Mucinous Cystic Neoplasm of Pancreas in a Pregnant Woman Presenting with Severe Anemia and Gastric Bleeding: Case Report and Review of the Literature

Abstract

Mucinous cystic neoplasms of the pancreas are uncommon and especially their occurrence during pregnancy is an extremely rare event which necessitates an individualized and interdisciplinary management. A 33-year old woman was referred to our department during her third trimester of pregnancy (34th week of gestation) with severe anemia and tarry stools. Based on gastroscopic findings, our interdisciplinary team suspected a gastrointestinal stromal tumor and therefore indicated a prompt delivery via cesarean section completed with an oncological resection of the neoplasm. Histological examination subsequently showed a mucinous cystic neoplasm of the pancreas with no evidence of malignancy. To review the prevalence of mucinous cystic neoplasms and to discuss diagnosis and treatment during pregnancy. Moreover, we critically value the indication of preterm delivery and the oncological procedure in the perspective of outcome for mother and infant. A bleeding gastrointestinal tumor during pregnancy represents a life-threatening risk for mother and infant and requires an immediate interdisciplinary treatment. The urgency and radicality of the therapy should be adapted according to individual findings. As our patient’s tumor was suspected of having a malignant progression, an extensive surgical intervention was necessary.

Mucinous Cystic Neoplasm of the Pancreas in Pregnancy: A Case Report

“…Their occurrence during pregnancy, though infrequent, has been documented in a limited number of case reports [1]. Notably, several studies have observed a rapid increase in the growth rate of MCNs during pregnancy [4][5][6][7].…”

“…This rapid growth raises concerns about the potential for malignant transformation into invasive carcinomas, increased risk of pancreatitis, and other complications such as tumor rupture or fetal hazards like intrauterine growth restriction [6,7]. Although the direct impact of elevated pregnancy hormones on the malignant transformation of MCNs is not fully understood, Farahmandi et al reported a higher incidence of invasive carcinoma within MCNs during pregnancy compared to non-pregnant cases [4]. Additionally, progesterone has been suggested to play a protective role by potentially suppressing malignant transformation in the ovarian-like stroma of MCNs [8][9][10].…”

Massive Größenprogredienz und maligne Transformation einer muzinös-zystischen Neoplasie des Pankreas in der Schwangerschaft – ein Fallbericht

“…Während einer Schwangerschaft können MCN allerdings rasant an Größe zunehmen, was ein hormonabhängiges Wachstum nahelegt [4]. In der Literatur sind seit der Erstbeschreibung durch Smithers et al 1986 [10] 37 Fälle von schwangerschafts-assoziierten MCN beschrieben [11,12]. Diese waren im Durchschnitt größer als bei nicht-schwangeren Patienten (14,5 cm vs. 6,5 cm [13]) und wiesen häufiger invasive Karzinome auf (25,7 % vs. 3,9-16,3 % [14]) .…”

Gestação de alto risco de paciente portadora de Tumor Pancreático, Nefropatia Membranosa, Hipertensão Arterial Crônica, Diabetes mellitus 2, Dislipidemia, Esteatose Hepática e Infecção Urinária de repetição: relato de caso

“…Apesar de se identificar um estado hipoglicêmico (Hemoglicoteste com resultado de 22 mg/dL) inicial, a RN evolui satisfatoriamente, sem intercorrências, e recebeu alta em 6 dias após a internação. Especificamente o tumor de pâncreas, considerado insólito no período gestacional, pode resultar em outras complicações, modificações bioquímicas e consequências clínicas, como por exemplo anemia, além de apresentar sintomas inespecíficos, como dor abdominal leve, náuseas, vômitos, dor nas costas, dor sistêmica (FARAHMANDI et al, 2021). Portanto, é possível que as dores relatadas pela paciente tenham relação direta com a presença do tumor.…”