi A, Tanaka N. Stenting and radiotherapy for malignant tracheal stenosis due to mediastinal lymph node recurrance from gastric cancer - a case report.  Gan To Kagaku Ryoho. 2006;  33 91-93
    PubMedGoogle Scholar
  • 39 Kondo S, Onodera H, Kan S, Uchida S, Toguchida J, Imamura M. Intramuscular metastasis from gastric cancer.  Gastric cancer. 2002;  5 107-111
    CrossrefPubMedGoogle Scholar
  • 40 Kurabayashi T, Isii K, Suzuki M, Takakuwa K, Shibazaki Y, Ozawa T, Narisawa R, Sekizuka N, Tanaka K. Advanced gastric cancer and a concomitant pregnancy associated with disseminated intravascular coagulation.  Am J Perinatol. 2004;  21 295-298
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Leibermann J, Chaim W, Cohen A, Czernobilsky B. Primary carcinoma of stomach with uterine metastasis.  Br J Obstet Gynaecol. 1975;  82 917-921
    PubMedGoogle Scholar
  • 42 Menzel T, Peters K, Hammerschmidt S, Ritter O. Metastastic signet ring cell gastric carcinoma presenting as an infrarenal aortic aneurysm.  Gastric cancer. 2005;  8 47-49
    CrossrefPubMedGoogle Scholar
  • 43 Miwa M, Matsumura H, Miwa T, Sato S. A young gastric carcinoma patient with umbilical and scrotal metastasis.  Tokai J Exp Clin Med. 1981;  6 305-308
    PubMedGoogle Scholar
  • 44 Saornil M A, Blanco G, Sarasa J L, Gonzalez-Sansegundo C, Rabano G. Isolated gastric adenocarcinoma to the retina: first presentation of systemic disease.  Acta Ophthalmol Scand. 2004;  82 86-88
    CrossrefPubMedGoogle Scholar
  • 45 Shimoyama S, Sto Y, Aoki F, Ogawa T, Toma T, Endo H, Itouji T, Kaminishi M. Gastric cancer with metastasis to the gingiva.  J Gastroenterol Hepatol. 2004;  19 831-835
    CrossrefPubMedGoogle Scholar
  • 46 Smolka W, Brekenfeld C, Buchel P, Iizuka T. Metastastic adenocarcinoma of the temporomandibular joint from the cardia of the stomach: a case report.  Int J Oral Maxillofac Surg. 2004;  33 713-715
    CrossrefPubMedGoogle Scholar

Dr. med. D. Brüggmann

Zentrum für Gynäkologie und Geburtshilfe · Universitätsklinikum Gießen und Marburg

Klinikstraße 32

35385 Gießen

Phone: +49/6 41/9 94 52 00

Fax: +49/6 41/9 94 52 59

Email: doerthe.brueggmann@gyn.med.uni-giessen.de

      >